Transcultural Psychiatry最新文献

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.

This study was designed to examine how cultural values affected mothers' perceptions of internalizing symptoms in youth, comparing Taiwanese and U.S. samples. We hypothesized that mothers' self-reported East Asian cultural values (e.g., conformity, emotional self-control, face culture) would mediate the relationship between their country of residence and perceptions of youth's depressed mood and anhedonia. Participants were 310 mothers from the United States and 294 mothers from Taiwan. All participants responded to questions regarding their adherence to specific East Asian cultural values. Four brief vignettes about a male adolescent experiencing internalizing symptoms were presented to all participants. After reading each vignette, participants rated their perceptions of the adolescent's symptoms. Results from a series of multilevel structural equation models indicated that Taiwan mothers reported more East Asian cultural values (conformity, emotional self-control, face culture) compared to U.S. mothers, which in turn led to rating youth internalizing problems as less acceptable, more impairing, and more problematic to the family, and feeling less proud and more ashamed of the youth. There was also an inconsistent mediation effect of East Asian cultural values on the relationship between country and rating of anhedonia. The mediation pathway was non-significant for the rating of depressed mood. In conclusion, to improve cultural understanding, researchers and clinicians should consider the driving force of the observed between-group differences to ensure appropriate conceptual frameworks in a cross-cultural context. Cross-cultural differences in ratings of youth symptoms highlight the importance of a culturally sensitive approach to assessing symptoms and functional impairment in different cultural groups.

Ghanaian migrants in Japan, who make up the second-largest population of African migrants in the country, may have faced heightened racial prejudice and challenges during the COVID-19 pandemic, impacting their well-being. This study explored cultural factors shaping the well-being of Ghanaians living in Japan during the COVID-19 pandemic through a qualitative study using the socioecological model. From June 2022 to August 2022, 18 in-depth interviews and 2 focus group discussions were conducted among Ghanaian migrants in Japan. Interviews were audio recorded and transcribed, and an inductive thematic approach was used to analyze the data. At the individual level, the internalized face mask culture, financial constraints, reluctance to access mental healthcare services, and hesitancy toward COVID-19 vaccine played major roles in the well-being of Ghanaian migrants. Adherence to social distancing and coping using religious and social circles influenced their well-being at the interpersonal level. At the community and societal levels, important influences on well-being were language barriers, discrimination and COVID-19-related stigma, and trust in Japan's healthcare system. In conclusion, while Ghanaian migrants in Japan faced challenges during the pandemic, affecting them physically and psychologically, they were able to cope through the religious and social ties from Ghana that they maintained.

There is evidence that Asian migrants in Australia may be relatively reluctant to seek professional help for depression. Reluctance may be related to poor mental health literacy, including limited knowledge of help-seeking options and treatments, and a preference to seek help from informal networks. This study investigated Sri Lankan Australians' knowledge about managing depression by examining their hypothetical help-seeking intentions and perceptions about interventions and help-providers' helpfulness. Following Jorm's mental health literacy framework, participants (N = 374) were presented with a vignette of a Sri Lankan Australian exhibiting symptomatology consistent with Major Depressive Disorder, and asked to indicate their intentions to seek help by responding to the question: "If you had Mr Silva's problem, what would you do?". Participants also rated the likely helpfulness of various professional and informal helpers and interventions in addressing a problem akin to Mr Silva's. Participants reported being likely to seek help from GPs (35.8%), psychologists (25.7%) and friends (24.3%). Additionally, those who intended to seek informal help were significantly less likely to seek professional help, and vice versa. Furthermore, psychologists (94.1%), counsellors (93.3%), close friends (92.5%) and compatriots (91.4%) were most frequently categorised as helpful. Given participants' high endorsement of psychiatric treatment, psychological treatment, and self-help strategies such as engaging in enjoyable activities, it would be helpful for clinicians to emphasise the benefits of these interventions for managing depression. Additionally, recognising some participants' inclination towards religious practices and helpers, clinicians can consider integrating these help-seeking behaviours into therapeutic approaches. Future research is warranted to examine the predictors of help-seeking intentions.

