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Transcultural Psychiatry
Journal Prestige (SJR): 0.644
Citation Impact (citeScore): 2
Number of Followers: 7  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1363-4615 - ISSN (Online) 1461-7471
Published by Sage Publications Homepage  [1174 journals]
  • Perspectives and feelings of refugee children from Syria and Iraq about
           places and relations as they resettle in Australia

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      Authors: Jeanette A. Lawrence, Ida Kaplan, Dina Korkees, Mardi Stow, Agnes E. Dodds
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Refugee children's experiences are situated in specific places where they interact with significant people. They are not usually asked about their perspectives although they are social agents with distinctive perspectives and feelings about relationships and events. We investigated the perspectives of refugee children on their experiences of places and relations as they resettled in Australia after their families fled from violence in Syria and Iraq and transitioned through Middle Eastern countries. One hundred-and-nine children chose to work with a computer program in either English or Arabic. They sorted feelings associated with home, school, and where they lived before and rated being nurtured at home. Hierarchical cluster analysis revealed five subgroups of children with distinctive patterns in their sorting of eight feelings for three places. Three subgroups had patterns of positive feelings about home and school. Two smaller subgroups had mixed, ambivalent feelings about either school or home. One subgroup was strongly positive, and two others were negative about before settlement. Subgroups identified on their sortings of feelings differed in their experiences of being nurtured, with positive feelings of places related to higher ratings of being nurtured at home. The study points to the importance of children's perspectives and feelings in how they interpret experiences with people and places and argues against assuming that refugee children are homogeneous in their experiences or perspectives.
      Citation: Transcultural Psychiatry
      PubDate: 2022-08-08T08:16:33Z
      DOI: 10.1177/13634615221107215
       
  • From idioms of distress, concern, and care to moral distress leading to
           moral injury in the time of Covid

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      Authors: Mark Nichter
      Abstract: Transcultural Psychiatry, Ahead of Print.
      In this invited commentary on the thematic issue of Transcultural Psychiatry on idioms of distress, concern, and care, I provide a brief overview of how my research agenda evolved over the years while conducting community and clinic-based research in South and Southeast Asia as well as North America. I then suggest areas where future research on idioms of distress, concern, care, and resilience will be needed among different demographics given social change and shifts in how we communicate face to face and in virtual reality, the impact of medicalization, pharmaceuticalization and bracket creep, changes in indigenous healing systems, and hybridization. I further call attention to the importance of conducting idioms guided research in occupational settings. Toward this end I highlight the moral distress health care workers in the U.S. have experienced during the Covid-19 pandemic and point out the importance of differentiating individual burnout from moral injury related to structural distress. I conclude by discussing the general utility of an idioms of distress perspective in the practice of cultural psychiatry and suggest that this perspective needs to be included in the training of all practitioners regardless of the system of medicine they practice. Doing so may enable the formation of mental health communities of practice in contexts where there are pluralistic health care arenas.
      Citation: Transcultural Psychiatry
      PubDate: 2022-08-08T07:33:21Z
      DOI: 10.1177/13634615221115540
       
  • Discussing the unspoken: A qualitative analysis of online forum
           discussions on mental health problems in young Moroccan-Dutch migrants

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      Authors: Madelien H. van de Beek, Erwin Landman, Wim Veling, Robert A. Schoevers, Lian van der Krieke
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Migrants and their offspring are at increased risk of developing mental disorders. Previous research has shown associations between adverse social factors (e.g., discrimination, lack of social support) and mental health problems in migrants, but it is unknown how these associations are understood by migrants themselves. In this study, we aimed to gain explorative insight into the way young Moroccan-Dutch people experience their social environment, and how they relate this social environment to the development of mental health problems. At www.marokko.nl, the largest online discussion platform for young Moroccan-Dutch people, contributors discuss a broad variety of subjects, including societal, cultural, religious, and mental health issues. Combining deductive and inductive approaches to qualitative data analysis, we analysed 22 forum discussions at marokko.nl about mental health problems, after which data saturation was reached. Contributors described feeling isolated and experiencing discrimination in their social environment. Contributor comments identified social challenges arising from Dutch society, Dutch culture (e.g., being too individualistic), Moroccan culture (e.g., strict parenting style), and living between these two cultures. These social challenges are perceived to be associated with mental health problems. Furthermore, we created a model describing the different types of explanations contributors used for mental health problems, being: religious (e.g., possession); medical (i.e., a bio-psycho-social cause); or a combination of both. This model can help clinicians in delivering culturally sensitive mental health care. Lastly, this study shows the taboo on mental health problems in the Moroccan-Dutch population and the opportunity to open up in the online environment.
      Citation: Transcultural Psychiatry
      PubDate: 2022-08-08T02:49:55Z
      DOI: 10.1177/13634615221105118
       
  • Finding agency in limbo: A qualitative investigation into the impact of
           occupational engagement on the mental health and wellbeing of asylum
           seekers in the UK

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      Authors: Temple Moore, Rochelle Ann Burgess, Cornelius Katona
      Abstract: Transcultural Psychiatry, Ahead of Print.
      The process of seeking asylum is complex and often leads to extended periods of uncertainty and liminality for people awaiting decisions on their status. Occupational engagement—defined as meaningful activities and roles that bring purpose and agency to one's life—may be a key driver for mental health recovery for marginalized populations, including asylum seekers with traumatic experiences pre- and post-migration. This study aimed to clarify how occupational engagement impacts on mental health and wellbeing and how asylum seekers maintain engagement in occupation in the context of socio-political constraints of the asylum process. We explored the occupational experiences of 12 clients of one human-rights charity, utilizing community-based participatory research methods. Participants completed group mapping sessions where they depicted routine journeys taken to perform occupations in London, which included discussion around the significance of their journeys. Four participants also completed additional “walking maps”—semi-structured interviews which occurred along a selected “occupational journey” they identified as meaningful to their wellbeing. All data were analyzed using thematic network analysis. Findings revealed that engagement in routine occupations within safe, social spaces positively affects the mental wellbeing of asylum seekers by promoting competence, agency, and feelings of belonging. The liminal space of the asylum process meant that participants’ occupational engagement was limited to ‘leisure’ activities but was still critical to establishing forms of agency associated with their wellbeing. Implications for programs and interventions responding to the needs of asylum seekers are discussed.
      Citation: Transcultural Psychiatry
      PubDate: 2022-08-05T07:50:15Z
      DOI: 10.1177/13634615221107202
       
  • Maasai women hearing voices: Implications for global mental health

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      Authors: Neely Myers, Elizabeth Lesitei Mollel, Luca Pauselli, Marne Chacon, Michael Compton
      Abstract: Transcultural Psychiatry, Ahead of Print.
      There is a sparse literature on women who hear voices globally, even though there are documented gendered dimensions of distress in the context of globalization and climate change and research indicates that trauma and psychosocial stress may be related to an increased prevalence of voice-hearing or auditory verbal hallucinations (AVHs). There is also a gap in the cultural phenomenology of voice-hearing in general, as well as idioms of distress for non-western peoples. This article presents results of a mixed methods study that: 1) estimated community prevalence of voice-hearing among Maasai women in northern Tanzania; 2) examined any demographic correlates and two specific hypothesized correlates (i.e., psychological stress and potentially traumatic events); and 3) engaged women in semi-structured interviews about their everyday lives and the phenomenological experience of voice-hearing. The prevalence of voice-hearing (39.4%) in this nonclinical sample (n = 71) was quite high compared to other studies in sub-Saharan Africa. Most women also reported high psychosocial stress and traumatic life events. They also talked about gendered conditions of social adversity in a context of rapid social, economic, and climate change. Women who reported hearing voices had a statistically significantly higher level of psychological distress, met criteria for severe psychological distress, and reported more potentially traumatic life events. In a logistic regression model, psychosocial stress predicted voice-hearing. The presence of distressing voices may offer a straightforward way to quickly identify people in the community experiencing the most extreme levels of psychosocial stress and traumatic events—a potentially simple but effective screening tool for health workers on the ground.
      Citation: Transcultural Psychiatry
      PubDate: 2022-08-01T08:03:41Z
      DOI: 10.1177/13634615221111628
       
  • Psychometric properties of two mental health screening tools in southeast
           Liberia: The Liberian Distress Screener and Patient Health Questionnaire

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      Authors: Katrin E. Fabian, Josiah Fannoh, George G. Washington, Wilfred B. Geninyan Weetol, Bethuel Nyachienga, Garmai Cyrus, Joyce N. Hallowanger, Jason Beste, Orvalho Augusto, Bradley H. Wagenaar
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Evidence suggests that locally developed and/or adapted screening tools for mental ill-health can have higher validity than directly translated tools developed in other settings. We administered the locally developed Liberian Distress Screener (LDS) and the Liberian-adapted Patient Health Questionnaire-9 (PHQ-9L) to a random sample of 142 outpatients at a regional hospital in Maryland County, Liberia. In the LDS, seven items demonstrated poor model fit and were excluded, resulting in an 11-item screener (LDS-11). Exploratory factor analysis of the 11-item screener (LDS-11) showed a single latent variable construct with significant factor loadings. Cronbach’s alpha revealed good internal consistency (α = 0.81). Rasch analyses showed that “brain hot” and “heart fall down” were the most difficult idioms of distress to endorse while “things playing on the mind” was the easiest. All LDS-11 elements were associated with elevated function impairment, with “things playing on the mind,” “worry too much,” “head is hurting,” and “heart cut/beat fast” achieving statistical significance. One item in the PHQ-9L demonstrated poor model fit and was excluded from psychometric analyses. The resultant eight-item PHQ demonstrated internal consistency (α = 0.76) and Rasch analysis revealed that “moving/talking too slowly/fast” was the most difficult item to endorse, while “not happy when doing things” was the easiest. Twelve items were significantly associated with functional impairment. Exploratory analyses reveal items that demonstrate ease and appropriateness of use for assessing mental distress in this population. Implementation research is needed to incorporate idioms of distress and screeners into Liberia’s mental healthcare system.
      Citation: Transcultural Psychiatry
      PubDate: 2022-08-01T08:03:19Z
      DOI: 10.1177/13634615221107201
       
  • The relationship between interdependent and independent self-construals
           and social anxiety symptom severity in a clinical sample of
           treatment-seeking patients

