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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  [1176 journals]
  • Susto as a cultural conceptualization of distress: Existing research and
           aspects to consider for future investigations

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      Authors: Fanny Beatriz Martínez-Radl, Devon Emerson Hinton, Ulrich Stangier
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Among the cultural conceptualizations of distress, susto is defined in the DSM-5 as “a cultural explanation of distress and misfortune in Latin America that refers to an illness attributed to a terrifying event that causes the soul to leave the body and leads to unhappiness and illness, as well as difficulties in performing key social functions” (American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Washington, DC: APA, p. 836). Thus, susto represents a cultural explanation that encompasses the symptoms of various mental disorders and physical diseases. We analyzed the descriptions of susto from different scientific fields and related them to definitions of DSM-5 syndromes. Three syndromic subtypes of susto show a symptomatic overlap with depression, post-traumatic stress disorder (PTSD) and somatic disorder. However, linguistic metaphors describing symptoms and perceived causes that are specific for Latin American culture support the concept of susto as a specific idiom of distress (e.g., loss of soul, shadow or ajayu; sunken, closed or white eyes; jumping and screaming in the night; being thrown to the ground). In addition, if diagnostic criteria are met for mental disorders, then susto describes a perceived cause of psychopathological states (e.g., depressive disorder, PTSD, somatic disorder, panic disorder, generalized anxiety disorder). Future research with people who have experienced susto is needed to clarify whether susto precedes the onset of other mental disorders (perceived cause) or whether it is a way of designating distress (idiom of distress).
      Citation: Transcultural Psychiatry
      PubDate: 2023-03-30T04:14:29Z
      DOI: 10.1177/13634615231163986
       
  • Cross-cultural, transnational or interdisciplinary' Eric Wittkower’s
           

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      Authors: Christina Hennig, Emmanuel Delille, Thomas Müller
      Abstract: Transcultural Psychiatry, Ahead of Print.
      This article traces the career, scientific achievements, and emigration of the Berlin-born physician, psychoanalyst, and psychosomatic researcher Eric Wittkower. Trained in Berlin and practicing internal medicine, he became persecuted by the Nazi regime and, after fleeing Germany via Switzerland, continued his professional career in the United Kingdom, where he turned to psychosomatic medicine and worked in the service of the British Army during World War II. After two decades of service in the UK, Wittkower joined McGill University in Canada. His increasingly interdisciplinary work contributed to the establishment of the new research field of transcultural psychiatry. Finally the paper provides a detailed history of the beginning of the section of transcultural psychiatry at the Allan Memorial Institute.
      Citation: Transcultural Psychiatry
      PubDate: 2023-03-29T07:17:25Z
      DOI: 10.1177/13634615221149352
       
  • From the Editors

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      Abstract: Transcultural Psychiatry, Ahead of Print.

      Citation: Transcultural Psychiatry
      PubDate: 2023-03-15T07:12:31Z
      DOI: 10.1177/13634615231162283
       
  • Global migration: Moral, political and mental health challenges

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      Authors: G. Eric Jarvis, Laurence J. Kirmayer
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Global migration is expected to continue to increase as climate change, conflict and economic disparities continue to challenge peoples' lives. The political response to migration is a social determinant of mental health. Despite the potential benefits of migration, many migrants and refugees face significant challenges after they resettle. The papers collected in this thematic issue of Transcultural Psychiatry explore the experience of migration and highlight some of the challenges that governments and healthcare services need to address to facilitate the social integration and mental health of migrants. Clinicians need training and resources to work effectively with migrants, focusing on their resilience and on long-term adaptive processes. Efforts to counter the systemic discrimination and structural violence that migrants often face need to be broad-based, unified, and persistent to make meaningful change. When migrants are free to realize their talents and aspirations, they can help build local communities and societies that value diversity.
      Citation: Transcultural Psychiatry
      PubDate: 2023-03-15T07:12:01Z
      DOI: 10.1177/13634615231162282
       
  • Corrigendum to Religiosity, perceived anti-Semitism, xenophobia and mental
           health: Experiences of Jewish immigrants from the former Soviet Union in
           Austria and Germany

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      Abstract: Transcultural Psychiatry, Ahead of Print.

      Citation: Transcultural Psychiatry
      PubDate: 2023-02-15T04:34:33Z
      DOI: 10.1177/13634615221148864
       
  • ‘All in good faith'’ An ethno-historical analysis of local faith
           actors’ involvement in the delivery of mental health interventions in
           northern Uganda

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      Authors: Elizabeth Storer, Costanza Torre
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Faith actors have become increasingly significant in the field of global mental health, through their inclusion in the delivery of psychosocial support in humanitarian settings. This inclusion remains empirically underexplored. We explore historical and contemporary activities of local faith actors in responding to mental disquiet in northern Uganda. Given pre-existing roles, we question what it means when humanitarians draw on faith actors to deliver mental health and psychosocial support (MHPSS) in conflict-affected settings. We argue for a recognition of faith actors as agents operating within a therapeutic marketplace, which on occasion links suffering to social inequality and exclusion. We show, moreover, that the formal inclusion of Christian actors within MHPSS may not equate to the enforcement of rights-based values at the core of international ideas of protection.
      Citation: Transcultural Psychiatry
      PubDate: 2023-02-06T08:36:54Z
      DOI: 10.1177/13634615221149349
       
  • Collective case formulation in situations of violent radicalization: A
           critical perspective in training