In 2021, university scholars hosted a conference titled "Dismantling Global Hindutva," which prompted Hindu activists to criticize psychoanalysts for superimposing colonial frameworks onto Hindus. Indian media organizations have questioned the validity of psychoanalysis as scholars uncover the complicity of psychoanalysts with the British Empire. Drawing upon concepts in cultural psychiatry, this article operationalizes ontological perspectivism as a way to decolonize the application of psychological theories among historically-marginalized communities. It presents three perspectives on psychological phenomena. It begins with analyzing the first psychoanalytic study on Hindu scriptures by the psychoanalyst-British colonial administrator Owen Berkeley-Hill through his autobiography, writings from contemporaries, the study itself, and subsequent citations. This study served as model for future work in psychoanalysis that portrayed Hindus in ways that Hindu activists now criticize. Next, the essay presents translations of Sanskrit commentaries on the same scriptures from Hindu philosophers to see how observant Hindus have received their tradition. Finally, it examines writings from contemporary psychoanalysts and psychiatrists who have tried reconciling mental health theories and Hinduism. Ontological perspectivism offers an approach for intercultural dialogues among scholars in distinct intellectual traditions to develop a postcolonial psychiatry.

A new style of thought is emerging in debates around psychiatry and mental health, which I term '5E Mental Health.' This goes beyond the well-known and much-criticized 'biopsychosocial' approach, and entails a fundamental challenge to the deeply socially embedded 'psychiatric complex.' It aims to map the biosocial mechanisms through which 'social determinants' give rise to the ailments that have become the province of clinical psychiatry. Those ailments are: embodied: brought forth not just by the brain but by the whole organism; extended: realized by the organism in interaction with the material and interpersonal environment; emplaced: always shaped in relation to a specific milieu and what it affords or disaffords; experienced: made meaningful by and to the individual (and to others) in language, meaning, memory, salience; and enacted: not just passively received but shaping an active agentive way of being with others, a form of life. These are the tractable pathways through which adverse social experiences give rise to those ailments conventionally diagnosed and treated in individual clinical encounters. It is possible and plausible to enact small-scale local changes in forms of life that can act on these pathways. This requires mental health professionals to work collaboratively with architects, planners, local and national policy makers, and, crucially, those who have experience of mental distress and psychiatric services. It thus requires a paradigm shift in the work of psychiatrists, mental health professionals, and policy makers that is as radical and fundamental as that entailed in the closure of the asylums.

Despite the universal nature of suffering, few studies have examined how Indigenous ethnic minorities in non-western regions understand and respond to adversity. This study explored the epistemology of suffering among the Temiar ethnic group of Peninsular Malaysia using participant observation and semi-structured interviews. Interview transcripts of 43 participants were coded through inductive thematic analysis and a consensual qualitative approach. Three-tier themes were defined and named after subsequent analysis of core ideas and domains in the data. Major adversities reported included a lack of basic needs, lack of land-rights and unjust treatment from authorities, destruction of the forest environment and livelihood, and lack of accessibility and facilities, which were attributed to authorities' negligence of responsibilities, increasing human-animal conflict, environmental threats and imposed lifestyle changes. Faced with adversity, the Temiar endeavoured to survive by working crops and gathering forest resources. They utilized resources from family, fellow villagers, external agencies and spiritual-religious traditions. Theoretical mapping of attribution styles into the Ecological Rationality Framework revealed predominantly external-focused and concrete-perceptual rationalities privileged by strong-ties societies. These findings pointed to the resilience of a strong-ties community while adapting to the systemic suffering and risk factors stemming from a rationality mismatch with modernization and globalization trends. To conclude, we advocate for culture-sensitive mental health and psychiatric practices, as well as sustainable development for the well-being of Indigenous communities locally and globally.

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 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.

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.