Transcultural Psychiatry最新文献

This prospective study examined the psychosocial adaptation of a community sample of newly resettled Syrian refugees in Canada (N = 235). Specifically, depressive symptoms, perceived stress, and perceived control were collected in Arabic at baseline and 1-year follow-up. Two theory-informed, cross-lagged panel models demonstrated that higher baseline depressive symptoms predicted lower perceived self-efficacy and lower perceived control at 1-year follow-up. Similarly, baseline depressive symptoms were concurrently correlated with higher perceived helplessness, lower perceived self-efficacy, and lower perceived control. Secondary regression analyses further demonstrated that baseline depressive symptoms predicted lower perceived social support and higher anxiety symptoms, though neither were assessed at baseline. Empirical results identify a potentially broad, precipitating, and persistent effect of depressive symptoms on Syrian refugees' psychosocial resources and adaptation post-migration, which is consistent with both the transactional model of stress and coping and the self-efficacy theory of depression, respectively. Clinically, the study results highlight the importance of early screening for depressive symptoms among refugee newcomers within a culturally and trauma-informed, integrated health setting. Furthermore, this study underscores the value and need for theoretically guided longitudinal studies to advance future research on refugee mental health and psychosocial adaptation.

Residential schools are commonly used in India to provide education for Indigenous youth, which requires young people to stay for long periods at distance from their families and communities. Internationally, there is clear evidence for the deleterious effects of residential schools on the mental health and social and community outcomes of Indigenous children, however little is known about the Indian Indigenous experience. This study examined the impact of residential schooling on Indigenous children's wellbeing and that of their communities, using data from an ethnographic research project in Attapadi, Kerala, including interviews, focus group discussions and participant observation with Indigenous communities. Key outcomes from residential schooling reported by the participants include the fear of losing Indigenous identity, shame of being Indigenous, change in the attitude of young people when they returned from schools, and feelings of confusion and stress that young Indigenous participants felt trying to fit into their communities on their return. Findings suggest that these Indigenous youth felt disconnected from several factors that are known to promote resilience for Indigenous communities including a strong cultural identity, connection to the land and ancestors, thereby making them more vulnerable to poor mental health and negative impacts on their overall wellbeing. Addressing these concerns requires a detailed understanding of the specific factors influencing outcomes for Indigenous youth within the Indian residential schooling system, and designing and implementing data-informed conceptual, structural and policy change including the provision of culturally safe mental health services.

Anxiety during pregnancy affects women worldwide and is highly prevalent in Pakistan. The Psychological Outcome Profiles (PSYCHLOPS) questionnaire is an instrument used in therapy to assess patient-generated problems and the consequent functional difficulties. Using the PSYCHLOPS, we aimed to describe the type of problems and the consequent functional difficulties faced by anxious pregnant women in Pakistan. Secondarily, we sought to explore if a cognitive behavioral therapy (CBT)-based intervention brought about changes in the severity score for certain problems or functional difficulties. Anxious pregnant women were recruited from the Obstetrics/Gynecology Department of a tertiary hospital in Rawalpindi, Pakistan. Of 600 pregnant women randomized to receive a psychosocial intervention for prenatal anxiety delivered by non-specialist providers, 450 received ≥1 intervention session and were administered the PSYCHLOPS. Eight types of problems were identified; worries about the unborn baby's health and development (23%), concerns about family members (13%), and financial constraints (12%) were the most frequently reported primary problems. Severity scores between baseline and the last available therapy session indicated the largest decrease for relationship problems (mean = 2.4) and for concerns about family members (mean = 2.2). For functional difficulties, 45% of the participants reported difficulties in performing household chores, but the intervention showed the greatest decrease in severity scores for mental or emotional functional difficulties. Focus on certain types of patient-generated problems, e.g., relationship problems, could anchor therapy delivery in order to have the greatest impact. Tailored CBT-based intervention sessions have the potential to address important but neglected problems and functional difficulties in anxious pregnant women.