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      Authors: Janique Johnson-Lafleur, Yann Zoldan, Rochelle L. Frounfelker, Cécile Rousseau
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Case formulation is used in clinical training to weave together theoretical perspectives and support a shared plan of action. Although a cornerstone of clinical practice, critical social theorists have highlighted the risks of depoliticizing political struggles and of reifying and fixing subjects when using psychopathology and case formulation to address situations of injustice. In the field of violent radicalization, this risk is increased by the extreme affects evoked by terror in practitioners and in societies. This article explores the challenges of training clinicians in the field of violent radicalization. It does so by analyzing a Community of Practice (CoP) that was developed to support practitioners involved in this domain of practice in Quebec, Canada. Four focus groups with CoP participants and participant observation of nine CoP meetings were conducted. Thematic and narrative analyses were used to explore the training potential of the CoP and to identify the discursive processes and group dynamics associated with this modality. Results indicate that the diversity of professional perspectives and social positionalities in the group plays a central role in helping participants become aware of their biases and in developing more complex understandings of cases and of their social embedding. Results also suggest that the collective holding of risk is key to preserve practitioners’ investment in patients involved with violent radicalization. The sensitive issue of partnership between health and social services and security agencies is also addressed. Results suggest that CoPs with strong leadership allow for experiential training to enhance clinical and critical thinking.
      Citation: Transcultural Psychiatry
      PubDate: 2023-01-12T07:49:11Z
      DOI: 10.1177/13634615221134932
       
  • Psychosocial health in adolescent unmarried motherhood in rural Uganda:
           Implications for community-based collaborative mental health education,
           and empowerment strategies in the prevention of depression and suicide

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      Authors: Lucy Webb, David Kyaddondo, Teri Ford, Anna Bergqvist, Nigel Cox
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Teenage pregnancy rates in Uganda are among the highest in sub-Saharan Africa. Child marriage is often the result of unmarried teenage pregnancy and is recognised by Uganda's government as a form of sexual violence and an outcome of inequality. However, unmarried motherhood incurs stigma and shame within traditionally living rural communities. Using co-produced Open Space and ethnographic methods, we examined the psychosocial impact of unmarried motherhood on girls and their communities, and explored problem-solving with key local stakeholders. Findings indicate that girls experience extreme stress, social exclusion and rejection by their families, and experience bereavement from school expulsion and the loss of their career aspirations. Depressive symptoms and suicidal behaviour are reportedly not uncommon among this population group. Community and family efforts to promote marriage for these mothers to avoid social stigma increased the mothers’ feelings of depression, whereas mothers who became independent appeared to fare better psychologically. Community members and local stakeholders demonstrated a willingness to act locally to reduce the negative impacts of unmarried motherhood but lacked knowledge and support resources. Our findings indicate that mental health promotion for teenage mothers is likely to be better served through empowerment strategies rather than marriage and, in a context of poor mental health service access, there is a substantial role for community mobilisation and the promotion of self-help strategies to support teenage mothers. This study raises important points regarding different community understandings of depression and indicates collaboration between professionals and communities for a values-based approach.
      Citation: Transcultural Psychiatry
      PubDate: 2023-01-11T07:28:51Z
      DOI: 10.1177/13634615221147361
       
  • Beyond the language barrier: A systematic review of selective mutism in
           culturally and linguistically diverse children

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      Authors: Ortal Slobodin
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Selective mutism is a childhood psychiatric disorder that has been associated with adverse psychological, social and educational outcomes. Although evidence suggests that culturally and linguistically diverse children might be overrepresented among children with selective mutism, a direct examination of how migration or minority status are associated with the development and persistence of the disorder is still scarce. Guided by eco-cultural perspectives of development, the current review aims to provide an overview of selective mutism in culturally and linguistically diverse children. A systematic literature review of selective mutism studies that included a group of culturally and linguistically diverse children yielded eight studies that met our inclusion criteria. Although these studies support the view that bilingualism and minority status might be associated with selective mutism, the role of sociocultural factors in the development and persistence of the disorder remained mostly unexamined. The review concludes with a discussion of potential directions for future research, including examination of the cultural and psychological meanings of silence and talk, socialization goals, gender inequality, and parental acculturation strategies.
      Citation: Transcultural Psychiatry
      PubDate: 2023-01-11T07:28:15Z
      DOI: 10.1177/13634615221146435
       
  • Concurrent and convergent validity of culture-specific psychopathology
           syndromes among Cambodian adolescents

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      Authors: Anh Dao, Sareth Khann, Desiree M. Seponski, Dang Hoang-Minh, Cong V. Tran, Bahr Weiss
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Psychopathology is defined in part by its impacts on life functioning (e.g., fulfillment of daily responsibilities at work or school, in family relationships). Relations to life functioning are particularly important in the validation of culture-specific syndromes (patterns of mental health symptoms specific to a particular culture), to demonstrate that culture-specific symptom patterns do in fact represent pathology. The current study's goal was to assess the construct validity of the Cambodian Somatic Symptom and Syndrome Inventory (CSSI). The study focused on the statistically unique effects of the CSSI on life functioning (i.e., effects of the CSSI on life functioning, controlling for Western psychopathology syndromes), to determine whether the CSSI contributes information beyond standard Western measures, which would support CSSI culture-specific convergent validity. Because adolescence is a key period when psychopathology often develops, study participants were 391 high-school students in one urban and one rural area of Cambodia. Participants completed the CSSI, the Western psychopathology surveys Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder questionnaire (GAD-7), and life functioning measures assessing functional impairment, quality of life, and help-seeking. Results indicated strong CSSI concurrent validity (canonical correlation = 0.75) with the PHQ-9 and GAD-7, and CSSI total effects convergent validity on life functioning indicators. All CSSI statistically unique effects (controlling for the PHQ-9 and GAD-7) on life functioning measures were non-significant indicating that the CSSI, shown to be a valid assessment measure in the current study, does not add predictive information beyond standard Western measures. A key limitation that should be considered in interpretation of these results is that the life functioning measures, although reviewed by Khmer psychologists, were Western-based, thus potentially inflating relations with Western psychopathology measures.
      Citation: Transcultural Psychiatry
      PubDate: 2022-12-27T06:00:05Z
      DOI: 10.1177/13634615221140704
       
