Transcultural Psychiatry最新文献

In 2016, the Ola During Children's Hospital (ODCH) in Freetown, Sierra Leone, introduced the country's first and only Children and Adolescent Mental Health (CAMH) service with treatments based on a biomedical understanding of mental illness. The service at ODCH contrasts with the prevailing traditionally defined mental health landscape in and around Freetown, Sierra Leone, which largely relies on supernatural and spiritual explanatory models. The study investigates how service-users perceive the biomedical treatment practices and makes a first attempt at examining how the different services relate to each other. Semi-structured interviews were conducted with eight female caregivers of children and adolescents with mental illness (aged 6-19), as well as with two traditional healers, two religious healers, and five mental health nurses. The interviews were thematically analysed following Braun and Clarke's six-phase approach, with Arthur Kleinman's concept of "explanatory models" (EMs) serving as the primary analytical lens to examine how understandings of illness shape perceptions and help-seeking behaviour. The study concludes first that biomedical explanations about children's mental health conditions were well received by care seekers and help to improve their understanding of the condition and ways to deal with it; second, the concept of EMs can be helpful to understand different help-seeking behaviours of caregivers of children with mental illness in Sierra Leone, however, this concept has to be taken as flexible and people adapt to what they are exposed to; and third, a scale-up of CAMH services should include awareness-raising among health practitioners and show itself open to cooperate with non-biomedical practitioners under certain conditions.

There is some evidence that Sufi music as a receptive music therapy might be beneficial for treatment of common psychological disorders, and mental well-being. The aim of this study was to test the feasibility of Sufi music intervention for adults with mild to moderate levels of depression and anxiety, attending Turkish community centres in England. This was a pilot randomised controlled trial of a 4-week Sufi makam music intervention with 60 participants conducted in two Turkish community centres in the UK with assessments at baseline, mid-intervention (2 weeks), post intervention (4 weeks) and at 2 weeks follow-up. The recruitment and retention rates in the intervention arm during the four weeks were 94.5% and 93.3%, respectively. The intervention was acceptable for most of the participants. According to analysis of clinical outcomes, Sufi music intervention was not associated with any clinical improvement in the music group relative to the control group when the means were compared at T3. However, when the results were adjusted for baseline scores as control variables in the linear regression, anxiety levels of the music group were significantly lower than the control group at the end of trial (p = .013), and mental and spiritual well-being had a statistically significant increase in the music group at the end of trial (p = .002; p < .001, respectively). The Sufi music therapy intervention was found to be feasible, acceptable and convenient to deliver, and the recruitment and retention rates in the intervention group were high. Furthermore, assessment of the clinical outcomes suggests that the intervention may reduce anxiety and improve mental and spiritual well-being.

Despite the importance of accessible psychiatric care for the ultra-Orthodox Jewish community, prior research has characterized how stigma and suspicion of secular institutions limit mental healthcare utilization by this population. No study, however, has interviewed a cohort of psychiatrists to identify commonly encountered challenges or successfully employed strategies in the care of ultra-Orthodox Jewish psychiatric patients who have overcome these barriers to present for care. We recruited by snowball sampling from a sample of convenience 18 psychiatrists affiliated with the Weill Cornell Department of Psychiatry, experienced in the care of ultra-Orthodox Jewish patients. Each participant was engaged in a 20-45-min, semi-structured interview, which was subsequently transcribed, de-identified, and analyzed with combined deductive and inductive thematic analysis. We identified 12 challenges and 11 strategies as particularly significant in psychiatric work with ultra-Orthodox Jewish patients at every phase of treatment, including rapport-building, history-taking, diagnostic formulation, and achieving concordance with patient and family. These challenges and strategies revolved around themes of community stigma, an extended family-patient-community team, cross-cultural communication, culture-related diagnostic complexity, transference/countertransference, and conflicts between Jewish law /community norms and treatment protocol. Psychiatrists caring for ultra-Orthodox Jewish patients face a range of complex challenges stemming from factors unique to ultra-Orthodox Jewish religion, culture, and family/community structure. However, they have also identified strategies to manage these challenges and provide culturally sensitive care. Further research is necessary to directly elicit perspectives from within the ultra-Orthodox Jewish community and validate our initial findings.

