Transcultural Psychiatry最新文献

This article describes the development and validation of a capability-based well-being scale: 'Escala de Bienestar Kankuamo' (EBK; the Kankuamo Well-Being Scale). The EBK is designed to measure the well-being of the Indigenous Kankuamo community of Colombia from an intercultural perspective. The mixed-methods study was composed of two phases. In phase I, an initial 27 items, which had been generated using qualitative data from a previous study, were reviewed and adjusted through workshops with the Kankuamo community. In phase II, an adapted list of 28 items was piloted within the Kankuamo communities (sample N = 213). A preliminary exploratory factor analysis was carried out. The internal consistency of the EBK was measured using McDonald's ω. Convergent and divergent validity were tested with the World Health Organization-Five Well-Being Index (WHO-5) and the Patient Health Questionnaire-9. Incremental validity was tested through a hierarchical regression analysis to determine the effect on the WHO-5 of age, gender, community and EBK. The exploratory factor analysis resulted in a 14-item scale with seven domains: (1) Relating (to others and one's emotions), (2) Guiding principles, (3) Choice of healthcare, (4) Self-grown food, (5) Community contributions, (6) Agency and (7) Respect and equality. The EBK had high internal consistency (McDonald's ω = 0.86). Statistical analyses aimed at determining the convergent and divergent validity were inconclusive, suggesting a need for caution in using western standardised mental health measures in Indigenous communities because these may lack adequate cultural fit. The findings of the current study identify local priorities and needs, and evidence the feasibility of operationalising the capability approach for Indigenous populations.

The number of African refugees migrating to North America (the United States and Canada) has increased significantly over the past decade. Notwithstanding, the prevalence of mental health disorders among African refugees signals an urgent need to address them. We reviewed mental health interventions tailored to African refugees in North America, identified existing gaps, and suggested mental health services improvement recommendations. Using PRISMA guidelines, we identified (n = 1,164), screened (n = 989), assessed (n = 79), and included (n = 7) peer-reviewed articles detailing interventions that addressed mental health and its associated concerns among African refugees in North America. Our results showed that pre-migration perils and acculturation stressors exacerbated mental health concerns such as anxiety, depression, dysphoria, and post-traumatic stress disorder symptoms. Interventions that culturally adapted cognitive behavior therapy, peer support, and psycho-education effectively reduced mental health symptoms and improved life satisfaction. Future interventions should contextualize and incorporate African cultural beliefs and practices within community settings to promote mental health services.

This qualitative study explores barriers to accessing treatment for Major Depressive Disorder (MDD) among Latino adults in the United States, with a novel focus on how these barriers were described based on participants' preferred language. Fifty Latino individuals (n = 24 primarily Spanish-speaking; n = 26 primarily English-speaking) participated in Zoom interviews and completed a demographic survey and the Patient Health Questionnaire-9 (PHQ-9) MDD self-report measure in their preferred language. Thematic analysis of interview data identified barriers across three levels: individual (e.g., stigma, service literacy, treatment readiness, caretaking responsibilities), provider (e.g., language barriers, cultural humility, perceived care quality), and clinic (e.g., cost, time constraints, waitlists, geographical access). While many challenges were shared across groups, key differences emerged. Spanish-speaking participants emphasized the importance of bilingual providers and described feelings of mistrust, communication fears, and concerns about emotional safety when language concordance was absent. English-speaking participants described prioritizing working with bicultural providers who demonstrated cultural humility and a nuanced understanding of possible intergenerational and structural stressors. Structural barriers, such as cost and scheduling, were often compounded by emotional experiences such as shame and mistrust, underscoring the need for both system-level and culturally responsive solutions. These findings reinforce the need for equity-informed strategies that attend to the intersection of language, culture, and structural barriers to MDD treatment.

The term "dual pandemics" refers to the intersection of the COVID-19 pandemic and ongoing systemic racism faced by Black Americans, highlighted by police killings during COVID-19. This study aimed to understand how these dual pandemics impacted Black college students' mental health. Data from 102 participants over 18 years of age was collected via an open-ended qualitative question on Qualtrics and analyzed using thematic analysis. Three themes emerged: 1) Cognitive, emotional, and physiological reactions to the killings, 2) Increased awareness of racial insensitivity and cruelty, and 3) Increased distrust of systems. The findings provide insight into how the dual pandemics exacerbate existing disparities, systemic trauma, and stress for Black college students, underscoring the urgent need for systemic change. We advocate for racial trauma-informed mental health support in response to police violence.

Sweden Finns are one of five officially recognized national minority groups in Sweden. As a group, Sweden Finns have been socioeconomically underprivileged in comparison with the Swedish majority population, and tend to be worse off in terms of somatic health. However, the literature on mental health among Sweden Finns has not previously been systematically appraised. The aim of this scoping review was to synthesize the available evidence on mental health among Sweden Finns or, when the minority terminology is not used in the literature, among individuals in Sweden with a Finnish background (including the so-called Finnish war children). Systematic literature searches in MEDLINE, Web of Science, and PsychINFO were performed. A total of 46 publications met the inclusion criteria; however, very few made use of the self-identification principle central to official Swedish minority politics. The synthesized evidence shows that Sweden Finns tend to be worse off in terms of mental health compared with the Swedish-born majority population, even after adjusting for socioeconomic factors. They are more often diagnosed with various serious psychiatric disorders, such as schizophrenia and other psychotic disorders. Alcohol and other substance-use disorders are also more common. Moreover, substantially higher suicide rates are consistently reported in this group, although no recent studies exist. The few published qualitative studies emphasize the importance of cultural competence in the care of elderly Sweden Finns with neurocognitive deficits. More qualitative and ethnographically oriented research is needed to explore causal pathways behind the observed patterns and to guide potential preventive measures.