  • Cultural adaptation considerations of a comprehensive housing outreach
           program for indigenous youth exiting homelessness

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      Authors: Jessie I. Lund, Elaine Toombs, Christopher J. Mushquash, Victoria Pitura, Kaitlyn Toneguzzi, Tina Bobinski, Scott Leon, Nina Vitopoulos, Tyler Frederick, Sean A. Kidd
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Generalist health interventions that aim to reduce chronic health disparities between Indigenous and non-Indigenous populations can be culturally adapted to better meet the needs of Indigenous people in Canada; however, little is known regarding best practices in implementing these adaptations. The present study first provides a review of the research process used to adapt a previous evidence-based housing initiative for Indigenous youth in Northwestern Ontario. Second, it includes an overview of the adaptations that were made and the associated rationale for such adaptations. Third, it examines the experiences of participants and staff involved in the cultural adaptation of the Housing Outreach Program Collaborative (HOP-C), a health intervention re-designed to improve physical and mental health outcomes, wellbeing, and social support for formerly homeless Indigenous youth as they secure housing. Qualitative feedback from interviews with 15 participants and eight program staff, in addition to one focus group with an additional six frontline workers, described perceived outcomes of the program's cultural adaptations. Modifications to the overall program structure, specific roles within the program (including counseling services, peer mentorship, cultural services, and case management), and adaptations to general implementation within the health organization providing the intervention were described by participants and staff as effective and helpful adaptations. The focus of Indigenous values at an organizational level led to consistent adaptations in counseling and case management to best meet the unique needs of the youth involved. Based upon participant interviews, recommendations to future adaptations are provided.
      Citation: Transcultural Psychiatry
      PubDate: 2022-12-26T06:57:23Z
      DOI: 10.1177/13634615221135438
       
  • The roles and impacts of worldviews in the context of meditation-related
           challenges

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      Authors: Jared R. Lindahl, Roman Palitsky, David J. Cooper, Willoughby B. Britton
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Previous research has shown that worldviews can serve as a coping response to periods of difficulty or struggle, and worldviews can also change on account of difficulty. This paper investigates the impacts worldviews have on the nature and trajectory of meditation-related challenges, as well as how worldviews change or are impacted by such challenges. The context of meditation-related challenges provided by data from the Varieties of Contemplative Experience research project offers a unique insight into the dynamics between worldviews and meditation. Buddhist meditation practitioners and meditation experts interviewed for the study report how, for some, worldviews can serve as a risk factor impacting the onset and trajectory of meditation-related challenges, while, for others, worldviews (e.g., being given a worldview, applying a worldview, or changing a worldview) were reported as a remedy for mitigating challenging experiences and/or their associated distress. Buddhist meditation practitioners and teachers in the contemporary West are also situated in a cultural context in which religious and scientific worldviews and explanatory frameworks are dually available. Furthermore, the context of “Buddhist modernism” has also promoted a unique configuration in which the theory and practice of Buddhism is presented as being closely compatible with science. We identify and discuss the various impacts that religious and scientific worldviews have on meditation practitioners and meditation teachers who navigate periods of challenge associated with the practice.
      Citation: Transcultural Psychiatry
      PubDate: 2022-12-08T07:31:46Z
      DOI: 10.1177/13634615221128679
       
  • Pasung: A qualitative study of shackling family members with mental
           illness in Indonesia

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      Authors: Børge Baklien, Marthoenis Marthoenis, Arif Rahman Aceh, Miranda Thurston
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Use of coercion on people with mental illness is a deeply embedded practice around the world. Not only does the practice raise human rights issues, it also leads to further mental, physical, and emotional harms. In Indonesia, ‘pasung’ is a common practice of physical restraint, which involves lay people using a variety of illegal methods to tie a person. In this article, we explore the meanings families attach to their actions when using pasung by asking the question: to what extent does the use of pasung by families emerge from socioculturally prescribed norms and conventions' To explore this question, we conducted and analysed eight interviews with family members from Nias Island, Indonesia using Giorgi's descriptive phenomenological method. Our findings reveal that pasung emerges in the disjunction between sociocultural demands and the family's capacity to meet these demands. Struggling to understand the behaviour of a family member with mental illness, the family tries to cope with neighbourhood reactions to ever more visible behavioural signs alongside managing their everyday life. These struggles, in turn, make their social situation increasingly stressful, which initiates a process of depersonalization as a response. Moreover, the prevailing sociocultural values convey a need to act according to expected norms. As such, pasung materializes as a socioculturally accepted practice that allows families to take back control in stressful social situations. In sum, when families feel overwhelming emotional stress and a sense of powerlessness, they try to resolve their situation by using pasung to regain control and thus manage their lives.
      Citation: Transcultural Psychiatry
      PubDate: 2022-11-24T10:13:20Z
      DOI: 10.1177/13634615221135254
       
