Causal attributions for illness among Turkish psychiatric out-patients and differences between diagnostic groups

Stress and Distress in Migration: Twenty Years After

Based on qualitative interviews with a group of immigrant women, “Stress and Distress in Migration: Problems and Resources of Turkish Women in Denmark” was published in this journal in 1984. Twenty years later, the same group was contacted and reinterviewed with the purpose of investigating the changes that had taken place in actual living conditions and subjective perception of well-being. Although the material situation of the women had markedly improved, and the number of somatic complaints had decreased, the level of distress was still high twenty years later. The changes in the women's conditions, expressions of grief, and implications for interventions are discussed.

One Size Does Not Fit All in Psychotherapy: Understanding Depression Among Patients of Turkish Origin in Europe

Over the last decades, Europe has become an immigration country hosting an estimated 56 million international immigrants. Yet, a large amount of literature suggests that migration is associated with a higher risk of common mental disorders, such as depression and anxiety. As representatives of one of the largest immigrant groups in Europe, various studies have shown that Turkish immigrants exhibit a higher prevalence of depression and anxiety disorders than do the background population. Nevertheless, it is also well demonstrated that this particular patient group is more likely to terminate treatment prematurely and displays lower rates of treatment compliance than their native counterparts. This reluctance for service utilization might be partially because of the fact that people from non-Western ethno-cultural backgrounds (e.g., Turkey) often have a different notion and comprehension of mental health and illness as compared with those of the people from Western societies. Such mismatch often results in discrepancies between the needs and expectations of immigrant patients and clinicians, which attenuate the communication and effectiveness of treatment and lead to unexplained high dropout rates. To provide continued provision of culture-sensitive, high quality, evidence-based mental health care, the advancement of researches exploring such sociocultural differences between the patients' and the clinicians' notions of mental health must occur. In response to these problems, the current review aims to explore the interplay between culture and mental processes that associate with the etiology, maintenance, and management of depression among Turkish immigrant patients. This is to inform clinicians regarding culture-specific correlates of depression among Turkish patients to enable them to present interventions that fit the needs and expectations of this particular patient group.

Exploring the relevance of autonomy and relatedness for mental health in healthy and depressed women from two different cultures: when does culture matter?

BACKGROUND

It is well known that the absence of both autonomy and social support (relatedness) are two important etiologic pathways to major depressive disorder (MDD). However, cross-cultural researchers state that the implications of autonomy and relatedness for mental health vary across cultures.

AIM

To test these assumptions, the current study investigated the relevance of autonomy and relatedness for mental health in healthy and depressed women from two different cultures (Germans and Turkish immigrants in Germany).

METHODS

One hundred and eight (108) women were evaluated for their levels of autonomy/relatedness satisfaction, for overall psychopathological complaints including depression, for affectivity and for perceived loneliness through self-report measures.

RESULTS

Among healthy groups, relatedness satisfaction predicted better mental health in Turkish women, whereas in German women, autonomy satisfaction was the better mental health predictor. Within depressed groups however, cultural differences in mental health outcomes regarding autonomy were no longer evident. Autonomy was associated with higher levels of mental health in Turkish as well as in German patients.

CONCLUSIONS

Our findings indicate that the relationship between autonomy and mental health is culture-specific in healthy women, but disappears in depressed women. These findings are discussed with consideration of clinical implications and an outlook regarding further research.

Illness causal beliefs in Turkish immigrants

BACKGROUND

People hold a wide variety of beliefs concerning the causes of illness. Such beliefs vary across cultures and, among immigrants, may be influenced by many factors, including level of acculturation, gender, level of education, and experience of illness and treatment. This study examines illness causal beliefs in Turkish-immigrants in Australia.

METHODS

Causal beliefs about somatic and mental illness were examined in a sample of 444 members of the Turkish population of Melbourne. The socio-demographic characteristics of the sample were broadly similar to those of the Melbourne Turkish community. Five issues were examined: the structure of causal beliefs; the relative frequency of natural, supernatural and metaphysical beliefs; ascription of somatic, mental, or both somatic and mental conditions to the various causes; the correlations of belief types with socio-demographic, modernizing and acculturation variables; and the relationship between causal beliefs and current illness.