Many evidence-based practices in autism aim to improve outcomes for both family and child. Caregiver-implemented intervention is one example of such evidence-based practice as it aims to strengthen caregivers' capacity in a natural environment. Although caregiver-implemented interventions in early autism intervention are supported by research and used by many practitioners and families, marginalized families of young autistic children from diverse cultural or linguistic backgrounds require additional adaptations to these interventions for increased contextual fit. Without these adaptations, interventions may not be equitably accessible among marginalized families who are underrepresented in autism research. While literature suggests that cultural adaptation of interventions may be an effective way to ensure equitable implementation, it is still difficult to claim its effectiveness among these populations without appraising the quality and rigor of cultural adaptation. Therefore, we conducted a review of 16 studies of caregiver-implemented interventions that were culturally adapted or tailored using the Cultural Adaptation Checklist, a novel tool for appraising the quality of cultural adaptation based on the ecological validity framework and implementation science. The results revealed great variation and use of a wide range of practices in cultural adaptation. Limitations of current literature and implications for future research are discussed.

While the impact of trauma on the well-being of forced migrants has been widely researched, there is still a notable lack of understanding regarding the consequences of collective trauma experiences within this population. This scoping review aims to explore and understand the current state of literature regarding collective trauma among forced migrants. A systematic review of the literature was conducted using Academic Search Complete, Ethnic Diversity Source, PsychINFO, Psychology and Behavioral Sciences Collection, Social Work Abstract, and SocINDEX. Of the 78 studies identified, 19 met inclusion criteria: peer-reviewed journal article; published between 2002-2022; written in English; involved forced migrants; and explored collective trauma. Six major themes were identified: (1) exploration of collective trauma; (2) impacts of collective trauma: (3) intergenerational trauma; (4) resilience and resistance; (5) practice and policy failures of the West; and (6) solutions to healing. Results support the inclusion of collective trauma in future research on forced migrant populations and advocate for interventions grounded in collective healing.

An existing body of research demonstrates the efficacy of Dialectical Behavior Therapy (DBT) Skills in reducing a range of psychiatric symptomatology in the United States, although the relevance of DBT Skills in low- and middle-income countries in the Global South has been understudied. Focusing on India, a middle-income country, in this qualitative study, we explored the relevance of DBT Skills for emerging adults-typically individuals aged 18-29 years-using focus groups with counseling psychology graduate students. Students (N = 22, 90% women) participated in initial focus groups where DBT Skills were outlined and were asked whether these skills would be relevant for emerging adults in India, and what adaptations may be needed. Then, students received a virtual four-week DBT Skills training program in which they learned extensively about DBT Skills and subsequently participated in focus groups to discuss the relevance of those skills for emerging adults in India. Incorporating the adaptations they recommended, students then facilitated DBT Skills groups with emerging adults in India for eight weeks and then participated in focus groups to discuss the relevance of the skills. Thematic analysis was used to analyze the data from the three sets of focus groups. Twelve themes were identified and organized into three separate domains: (a) views about optimal interventions; (b) relevance of DBT Skills; and (c) sociocultural adaptations to DBT Skills. Overall, findings suggest relevance of DBT Skills for emerging adults in India with specific adaptations to emotion regulation, and more broadly to all modules by integrating collectivistic values and local cultural norms.

Large numbers of refugees from Iraq continue to resettle in the United States, but there is limited information about the mental health and psychosocial wellbeing of ethnoreligious Yazidi refugees in a U.S. resettlement context. Thus, we sought to answer the following questions: (1) How do different groups of Yazidi refugees experience and perceive mental health and psychosocial wellbeing?; (2) What are Yazidi refugees' preferred help-seeking strategies and supportive resources to promote psychosocial resilience?; and (3) What role does future-making play in the psychosocial resilience of Yazidi refugees? To answer these questions, we conducted four age- and gender-disaggregated focus groups with 28 Yazidi refugees living in the U.S. Midwest. Using narrative and matrix analysis approaches, we generated three themes highlighting the importance of hope and future-making in individual and collective psychosocial resilience: (1) psychosocial distress and the precarity of future-making out-of-place, (2) perceptions of mental health and psychosocial help-seeking using unfamiliar systems of care, and (3) liminality, cultural negotiation, and future-making. Our findings reveal an interplay between the cultural and structural dimensions of wellbeing and suggest an ecosocial-structural approach is essential for effective mental health and psychosocial support (MHPSS) with Yazidi refugees.

Posttraumatic stress disorder (PTSD) in refugees has been linked to poor social outcomes. Self-stigma appears to be a potential barrier to social engagement in refugees with PTSD, however research into this relationship is scarce. As such, the study aimed to 1) investigate whether self-stigma of PTSD (SSPTSD) and self-stigma of seeking help (SSOSH) underlie the association between PTSD and reduced social engagement in refugees, and 2) identify psychological mechanisms underpinning the association between PTSD and both types of self-stigma. In this online study, 262 Arabic-speaking refugees who had resettled in Australia completed measures indexing PTSD, two types of self-stigma (SSPTSD and SSOSH), social engagement outcomes (help-seeking behaviour, perceived social support), and potential mechanisms (self-esteem, hope, and negative help-seeking beliefs). Path analyses revealed that greater PTSD symptom severity was associated with reduced help-seeking behaviour via greater SSOSH and lower perceived social support via greater SSPTSD. Path analyses also revealed that greater PTSD symptom severity had an indirect effect on both types of self-stigma via greater negative help-seeking beliefs and an indirect effect on SSPTSD via lower hope. Findings demonstrate the deleterious effect of self-stigma on refugee mental health, yet also indicate potential intervention targets to reduce the negative impact of self-stigma.