  • “I wanted to be a bride, not a wife”: Accounts of child marriage in
           the Bedouin community in Israel

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      Authors: Iris Manor Binyamini, Avihu Shoshana
      Abstract: Transcultural Psychiatry, Ahead of Print.
      This article presents a qualitative study of the experience of child marriage among Bedouin in Israel. We conducted semi-structured interviews with a convenience sample of 17 young Bedouin women, aged 17–21, who were married between the ages of 12–17. The interviewees’ descriptions indicate that child marriage is a powerful cultural practice that has evolved into a “natural” and “obvious” tool for supervising girls and women. All the interviewees reported domestic violence, despair, and reported suicide attempts as a response to their existential suffering in their marriage and as an act of daily resistance to a powerful and oppressive cultural practice. These findings raise challenges in the case of global mental health interventions since these interventions not only require cultural sensitivity to avoid the constraint of Western psychiatric diagnoses and classifications, but also more critical thinking about the interactions between global and local, universalist and culturalist perspectives.
      Citation: Transcultural Psychiatry
      PubDate: 2022-11-17T06:57:40Z
      DOI: 10.1177/13634615221135936
       
  • No time to grieve: Inuit loss experiences and grief practices in Nunavik,
           Quebec

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      Authors: Shawn Renee Hordyk, Mary Ellen Macdonald, Paul Brassard, Looee Okalik, Louisa Papigatuk
      Abstract: Transcultural Psychiatry, Ahead of Print.
      This article presents an overview of past and current grief rituals and practices and existing grassroots and institutional initiatives seeking to address the complex, prolonged, and traumatic grief experienced by many Inuit living in Quebec. While conducting a study seeking to identify the strengths, resources, and challenges for Nunavik's Inuit communities related to end-of-life care, results emerged concerning how family caregivers’ grief related to the dying process was compounded by the sequelae of historic loss experiences (e.g., losses related to Canada's federal policies, including residential schools, forced relocations, and dog slaughters) and by present loss experiences (e.g., tragic and sudden deaths in local communities). To better support caregivers, an understanding of these grief experiences and a vision of bereavement care inclusive of community mobilization efforts to develop bereavement training and support is needed. We conclude with a discussion of a community capacity approach to bereavement care.
      Citation: Transcultural Psychiatry
      PubDate: 2022-11-08T02:19:55Z
      DOI: 10.1177/13634615221135423
       
  • Forcibly displaced persons and mental health: A survey of the experiences
           of Europe-wide psychiatry trainees during their training

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      Authors: Iryna Frankova, Karl Scheeres, Giulia Menculini, Uğur Cikrikcili, Ioan-Costin Matei, Matthäus Fellinger, Ilaria Riboldi, Laura Uzer-Kremers, Levent Küey
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Many European countries have seen increasing refugee populations and asylum applications over the past decade. Forcibly displaced persons (FDPs) are known to be at higher risk of developing mental disorders and are in need of specific care. Thus, specific training for mental health professionals is recommended by international health organizations. The aim of this exploratory study was to assess the experience of clinical work with FDPs among psychiatric trainees in Europe and Central Asia as well as their interest and specific training received on this topic. An online questionnaire was designed by the Psychiatry Across Borders working group of the European Federation of Psychiatric Trainees (EFPT) and was distributed via email through local networks among European trainees from 47 countries between March 2017 and April 2019. Answers of 342 psychiatric trainees from 15 countries were included in the survey analysis. A majority of trainees (71%) had had contact with FDPs in the last year of their clinical work. Although three-quarters expressed a strong interest in the mental health of FDPs, only 35% felt confident in assessing and treating them. Specific training was provided to 25% of trainees; of this subset, only a quarter felt this training prepared them adequately. Skills training on transcultural competencies, post-traumatic stress disorder, and trauma management was regarded as essential to caring for refugees with confidence. Although psychiatric trainees are motivated to improve their skills in treating FDPs, a lack of adequate specific training has been identified. The development of practical skills training is essential. International online training courses could help meet this pressing need.
      Citation: Transcultural Psychiatry
      PubDate: 2022-11-08T02:18:35Z
      DOI: 10.1177/13634615221135421
       
  • “I didn’t do it!”: Lived experiences of suicide attempts made
           without perceived intent or volition

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      Authors: Shahnaz Savani, Robin E. Gearing
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Suicide is considered to be a conscious and intentional act that is carried out within a social and cultural context. This study examines the unique phenomenon of a cluster of suicide attempts conducted without perceived intent, ideation, plan, volition, or agency in a remote province in Central Asia. This study investigated the lived experiences of individuals who made such unintended suicide attempts and examined the differences between these experiences and those of individuals who made their suicide attempt with intent and agency. The authors conducted a secondary analysis of qualitative data originally collected for a prior grounded theory study. The present study examined a specific and unique set of participant experiences related to suicide attempts made without agency. Results found that instances of suicide attempts made without perceived intent by participants included themes of impulsivity, not knowing what happened, feeling out of control, attributing these experiences to the supernatural, and being fearful of such events occurring again. Clinical practice may need to be adapted to address experiences of such unique suicide attempt experiences. In addition, further research is warranted to understand and examine the phenomenon of suicide attempts carried out without perceived intent, ideation, plan, volition, or agency.
      Citation: Transcultural Psychiatry
      PubDate: 2022-11-08T02:16:56Z
      DOI: 10.1177/13634615221126057
       