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      Authors: Antonia N. Kaczkurkin, Savannah Simon, Lily Brown, Anu Asnaani
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Differences in cultural orientations, such as interdependent and independent self-construals, may influence social anxiety disorder (SAD) symptom presentations. However, prior research on the association between interdependent/independent self-construals and SAD was limited to non-clinical samples. Using a treatment-seeking population with clinical levels of anxiety, the current study extends prior research by examining whether the relationship between interdependent/independent self-construals and SAD is specific to SAD or indicative of a broader relationship with anxiety or depression more generally. We also expand upon prior work by examining the effect of self-construals on treatment outcomes and whether self-construals change over time. The results showed that endorsing a less independent self-construal was associated with greater SAD symptoms specifically, and was not associated with other anxiety or depression symptom measures. Additionally, while interdependent and independent self-construals did not moderate SAD treatment outcomes, there was a decrease in interdependent self-construal and increase in independent self-construal over a course of cognitive behavioral therapy. Notably, this change over time was tied to specific items that correlated strongly with SAD symptoms. Together, these results increase our understanding of the relationship between interdependent/independent self-construals and SAD symptoms in treatment-seeking anxiety patients.
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-25T12:57:46Z
      DOI: 10.1177/13634615221111629
       
  • Association between unmet post-arrival expectations and psychological
           symptoms in recently arrived refugees

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      Authors: Claire H. Allinson, David Berle
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Thwarted expectations regarding one's post-settlement life may challenge the mental health of refugees. The present study aimed to investigate the relationship between pre-arrival expectations and the course of psychological symptoms across time. A secondary analysis of 1,496 principal visa applicants across five waves of the Building a New Life in Australia (BNLA) study was conducted. The cross-sectional associations between expectations on the one hand, and post-traumatic stress (PTSD-8) symptoms and psychological distress (Kessler-6; K6) on the other, were assessed using multiple regression. Latent class growth analysis (LCGA) was used to identify discrete symptom trajectories of psychological symptoms across five years following settlement, and multinomial regressions were used to determine if violated expectations predicted membership of identified PTSD-8 and K6 class trajectories. LCGA supported a four-class solution for the PTSD-8 “Resilient Post Traumatic Stress (PTS)” (54.1%), “Improving PTS” (15.0%), “Deteriorating PTS” (17.3%), and “Persistently High PTS” (13.6%). For the K6, three classes were identified: “Persistently Mild K6” (60.4%), “Resilient K6” (9.4%), and “Persistently High K6” (30.2%). Thwarted expectations were found to significantly predict membership of less favourable symptom trajectories classes in the context of other established predictors. Post-settlement expectations may thus have weak but unique predictive value for the course of psychological symptoms alongside other factors such as older age and financial stress. Implications of these findings for service provision and policy are discussed.
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-25T12:10:19Z
      DOI: 10.1177/13634615221111022
       
  • The associations between basic psychological need satisfaction at work and
           the wellbeing of Indigenous and non-Indigenous employees

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      Authors: Natasha R. Magson, Rhonda G. Craven, Richard M. Ryan, Fabri Blacklock, Alicia Franklin, Janet Mooney, Alexander S. Yeung, Anthony Dillon
      Abstract: Transcultural Psychiatry, Ahead of Print.
      We investigated how satisfaction of the basic psychological needs at work was associated with the psychological and physical wellbeing of Indigenous and non-Indigenous employees both within and outside of the workplace. Participants included 1,146 Indigenous (n = 559) and non-Indigenous Australians (60.9% female), aged 18 to 81 years (Mage = 43.54) who were recruited through their employer or online advertisements. Structural equation modelling (SEM) was used to analyse the data, and Indigenous status and occupation type were investigated as moderators. Results revealed that independent of income, autonomy satisfaction was related to better physical and psychological health, satisfaction of the need for relatedness was associated with increased family and community thriving, and competence satisfaction was linked to decreased psychological distress. Results also showed that autonomy, competence, and relatedness need satisfaction was lower among Indigenous employees compared to non-Indigenous employees. Moderation analyses suggested that relatedness at work was especially important for non-Indigenous employees’ connection with their community, as were high levels of competence satisfaction for Indigenous employees. These findings are discussed in the context of self-determination theory and the implications for organizations wanting to improve the wellbeing of their Indigenous and non-Indigenous workforce.
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-22T07:29:05Z
      DOI: 10.1177/13634615221111634
       
  • Examining the hikikomori syndrome in a French sample of hospitalized
           adolescents with severe social withdrawal and school refusal behavior

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      Authors: Xavier Benarous, Marie-Jeanne Guedj, Cora Cravero, Barbara Jakubowicz, Julie Brunelle, Kunifumi Suzuki, David Cohen
      Abstract: Transcultural Psychiatry, Ahead of Print.
      While the term hikikomori (HKM) has spread internationally to describe a chronic and severe form of social withdrawal, its place in current nosography and its transposition into non-Asian cultures are still debated. A retrospective chart review was conducted to determine the rate and the clinical profiles of HKM among a French sample of adolescent inpatients. Data were obtained from 191 adolescents aged 12–18 years (M = 15.0, 44% boys) consecutively admitted in two inpatient units from January 2017 to December 2019. Using a retrospective diagnosis of HKM based on Teo and Gaw's criteria, we compared socio-demographic characteristics, clinical features, and treatment outcomes between HKM patients and those with other forms of social withdrawal and/or school refusal (SW/SR). At admission, 7% of participants met HKM criteria (n = 14, M = 14.3, 64% boys), one out of six adolescents with SW/SR. Among those with SW/SR, HKM + vs. HKM- participants had higher rates of anxiety disorder (Odd Ratio, OR = 35.2) and lower disruptive behavioral disorder (OR = 0.03). A minority of the participants with anxiety and depressive disorders met the HKM criteria (respectively, 15% and 9%), but those with HKM had a longer duration of symptoms, longer hospitalization, and required more daily care facilities at discharge compared to HKM-. While HKM syndrome could not be delimitated from anxiety disorder, it was associated with specific clinical features and treatment outcomes. The clinical characteristics observed were consistent with the features reported in Asian HKM adults, supporting face validity of this clinical concept in adolescent inpatients with different cultural contexts.
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-22T06:51:34Z
      DOI: 10.1177/13634615221111633
       
  • Building a multicultural peer-consultation team: Planning, implementing,
           and early sustainment evaluation

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      Authors: Gabriela A. Nagy, Clair Cassiello-Robbins, Deepika Anand, Macey L. Arnold, Jessica N. Coleman, Joshua Nwosu, R. Sonia Singh, Eva N. Woodward
      Abstract: Transcultural Psychiatry, Ahead of Print.
      This article represents an implementation-focused evaluation of a multicultural peer-consultation team situated within a psychiatry department in a large academic medical center in the Southern United States. The evaluation comprised anonymous self-report questionnaires (n = 14) as well as individual (n = 3) or group interviews (n = 10) conducted by outside independent evaluators. Participants were current and former team members (i.e., graduate trainees, mental health care providers, clinical and research staff members) who voluntarily participated in this multimethod implementation evaluation. Results indicated that attendance on the team had several important impacts on members, and most notably an increased ability to provide multiculturally competent care, that is treatment that carefully and routinely considers the influence of culture and context on patients and therefore their clinical presentation. Further, no negative impacts from participating on the team were noted. A primary strength of the team's sustainability is that participation on the team was deemed to be relevant and useful by current and former team members. A major barrier to participation on the team is competing demands, such as high clinical loads. We conclude that this model for multicultural peer-consultation holds promise as an effective and implementable educational method for mental health care professionals. We discuss strengths, limitations, and future directions for research.
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-22T06:51:19Z
      DOI: 10.1177/13634615221105117
       
  • Relations between bullying and distress among youth living in First
           Nations communities: Assessing direct and moderating effects of
           culture-related variables

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      Authors: Jocelyn Paul, Robyn J. McQuaid, Carol Hopkins, Amanda Perri, Sherry Stewart, Kim Matheson, Hymie Anisman, Amy Bombay
      Abstract: Transcultural Psychiatry, Ahead of Print.
      The well-being of Indigenous peoples continues to be affected by intergenerational effects of numerous harmful government policies, which are considered root causes for bullying and cyberbullying that exist in some communities. Despite ongoing stressors, Indigenous youth demonstrate resilience, which often appears grounded in connecting to their cultural identities and traditional practices. However, few studies have tested the direct and stress-buffering role of various aspects of culture in relation to well-being among First Nations youth. Analyses of the 2015–16 First Nations Regional Health Survey (RHS) revealed that bullying and cyberbullying were associated with increased psychological distress among youth aged 12–17 living in First Nations communities across Canada (N = 4,968; weighted = 47,918), and that these links were stronger for females. Feelings of community belonging were directly associated with lower distress and buffered the relationships between bullying/cyberbullying and distress. Among youth who experienced cyberbullying, those who participated in community cultural events at least sometimes reported lower distress compared to those who rarely or never participated. Those who disagreed that traditional cultural events were important reported the highest levels of distress, but perceived importance of such events failed to buffer the associations between bullying/cyberbullying and distress. These national data highlight the importance of certain culture-related variables as key factors associated with the well-being of youth living in First Nations communities across Canada.
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-21T03:44:38Z
      DOI: 10.1177/13634615221109359
       
  • Causal beliefs regarding schizophrenia and help-seeking behaviors among
           patients with schizophrenia and family caregivers attending psychiatric
           clinics in Cambodia

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      Authors: Toshiyuki Marutani, Sotheara Chhim, Sopheap Taing, Akihiro Nishio
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Schizophrenia often follows a chronic or recurrent course, placing an immense burden on patients and their families. Mental health services in Cambodia are still highly limited, thus there is a major treatment gap. It is common that people consult traditional healers (Kru Khmer) and monks. In this culture, people who receive psychiatric medical treatment are expected to exhibit higher mental health literacy, but little is known about this factor. In this study, we interviewed 59 patients with schizophrenia and 59 family caregivers attending psychiatric clinics in Cambodia. Through qualitative analysis using a thematic analysis approach, we extracted eight themes of causal beliefs regarding schizophrenia: (1) spiritual beliefs, (2) cultural symptoms, (3) physical problems, (4) heredity, (5) substance abuse, (6) traumatic events, (7) stress in human relationships or in one's social environment, and (8) socioeconomic position. We found that “thinking too much” (kit chroeun) and “worrying too much” (prouy / barom chroeun), cultural idioms of distress, were recognized as causal factors of schizophrenia by both parents and family caregivers. Some participants were aware of the possible causal factors in light of the latest psychiatry findings, such as genetic factors and childhood trauma. Our data show that causal beliefs are not a decisive factor in shortening the duration of untreated psychosis (DUP). In Cambodia, where the treatment for schizophrenia is pluralistic, we suggest that it is crucial to embed the meaning of psychiatric treatment into local meaning worlds for better help-seeking behaviors.
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-15T07:26:47Z
      DOI: 10.1177/13634615221107207
       
  • Cross-cultural adaptation of four instruments to measure stigma towards
           people with mental illness and substance use problems among primary care
           professionals in Chile