This phenomenological study concerns the Druze cultural idiom Notq-the remembrance and talking about the previous incarnation. Specifically, it deals with stories that are open or referred to in the literature as unsolved. "Open" Notq stories are in contrast to solved ones in which the person's identity in the previous life is known and in many cases the person meets the previous life family. The study's core question is: What is the phenomenological experience of Druze who live with an "open" Notq? The study was based on interviews with 11 Israeli Druze women and men who have an open Notq story. The findings illustrate the open Notq scenario, the elements that validate it and the individual and collective implications of these stories. Through the open Notq cases we discuss the intersection between personal and master cultural narratives and the effects of this intersection on psychological well-being. We propose that the open Notq, despite its ambiguity and many unsolved questions, does not essentially harm the individual psychologically and may contain therapeutic value due to being consistent with the Druze reincarnation master narrative.

Mediumship is a well-accepted spiritual practice in Brazil relating to the grief process and beliefs in the afterlife. For this reason, there is considerable interest among Brazilians in trying to determine whether mediums can obtain information beyond what can be obtained through conventional means (Anomalous Information Reception - AIR). However, there is a dearth of in-depth qualitative studies about these issues. This study aimed to investigate reported AIR in a mediumistic trance and the meaning of this information to the family of the deceased. In a controlled observation-based study, following 43 seconds of filmed interaction with the parents, the medium wrote a letter attributed to their deceased son. Information obtained or deducible from the medium-sitter interaction was excluded from the items of information verifiable in the letter. The degree of accuracy and specificity of the remaining items were investigated in three interviews with the parents and through the deceased's documents and objects. An expert carried out a handwriting analysis of the letter's signature. The medium produced 19 items of information, one of which could not be evaluated, one that was unrecognized, two that were deducible, nine that were generic and six specific. Items of information described the deceased's present and past habits, plans, and distinguishing physical characteristics which came across to the parents as unlikely to be obtained through routine interactions or by chance. Comparison of signatures is common in mediumistic practice, and in this case, the signature had some general similarities to that of the deceased, but there were many differences in more subtle aspects. The production of six verifiable items of information that had not previously been communicated to the medium through conventional means illustrates what many Brazilians believe to be AIR phenomena. Qualitative studies of AIR can shed light on the practice of mediumship and its mental health implications, especially with respect to grief and loss in the Brazilian context.

In recent decades, there have been many calls for the inclusion of spirituality and religion (S/R) in therapeutic contexts. In some contexts, this has been an institutionalized form of spiritual and religious assistance (SRA). This article examines the concepts and practices involved in SRA services at three psychiatric institutions in Portugal, a country with strong Catholic roots but increasing efforts at secularity and recognition of religious diversity. The case of a user who contacted the SRA service allows us to better grasp this new practice in action. Although some SRA practices have similarities with mindfulness, a systematic comparison allows us to explore the links between SRA and the global dynamics related to S/R in mental health and the particularities of Catholic spirituality. In the contexts observed, the transition from the Catholic hospital chaplaincy system to the SRA model is developing through the integration of features of the Catholic spiritual tradition with concepts and practices drawn from the psychology of religious experience. The accompaniment of the 'whole person' emerges as the central concept of this form of SRA. Spirituality gains significance as an integrative approach to the subjectivity fragmented by the illness and the fragmentation of care across multiple clinical specialties. Furthermore, the prioritization of the spiritual needs expressed by users suggests that SRA combines well with the individualistic rationales and the technification of care in the field of mental health.