  • Chasing dön spirits in Tibetan medical encounters: Transcultural
           affordances and embodied psychiatry in Amdo, Qinghai

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      Authors: Tawni L. Tidwell, Nianggajia, Heidi E. Fjeld
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Although spirit possession is generally considered a psychiatric illness, the class of conditions designated as dön (Tib. gdon, “afflictive external influences,” often glossed as “spirit affliction”) in Tibetan medicine represents a distinctive paradigm for an etiology where physical and mental facets inhere in every illness. This study draws upon ethnographic fieldwork in eastern Tibet to examine two conditions that represent illness presentations at both ends of the dön spectrum: one that maps onto a biomedical etiology of stroke and another that presents in a way similar to schizophrenia. The case studies illuminate the forms of harmful external influences that (1) have physiological and psychological impacts that present as symptoms and (2) contribute to a pathogenesis common to both conditions. Our analysis considers the dual role of cultural affordances and bio-looping in the cultural presentation of the two conditions, as well as how the Tibetan medical tradition draws upon cultural, social, biological, and psychological determinants to understand this class of conditions. We also explore the implications the dön illness category has for biomedically oriented paradigms through the way in which it accounts for cultural models for both diagnosis and treatment of several chronic inflammatory conditions that have significant concomitant mental health presentations.
      Citation: Transcultural Psychiatry
      PubDate: 2022-10-19T07:11:01Z
      DOI: 10.1177/13634615221126058
       
  • Help-seeking strategies and treatment experiences among individuals
           diagnosed with Bipolar Spectrum Disorder in Iran: A qualitative study

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      Authors: Fahimeh Mianji, Laurence J. Kirmayer
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Social, cultural, and structural factors are associated with delays in seeking help from mental health professionals and poor treatment adherence among patients with mood disorders. This qualitative study examined the perspectives on the services and response to treatments of individuals diagnosed with Bipolar Spectrum Disorder (BSD) in Iran through 37 in-depth semi-structured interviews with patients who had received BSD diagnosis and treatment (excluding Bipolar-I). Interviews explored two broad areas: 1) coping and help-seeking strategies; and 2) barriers to treatment and expectations of outcomes from treatment. Multiple factors influenced the help-seeking strategies and trajectories of patients with BSD diagnoses in Iran, including: structural limitations of the mental healthcare system; modes of practice of biological psychiatry; characteristics of the official psychology and counseling services permitted by Iran’s government; popular psychology and consultation (offered through social media from the diaspora) by Iranian psychologists and counsellors in the diaspora; and alternative spiritual and cult-based groups. To improve the quality and accessibility of mental health services, it is essential to have structural changes in the healthcare system that prioritize human rights and individuals’ values over the political and ideological values of the state and changes in the professions that promote secular training of mental healthcare providers and an ecosocial model of care.
      Citation: Transcultural Psychiatry
      PubDate: 2022-10-17T07:14:36Z
      DOI: 10.1177/13634615221127855
       
  • Challenges and strategies in the psychiatric care of the ultra-Orthodox
           Jewish population: A thematic analysis of 18 psychiatrist interviews

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      Authors: Aaron M. Bloch, Ezra Gabbay, Linda M. Gerber, Anna Lopatin Dickerman, Samantha Knowlton, Joseph J. Fins
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Despite the importance of accessible psychiatric care for the ultra-Orthodox Jewish community, prior research has characterized how stigma and suspicion of secular institutions limit mental healthcare utilization by this population. No study, however, has interviewed a cohort of psychiatrists to identify commonly encountered challenges or successfully employed strategies in the care of ultra-Orthodox Jewish psychiatric patients who have overcome these barriers to present for care. We recruited by snowball sampling from a sample of convenience 18 psychiatrists affiliated with the Weill Cornell Department of Psychiatry, experienced in the care of ultra-Orthodox Jewish patients. Each participant was engaged in a 20–45-min, semi-structured interview, which was subsequently transcribed, de-identified, and analyzed with combined deductive and inductive thematic analysis. We identified 12 challenges and 11 strategies as particularly significant in psychiatric work with ultra-Orthodox Jewish patients at every phase of treatment, including rapport-building, history-taking, diagnostic formulation, and achieving concordance with patient and family. These challenges and strategies revolved around themes of community stigma, an extended family-patient-community team, cross-cultural communication, culture-related diagnostic complexity, transference/countertransference, and conflicts between Jewish law /community norms and treatment protocol. Psychiatrists caring for ultra-Orthodox Jewish patients face a range of complex challenges stemming from factors unique to ultra-Orthodox Jewish religion, culture, and family/community structure. However, they have also identified strategies to manage these challenges and provide culturally sensitive care. Further research is necessary to directly elicit perspectives from within the ultra-Orthodox Jewish community and validate our initial findings.
      Citation: Transcultural Psychiatry
      PubDate: 2022-10-12T07:36:20Z
      DOI: 10.1177/13634615221126052
       
  • Psychological distress and anxiety in Arab refugees and migrants during
           the COVID-19 pandemic in Germany