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      Authors: Claudia Parra Videla, Jaime C. Sapag, Rachel Klabunde, Paola R. Velasco, Samanta Anríquez, Marcela Aracena Álvarez, Franco Mascayano, Paulina Bravo, Brena F. Sena, Ana Jofré Escalona, Sireesha J. Bobbili, Patrick W. Corrigan, Inés Bustamante, Fernando Poblete, Rubén Alvarado
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Stigma toward people with mental illness and substance use problems is a significant global concern, and prevents people with these conditions from accessing treatment, particularly in primary health care (PHC) settings. Stigma is a cultural phenomenon that is influenced by particular contexts and can differ by country and region. The majority of stigma research focuses on Europe or North America leading to a lack of culturally relevant stigma research instruments for the Latin American context. The present study describes and discusses the methodology for cross-culturally adapting four stigma measurement scales to the Chilean context. The cross-cultural adaptation process included nine phases: (1) preparation; (2) independent translations; (3) synthesis 1 with expert committee; (4) focus groups and interviews with researchers, PHC professionals, and PHC users; (5) synthesis 2 with expert committee; (6) independent back translations; (7) synthesis 3 with expert committee; (8) pilot with PHC professionals; and (9) final revisions. The adaptation process included an array of diverse voices from the PHC context, and met three adaptation objectives defined prior to beginning the process (Understandability, Relevance, and Acceptability and Answer Options). The resulting, culturally adapted questionnaire is being validated and implemented within PHC settings across Chile to provide in-depth insight into stigma among PHC professionals in the country. The authors hope it will be useful for future research on mental illness and substance use stigma in similar settings across Latin America.
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-13T04:17:35Z
      DOI: 10.1177/13634615221100377
       
  • Instruments for assessing sexual dysfunction in Arabic: A systematic
           literature review

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      Authors: Stephanie Zakhour, Aline Sardinha, Michelle Levitan, William Berger, Antonio Egidio Nardi
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Sexual health is relevant throughout a person’s life; however, studying human sexuality is complex and requires particular care when working with individuals from different cultural and social backgrounds. Much of the research addressing this subject has been conducted in Western countries, and that in non-Western countries is generally based on small sample sizes. The biopsychosocial nature of sexuality and its dysfunctions should be taken into consideration given that it is indispensable when conducting and assessing sexual studies in different countries and cultures. Therefore, culturally sensitive studies that consider cultural contexts and determinants as well as social markers are needed. The topic of sexuality in Arab culture is still enigmatic. This enigma has impacted the advancement of sexual science and limited researchers, health care practitioners, and patients. Thus, the aim of this systematic literature review was to find and assemble all scales and questionnaires regarding human sexual health that have been translated into Arabic and validated in order to promote a critical analysis of the methods used in each instrument and to inform readers and researchers of the limits and potential of each scale. Electronic databases were systematically searched, and eight instruments were selected for inclusion: the Arabic Index of Premature Ejaculation (AIPE), the Sexual Health Inventory for Men (SHIM), the Arabic Female Sexual Function Index (ArFSFI), the Female Genital Self-Image Scale (AVFGSIS), the Arabic Arizona Sexual Experiences Scale (ASEX), the Egyptian Pelvic Organ Prolapse/Incontinence Sexual Questionnaire (PISQ-IR), the Saudi Arabian Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire in Arabic (PSIQ-IR), and the Arabic Female Sexual Distress Scale (FSDS). All included instruments showed good validity and reliability for the target population. Future studies are needed to develop culturally sensitive instruments
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-12T08:01:20Z
      DOI: 10.1177/13634615221105120
       
  • The culturally and contextually sensitive assessment of mental health
           using a structured diagnostic interview (MINI Kid) for Syrian refugee
           children and adolescents in Lebanon: Challenges and solutions

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      Authors: Vanessa Kyrillos, Tania Bosqui, Patricia Moghames, Nicolas Chehade, Stephanie Saad, Diana Abdul Rahman, Elie Karam, Georges Karam, Dahlia Saab, Michael Pluess, Fiona S. McEwen
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Elevated rates of mental health difficulties are frequently reported in conflict-affected and displaced populations. Even with advances in improving the validity and reliability of measures, our knowledge of the performance of assessment tools is often limited by a lack of contextualization to specific populations and socio-political settings. This reflective article aimed to review challenges and share lessons learned from the process of administering and supervising a structured clinical interview. We administered the MINI International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) and used the Clinical Global Impression (CGI) severity scale with N = 119 Syrian refugee children (aged 8–17) resident in ITSs in Lebanon. Qualitative data were derived from supervision process notes on challenges that arose during assessments, analyzed for thematic content. Five themes were identified: (1) practical and logistical challenges (changeable nature of daily life, competing demands, access to phones, temporary locations, limited referral options); (2) validity (lack of privacy, trust, perceptions of mental health, stigma, false positive answers); (3) cultural norms and meaning (impact of different meanings on answers); (4) contextual norms (reactive and adaptive emotional and behavioral responses to contextual stress); and (5) co-morbidity and formulation (interconnected and complex presentations). The findings suggest that while structured assessments have major advantages, cultural and contextual sensitivity during assessments, addressing practical barriers to improving accessibility, and consideration for inter-connected formulations are essential to help inform prevalence rates, treatment plans, and public health strategies.
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-12T08:01:04Z
      DOI: 10.1177/13634615221105114
       
  • Two-eyed Seeing for youth wellness: Promoting positive outcomes with
           interwoven resilience resources

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      Authors: Linda Liebenberg, Jenny Reich, Jeannine Faye Denny, Matthew R. Gould, Daphne Hutt-MacLeod
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Despite the challenges facing Indigenous youth and their communities due to historical and contemporary institutionalised racism in Canada, communities are drawing on the richness of their own histories to reassert their cultural heritage. Doing so supports mental health outcomes of young people in particular, as highlighted in a compelling body of research. The question facing many communities, however, is how they can facilitate such child and youth engagement in order to support related positive mental health outcomes. This article reports on findings from a Participatory Action Research (PAR) study conducted in a First Nations community in Unama’ki (Cape Breton), Atlantic Canada. The study, Spaces & Places, was a partnership between the community-based mental health service provider (Eskasoni Mental Health Services, EMHS), eight community youth (14–18 years old), and a team of academics. Situated within a resilience framework, the team explored the ways in which the community facilitated, or restricted, youth civic and cultural engagement. Foregrounded against a strong legacy of cultural reassertion within the community, findings highlight the core resilience-promoting resources that support positive youth development. Additionally, findings demonstrate how these resources provide meaningful support for youth because of the way in which they are intertwined with one another. Furthermore, cultural engagement is underpinned by the Two-eyed Seeing model, supporting youth to integrate their own culture with settler culture in ways that work best for them. Findings support community-based service structures, and underscore the importance of community resilience in the effective support of Indigenous children and youth.
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-12T07:21:06Z
      DOI: 10.1177/13634615221111025
       
  • Modalities of the psychedelic experience: Microclimates of set and setting
           in hallucinogen research and culture

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      Authors: Ido Hartogsohn
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Mid-20th-century American research on psychedelics evinced a stunning diversity of interpretations of hallucinogenic effects. While some researchers viewed psychedelics as invaluable tools for psychotherapy, others persisted in treating them as psychosis-inducing agents. As some groups considered psychedelics as catalysts for artistic creativity, others investigated their potential use as psychochemical weapons in the battlefield, or conversely as tools for spiritual ecstasy and revelation. This bewildering array of perceptions regarding the nature of hallucinogenic effects led to stark contrasts in the contexts (set and setting) of psychedelic research and experimentation, leading to wildly divergent outcomes and reports on the effects of the drugs, and strident disagreements between the actors in the field. Examining this remarkable historical moment of epistemological unclarity regarding psychedelics and their effects, this article describes how distinct scientific and cultural trends and moments of mid-20th-century America contributed to the creation of diverse microclimates of set and setting that reproduced investigator beliefs and attitudes and brought about a beguiling Pygmalion effect that left researchers befuddled and perplexed. I propose the concept of psychedelic modality to describe how distinct sociocultural microclimates lead to thematic aggregates in which distinct types of expectations, intentions as well as physical, social, and cultural environments all tend to cluster, producing characteristic outcomes and results. By exploring the historical context and consequences of the emergence of seven psychedelic modalities (psychotomimetic, military, psychotherapeutic, spiritual, artistic-creative, tech-innovative, and political) in mid-20th-century America, this article outlines the varieties of psychedelic experiences in their relationship with culture at large, and subcultures in particular.
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-12T07:13:13Z
      DOI: 10.1177/13634615221100385
       
  • Technology and addiction: What drugs can teach us about digital media

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      Authors: Ido Hartogsohn, Amir Vudka
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Comparisons between digital media and narcotic drugs have become increasingly common in the vigorous discussion on smartphone addiction and technology addiction. Commentators have used evocative terms such as “digital heroin,” “electronic cocaine,” and “virtual drugs” when discussing users’ growing dependence on their devices. This article looks at the spreading discourse comparing digital media with drugs from a set of interdisciplinary perspectives including media studies, political economy, critical theory, science and technology studies, and addiction studies. It engages several key questions: To what extent can heavy smartphone use be considered an addiction, and how is it similar or different from drug addiction' How do the analogies between media and drugs fit within prevalent imaginaries of information technologies, and within the greater cultural themes and preoccupations of late capitalism' And finally, what can drugs teach us about the possible escape routes from our society's current predicament'
      Citation: Transcultural Psychiatry
      PubDate: 2022-07-08T06:11:50Z
      DOI: 10.1177/13634615221105116
       
  • Knowledge of psychology in Cambodia: Exploring the relationships to
           demographics, psychopathology, and idioms of distress

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      Authors: Amber N. Kelley, Desiree M. Seponski, Sareth Khann, Cindy Lahar, Sovandara Kao, Tanja E. Schunert
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Rates of mental health disorders in Cambodia are markedly higher than in other low- or middle-income countries. Despite these high rates, mental healthcare resources remain scarce and mental health stigma is pervasive, particularly for vulnerable populations of young women and individuals of low socioeconomic status. To address this gap, teaching Western mental health treatments and using a mental healthcare framework are recommended within the Cambodian context. However, Western frameworks do not address cultural syndromes or idioms of distress and operate from an individualistic perspective that does not address cultural values and beliefs. The present study employs a mental health literacy framework in an exploratory analysis of rates of psychological knowledge in a nationally representative sample of Cambodian adults (N = 2,690). To address recommendations for increasing mental healthcare, we designed a survey to investigate Cambodians’ knowledge about mental health constructs. Results indicated that only 18.9% of Cambodians knew about psychology, and chi-square analyses revealed that women, individuals in rural areas, and individuals with significant distress due to cultural symptoms and syndromes reported knowing about psychology significantly less than their male and non-distressed counterparts. Additionally, those who reported higher income and higher levels of education indicated significantly higher rates of psychological knowledge, as did those with clinically significant rates of PTSD, at a rate of knowledge approaching significance. Implications for this study include the need to tailor interventions and resources to vulnerable populations, to assess the fit of current recommendations for the Cambodian context, and to further emphasize the need for culturally responsive interventions that address all presentations of Cambodian distress and align with understandings of mental health within the nation.
      Citation: Transcultural Psychiatry
      PubDate: 2022-06-29T05:27:10Z
      DOI: 10.1177/13634615221107199
       