Heavy drinking and smoking have been found to be among the leading causes of morbidity and mortality within Indigenous youth in North America. The focus of this study was to examine the relative roles of cultural identity, parent-child communication about the harms of substance use (SU), and perception about peers' opinions on heavy drinking and cigarette smoking among Indigenous youth. Strong Indigenous cultural identity, parent-child communication about SU, and affiliation with peers who do not use and/or who disapprove of substance use were all expected to reduce risk for heavy drinking and smoking. Substance use beliefs were hypothesized to mediate these effects. Youth (N  =  117; M_age  =  14.07; grades 6-11) from two Indigenous communities in Quebec completed self-reports. Consistent with the hypotheses, strong cultural identity predicted increased negative beliefs about substance use, which predicted reduced drinking and smoking. Similarly, affiliating with peers who did not use alcohol predicted decreased positive beliefs about alcohol use, which predicted reduced drinking. Affiliating with peers who did not smoke cigarettes predicted reduced cigarette smoking. Parental influences were not supported in this model. Intervention strategies may benefit from targeting cultural identity, peer groups, and substance use beliefs among Indigenous youth.

American Indian (AI) people experience disproportionate exposure to stressors and health inequities, including type 2 diabetes (T2D) and mental health problems. There is increasing interest in how historical trauma and ongoing experiences of discrimination and marginalization (i.e., historical oppression) interact to influence AI health. The purpose of this study is to examine the relationships between historically traumatic experiences (i.e., boarding schools, relocation programs, and foster care), current reports of historical cultural loss, microaggressions, and their relationship to internalizing symptoms among AI adults living with T2D. This community-based participatory research study with five AI tribal communities includes data from 192 AI adults with T2D recruited from tribal clinics. Results from structural equation modeling revealed that personal experiences in foster care and ancestral experiences in boarding schools and/or relocation were associated with increased reports of historical loss, and indirectly associated with internalizing symptoms through racial microaggressions and historical losses. The findings highlight the importance of considering multiple dimensions of historical trauma and oppression in empirical and practice-based assessments of mental health problems.

Generalist health interventions that aim to reduce chronic health disparities between Indigenous and non-Indigenous populations can be culturally adapted to better meet the needs of Indigenous people in Canada; however, little is known regarding best practices in implementing these adaptations. The present study first provides a review of the research process used to adapt a previous evidence-based housing initiative for Indigenous youth in Northwestern Ontario. Second, it includes an overview of the adaptations that were made and the associated rationale for such adaptations. Third, it examines the experiences of participants and staff involved in the cultural adaptation of the Housing Outreach Program Collaborative (HOP-C), a health intervention re-designed to improve physical and mental health outcomes, wellbeing, and social support for formerly homeless Indigenous youth as they secure housing. Qualitative feedback from interviews with 15 participants and eight program staff, in addition to one focus group with an additional six frontline workers, described perceived outcomes of the program's cultural adaptations. Modifications to the overall program structure, specific roles within the program (including counseling services, peer mentorship, cultural services, and case management), and adaptations to general implementation within the health organization providing the intervention were described by participants and staff as effective and helpful adaptations. The focus of Indigenous values at an organizational level led to consistent adaptations in counseling and case management to best meet the unique needs of the youth involved. Based upon participant interviews, recommendations to future adaptations are provided.