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      Authors: Jinan Abi Jumaa, Antonia Bendau, Andreas Ströhle, Andreas Heinz, Felix Betzler, Moritz Bruno Petzold
      Abstract: Transcultural Psychiatry, Ahead of Print.
      The COVID-19 pandemic is associated with various psychological stressors due to health-related, social, economic, and individual consequences, especially for minority groups such as refugees and other migrants who live in unstable conditions and have lost their social support groups. The aim of this study was to explore the impacts of the COVID-19 pandemic on this specific population in Germany.This study used a mixed-method approach. A total of 85 migrants took part in an online survey in Germany from April to July 2020. The questionnaire included demographic information and measures of psychological distress, anxiety and depressive symptoms, as well as risk and protective factors for psychological health during the COVID-19 pandemic. Semi-structured interviews with 10 refugees were conducted between May and June 2020. In our sample, 54.5% expressed fear of being infected with COVID-19. Participants spent several hours per day thinking about COVID-19 (M  =  3.13 hours). Psychological and social determinants of mental health showed stronger associations with anxiety regarding COVID-19 than experiences with the disease. Interviews showed that especially for refugees with limited information regarding access to medical treatment, the pandemic increased already-existing psychological symptoms and worries about their families back home and reminded them of their flight from their home country to Europe. The COVID-19 pandemic is associated with psychological distress, anxiety, and depression in refugees and migrants in Germany. Information on where to get medical treatment, if needed, is of utmost importance to this population group, in addition to other strategies such as maintaining a healthy lifestyle and social contacts, and acceptance of strategies to cope with anxiety and negative emotions.
      Citation: Transcultural Psychiatry
      PubDate: 2022-09-26T06:06:41Z
      DOI: 10.1177/13634615221122536
       
  • Why local concepts matter: Using cultural expressions of distress to
           explore the construct validity of research instruments to measure mental
           health problems among Congolese women in Nyarugusu refugee camp

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      Authors: M. Claire Greene, Peter Ventevogel, Samuel L. Likindikoki, Annie G. Bonz, Rachael Turner, Susan Rees, Lusia Misinzo, Tasiana Njau, Jessie K. K. Mbwambo, Wietse A. Tol
      Abstract: Transcultural Psychiatry, Ahead of Print.
      There is considerable variation in the presentation of mental health problems across cultural contexts. Most screening and assessment tools do not capture local idioms and culturally specific presentations of distress, thus introducing measurement error and overlooking meaningful variation in mental health. Before applying screening and assessment tools in a particular context, a qualitative exploration of locally salient idioms and expression of distress can help assess whether existing measures are appropriate in a specific context as well as what adaptations may improve their construct validity. We aimed to employ a mixed-methods approach to describe and measure cultural concepts of distress among female Congolese survivors of intimate partner violence in Nyarugusu refugee camp, Tanzania. This sequential study used data from 55 qualitative (free-listing and in-depth) interviews followed by 311 quantitative interviews that included assessments of symptoms of common mental disorder to explore whether the symptom constellations were consistent across these methodologies. Results from thematic analysis of qualitative data and exploratory factor analysis of quantitative data converged on three concepts of distress: huzuni (deep sadness), msongo wa mawazo (stress, too many thoughts), and hofu (fear). The psychometric properties of these constructs were comparable to those of the three original common mental disorders measured by the quantitative symptom assessment tools—anxiety, depression, and post-traumatic stress disorder—adding weight to the appropriateness of using these tools in this specific setting. This mixed-methods approach presents an innovative additional method for assessing the local “cultural fit” of globally used tools for measuring mental health in cross-cultural research.
      Citation: Transcultural Psychiatry
      PubDate: 2022-09-17T05:06:37Z
      DOI: 10.1177/13634615221122626
       
  • “It's like having strong roots. We’re firmly planted”: Cultural
           identity development among Alaska Native University students

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      Authors: Sara L. Buckingham, Jacy R. Hutchinson
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Cultural identity is associated with positive emotional and behavioral health. However, colonialism and its forces, past and present, have led to cultural loss in many Indigenous communities, contributing to health disparities. And yet, Indigenous peoples actively resist colonialism and work to maintain and revitalize their cultures around the globe. This study sought to understand how Alaska Native university students from diverse cultural backgrounds are presently developing and constructing their cultural identities. Transformational grounded theory methods were used to analyze seven focus groups with 20 Alaska Native university students from diverse cultural regions, now living in an urban center. Results revealed that identity was constructed as a series of nested and intersecting identities that centered on relations, place, and time across cultural groups. Cultural practices and values were often drawn upon to understand identity. Cultural identity was developed through storytelling, experiential learning, connection, personal exploration, and sharing with others. Relatives, particularly grandparents and Elders, and communities played a critical role in shaping cultural identity. The construction of cultural identity and its development diverged by setting of upbringing (rural, urban). Results have implications for the modification of structures and the development of cultural identity promotion programming to support Alaska Native young peoples’ identity development in an effort towards emotional and behavioral health.
      Citation: Transcultural Psychiatry
      PubDate: 2022-09-15T06:33:16Z
      DOI: 10.1177/13634615221122524
       
  • South Asian youth mental health in Peel Region, Canada: Service provider
           perspectives