  • Grisi Siknis: A cultural idiom of gender-based violence and structural
           inequalities in eastern Nicaragua

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      Authors: Maria D. Venegas
      Abstract: Transcultural Psychiatry, Ahead of Print.
      For the Miskitu of Nicaragua, Grisi Siknis is a contagious illness that predominantly affects women. It is characterized by numerous psychosomatic symptoms, including headache, fear, aggressive behavior, loss of consciousness, and periods of rapid frenzy. Although Grisi Siknis has gained academic and public attention due to its unique cultural elements and perceived sexual aspects, little is known how the contextual and gender dimensions of Grisi Siknis are played out in relation to the socio-political context in the region. Based on 16 months of ethnographic work in the Nicaraguan Miskitu Coast, including semi-structured interviews (n = 20) and participant observation, this article documents a semantic shift in the embodied and symbolic language of a cultural idiom of distress. I show how duhindu (Miskitu spirit associated with illness and misfortune) and witchcraft are symbols that share cultural resonance in the Miskitu community, while gender violence discourse is a new language incorporated into the logic of this cultural idiom of distress. I argue that this semantic shift allows the individuals in this study to communicate local experiences of complex forms of structural inequalities (migration status, unemployment, ethnic identity) and gender-based violence that tend to be normalized as a ubiquitous cultural problem while preserving the broader socio-cultural meaning the Grisi Siknis represents. The ethnographic accounts of Grisi Siknis provide empirical data to unpack the unexplored contextual processes and local discourses that transform the meaning and logic of cultural idioms of distress at the individual level of experience.
      Citation: Transcultural Psychiatry
      PubDate: 2022-06-29T05:22:50Z
      DOI: 10.1177/13634615221098310
       
  • Distinct trajectories of psychological distress among resettled refugees:
           Community acceptance predicts resilience while low ingroup social support
           predicts clinical distress

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      Authors: Alexander W. O’Donnell, Stefania Paolini, Jaimee Stuart
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Refugees can experience elevated levels of psychological distress upon resettlement, although disparate outcomes over time are expected. The current study modeled trajectories of changes in distress over a 5-year period among resettled refugees and sought to explicate post-settlement factors that influence distress over time. A large-scale sample of refugees resettled in Australia (2,399) was tracked over a 5-year period, completing measures of psychological distress at each wave and initial risk and protective factors immediately after resettlement. A latent class growth analysis conducted on distress found four unique classes characterized by (1) resilient levels of distress, (2) consistent clinical distress, (3) recovering levels of distress, and (4) deteriorating distress. Lower perceived discrimination and greater positive context of reception predicted membership to the resilient group and differentiated the recovering and deteriorating groups. Further, lower ingroup social support predicted membership to the clinically distressed group relative to all others. We conclude by echoing calls to strengthen community support for refugees and promote ingroup ties, particularly among those who are the most vulnerable.
      Citation: Transcultural Psychiatry
      PubDate: 2022-06-07T04:16:43Z
      DOI: 10.1177/13634615221098309
       
  • Corrigendum to Communication about distress and well-being: Epistemic and
           ethical considerations

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      Abstract: Transcultural Psychiatry, Ahead of Print.

      Citation: Transcultural Psychiatry
      PubDate: 2022-06-03T08:18:26Z
      DOI: 10.1177/13634615221101303
       
  • Impact of COVID-19 and lockdown on mental health and future orientation
           among young adult asylum seekers in Italy: A mixed-methods study

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      Authors: Chiara Ceccon, Ughetta Moscardino
      Abstract: Transcultural Psychiatry, Ahead of Print.
      The COVID-19 outbreak caused a worldwide health emergency which disproportionately affected migrants and ethnic minorities. Yet, little is known about the psychosocial effects of the pandemic among refugees and asylum seekers. This study used a convergent parallel mixed-method design to explore knowledge and opinions concerning COVID-19 and the impact of lockdown on perceived mental health and future orientation among 42 young adult asylum seekers residing in northeastern Italy. Participants took part in individual interviews comprising both qualitative and quantitative questions. Qualitative reports were analyzed using thematic content analysis, whereas descriptive statistics and paired sample t-tests were computed on quantitative data. Results indicated that most participants were correctly informed about the nature, origin, and spread of COVID-19, expressed moderate or high satisfaction concerning the clarity of communication about safety measures, and followed them most of the time. Worries about family in the home country, loneliness, fear for own and loved ones’ health, and concerns about delays in the asylum application were the most frequently mentioned stressful events. Psychological and physical distress significantly increased, and positive future orientation significantly decreased during the lockdown. However, participants also emphasized the usefulness of instrumental support from social workers and exhibited a resilient attitude characterized by the acceptance of uncertainty, sense of connectedness, and positive outlook. Overall, findings suggest that the current emergency may exacerbate psychological vulnerabilities of asylum seekers due to continued existential uncertainty. Thus, individual and contextual assets should be strengthened to promote psychosocial adjustment and coping resources in the context of the pandemic.
      Citation: Transcultural Psychiatry
      PubDate: 2022-05-13T07:06:20Z
      DOI: 10.1177/13634615221098306
       
  • Loneliness in Kenyan adolescents: Socio-cultural factors and network
           association with depression and anxiety symptoms

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      Authors: Micaela Rodriguez, Tom L. Osborn, Jenny Y. Gan, John R. Weisz, Benjamin W. Bellet
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Loneliness is associated with negative mental health outcomes and is particularly common among adolescents. Yet, little is known about the dynamics of adolescent loneliness in non-Western, low-income nations. Accordingly, we estimated the severity of loneliness in a sample of Kenyan adolescents and used mixed-effects regression modelling to determine the socio-cultural factors associated with loneliness. We also used network analysis to examine the associations between loneliness, depression, and anxiety at the symptom level. We analyzed data from a large sample (N = 2,192) of school-attending Kenyan adolescents aged 12–19 (58.3% female, 41.7% male). Standardized measures of loneliness (ULS-8), depression (PHQ-8), and anxiety (GAD-7) were used. Our mixed-effects model revealed that female and lower-income adolescents felt lonelier. The perception of feeling alone emerged as the aspect of loneliness most strongly linked to depression and anxiety symptoms. Our findings establish an estimate of loneliness levels in Kenyan adolescents, and identify possible socio-cultural factors associated with loneliness. We found that perceptions of isolation more strongly linked loneliness to psychopathology than did objective measures of isolation or preferences for social contact. Finally, we identify specific aspects of loneliness that could prove to be treatment targets for youth psychopathology; however, further research is needed. Limitations, future directions, and clinical implications are discussed.
      Citation: Transcultural Psychiatry
      PubDate: 2022-05-11T07:52:56Z
      DOI: 10.1177/13634615221099143
       
  • The association of mindfulness and depression stigma among African
           American women participants in a mindfulness-based intervention: A pilot
           study

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      Authors: Sunghyun Hong, Maureen D. Satyshur, Inger Burnett-Zeigler
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Depression stigma is a potential barrier to engagement in and efficacy of depression treatment. This pilot study examined the association of mindfulness with depression stigma among participants in an eight-week mindfulness-based intervention for depressive symptoms. Thirty-one African American women with depressive symptoms were recruited from an urban Federally Qualified Health Center (FQHC) to participate in a mindfulness intervention (M-Body). Mindfulness, depressive symptoms, and depression stigma were assessed at baseline, eight weeks, and 16 weeks. Focus groups were conducted to examine participants’ subjective experiences with the mindfulness intervention. Mindfulness significantly increased from baseline to eight weeks. There was a non-significant decrease in depression from baseline to eight weeks and a significant decrease in depression from baseline to 16 weeks. Depression stigma significantly increased from baseline to eight weeks and significantly decreased from eight to 16 weeks; however, depression stigma did not return to the baseline. An exploratory qualitative analysis of focus group data revealed themes related to direct and indirect factors that may perpetuate and maintain depression stigma. This is one of the first studies to explicitly explore the relationship between mindfulness, depression symptoms, and depression stigma among African American women.
      Citation: Transcultural Psychiatry
      PubDate: 2022-05-04T05:51:08Z
      DOI: 10.1177/13634615221076709
       
  • Prevalence of spiritual and religious experiences in the general
           population: A Brazilian nationwide study

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      Authors: Maria Cristina Monteiro de Barros, Frederico Camelo Leão, Homero Vallada Filho, Giancarlo Lucchetti, Alexander Moreira-Almeida, Mario Fernando Prieto Peres
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Spiritual and religious experiences (SREs) are common subjective phenomena related to the awareness of transcendence, which transforms one's perception of life, death and suffering. Despite the high prevalence of SREs worldwide, not enough studies have been conducted beyond Europe and North America. To fill this gap, this study investigates the prevalence of SREs in Brazil and their association with socio-demographic variables. This online cross-sectional study includes participants from all regions of Brazil. Sixteen SREs were investigated, being categorized into 4 groups: mystical, mediumistic, psi-related and past life/near-death experiences. Prevalence was calculated as percentages and multinomial logistic regression models were used. A total of 1,053 Brazilians were included; 92% reported one SRE in their lifetime and 47.5% experienced at least one SRE frequently. Participants reported having had at least one mystical experience (35%), one psi-related experience (27.7%), and one mediumistic experience (11%). Half the sample had “felt the presence of a dead person” and 70% experienced precognitive dreams at least once. In a multivariate analysis, SREs were associated with the female gender but showed no associations with income, education, employment status and ethnicity. Mystical experiences were associated with age 55 and older. In summary, SREs are very prevalent across different strata of the population, and deserve more attention from researchers and clinicians in order to clarify their nature and implications for mental health care and research in Brazil.
      Citation: Transcultural Psychiatry
      PubDate: 2022-04-06T07:06:06Z
      DOI: 10.1177/13634615221088701
       
  • The Cultural Formulation Interview—Generating distance or alliance'
           A qualitative study of practice changes in Danish mental healthcare

