Transcultural Psychiatry最新文献

COVID-19-related lockdowns resulted in strict visiting restrictions in care homes, placing a vulnerable population at further risk of functional and cognitive decline, and psychological difficulties due to isolation. Experiences of vulnerable minority groups of older persons who reside in care homes are not well researched. In New Zealand, the Chinese community is a fast-growing ethnic group that faces challenges such as language barriers, differing cultural beliefs and COVID-19-related discrimination. The aim of this study was to explore the experiences of Chinese care home residents in New Zealand during COVID-19 lockdowns. In this qualitative study, we interviewed residents (n = 6), family members (n = 6) and facility staff (n = 6) across two Chinese-run care homes in Auckland, New Zealand. Resident and family member participants were exclusively Chinese. Interviews were conducted and transcribed in either English or Mandarin Chinese. Transcripts were coded and analysed to synthesise themes. We identified five themes: (a) acceptance and pragmatism; (b) attitudes towards authority; (c) the concept of máfan: (to trouble); (d) challenges to fulfilling filial duties; and (e) responding to pandemic challenges. This research reframes the narrative of older Chinese care home residents during COVID-19-related restrictions. We recommend integrating the findings and philosophical values identified in this study to develop future protocols that consider the cultural and language needs of Chinese care home residents.

This qualitative study was carried out with 30 high-risk pregnant women from a Brazilian referral service in women's health. The objective was to analyze the perception of participants regarding their condition, emphasizing their psychosocial needs, to deepen the understanding of subjective, relational, and sociocultural aspects associated with high-risk pregnancy. Data were collected through interviews and participant observation and then explored by thematic content analysis. The participants described pregnancy as planned or as unexpected and associated with greater social prestige and the need for changes, especially related to work and financial conditions. On the other hand, participants mentioned that the risk aspect of pregnancy condition was seen by their social group as something that could have been avoided. Because a high-risk pregnancy is a threat to the baby's physical integrity and life, it leads to the fear of death, which is reinforced by experiences of previous pregnancies. The psychosocial aspects elucidated in the study deal with emotional and labor factors, consistent with existing literature. Participants mentioned family members and health professionals as important support during their pregnancy, especially with regard to daily activities and health care, aimed at promoting favorable outcomes. Some participants reported a lack of support, relational difficulties, and social stigma due to mental illness or advanced age, which were related to experiences of guilt and accountability.

Understanding of local conceptions of personhood and mental illness is central for developing therapeutic alliance and treatment regimens for persons living with mental illness. Such persons are exposed to several discriminatory behaviours yet factors that seem to encourage these behaviours are still not entirely understood. Personhood as construed from an emic perspective could potentially guide an understanding of societal attitudes toward individuals suffering from mental illness. This study explored Akan and Ewe conceptions of personhood in relation to mental illness. Using a semi-structured interview guide, seven Focused Group Discussions (FGDs) were conducted in the Tutu and Taviefe communities of the Eastern and Volta Regions of Ghana. A thematic analysis of interviews brought out three main themes: loss of sense of personhood during mental illness; liminality of personhood status after mental illness; and restoration of personhood status. Within these conceptions, activities such as restoring routines and occupational therapy could be utilized to "restore personhood" at least at the performative level. This demonstrates the dynamic interface between notions of personhood and mental illness with implications for stigma reduction.

Mental health service use by individuals of South Asian origin living outside of South Asia is influenced by cultural factors such as endorsing psycho-social-spiritual over biological explanations, somatisation, and stigma. The aim of this review is to synthesise the evidence about (a) explanatory models of common mental disorders (CMDs) among people of South Asian origin residing in high-income countries, and (b) their help-seeking for CMDs, including formal and informal care. The systematic review protocol was registered a priori on Prospero (registration number CRD42021287583). We ran extensive searches on explanatory models and help-seeking of people of South Asian origin across five databases (MEDLINE, Embase, Cumulated Index to Nursing and Allied Health (CINAHL), PsycINFO, and Global Health). We extracted the data and conducted a narrative synthesis. We included 33 reports and 29 studies (9,030 participants). The participants in the included studies viewed CMDs through a psychosocial rather than a biological lens (e.g., resulting from family issues vs. neurotransmitters). Causal attributions included life stressors and attitudinal and religious/spiritual factors. Commonly used help-seeking strategies included private coping (i.e., crying or praying), speaking to friends and family, and visiting their General Practitioner. We can conclude that cultural factors play an important role in how South Asian individuals experience and understand CMDs. To cope, they use pluralistic help-seeking strategies. Implications for clinical practice and policy include increasing research on the explanatory models of CMDs, involving family in services, and developing community-based interventions for individuals who do not engage with formal care.

This study aimed to understand the perceptions and experiences of suicide attempters in order to suggest potential initiatives to reduce the suicide burden in rural India. The study is based on 46 in-depth interviews with suicide attempters and 4 focus group discussions with their family members. Interview content analysis revealed information related to four anticipated themes: the characteristics of a suicide attempt are complex; suicide attempters are taken to public hospitals for first aid and treatment; the consequences of suicide attempts are diverse; and quality of life improved after the suicide attempt. There were also two unanticipated themes: suicide attempters sought help from potential rescuers; and the underreporting of suicide attempts. Emergent themes from the focus group discussions were the vulnerable group for suicide; poverty, indebtedness, family conflicts and unemployment are the main reasons for suicide; non-violent methods are used to commit suicide; there were no behavioral changes before suicide; the devastating effects on the families of decedents; positive community support to suicide survivor families; and expectations of preventive measures from both the community and government. The article argues that to reduce the suicide burden, the government should adopt a two-pronged strategy of creating a secure livelihood all-year round and providing psychological counseling at both the household and community levels.