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      Authors: Farah Islam, Syeda Qasim, Muhanad Ali, Michaela Hynie, Yogendra Shakya, Kwame McKenzie
      Abstract: Transcultural Psychiatry, Ahead of Print.
      The Peel Region of Toronto, Canada is home to over a third of the province's South Asian population. Youth are at a vulnerable time period in terms of their mental health. South Asian youth populations may face additional challenges to their mental health such as acculturative stress, intergenerational conflict, and racism and discrimination. This qualitative study set out to understand the mental health concerns and service access barriers experienced by South Asian youth populations in the Peel Region of Toronto, Canada from the perspective of mental health service providers. In-depth semi-structured interviews were carried out with mental health service providers (n  =  22) who work with South Asian youth living in Peel Region. Thematic analysis was used to elucidate themes related to mental health stressors and service access barriers experienced by youth. According to mental health service providers, South Asian youth navigate a number of unique stressors related to the domains of culture, religion, and family dynamics, experiences of discrimination, the impact of migration, beliefs around mental illness and help-seeking, help-seeking trajectories and therapy recommendations, and lastly, sex differences. Mental health service providers outlined steps needed to effectively address the unique mental health challenges, best practice guidelines, and recommendations for working with South Asian youth, families, and communities to provide a practical and nuanced overview on how a multi-level strategy for mental health care can effectively meet the needs of South Asian youth populations.
      Citation: Transcultural Psychiatry
      PubDate: 2022-09-14T05:20:13Z
      DOI: 10.1177/13634615221119384
       
  • Religiosity, perceived anti-Semitism, xenophobia and mental health:
           Experiences of Jewish immigrants from the former Soviet Union in Austria
           and Germany

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      Authors: Beata Trilesnik, Iris Tatjana Graef-Calliess, Thomas Stompe, Thomas Fydrich
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Research about the relation between migration and mental health as well as factors influencing the mental health of migrants has been growing because challenges of migration can constitute a significant mental health burden. However, its divergent findings seem to reflect group-specific differences, e.g., regarding country of origin and receiving country. Almost no empirical studies about individual migrant groups in different receiving countries have been undertaken so far. The present population-based study explores symptoms of depression, anxiety, and somatization as well as quality of life in an Austrian and a German sample of ex-Soviet Jewish migrants. We mainly investigate the relationship of religiosity and perceived xenophobic and anti-Semitic discrimination to the psychological condition of the migrants. Standardized self-report scales, specifically the Beck-Depression-Inventory-II (BDI), State-Trait-Anxiety-Inventory (STAI), Brief Symptom Inventory (BSI), and WHO Quality of Life Questionnaire (WHOQOL-BREF), were used to measure mental health. Ex-Soviet Jewish migrants in Austria showed significantly more depression, anxiety, and somatic symptoms than those in Germany. Regression analyses support a protective effect of religiosity on mental health in the sample in Germany and an adverse effect of perceived discrimination in the sample in Austria. The present study reveals a less favorable situation for ex-Soviet Jewish migrants in Austria, in terms of income, residence status, and xenophobic attitudes in the local population, compared to the group in Germany. Furthermore, our data suggest that the receiving country matters for the mental health of this migrant group. However, further research is needed to support these conclusions.
      Citation: Transcultural Psychiatry
      PubDate: 2022-09-14T05:19:53Z
      DOI: 10.1177/13634615221107204
       
  • Interpreter-mediated psychiatric assessments: Metacommunication as key

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      Authors: Orest Weber, Jonathan Klemp, Florian Chmetz, Argyro Daliani, Esther-Amélie Diserens, Florence Faucherre
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Psychiatric assessments of non-native migrant patients facilitated by an interpreter pose specific communication challenges to all participants. In this study, we developed an original interdisciplinary approach to the verbal and non-verbal practices in this triadic activity. The aim was a data-based description of challenges for clinicians and interpreters, and the identification of relevant strategies. We filmed, transcribed and translated 10 interpreter-mediated consultations focused on the psychiatric assessment of the patient. Subsequently, we submitted the consultations to clinical, interactional sociolinguistic, and interdisciplinary analyses. We identified six challenges for interpreters and clinicians engaged in psychiatric assessments: barely comprehensible and confusing speech, speech about emotions and subjective perceptions, sensitive remarks in relational terms, conclusive clinician interventions, interruptions during interpreter renditions, and non-verbal communication. Attempts by the interpreter to avoid relational offenses (protection of positive face) and to defend the participants’ autonomy (protection of negative face) play a major role in these challenges. So does an insufficient awareness of mutual needs by the clinician and the interpreter. We identified specific strategies of inter-professional metacommunication for each challenge. Clinicians and interpreters should be aware of the challenges they may face in triadic psychiatric assessments. They should take a reflexive stance towards their common practices and may consider using metacommunication tools to reach better communicational and clinical outcomes.
      Citation: Transcultural Psychiatry
      PubDate: 2022-09-09T02:22:42Z
      DOI: 10.1177/13634615221119383
       
  • “Mending fractured personalities”: A photography-based cultural study
           of recovery from mental distress in Romania

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      Authors: Lucian Hadrian Milasan
      Abstract: Transcultural Psychiatry, Ahead of Print.
      This study explored the lived experiences and meanings of recovery from mental distress from the perspective of mental health service users in Romania, along with investigating cultural particularities of recovery in this country. Research in this area is essential in the context of Romania's mental health reform marked by a transition from institutionalised mental health services to a recovery-based approach, and profound social and economic changes during the post-communist era. Subscribing to the recovery framework, this study employed a qualitative phenomenological design involving 15 adults with mental health problems purposively recruited from a community day centre in Romania. The phenomenological background was enriched with elements of participatory photography to elicit subjective experiences and meanings of recovery. The outcome of this study was a better understanding of recovery in Romanian adults living with mental distress, as a complex and multi-layered phenomenon. Three key themes were identified through Interpretative Phenomenological Analysis: awakening, healing, and reconstructing life. The findings add to the current recovery models by showing that recovery cannot be fully understood unless situated in a socio-political, cultural, and historical context. Implications for mental health practice in Romania are discussed and directions for future research are recommended.
      Citation: Transcultural Psychiatry
      PubDate: 2022-08-29T07:16:31Z
      DOI: 10.1177/13634615221119373
       