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      Authors: Laura Glahder Lindberg, Jessica Carlsson, Maria Kristiansen, Signe Skammeritz, Katrine Schepelern Johansen
      Abstract: Transcultural Psychiatry, Ahead of Print.
      This article presents provider experiences with the Cultural Formulation Interview (CFI) in Danish mental healthcare for migrant patients. Semi-structured interviews with 17 providers and 20 recorded CFI sessions were analyzed with a constructivist grounded theory approach. Based on our empirical material, we endorse the CFI’s ability to facilitate working alliance and a profound and contextually situated understanding of the patient. Further, the CFI supported less-experienced providers in investigating cultural issues. Conversely, we found that CFI questions about cultural identity and background evoked notions of distance and ‘othering’ in the encounter. Nine providers had felt discomfort and professional insecurity when the CFI compelled them to introduce explanatory frameworks of culture in the mental health assessment. Eleven providers had experienced that the abstract nature of the questions inhibited patient responses or led to short and stereotypical descriptions, which had limited analytical value. We describe the contradictory CFI experiences of alliance versus distance at three levels: 1) at the CFI instrument level; 2) at the organizational level; and 3) at the contextual and structural level. We demonstrate benefits and pitfalls of using the CFI with migrants in Denmark, which is an example of a European healthcare context where cultural consultation is not an integrated concept in health education programs and where the notion of culture is contentious due to negative political rhetoric on multiculturalism.We suggest that the CFI should be introduced with thorough training; focus on fidelity; and supervision in the clinical application and understanding of the concept of culture.
      Citation: Transcultural Psychiatry
      PubDate: 2022-03-25T05:36:50Z
      DOI: 10.1177/13634615211065617
       
  • Towards psychedelic apprenticeship: Developing a gentle touch for the
           mediation and validation of psychedelic-induced insights and revelations

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      Authors: Christopher Timmermann, Rosalind Watts, David Dupuis
      Abstract: Transcultural Psychiatry, Ahead of Print.
      A striking feature of psychedelics is their ability to increase attribution of truth and meaningfulness to specific contents and ideas experienced, which may persist long after psychedelic effects have subsided. We propose that processes underlying conferral of meaning and truth in psychedelic experiences may act as a double-edged sword: while these may drive important therapeutic benefits, they also raise important considerations regarding the validation and mediation of knowledge gained during these experiences. Specifically, the ability of psychedelics to induce noetic feelings of revelation may enhance the significance and attribution of reality to specific beliefs, worldviews, and apparent memories which might exacerbate the risk of iatrogenic complications that other psychotherapeutic approaches have historically faced, such as false memory syndrome. These considerations are timely, as the use of psychedelics is becoming increasingly mainstream, in an environment marked by the emergence of strong commercial interest for psychedelic therapy. We elaborate on these ethical challenges via three examples illustrating issues of validation and mediation in therapeutic, neo-shamanic and research contexts involving psychedelic use. Finally, we propose a pragmatic framework to attend to these challenges based on an ethical approach which considers the embeddedness of psychedelic experiences within larger historical and cultural contexts, their intersubjective character and the use of practices which we conceptualise here as forms of psychedelic apprenticeship. This notion of apprenticeship goes beyond current approaches of preparation and integration by stressing the central importance of validation practices based on empathic resonance by an experienced therapist or guide.
      Citation: Transcultural Psychiatry
      PubDate: 2022-03-22T07:10:31Z
      DOI: 10.1177/13634615221082796
       
  • Communication about distress and well-being: Epistemic and ethical
           considerations

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      Authors: Ross G. White, Richard Fay, Anna Chiumento, Catalina Giurgi-Oncu, Alison Phipps
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Communication about well-being and distress involves multiple stakeholders, including experts by experience (EBE), researchers, clinical practitioners, interpreters, and translators. Communication can involve a variety of discourses and languages and each of the stakeholders may employ diverging epistemologies to understand and explain experiences. These epistemologies may link to different sources of authority and be articulated using particular linguistic resources. Epistemic injustice can occur when stakeholders, intentionally or unintentionally, fail to recognise the validity of other stakeholders’ ways of conceptualising and verbalising their experience of well-being and distress. Language lies at the heart of the risk of epistemic injustice involved in the process of expressing well-being and distress as seen in: 1) the interface between divergent discourses on well-being and distress (e.g., biomedical vs. spiritual); and 2) communications involving multiple linguistic resources, which can be subdivided into multi-language communications involving a) translation of assessment measures, and b) interpreted interactions. Some of the challenges of multi-language communication can be addressed by translators or interpreters who strive for conceptual equivalence. We argue, however, that all stakeholders have an important role as “epistemic brokers” in the languaging of possible epistemological differences. Effective epistemic brokering requires that all stakeholders are reflexively and critically aware of the risks of epistemic injustice inherent in multi-language communication. The article concludes with a set of prompts to help raise stakeholder awareness and reflexivity when engaging in communication about well-being and distress.
      Citation: Transcultural Psychiatry
      PubDate: 2022-03-18T08:31:21Z
      DOI: 10.1177/13634615221082795
       
  • Historical trauma and oppression: Associations with internalizing outcomes
           among American Indian adults with type 2 diabetes

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      Authors: Stefanie L. Gillson, Dane Hautala, Kelley J. Sittner, Melissa Walls
      Abstract: Transcultural Psychiatry, Ahead of Print.
      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.
      Citation: Transcultural Psychiatry
      PubDate: 2022-02-28T01:03:33Z
      DOI: 10.1177/13634615221079146
       
  • The contagion of mental illness: Insights from a Sufi shrine

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      Authors: Bhrigupati Singh, Pratap Sharan
      Abstract: Transcultural Psychiatry, Ahead of Print.
      In this article, an anthropologist and a psychiatrist examine a Sufi shrine-based concept of affliction known as asrat (an “effect” in Hindi-Urdu, “difficulty” in Arabic) and related practices of healing in urban north India. Rather than being located in an individual body, asrat afflictions are shared, most often within a household or kinship group. Through surveys, clinical assessments, and ethnographic work, we track three different ways in which afflictions move between bodies, and the mechanisms at work in asrat healing processes. Rather than a “collectivist” concept of the psyche, we suggest that a key role of shrine-based therapeutic processes is to manage a “suspicion system,” related to experiences of psychic and economic injuries and conflict between intimates and kin. Through a multi-sited research design that moves across a leading Sufi shrine, an urban poor neighborhood in Delhi, and one of India's leading psychiatric facilities, we argue that within asrat-related processes, psychic vulnerabilities are addressed by “re-combining” relations through forms of inter-subjective attunement within a smaller segment of the kin group, potentially making symptoms and the burden of care and conflict more livable. We suggest that shrine-based concepts and practices may be cross-culturally significant, even for secular understandings of the inter-subjective dimensions of mental illness.
      Citation: Transcultural Psychiatry
      PubDate: 2022-02-24T04:51:33Z
      DOI: 10.1177/13634615221078131
       
  • Transgenerational trauma in Rwandan genocidal rape survivors and their
           children: A culturally enhanced bioecological approach

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      Authors: Sarilee Kahn, Myriam Denov
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Multiple theories, including attachment, family systems, and epigenetics, among many others, have been invoked to explain the mechanisms through which trauma is transmitted from one generation to the next. To move toward integration of extant theories and, thus, acknowledgement of multiple pathways for transmission of trauma, the authors explore the potential of applying a culturally enhanced bioecological theory to transgenerational trauma (TGT). Data from in-depth qualitative interviews in Rwanda more than two decades after the genocide, with 44 mothers of children born of genocidal rape, and in-depth interviews and focus groups with a total of 60 youth born of genocidal rape, were analyzed according to the processes of culturally enhanced bioecological theory. The findings from a hybrid inductive and deductive thematic analysis suggest that a culturally enhanced bioecological theory of human development allows for an integrated, multi-dimensional analysis of individual, family, cultural, and societal factors of transmission of TGT. Some facets of the data, however, are not accounted for in the theory, specifically, how some mothers were able to create and sustain a positive bond with their children born of genocidal rape, despite societal and family pressure to abandon or abort them. Nonetheless, the findings demonstrate how a culturally enhanced bioecological theory can be an important overarching framework for developing policies and practices to help interrupt or mitigate TGT, strengthen resilience, and facilitate healing for children born of genocidal rape, their mothers, and their families.
      Citation: Transcultural Psychiatry
      PubDate: 2022-02-24T04:39:08Z
      DOI: 10.1177/13634615221080231
       
  • An interview-based evaluation of an Indigenous traditional spirituality
           program at an urban American Indian health clinic

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      Authors: Tony V Pham, Andrew Pomerville, Rachel L. Burrage, Joseph P. Gone
      Abstract: Transcultural Psychiatry, Ahead of Print.
      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.
      Citation: Transcultural Psychiatry
      PubDate: 2022-02-24T04:38:52Z
      DOI: 10.1177/13634615221076706
       
  • Stigma, lost opportunities, and growth: Understanding experiences of
           caregivers of persons with mental illness in Tamil Nadu, India

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      Authors: Mirjam A. Dijkxhoorn, Archana Padmakar, Joske F. G. Bunders, Barbara J. Regeer
      Abstract: Transcultural Psychiatry, Ahead of Print.
      This study aimed to address gaps in understanding of the lived experiences of caregivers of persons with mental illness in low-income countries. It was conducted among caregivers of persons with mental illness making use of a free non-governmental clinic in and around Chennai, India. The study adopted a qualitative methodology, with semi-structured interviews and life history exercises (n = 29) and six focus group discussions with caregivers (n = 21) and mental health professionals and community-based workers (n = 39). The experiences of caregivers were analyzed in the framework of “The Banyan model of caregiving,” which identifies six phases. Major themes in caregivers’ experience were: embarrassment and losing honor; fear; awareness; stigma and social exclusion; and reduced social interaction and loneliness. Posttraumatic growth considered as the result of caregiver experiences was found to consist mainly of personal growth and focusing on positive life experiences. Lost opportunities particular to the context of Tamil Nadu were described as the inability to get married, obtaining less education than desired, and loss of employment. Siblings faced lower levels of burden, while elderly mothers experienced especially high levels of burden and lack of happiness in life. Caregiver gains were identified as greater compassion for other people with disabilities, resulting in a desire to help others, as well as increased personal strength and confidence. Understanding the nuances of the caregiving experiences over time can provide a framework to devise more fine-tuned support structures that aim to prevent reductions in social interaction and lost opportunities, and improve a sense of meaning, in order to assist caregivers to continue providing care for their relatives with mental illness in a context with scarce mental health resources.
      Citation: Transcultural Psychiatry
      PubDate: 2022-02-16T04:22:21Z
      DOI: 10.1177/13634615211059692
       