After years of armed conflict in northern Uganda, many local people have turned to Evangelical churches for help with healing and recovery. We observe that the healing practices in these churches encourage particular notions of what the mind is, how the mind works and whether it is bounded or porous to the outside world. In the traditional cultural setting in which these people grew to adulthood, many accept that vengeance can attack supernaturally from without. Based on ethnographic research conducted in the region between 2015 and 2025, this article argues that these new ideas about mind (broadly conceived) may help some community members recover (to some extent) from traumatic experiences arising from the armed conflict by modeling trauma as not supernatural, and modeling the mind as protected by God from attack. Learning a new way of understanding the mind and its boundaries with the outside world-e.g., as more closed and bounded-and learning to practice a certain amount of control over this boundary, may have a significant effect on the experiences of mental distress This argument contributes to debates on anthropology of mind, and on the way local theories of mind may shape mental experience.

The growing number of migrant patients in western countries calls for better cross-cultural competence among health providers. As workplaces, hospitals have become increasingly multicultural, and many doctors are themselves of foreign origin, including psychiatrists. The aims of this study were to explore what clinical challenges International Medical Graduates (IMGs) and native-born Norwegian doctors training in psychiatry perceived when treating patients from other cultures, and what factors might be associated with such cross-cultural challenges. We developed a six-item inventory of perceived cross-cultural clinical challenges (PCC), to assess what cross-cultural problems trainees in psychiatry found most challenging. The PCC was completed by 216 trainees who also reported on individual- and work-related background factors. Comparisons of PCC between the two groups were done by one-way analysis of variance, and associations between PCC and background factors were analyzed by linear multiple regression. The overall response rate was 93%. Native -born Norwegian doctors reported higher levels of PCC than did IMGs. Both native-born Norwegian doctors and IMGs rated "assessing psychosis," "assessing suicide risk," and "lacking tools in cross-cultural consultations" as the most demanding challenges in cross-cultural consultations. Independent factors associated with higher PCC included being a native-born Norwegian doctor and experiencing high levels of work-home conflict. The findings suggest that trainees in psychiatry may need more training and better tools in cross-cultural assessment of mental disorders. Possible differences in PCC between native-born doctors and IMGs should be taken into consideration when developing mentoring programs, as should the doctors' work-home conflict level, which might impact the PCC.

The Refugee Access Service (RAS) is a triage, assessment and referral service established in Melbourne, Australia to ensure timely and appropriate mental health support for young refugees. This qualitative study sought to explore the experiences of young people aged 12-25 years, and their families, newly arrived from Iraq and Syria, who had contact with the RAS, for the purposes of further programme development. Semi-structured interviews were conducted with participants, either individually or in family groups. Thematic analysis was used to identify themes. Four key themes were identified. These were that mental health help-seeking of newly arrived young people and families is influenced by cultural norms; that trauma, grief and loss influence mental health service needs; that settlement challenges influence mental health service needs; and that the cultural responsiveness of mental health care is important to young people and families. Results highlight ways in which this service, and similar models, can improve to better meet the needs of young refugees and their families. Services should be developed in partnership with the wider operating environment. This will improve providers' understanding of communities they serve. It will also promote pathways between, and collaboration with, different types of services.

Activist burnout is a common threat to activists' personal sustainability and to a movement's effectiveness. Compared to related fields such as humanitarian aid or social work we know relatively little about mental health risks in activists or how a specific activist environment may contribute to mental health outcomes. This study examines the case of the No Borders movement in Europe, a grassroots movement fighting for migrant rights. The movement's groups are highly diverse in terms of nationality, ethnicity, culture, and religion because they are composed of refugees, migrants, and local populations. Following the vulnerability-stress-model, the article asks: which specific stressors occur in the No Borders movement? The analysis is exploratory and based on ethnographic research and qualitative interviews (N = 26). Situational Analysis (SitA) shows that: a) activists have to navigate a complex environment in which radical grassroots activism meets humanitarian emergencies, and b) in dealing with diversity and intergroup conflicts they are under pressure to live up to their political ideals. These insights led to the identification of three stressors: prefigurative betrayal, inadequate expectations, and split of life-worlds. Understanding these stressors can contribute to informing preventive measures in No Borders and in other migrant or antiracist movements.

The COVID-19 pandemic exacerbated the challenging working conditions of healthcare workers (HCWs) in many regions. A considerable proportion of HCWs in Germany are migrants facing additional migration-related stressors. The aim of this cross-sectional web-based survey was to examine depressive and generalized anxiety symptoms among migrant and native HCWs in Germany during the pandemic. We compared 780 migrant (first- and second-generation) HCWs from different backgrounds with 6,407 native HCWs. Multiple linear regression analyses were used to examine associations between occupational and COVID-19 related variables, controlling for sociodemographics. Migrant HCWs from low-/middle-income countries more frequently had clinically relevant depressive symptoms (PHQ-2 ≥ 3) than did those from high-income countries (29.9% vs. 16.7%, p = .002, ϕ = .156) (all other ϕs/Cramer's Vs ≤ .036). There were no clinically relevant differences in anxiety levels (GAD-2 ≥ 3) between native vs. migrant HCWs, native vs. the individual migrant HCW groups, or between the sexes (all ϕs/Cramer's Vs ≤ .036). After controlling for key sociodemographic characteristics, native HCWs did not differ from the individual migrant HCW groups on depression and anxiety severity (depression: all βs ≤ |.030|, anxiety: all βs ≤ |.014|). A high percentage of HCWs reported distress, with migrants from low-/middle-income countries reporting highest burden. The results indicate the need to establish prevention programmes for HCWs, with special consideration to vulnerable populations including certain migrant groups.