RESULTS

Principal components analysis revealed two broad factors, accounting for 58 percent of the variation in scores on illness belief scales, distinctly interpretable as natural and supernatural beliefs. Second, beliefs in natural causes were more frequent than beliefs in supernatural causes. Third, some causal beliefs were commonly linked to both somatic and mental conditions while others were regarded as more specific to either somatic or mental disorders. Last, there was a range of correlations between endorsement of belief types and factors defining heterogeneity within the community, including with demographic factors, indicators of modernizing and acculturative processes, and the current presence of illness.

CONCLUSION

Results supported the classification of causal beliefs proposed by Murdock, Wilson & Frederick, with a division into natural and supernatural causes. While belief in natural causes is more common, belief in supernatural causes persists despite modernizing and acculturative influences. Different types of causal beliefs are held in relation to somatic or mental illness, and a variety of apparently logically incompatible beliefs may be concurrently held. Illness causal beliefs are dynamic and are related to demographic, modernizing, and acculturative factors, and to the current presence of illness. Any assumption of uniformity of illness causal beliefs within a community, even one that is relatively culturally homogeneous, is likely to be misleading. A better understanding of the diversity, and determinants, of illness causal beliefs can be of value in improving our understanding of illness experience, the clinical process, and in developing more effective health services and population health strategies.

Finding help: Turkish-speaking refugees and migrants with a history of psychosis

There is a large population of Turkish-speaking migrants living in London, many of whom are refugees (Enneli, Modood, & Bradley, 2005). Primary care and secondary mental health services have consistently reported poor continuity of care among patients from this community. The aim of this study was to explore the possible interconnection of causal attributions and pathways into care among Turkish-speaking, mainly Kurdish, patients with a past history of psychosis. Narratives of illness were elicited from informants. Physical symptomatology was a prominent feature of presentation in this group. These patients did not discuss their health problems conceptualized as uniform ;models' of illness, but rather in an attributional style that emphasized the experience of traumatic life events, often related to the overarching problem of exile and settlement. Childhood and family issues of poverty and domestic violence were often raised by patients, but tended to be backgrounded as having little contributory significance. These patients sought intervention, serially or in combination, from a diverse range of practitioners, including private healthcare and traditional healers or hocas. Their explanatory models of illness were complex and fragmentary and the relationship between explanations and help seeking is seldom linear. The implications of these findings for health services are discussed.

Against over-interpretation: the understanding of pain amongst Turkish and Kurdish speakers in London

The understanding of experienced pain has recently moved from the biological to the metaphorical. Detailed interviews with twelve Turkish and Kurdish patients in London who had been unsuccessfully investigated medically for chronic pain showed that their understanding reflected local, typically humoural, conceptions of self and body. However there was little to suggest interpretation of the illness as a more specific and grounded idiom for social or political experience. It is suggested that the current vogue for 'interpretation' in medical anthropology and social psychiatry may occasionally be, as Umberto Eco puts it, 'over-interpretation'.

Caregivers of Turkish schizophrenic patients: causal attributions, burdens and attitudes to help from the health professionals

The purpose of this study was to examine the causal attributions, difficulties, perceived and expected help behaviour of health care professionals, and hope for the future well-being of the caregivers of Turkish schizophrenic patients in order to form guidelines for forming a collaboration with the families of schizophrenic patients. Sixty caregivers were interviewed by using a semi-structured interview schedule. The responses of the caregivers were categorized within the guidelines of the literature in this area. The caregivers attributed schizophrenia mainly to psychosocial causes, namely stressful events (50%), family conflicts (40%) and patients' characteristics (28%). The most frequently reported difficulties were family conflicts and disruptions of family life, subjective burden (48%), and financial costs due to the patient (27%). The number of difficulties reported by caregivers was related to the duration of the patient's illness. Caregivers perceived pharmacological treatment (42%), interest and support given to the caregiver (28%), and the hospitalization of the patient (20%) as helpful. THeir expectations of help were in similar areas. About half of the caregivers were optimistic about the future well-being of their relatives. Optimistic and pessimistic caregivers differed in the educational level of the caregiver and the duration of the patient's illness. The results suggested that the families of schizophrenics need support of professionals and the establishment of networks focusing on the caregivers and their relationships with their ill relatives and with health care institutions.