  • Conceptual and methodological challenges in idioms of distress research:
           Common questions and a step-by-step guide

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      Authors: Lesley Jo Weaver, Karl Krupp, Purnima Madhivanan
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Research premised on the construct of idioms of distress has proliferated in the last 40 years. The aim of this work is to foreground the experiential and socially adaptive functions of cultural expressions of distress around the world. Researchers who work in this field often begin from very different starting points in terms of their prior knowledge of the research context, their interest in theoretical or applied implications of their work, and the target areas of distress that they study. While this multiplicity of approaches ensures that the literature captures diverse manifestations of suffering, it also creates confusion for those who are new to the field and who may not know where to begin. This article seeks to resolve some of that confusion by identifying common conceptual challenges across the idioms of distress literature, and then providing a detailed step-by-step methodological example of an idioms of distress study in India that could be adapted for similar work in other contexts.
      Citation: Transcultural Psychiatry
      PubDate: 2022-02-15T05:52:34Z
      DOI: 10.1177/13634615211042235
       
  • Mujeres abnegadas: The influence of gender expectations on the psychiatric
           encounter in Mexico

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      Authors: Alyssa Marie Ramírez Stege
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Theories on the cause of mental and emotional distress contribute to illness course and treatment. The theorizing of women's experience “as problem” has been widely critiqued by feminist psychologists yet continues in clinical practice. This qualitative study reports on data collected in a psychiatric outpatient clinic in south/central Mexico on the culturally embedded causal theories of mental illness among Mexican patients, a family member or caregiver, and their psychiatrists. The author reports on the influence of gender expectations and the view of “women as problem” in Mexico. Specifically, stakeholders considered that the idea of “mujeres abnegadas” (self-sacrificing women) was the cause of illness in female patients diagnosed with depressive or anxiety-related disorders. In the face of gendered violence and abuse, Mexican women were expected to be silent and submissive, to suppress their thoughts and feelings, and to endure (“aguantar”) their experiences to conform to gender-based expectations, and psychiatrists expressed little hope of alleviating women's suffering. The author discusses her findings in the context of broader sociocultural factors and globalizing forces in psychological theory and practice and provides future directions to help de-pathologize patients’ distress, broaden awareness of the contextual forces that influence distress, and galvanize appropriate resources and support.
      Citation: Transcultural Psychiatry
      PubDate: 2022-02-15T04:46:56Z
      DOI: 10.1177/13634615221079134
       
  • Strategic universality in the making of global guidelines for mental
           health

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      Authors: China Mills
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Based on interviews with members of the Guideline Development Group (GDG) of the World Health Organization’s (WHO) Mental Health Gap Action Programme (mhGAP) Guidelines for Mental, Neurological and Substance Use Disorders, this article adds empirical depth to understanding the contingent and strategic nature of universality in relation to mental health. Differently from debating whether or not mental health is global, the article outlines the people, ideas, and processes involved in making it global. Thematic analysis of interviews carried out with nine (out of 21) members of the original mhGAP GDG identified six intersecting strategies that enable the construction of universality in global mental health (GMH): 1) processes and practices of assembling expertise; 2) decisions on what counts as evidence; 3) framing cultural relativism as nihilistic; 4) the delaying of complexity to prioritize action; 5) the narration of tensions as technical rather than epistemological; and 6) the ascription of messiness to local contexts rather than to processes of standardization. Interviews showed that differently from the public-facing consensus often presented in GMH, GDG members hold contrasting and contingent understandings of the nature of universality in relation to mental health diagnoses and interventions. Thus, the universality of mental health achieved through the mhGAP Guidelines is partial and temporary, requiring continuous (re)iteration. The article uses empirical data to show nuance, complexity, and multi-dimensionality where binary thinking sometimes dominates, and to make links across arguments ‘for’ and ‘against’ global mental health.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-19T11:52:36Z
      DOI: 10.1177/13634615211068605
       
  • “It's easy to dismiss it as simply a spiritual problem.” Experiences
           of mental distress within evangelical Christian communities: A qualitative
           survey

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      Authors: Christopher E. M. Lloyd, Jonathan Hutchinson
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Evidence suggests that faith communities can support psychological wellbeing but can also potentially diminish wellbeing through stigma, imposed spiritualization, and marginalization. In particular, for evangelical Christianity, whose theological praxis typically accentuates literalist spiritual onto-etiologies, including the belief that mental distress can be treated solely through spiritual intervention (prayer, fasting, and deliverance), there may be negative implications for Christians with mental distress. The current qualitative survey examined the responses of 293 self-identified evangelical Christians, concerning their experiences of mental distress in relation to their church community. An inductive thematic analysis revealed five themes: 1) Tensions between Faith and Suffering; 2) Cautions about a Reductive Spiritualization; 3) Feeling Othered and Disconnected; 4) Faith as Alleviating Distress; and 5) Inviting an Integrationist Position. Findings reveal stigma and the totalizing spiritualization of mental distress can be experienced as both dismissive and invalidating and can problematize secular help-seeking. This lends support to previous research which has suggested that evangelical Christian communities tend to link mental distress to spiritual deficiencies, which can hold potentially negative consequences for their wellbeing. Nevertheless, a degree of complexity and nuance emerged whereby spiritual explanations and interventions were also experienced as sometimes helpful in alleviating suffering. Overall, findings suggest evangelical communities are increasingly adopting integrationist understandings of mental distress, whereby spiritual narratives are assimilated alongside the biopsychosocial. We argue that church communities and psychotherapeutic practitioners should support movement from a position of dichotomizing psychological suffering (e.g., spiritual vs. biopsychosocial) towards a spiritually syntonic frame, which contextualizes distress in terms of the whole person. Considerations for psychotherapeutic practice and further research are made.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-18T02:51:36Z
      DOI: 10.1177/13634615211065869
       
  • A comparative study of mental health diagnoses, symptoms, treatment, and
           medication use among Orthodox Jews

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      Authors: Steven Pirutinsky, David H. Rosmarin
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Historical clinical reports and media narratives suggest that Orthodox Jews are reticent to seek treatment for mental illness, present only with serious concerns, and hesitate to comply with treatment in general and psychopharmacology in particular. On the other hand, recent developments, and some limited research, suggest that Orthodox Jews may be likely to seek and comply with treatment. The current study compared the diagnostic, symptomatic, and treatment characteristics of 191 Orthodox Jews and 154 control patients all presenting to a large private mental health clinic with offices throughout greater New York. Results indicated that the groups were largely demographically similar, and that their diagnoses did not significantly differ. Orthodox Jews initially presented with lower levels of symptoms, terminated with similar symptom levels, attended a similar number of sessions, and were equally likely to use psychopharmacological interventions of similar types, compared to controls. This was equally true of ultra-Orthodox and modern Orthodox Jews. Clinicians providing mental health services to Orthodox Jews should be aware of these findings, which contrast with existing clinical and popular stereotypes. Further, excessive efforts to protect Orthodox Jewish patients against stigma may be unnecessary and counterproductive.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-12T12:32:52Z
      DOI: 10.1177/13634615211068607
       
  • Identity and memory as resilience: Applications of liberation psychology
           in a rural Maya Achi community

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      Authors: Heidi Mitton
      Abstract: Transcultural Psychiatry, Ahead of Print.
      This study sought to understand interpretations of interconnections between historical trauma, contemporary violence, and resilience in a Maya Achi community currently engaged in promoting peace and social change through popular education. In particular, the ways in which participants drew upon identity and memory in articulating characteristics of community distress and resilience are discussed. The research is informed by liberation psychology and critical perspectives of mental health, particularly considering the challenges inherent in the promotion of collective memory of trauma and resistance in contexts of violence and humanitarian settings. Participant reflections on historical and contemporary violence highlight elements of collective distress, connecting identity and memory with acts of both oppression and resistance. Education and development are signaled as possible sites of resilience but also experienced as sites of power upholding the status quo. Diverse experiences and applications of identity and memory provide insight into the ways in which community organizations working in contexts of political violence might navigate polarizing and paradoxical discourses in order to subvert, co-opt, or adapt to hegemonic cultural, political, and economic power relations in the process of transformation for collective resilience.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-12T12:32:12Z
      DOI: 10.1177/13634615211067357
       
  • Metaphor and the politics and poetics of youth distress in an
           evidence-based psychotherapy

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      Authors: Rebecca Seligman
      Abstract: Transcultural Psychiatry, Ahead of Print.
      This article explores the relationship between metaphors and emotion in the context of adolescent distress and psychotherapeutic treatment. Drawing on data from an ethnographic study of Mexican American adolescents receiving outpatient treatment for a variety of emotional and behavioral problems, the article examines what I call “prescribed” metaphors deployed in mainstream, manualized child and adolescent Cognitive Behavioral Therapies commonly used in mainstream clinical contexts. I explore the models of emotion communicated to youth by one such metaphor, youth responses to this metaphor, and the potential implications for young people as they take up the underlying models and affective practices embedded in the metaphor. Specifically, I examine how youth respond to messages about emotion metacognition and emotion regulation embedded in a metaphor that equates feelings with temperatures that can be monitored and objectively measured. I find that youth are at once convinced that abstract knowledge about internal states is inherently valuable because it is linked to desired forms of personhood, but also concerned about the limits of technical metaphors to capture aspects of lived experience and the flattening and homogenization of affect that might accompany the practices such metaphors help to enact. I analyze alternative interpretations of prescribed metaphors as well as the spontaneous metaphors used by youth to talk about their emotions and experiences of distress, in an effort to think through the politics and poetics of emotion metaphors in the context of an evidence-based psychotherapy for young people.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-07T11:15:14Z
      DOI: 10.1177/13634615211066692
       
  • Refugee posttraumatic growth: A grounded theory study

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      Authors: Sara Hirad, Marianne McInnes Miller, Sesen Negash, Jessica E. Lambert
      Abstract: Transcultural Psychiatry, Ahead of Print.
      In response to the unprecedented refugee crisis around the world, a growing body of research has focused on psychological distress among individuals and families forced to flee their homelands. Less attention has been directed toward understanding resilience, adaptation, and growth among this population. This grounded theory study explored the posttraumatic growth experiences of Middle Eastern and Afghan refugees resettled in the United States. The principal researcher conducted 23 interviews with seven couples and 16 individuals aged 25 to 67 years, from Afghanistan, Iraq, Iran, and Syria. This study aimed to explore how refugees understand, process, overcome, and grow from the trauma and adversity they have experienced. Findings were used to delineate a model of the process through which refugees experience posttraumatic growth. The overarching theme of moving forward had five specific growth themes: increased awareness of context; tolerating uncertainty; spiritual/religious attunement; consideration of others; and integrating into society. Findings shed light on the complex process of growth and adaptation in the aftermath of war and forced migration. The model can serve as a tool for clinicians to facilitate more empowering posttraumatic narratives with refugee clients rooted in growth experiences.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-07T02:32:56Z
      DOI: 10.1177/13634615211062966
       
