Transcultural Psychiatry最新文献

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 2019, 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.

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.

Indigenous peoples' worldviews are intricately interconnected and interrelated with their communities and the environments in which they live. Their worldviews also manifest in a holistic view of health and well-being, which contrasts with those of the dominant western biomedical model. However, screening depression and/or anxiety in Indigenous peoples often occurs using standard western tools. Understandably, the cultural appropriateness of these tools has been questioned. The purpose of this scoping review was to map the literature that used any type of tool to screen depression or anxiety in Indigenous adults globally. A systematic scoping review method was used to search databases including, but not limited to, CINAHL, PubMed, Scopus and Google. Database-specific search terms associated with Indigenous peoples, depression and anxiety, and screening tools were used to identify literature. In addition, citation searches of related systematic reviews and relevant websites were conducted. The data set was limited to English language publications since database inception. Fifty-four publications met the review's inclusion criteria. Most studies were completed in community settings using standard western depression and anxiety screening tools. Thirty-three different tools were identified, with the Patient Health Questionnaire-9 being the most frequently used. The review's findings are concerning given repeated calls for culturally appropriate screening tools to be used with Indigenous peoples. Although there has been some work to cross-culturally adapt depression screening tools for specific Indigenous populations, clearly more clinicians and researchers need to be aware of, and use, culturally appropriate approaches to screening.

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.

Culture significantly influences the understanding, presentation, diagnosis, and treatment of mental disorders, particularly among migrant patients. This observational study examines the frequency and timing of diagnostic changes among migrant patients in a specialized psychiatric outpatient clinic. Furthermore, the study includes a qualitative sub-study to provide insights into the diagnostic process. Out of the 119 migrant patients included in the study, 27.7% changed referral diagnoses during treatment. Diagnostic changes occurred in 15.7% of cases by the end of treatment, 13.4% at midterm, and 9.1% after the initial assessment. No significant associations were found between diagnostic changes and sociodemographic or treatment-related factors. While the qualitative sub-study primarily offered broader insights into the cultural aspects of treatment and the clinical encounter, rather than establishing causal effects on the diagnostic process, it revealed how acculturative stress and cultural identity influenced the presentation of symptoms. The study is conducted in a real-life clinical setting and, thus, reflects the everyday clinical practice of diagnostic changes at a specialized cultural psychiatric clinic. The findings from this study indicate that in addition to a culturally sensitive assessment, time is an important factor for diagnostic changes, which can be essential knowledge for clinical practice when planning diagnostic assessment and treatment. The findings underscore the need for enhancing clinicians' cultural competencies through targeted training, emphasizing cultural awareness in clinical practice.

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.

The comparative study of voice hearing is in its early stages. This approach is important due to the observation that the content of voices differs across different settings, which suggests that voice hearing may respond to cultural invitation and, ultimately, to learning. Our interview-based study found that persons diagnosed with schizophrenia in China (Shanghai), compared to those diagnosed with schizophrenia in the United States, Ghana, and India, reported voices that were strikingly concerned with politics. Compared to participants in the United States in particular, voices seemed to be experienced more relationally: Shanghai participants reported voices notable for a sense of benevolent persuasion rather than harsh command, and knew the identities of their voices more so than in the United States. The voices were striking as well for their religious content, despite the previous prohibition of religion in China. Our findings further support the hypothesis that voice hearing seems to be shaped by context, and we observe that this shaping may affect not only conceptual content but the emotional valence of the experience.

This article introduces a thematic issue of Transcultural Psychiatry dedicated to understanding the role of culture in the expression and treatment of psychotic symptoms. While many clinicians and researchers view psychotic disorders as brain diseases firmly rooted in neurological processes and requiring medical treatments to resolve, the papers in this issue propose something different: that psychotic symptoms are refracted through the lens of culture with the result being socially and culturally constructed disorders that have as much to do with the attitudes and knowledge systems of the observer as the lived experience of patients. Hence, expression of psychotic symptoms and disorders represent the result of a negotiated space between individual distress and the values and norms of the wider society. This thematic issue touches on several important points: critical perspectives of high rates of psychosis in migrants, the lack of culturally adapted research and clinical tools in psychosis work, new methods to engage people with psychosis from diverse backgrounds, and cultural issues related to the etiology of psychosis, interpretation of symptoms, and help-seeking. There remain many important topics at the intersection of culture and psychosis not covered by this thematic issue, including stigma and psychosis, delusion formation in cultural context, the history of psychosis concepts, and insight in psychosis. Yet, despite these omissions, the articles in this issue, as a whole, foster recognition of the limits of standard approaches to psychosis and advocate for culturally adapted assessments and interventions, which if implemented from a position of cultural humility, carry the long-term potential of revolutionizing the field.

Language is an important aspect of communication and language status is known to impact healthcare accessibility, its perceived suitability, and outcomes. However, its influence on treatment engagement and/or disengagement is unknown. Our study therefore sought to investigate the impact of language on service disengagement in an early intervention psychosis program in Montreal, Quebec (a province with French as the official language). We aimed to compare service disengagement between a linguistic minority group (i.e., English) vis-à-vis those whose preferred language was French and to explore the role of language in service engagement. Using a mixed methods sequential design, we tested preferred language and several sociodemographic characteristics associated with service disengagement in a time-to-event analysis with Cox proportional hazards regression models (N = 338). We then conducted two focus groups with English (seven patients) and French speakers (five patients) to further explore differences between the two linguistic groups. Overall, 24% (n = 82) disengaged from the service before the two-year mark. Those whose preferred language was English were more likely to disengage (n = 47, 31.5%) than those whose preferred language was French (n = 35, 18.5%; χ2 = 9.11, p < .01). This remained significant in the multivariate regression. In focus groups, participants identified language as one aspect of a complex communication process between patients and clinicians and highlighted the importance of culture in the clinical encounter. Language status of patients plays an important role in their engagement with early psychosis services. Our findings underscore the value of establishing communication and cultural understanding in creating clinical/therapeutic alliance.