Self-transcendence has been associated with lower levels of psychopathology. Most studies of self-transcendence have focused on samples of Western participants, and used scales addressing such concepts as self-awareness and feelings of oneness with the larger universe. However, a common Eastern notion of transcendence-perception of ongoing relationships with ancestors-has not been studied. We conducted a cross-cultural investigation of the association between self-transcendence, perceived degree of relationship to ancestors and depression and anxiety in the United States (N = 1499), China (N =  3,150), and India (N = 863). Degrees of perceived relationship to ancestors differed across countries, with the highest rates in India and China, and lowest rates in the United States. Self-transcendence was negatively associated with risks for depression and anxiety in the United States. In India, self-transcendence was also negatively associated with risks for depression and anxiety, and a strong perceived relationship with ancestors had further protective benefit. In China, those with a high level of perceived relationship to ancestors and a high level of self-transcendence exhibited lower levels of psychopathology. Results suggest that measures of relationship to ancestors might be included in future cross-cultural studies of transcendence.

In South Africa, neuropsychiatric disorders rank third in their contribution to overall burden of disease. Stigma, lack of mental health awareness, and limited access to health services and to appropriate treatment contribute to the high level of unmet need for treatment of neuropsychiatric conditions. Little is known about how young adults make decisions to access mental health services and how their adult family members influence these decisions. This study explored young adults' perceptions of the influence their adult family members on their own mental health service uptake. We conducted semi-structured in-depth interviews with a convenience sample of 21 people (18-24 years) from KwaZulu-Natal Province (KZN). Thematic analysis of interviews found that: young people had partial knowledge of mental health conditions and services; both adult family members as well as peers and other community members influenced mental health care seeking behaviours. Participants who had accessed mental health services attested to their long-term benefit. Transition to adulthood was a time of mental health challenges. The results point to the need to scale up community-level awareness on mental health conditions in rural South Africa. This can include targeted education interventions to increase knowledge of mental health, and ways to adjust to the stresses of the transition to adulthood. More research is needed to further understand the gendered dimensions of peers' influence of mental health service uptake.

Indonesia is a country of immense socio-cultural and economic diversity in Southeast Asia. Over the past century, Indonesia epitomized a colonial and post-colonial scientific laboratory for developing early interventions in international health, transcultural psychiatry, and Global Mental Health (GMH). Psychological and psychiatric anthropology have greatly benefited from research on the interplay between culture, mental health, and illness in Indonesia. Given the impact research on severe mental illnesses (SMI) in Indonesia has had on the development of GMH and adjacent disciplines, this review aims first, to provide a systematic review of the scope of SMI research in Indonesia. Second, it aims to identify potential gaps in the literature, cross-country collaborative networks, and traveling concepts of mental health and illness. Third, it points to entanglements between cultural concepts and illness experiences. We focused our search on the PubMed database and discovered 110 relevant records to review. We found a heterogenous body of literature that shows the complexities of being confronted with or living with SMI in Indonesia. We also identified a reliance on high-resource settings for mostly quantitative research. Some limitations appear to be, accounting for cultural hyperdiversity, limiting population samples, and relatively few geographical areas covered in the studies. Inspired by recent commentaries in Global Health research, we suggest more solidarity with low-resource settings and more horizontal approaches in international mental health and illness research. Ultimately, we highlight the need for GMH research and researchers working in contexts of hyperdiversity to ask more culturally sensitive questions.

The use of the Cultural Formulation Interview (CFI), a semi-structured 16-item cultural assessment developed for the DSM-5, has not yet been evaluated in the context of post-secondary education campuses (Cégeps and universities). The aim of this study was to assess whether a 2-h training session on the CFI improved cultural competence in clinicians working in student counseling centers throughout the province of Québec as well as to evaluate the clinicians' attitudes toward the adoption of the CFI and their perceptions of the tool's feasibility, acceptability, and clinical utility. Thirty-nine clinicians from seven Cégeps and universities completed the pre-training questionnaires, participated in the 2-h training session, and then completed the post-training questionnaires. Paired-samples t tests were used to compare change in the scores of self-reported cultural competence pre and post training. Clinicians favorably rated the assessment tool, and most clinicians (89%) reported that they planned to incorporate the CFI into their routine clinical practice. There was an increase in multicultural counseling knowledge post training session, as well as a decrease in the multicultural counseling relationship subscale. Potential barriers to the use of CFI were also identified. More research is needed to explore the use of the CFI in different clinical contexts, as well as to evaluate the impact of cultural competence training on clinical practice.