American Indians suffer from disproportionately high rates of mental health problems. Professional therapies may not meet the specific mental health needs of American Indians, owing to cultural mismatch and long histories of political disempowerment. Instead, Indigenous traditional spiritual practices are often promoted as alternative sources of health and help in these communities. In response to a community needs assessment, we developed a 12-week traditional spirituality curriculum in partnership with the urban American Indian health clinic in Detroit. Centered on the sweat lodge ceremony, the program was pilot tested with 10 community members. Semi-structured interviews were conducted with nine participants following the program. Based on our analyses, all participants endorsed responses within two overarching themes: impact on personal well-being, and suggestions for improvement reflecting their desire for an ongoing program. Participant responses about the program's impact comprised four themes: (1) improved psychological and spiritual well-being, (2) community benefit, (3) increase in cultural knowledge, and (4) a desire for further learning and sharing. Participant responses about their desire for an ongoing program also comprised four themes: (1) drop-in classes may be more practical as regular attendance was difficult for some, (2) future classes should include more areas of knowledge, (3) the program could be expanded to include more knowledge-holders and perspectives, and (4) the program should include a progression of classes to accommodate more diversity. Overall, participants reported benefit from participation in Indigenous spiritual practices; however, the program can be improved by further adapting the curriculum to the sometimes-challenging lives of its participants.

Cultural identity is associated with positive emotional and behavioral health. However, colonialism and its forces, past and present, have led to cultural loss in many Indigenous communities, contributing to health disparities. And yet, Indigenous peoples actively resist colonialism and work to maintain and revitalize their cultures around the globe. This study sought to understand how Alaska Native university students from diverse cultural backgrounds are presently developing and constructing their cultural identities. Transformational grounded theory methods were used to analyze seven focus groups with 20 Alaska Native university students from diverse cultural regions, now living in an urban center. Results revealed that identity was constructed as a series of nested and intersecting identities that centered on relations, place, and time across cultural groups. Cultural practices and values were often drawn upon to understand identity. Cultural identity was developed through storytelling, experiential learning, connection, personal exploration, and sharing with others. Relatives, particularly grandparents and Elders, and communities played a critical role in shaping cultural identity. The construction of cultural identity and its development diverged by setting of upbringing (rural, urban). Results have implications for the modification of structures and the development of cultural identity promotion programming to support Alaska Native young peoples' identity development in an effort towards emotional and behavioral health.

Research with Indigenous communities has demonstrated the detrimental impacts of intergenerational trauma and disproportionate adverse childhood experiences (ACEs) on health and behavioral outcomes in adulthood. A more balanced narrative that includes positive childhood experiences is needed. The construct of benevolent childhood experiences (BCEs) facilitates assessment of positive early life experiences and their impact on well-being for Indigenous peoples. We consider associations between BCEs and well-being when taking into account ACEs and adult positive experiences. Participants are from Healing Pathways, a longitudinal, community-based panel study with Indigenous families in the Midwestern United States and Canada. Data for the current analyses are derived from 453 participants interviewed at wave 9 of the study. Participants reported high levels of positive childhood experiences in the form of BCEs, with 86.5% of the wave 9 participants reporting experiencing at least six of seven positive indicators. BCEs were positively associated with young adult well-being. This relationship persisted even when accounting for ACEs and adult positive experiences. While ACEs were negatively correlated with young adult well-being, they were not significantly associated with well-being when considering family satisfaction and receiving emotional support. Evidence of high levels of BCEs reflects realities of strong Indigenous families and an abundance of positive childhood experiences.

Research on self- and cultural continuity has contributed to our understanding of resilience processes in Indigenous communities, as connecting oneself to the past, present, and future of one's family, community, and traditional culture has been found to protect against deleterious developmental outcomes. To examine factors associated with self-continuity for Indigenous youth in the current study, Indigenous youth from six rural Ojibway and Métis communities in Treaty 2 Territory completed self-report questionnaires aimed at understanding the relationship between the concept of oneself across time and protective and risk factors at different systemic levels (family, community, culture, and colonial). The concept of oneself across time was measured by self-efficacy (global self-worth) and future orientations (optimism and sense of self in the future). The findings indicated that connectedness to caregivers, siblings, friends, neighborhoods, and culture was associated with higher self-efficacy, seeing oneself as more connected to the future, and seeing the future more positively. These findings support the notion that familial, community, and cultural connectedness are associated positive self-concepts in the present and future, which aligns with our understanding of self- and cultural continuity in Indigenous communities.