  • Overcoming epistemic injustices in the biomedical study of ayahuasca:
           Towards ethical and sustainable regulation

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      Authors: Eduardo Ekman Schenberg, Konstantin Gerber
      Abstract: Transcultural Psychiatry, Ahead of Print.
      After decades of biomedical research on ayahuasca's molecular compounds and their physiological effects, recent clinical trials show evidence of therapeutic potential for depression. However, indigenous peoples have been using ayahuasca therapeutically for a very long time, and thus we question the epistemic authority attributed to scientific studies, proposing that epistemic injustices were committed with practical, cultural, social, and legal consequences. We question epistemic authority based on the double-blind design, the molecularization discourse, and contextual issues about safety. We propose a new approach to foster epistemically fair research, outlining how to enforce indigenous rights, considering the Brazilian, Peruvian, and Colombian cases. Indigenous peoples have the right to maintain, control, protect, and develop their biocultural heritage, traditional knowledge, and cultural expressions, including traditional medicine practices. New regulations about ayahuasca must respect the free, prior, and informed consent of indigenous peoples according to the International Labor Organization Indigenous and Tribal Peoples Convention no. 169. The declaration of the ayahuasca complex as a national cultural heritage may prevent patenting from third parties, fostering the development of traditional medicine. When involving isolated compounds derived from traditional knowledge, benefit-sharing agreements are mandatory according to the United Nations’ Convention on Biological Diversity. Considering the extremely high demand to treat millions of depressed patients, the medicalization of ayahuasca without adequate regulation respectful of indigenous rights can be detrimental to indigenous peoples and their management of local environments, potentially harming the sustainability of the plants and of the Amazon itself, which is approaching its dieback tipping point.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-06T09:02:33Z
      DOI: 10.1177/13634615211062962
       
  • The impact of perceived relationship to ancestors on the association
           between self-transcendence and psychopathology: A cross-cultural
           examination

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      Authors: Simon Hanseung Choi, Clayton Hoi-Yun McClintock, Elsa Lau, Lisa Miller
      Abstract: Transcultural Psychiatry, Ahead of Print.
      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.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-05T06:55:19Z
      DOI: 10.1177/13634615211049072
       
  • Health professionals’ experiences of and attitudes towards mental
           healthcare for migrants and refugees in Europe: A qualitative systematic
           review

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      Authors: E. Peñuela-O’Brien, M. W. Wan, D. Edge, K. Berry
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Migrants living in Europe constitute over half of the world's international migrants and are at higher risk of poor mental health than non-migrants, yet also face more barriers in accessing and engaging with services. Furthermore, the quality of care received is shaped by the experiences and attitudes of health professionals. The aim of this review was to identify professionals’ attitudes towards migrants receiving mental healthcare and their perceptions of barriers and facilitators to service provision. Four electronic databases were searched, and 23 studies met the inclusion criteria. Using thematic synthesis, we identified three themes: 1) the management of multifaceted and complex challenges associated with the migrant status; 2) professionals’ emotional responses to working with migrants; and 3) delivering care in the context of cultural difference. Professionals employed multiple strategies to overcome challenges in providing care yet attitudes towards this patient group were polarized. Professionals described mental health issues as being inseparable from material and social disadvantage, highlighting a need for effective collaboration between health services and voluntary organizations, and partnerships with migrant communities. Specialist supervision, reflective practice, increased training for professionals, and the adoption of a person-centered approach are also needed to overcome the current challenges in meeting migrants’ needs. The challenges experienced by health professionals in attempting to meet migrant needs reflect frustrations in being part of a system with insufficient resources and without universal access to care that effectively stigmatizes the migrant status.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-05T06:55:09Z
      DOI: 10.1177/13634615211067360
       
  • Psychosocial concerns in a context of prolonged political oppression: Gaza
           mental health providers’ perceptions

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      Authors: Marwan Diab, Guido Veronese, Yasser Abu Jamei, Rawia Hamam, Sally Saleh, Hasan Zeyada, Ashraf Kagee
      Abstract: Transcultural Psychiatry, Ahead of Print.
      In this qualitative exploratory study, we investigated the perspectives of mental health providers in Gaza, Palestine, regarding the primary concerns of their clients who are exposed to low-intensity warfare and structural violence. We conducted qualitative interviews with 30 psychologists, social workers, psychiatric nurses, and psychiatrists providing services to communities in Gaza. Participants were asked to discuss their clients’ most commonly occurring mental health problems, diagnoses, and psychosocial conditions. Thematic analysis identified one superordinate theme (Impact of the Blockade on Mental Health and Quality of Life) and four second-order themes (Concerns about Social Problems, General Concerns about Quality of Life, Concerns about the Mental Health of the Community, and Concerns Related to Children's Mental Health). Participants indicated that the social and political dimensions of mental health and the economic, educational, and health-related consequences of the ongoing blockade of Gaza were the main determinants of psychological burden among their clients. Findings demonstrated the importance of adopting an approach to mental health that includes understanding psychological indicators in a broader framework informed by human rights and social justice. Implications for research and clinical work are discussed, including the role of investments in social capital that may provide individuals with access to resources such as social support, which may in turn promote overall mental health.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-05T06:55:07Z
      DOI: 10.1177/13634615211062968
       
  • Perspectives of university health care students on mental health stigma in
           Nigeria: Qualitative analysis

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      Authors: Aderonke Bamgbose Pederson, J. Konadu Fokuo, Graham Thornicroft, Olamojiba Bamgbose, Oluseun Peter Ogunnubi, Kafayah Ogunsola, Yewande O. Oshodi
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Mental illness is a significant public health burden in low- and middle-income countries. A wide treatment gap in mental health care exists within the Nigerian health care system and this gap is worsened by the presence of stigma associated with mental illness, which leads to delay in treatment or acts as a barrier to any care. In this study, our aim was to understand the factors that underlie mental illness stigma in order to inform the design of effective stigma-reducing interventions among health care students in Nigeria. We conducted four focus groups among university health care students in March 2019 in Nigeria. The students included nursing, pharmacy, and medical trainees from a university teaching hospital. We used an inductive-driven thematic analysis to identify codes and themes related to mental health stigma and conceptualization of mental health within the study group. Among the 40 participants, we identified how specific interpretations of religious and spiritual beliefs may be associated with stigmatizing behaviors such as social distancing and discrimination. Conceptualization of mental illness as a communicable disease and the attribution of mental illness to a moral failing contributed to stigma mechanisms. Overall, eight themes associated with mental health stigma and mental health-related concepts were found: spirituality, discrimination and devaluation, conceptualization of mental health, attribution theories, methods to reduce stigma, shortage of resources, violence and dangerousness, and maltreatment. We found that the co-existence of spiritual beliefs and biomedical and psychological models of mental health is a key factor to consider in the design of effective stigma-reducing interventions among university health students in Nigeria.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-05T06:54:49Z
      DOI: 10.1177/13634615211055007
       
  • Edinburgh Postnatal Depression Scale (EPDS) for screening for depression
           

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      Authors: Victoria N. Mutiso, Christine W. Musyimi, Albert Tele, Rita Alietsi, Pauline Andeso, David M. Ndetei
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Postnatal depression is one of the most common mental disorders among postnatal mothers and may have severe consequences for mothers and their children. Locally validated screening tools that can be self- or lay interviewer-administered are required to identify at-risk women, especially in settings with no mental health specialists. This study aimed to assess the validity and reliability of a culturally adapted version of the Edinburgh Postnatal Depression Scale (EPDS) in a local dialect (Kamba) in a Kenyan setting. Trained research assistants administered the local-language version of self-report scales (EPDS) to a sample of 544 Kamba-speaking women. The same scale was re-administered to the same research participants two weeks later by the same research assistants. The test scores were compared with an external ‘gold standard’ according to the DSM-IV criteria Mini-International Neuropsychiatric Interview for adults (MINI-Plus). The EPDS had an area under the curve (AUC) of 0.867 with 95% C.I of 0.836 to 0.894, with a cut-off point of ≥11, sensitivity of 81.0% (95% C.I 70.6–89.0) and specificity of 82.6% (95% CI 78.8–85.9). The positive predictive value (PPV) and negative predictive value (NPV) were 44.1% and 96.2%, respectively. The internal reliability was 0.852 and the test-retest reliability was 0.496. The EPDS showed good utility in detecting depressive disorder in Kamba-speaking postnatal women. It does not have to be administered by mental health workers (who are few in low- and middle-income countries); rather, this can be done by a trained lay interviewer.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-05T06:21:56Z
      DOI: 10.1177/13634615211043764
       
  • Orphans in post-conflict Liberia: Seeking care in fractured communities

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      Authors: Elizabeth J. Levey, Benjamin L. Harris, Lance D. Laird, Isaac Kekulah, Christina P. C. Borba, David C. Henderson, Anne E. Becker
      First page: 235
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Orphans in post-conflict settings have unique needs that have not been well-characterized. In post-conflict Liberia, maternal orphans are more likely to be without care than paternal orphans. This study examined the experiences of maternal orphans in Liberia, as they attempted to care for themselves and seek care from others, and the barriers they faced. In-depth interviews were conducted with 75 post-conflict Liberian orphans. We performed a secondary narrative analysis of interview transcripts from all maternal or double orphans (n = 17). We identified similar elements across narratives: traumatic loss, disconnection from family and community, and the desire for a savior. Female high-risk orphans were more likely to have formal substitute caregiving arrangements in which they were living with someone who was a relative or had been selected by a relative. Male orphans more commonly lacked arranged substitute care, but this allowed them to form relationships with substitute caregivers of their choosing. Sex also played a role in the provision of caregiving; substitute care was provided by women. Findings highlighted the syndemic relationship between poverty, violence, transactional sex, trauma, and substance use that traps high-risk Liberian orphans. Interventions are needed to improve access to mental health care, sober communities, housing, and education support. The need to integrate these services into indigenous institutions and address barriers related to stigma is explored.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-13T08:56:04Z
      DOI: 10.1177/13634615211066696
       
  • Traditional healers’ explanatory models of intellectual disability
           in Cape Town