  • Understanding mechanisms of change in a family-based preventive mental
           health intervention for refugees by refugees in New England

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      Authors: Kira DiClemente-Bosco, Sarah Elizabeth Neville, Jenna M. Berent, Jordan Farrar, Tej Mishra, Abdirahman Abdi, William R. Beardslee, John W. Creswell, Theresa S. Betancourt
      Abstract: Transcultural Psychiatry, Ahead of Print.
      Transnational migration of refugees is associated with poor mental health, particularly among children. We conducted a pilot trial of the Family Strengthening Intervention for Refugees (FSI-R), using a community-based participatory research (CBPR) approach to deliver a home-based intervention “for refugees by refugees” to improve family functioning and child mental health. N = 80 refugee families in the Greater Boston area participated in the study (n = 40 Somali Bantu families; n = 40 Bhutanese families) with n = 41 families randomized to care-as-usual. Of the 39 families who received FSI-R, n = 36 caregivers and children completed qualitative exit interviews. We present findings from these interviews to identify the mechanisms through which a family-strengthening intervention for refugees can be acceptable, feasible, and effective at improving family functioning and children's mental health outcomes.
      Authors applied Grounded Theory to code interview transcripts and detailed field notes and used an iterative process to arrive at final codes, themes, and a theoretical framework. The greatest contributors to acceptability and feasibility included flexibility in scheduling intervention sessions, the interventionist being a community member, and improvements to family communication and time spent together. All of these factors were made possible by the CBPR approach. Our findings suggest that given the socio-political context within the U.S. and the economic challenges faced by refugee families, the successful implementation of such interventions hinges on culturally-grounding the intervention design process, drawing heavily on community input, and prioritizing community members as interventionists.
      Citation: Transcultural Psychiatry
      PubDate: 2022-08-22T07:36:36Z
      DOI: 10.1177/13634615221111627
       
  • Non-affective psychosis in traditional Andean culture

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      Authors: Marucela Uscamayta Ayvar, Rodolfo Sanchez Garrafa, Javier I. Escobar, Carla Gallo, Abraham Vaisberg, Giovanni Poletti, Gabriel A. de Erausquin
      Abstract: Transcultural Psychiatry, Ahead of Print.
      We report a case of non-affective psychosis with a brief discussion of the phenomenology and its characterization and treatment by traditional Inka healers and eventually by Western-trained psychiatrists. Traditional Inka psychopathology provided empirical support for the transcultural stability of the Kraepelinian dichotomy.
      Citation: Transcultural Psychiatry
      PubDate: 2022-08-17T08:03:52Z
      DOI: 10.1177/13634615221099795
       
  • Intergenerational conflict among resettled South Sudanese in Australia

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      Authors: Troy Pittaway, Elisha Riggs, Jaya A. R. Dantas
      Abstract: Transcultural Psychiatry, Ahead of Print.
      South Sudanese families have faced many hardships in the process of acculturation to Australian society. This has led to rapid family breakdown amongst refugees from South Sudan who live in Melbourne, Australia, and has created tension between families, the wider South Sudanese community, and authorities. This qualitative study explores how shifting dynamics of religious faith, the concept of family and cultural values impacts South Sudanese families and young people. The study consisted of 23 semi-structured interviews, three focus groups and two feedback forums, gathering data from South Sudanese youth aged 14 to 21 years, social workers, elders and parents from the South Sudanese community. Several themes were identified including the impact of intergenerational conflict, coping with new freedoms in Australia, the associated tensions these freedoms create within the South Sudanese community, and young people’s conflict with religion. The patriarchal system that underpins the family structure of the South Sudanese culture is under significant strain as women and children are becoming aware of their rights, resulting in friction between men and women, parents and children. Male elders believed the embracing of freedom by women and children was at the core of family breakdown, leading to cultural erosion, and was the root of the problems experienced by the youth. The church as a traditional meeting place and a centre point for social inclusion within the South Sudanese community remains relevant as an important factor in social networking for parents and elders but lacks relevance for many South Sudanese youth.
      Citation: Transcultural Psychiatry
      PubDate: 2022-08-16T05:40:12Z
      DOI: 10.1177/13634615221105115
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • Transgenerational trauma in Rwandan genocidal rape survivors and their
           children: A culturally enhanced bioecological approach

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      Authors: Sarilee Kahn, Myriam Denov
      First page: 727
      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
       
  • 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
      First page: 740
      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
       
  • 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
      First page: 756
      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
       
  • Mujeres abnegadas: The influence of gender expectations on the psychiatric
           encounter in Mexico

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      Authors: Alyssa Marie Ramírez Stege
      First page: 767
      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
       
  • 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
      First page: 782
      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
      First page: 797
      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
       
  • 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
      First page: 810
      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
       
  • 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
      First page: 819
      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
       
  • 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
      First page: 831
      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
      First page: 844
      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
       
  • 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
      First page: 863
      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
       
  • 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
      First page: 878
      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
       
 
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