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      Authors: Siyabulela Mkabile, Leslie Swartz
      First page: 263
      Abstract: Transcultural Psychiatry, Ahead of Print.
      While intellectual disability is experienced worldwide, with much greater rates in contexts of poverty, relatively few studies on intellectual disability have been conducted in low- and middle-income countries. High levels of intellectual disability in South Africa exist alongside high levels of poverty, malnutrition and poor or inaccessible healthcare services. The lack of access to services partly explains why many turn to traditional healers. Within this context there is very limited research on the role that traditional healers play in relation to intellectual disability in South Africa. The current study investigated traditional healers’ understanding and beliefs about intellectual disabilities and the treatment modalities that they use. An exploratory qualitative research design was used to examine the views and perspectives of traditional healers on intellectual disability. Fifteen traditional healers participated in the study. Key findings show that the naming of and the terminology used to describe and identify intellectual disability are very much similar to what has been observed in African cultures in general where intellectual disability is identified as an abnormality. Some traditional healers located the presentation of intellectual disability within the biomedical sphere while others gave supernatural explanations for how intellectual disability presents in children and for its causes. All traditional healers expressed a willingness to work with the Western formal healthcare system. Findings on traditional healers’ views on future collaborations with the formal health system provide opportunities for these two forms of healthcare services to be synergised for the strengthening and improvement of services provided to children with intellectual disability and their families.
      Citation: Transcultural Psychiatry
      PubDate: 2022-02-28T01:03:58Z
      DOI: 10.1177/13634615211055967
       
  • Starving to death and the anorexic frame of mind

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      Authors: Jennifer Radden
      First page: 302
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Because some forms of self-starvation such as hunger striking are exempt from attributions of pathology, and due to incomplete understanding of its etiology, anorexia nervosa (AN) is and must presently be defined by psychological criteria as well as behavioral and bodily measures. Although opaque, typical motivational frames of mind in AN lack the apparent cognitive and volitional dysfunction usually indicating disorder. In contrast to other conditions that exhibit more evident dysfunction, this distinguishes AN from the perspective of medical epistemology: the opacity of AN motivation jeopardizing the epistemic warrant for assigning it to the category of a mental disorder (and so influencing decisions over diagnosis and recovery). This seems to invite non-medical approaches to its prevention and care.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-06T09:03:02Z
      DOI: 10.1177/13634615211066697
       
  • Climate change and Indigenous mental health in the Circumpolar North: A
           systematic review to inform clinical practice

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      Authors: Laurence Lebel, Vincent Paquin, Tiff-Annie Kenny, Christopher Fletcher, Lucie Nadeau, Eduardo Chachamovich, Mélanie Lemire
      First page: 312
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Climate change is disproportionally impacting the Circumpolar North, with particular impacts among Indigenous populations. Environmental changes are felt in many aspects of daily life of Northern communities, including both physical and mental health. Thus, health institutions from around the Arctic must meet emerging needs, while the phenomenon remains marginal to their southern counterparts. In this systematic review, we aimed to review current scientific knowledge on the mental health impacts of climate change in Indigenous Peoples across the Circumpolar North. Seven databases were searched. Original peer-reviewed research articles were included if they addressed links between climate change and mental health in Arctic or Subarctic Indigenous Populations. After extraction, data were synthesized using thematic analysis. Of the 26 articles that met inclusion criteria, 16 focused on Canadian Inuit communities and 21 were exclusively qualitative. Being on the land was identified as a central determinant of wellbeing. Immediate impacts of climate change on mental health were felt through restricted mobility and disrupted livelihoods. Effects on mental health were further felt through changes in culture and identity, food insecurity, interpersonal stress and conflicts, and housing problems. Various ways in how communities and individuals are coping with these effects were reported. Understanding climate-related pathways of mental health risks in the Arctic is crucial to better identify vulnerable groups and to foster resilience. Clinicians can play a role in recognizing and providing support for patients affected by these disruptions. Policies sensitive to the climate–mental health relationship must be advocated for.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-06T11:44:07Z
      DOI: 10.1177/13634615211066698
       
  • Perceived Discrimination, Experiential Avoidance, and Mental Health among
           Hispanic Adults in Primary Care

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      Authors: Michael J. Zvolensky, Andrew H. Rogers, Nubia A. Mayorga, Justin M. Shepherd, Jafar Bakhshaie, Monica Garza, Andres G. Viana, Melissa Ochoa-Perez, Chad Lemaire, Ana Ruiz, Natalia Peraza
      First page: 337
      Abstract: Transcultural Psychiatry, Ahead of Print.
      The Hispanic population is the largest minority group in the United States and frequently experiences racial discrimination and mental health difficulties. Prior work suggests that perceived racial discrimination is a significant risk factor for poorer mental health among Hispanic in the United States. However, little work has investigated how perceived racial discrimination relates to anxiety and depression among Hispanic adults. Thus, the current study evaluated the explanatory role of experiential avoidance in the relation between perceived racial discrimination and anxiety/depressive symptoms and disorders among Hispanic adults in primary care. Participants included 202 Spanish-speaking adults (Mage = 38.99, SD = 12.43, 86.1% female) attending a community-based Federally Qualified Health Center. Results were consistent with the hypothesis that perceived racial discrimination had a significant indirect effect on depression, social anxiety, and anxious arousal symptoms as well as the number of mood and anxiety disorders through experiential avoidance. These findings suggest future work should continue to explore experiential avoidance in the association between perceived racial discrimination and other psychiatric and medical problems among the Hispanic population.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-12T12:31:55Z
      DOI: 10.1177/13634615211038159
       
  • “They tell us little and we end up being confused”: Parent–child
           communication on familial experiences of genocide and its aftermath in
           Rwanda

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      Authors: Chantal Marie Ingabire, Grace Kagoyire, Nicolas Habarugira, Theoneste Rutayisire, Annemiek Richters
      First page: 349
      Abstract: Transcultural Psychiatry, Ahead of Print.
      In the current study we explore how Rwandan youth negotiate, within the family setting, a myriad of social and interpersonal dilemmas around silence and disclosure of genocide-related experiences of their parents. The study draws primarily on individual interviews and focus group discussions with 20 children of genocide survivor and perpetrator parents in the western and eastern provinces of Rwanda. Using the conceptual framework of social navigation which theorizes agency in a fluid, often unpredictable, and constantly moving social environment, we focus specifically on the difficult and often contradictory complex of factors that drive the communication strategies and tactics of the children as they seek information to understand the past of their parents. This includes the children’s urge to get to know the specific stories of their family but fearing the emotional disruption it may cause in the parent–child relationship; the push–pull dynamics of the parents wanting to disclose some experiences but admonishing silence on others; and the often ambiguous divergences between the public and private discourses. Our findings show that the steadiest navigational point guiding communication choices, made by both parents and their offspring, was a desire to contribute to a peaceful social environment, and to reduce the risk of future violence. We present emerging evidence suggesting that community-based sociotherapy, a program that includes healing the social space and not only intrapsychic wounds, may contribute to a steadier navigation of the tricky communication issues, enhancing psychosocial wellbeing.
      Citation: Transcultural Psychiatry
      PubDate: 2022-02-24T04:39:08Z
      DOI: 10.1177/13634615221078483
       
  • Elevated trauma exposure and mental health burden among men who have sex
           with men in Vietnam

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      Authors: Kathy Trang, Tanja Jovanovic, Devon E. Hinton, Patrick Sullivan, Carol M. Worthman, Le Xuan Lam, Nguyen Kim Chi, Nguyen Cong Thanh, Tran Viet Ha, Vivian Go, Irving Hoffman, Le Minh Giang
      First page: 362
      Abstract: Transcultural Psychiatry, Ahead of Print.
      The purpose of this study was to characterize trauma exposure and mental health burden among men who have sex with men (MSM) in Hanoi, Vietnam. Participants comprise 100 HIV-positive and 98 high-risk, HIV-negative MSM, ranging from 18 to 29 years of age. Data were collected using the Childhood Trauma Questionnaire, Traumatic Events Inventory, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and PTSD Symptom Scale. A subset of participants (n  =  12) were also interviewed to evaluate community perception of the prevalence, causation, and available treatment options for mental health issues within the MSM community in Vietnam. In our sample, 23.2% reported having experienced moderate-to-severe childhood physical abuse; 18.7% physical neglect; 13.6% emotional abuse; 11.1% emotional neglect; and 26.8% sexual abuse. Such trauma exposure continued into adulthood and manifested most commonly in the form of interpersonal violence. Approximately 37.4% of the sample met the criteria for probable PTSD; 26.8% for moderate-to-severe depression; and 20.2% for moderate-to-severe anxiety. Neither exposure nor mental health burden differed by serostatus. Linear regression revealed that childhood emotional abuse was the only sub-type of trauma significantly associated with depression, anxiety, and PTSD symptoms. The majority of interviewees believed that mental health burden was higher among MSM relative to the general population and attributed this to their vulnerability to interpersonal violence and lack of available coping resources. However, few believed that these mental health issues warranted clinical attention, and only one participant was able to identify a mental health service provider. Our findings suggest that trauma exposure and mental health burden are prevalent among MSM, irrespective of serostatus, and much higher than what has been previously reported among the general population in Vietnam.
      Citation: Transcultural Psychiatry
      PubDate: 2022-01-24T02:58:53Z
      DOI: 10.1177/13634615211058348
       
  • The psychological impact of sexual torture: A gender-critical study of the
           perspective of UK-based clinicians and survivors

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      Authors: Roghieh Dehghan, Caroline Osella
      First page: 380
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Despite the high prevalence of sexual torture and its close link with gender, little work has been published on refugee torture survivors from Muslim-majority countries. The aim of this project was to introduce a gender-critical framework, that draws on post-modern and post-colonial feminism, to the study of sexual torture in terms of its operationalization and psychological impact in Iranian, Afghan, and Kurdish refugees in the United Kingdom (UK). This exploratory qualitative research was conducted in collaboration with two voluntary organizations in the UK. Mental healthcare providers (HCPs) were invited to participate through convenience sampling from amongst their staff as well as from community mental health services. Torture survivors were recruited through snowball sampling. The study consists of two parts: 1) semi-structured face-to-face interviews with a total of eight experts (doctors and therapists) and three torture survivors; followed by 2) a focus group with four experts to discuss the emerging results from the interviews and together reflect on the politics of gender and sexuality in the context of torture (‘assisted sense-making’). A thematic gender-critical analysis was performed for the qualitative data. Our findings from interviews with (only Kurdish) torture survivors and HCPs suggest that gender mediates the impact of sexual torture at the intersection of gender, cultural norms, forms of social inequality, and body politics. The conclusions of the study will have implications for health services by deepening our understanding of variables that intersect in an entangled and unpredictable network.
      Citation: Transcultural Psychiatry
      PubDate: 2022-04-06T07:35:21Z
      DOI: 10.1177/13634615221089491
       
 
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