Knowledge and preferences regarding schizophrenia among Chinese-speaking Australians in Melbourne, Australia

Associations between demographic factors and psychological distress among Chinese residents in Hong Kong: beyond socioeconomic classes

Most studies highlighted the association between psychological distress and socioeconomic status (SES). There were weaker explanations for distress found in the middle classes, especially in Asian countries. We conducted a questionnaire survey with 1626 adult Chinese primary-care attenders from 13 private and 6 public clinics in different districts of Hong Kong. Their demographic background and distress level measured by GHQ-12 were analysed. We found that respondents with younger age, better education, and lower income were more likely to be distressed. In a multiple logistic regression model, age and income, but not education, were significant predictors for distress. Highest rates of distress were found among the unemployed (45.5%) and the students (37.1%), followed by service workers and shop sales workers (33.0%), associate professionals (32.0%), and clerks (29.2%). Craftworkers (9.1%), plant and machine operators (11.5%), and retired people (12.8%) were least likely to be distressed, followed by professionals (21.0%). Apart from SES, the findings suggest that young age, academic and job stressors, and low self-esteem are significant factors for distress. These factors may be intensified in a Chinese context by peer comparison resulting in a state of relative deprivation.

Making the subjects of mental health care: a cross-cultural comparison of mental health policy in Hong Kong, China and New South Wales, Australia

Constituting 'social problems' in particular ways has a range of effects, including for how subjects are positioned within policy and discourse. Employing an approach grounded in poststructuralist and social constructionist thinking, this analysis interrogates how the subjects of mental health care were constituted and problematised in mental health policies in two distinctive contexts, unsettling the taken-for granted assumptions which underpin these problematisations. Two policies were selected for analysis as exemplar pieces of mental health policy reform in Hong Kong and New South Wales (NSW). Subjects were constituted as 'patientised' individuals (in Hong Kong) encouraged to depend on professionals who help them reintegrate into the 'normal' community, and as 'traumatised' individuals (in NSW) expected to take responsibility to guide the delivery of mental health care and respected as a part of diversity in community settings. While both policies constituted subjects as 'unwell individuals' and enacted 'dividing practices', subjectivities were shaped by distinctive cultural and socio-political contexts. This analysis shifts our attention away from a focus on the effectiveness of policy solutions to the heterogeneity and contingency of policy 'problems' and 'subjects', opening up new possibilities for 'out-of-the-box' policy responses to mental health.

Public beliefs and attitudes toward schizophrenia and depression in Taiwan: A nationwide survey

Beliefs about and attitudes toward mental illness may be influenced by cultural- or country-specific contexts. Through a national survey, the current study investigated beliefs and attitudes toward people with schizophrenia and depression among the general public in Taiwan. A random-digit-dialing telephone-based cross-sectional survey was administered to Taiwanese adults aged 20-64 years (n = 1600). The data were analyzed through binary logistic regressions to test for differences between these disorders in causal beliefs, stereotypes, emotional reactions, desire for social distance, and help-seeking behavior. The results revealed that respondents were more concerned with biogenetic causal explanations for people with schizophrenia than for those with depression. Significantly more respondents perceived people with schizophrenia as more likely to be unpredictable and violent toward others. A similar trend was observed for the desire for social distance. For both disorders, respondents were significantly more likely to express compassion than to express anger toward the person described in the vignette. Respondents also expressed more desire for social distance from someone like the vignette who have received psychiatric treatment. These findings provide useful directions for the implementation of optimal psychoeducation among such communities. .

Psychosis Literacy Among Latinos With First-Episode Psychosis and Their Caregivers

OBJECTIVE

The study examined psychosis literacy among Latinos with first-episode psychosis (FEP) and their caregivers. The authors tested a model that knowledge of psychosis and attribution of illness to psychosis predicted professional help seeking in a cross-sectional design.

METHODS

The sample (N=148) consisted of 79 Latino consumers who met criteria for a clinical diagnosis of a psychotic disorder and 69 family caregivers. Participants watched a four-minute narrative about a woman with psychosis and were asked to identify the symptoms of serious mental illness (knowledge of psychosis), describe the character's problem and whether she had a serious mental illness (illness attribution), and offer suggestions about what the parents should do (help seeking). Responses to the open-ended questions were reliably coded by two trained raters.

RESULTS

Consumers reported low psychosis literacy across all indices (e.g., only 8% included delusions in their knowledge of serious mental illness). Compared with consumers, caregivers reported significantly greater psychosis literacy across most indices, although relatively few reported knowledge of delusions (28%) and disorganized speech (36%). Logistic regression analyses found that caregivers were more than twice as likely as consumers to suggest that the parents seek professional help. Among both consumers and caregivers, greater knowledge of psychosis and attribution of symptoms to serious mental illness were associated with increased likelihood of recommending professional help seeking.

CONCLUSIONS

Community campaigns and psychoeducation interventions within clinical settings are needed to improve psychosis literacy among Latinos with FEP. Increasing knowledge of psychosis and facilitating attributions of psychotic symptoms to serious mental illness have the potential to promote professional help seeking.

Perceptions about pasung (physical restraint and confinement) of schizophrenia patients: a qualitative study among family members and other key stakeholders in Bogor Regency, West Java Province, Indonesia 2017

Background

The UN resolution recommends treating all mentally ill patients with humanity and respect. However, social stigma continues to prevail for patients with schizophrenia. Physical restraint and confinement of the mentally ill is a well-known phenomenon in Indonesia and is termed as pasung.

Objective

To explore the perceptions of family members of patients of schizophrenia and other key stakeholders concerning pasung in Bogor Regency, West Java Province 2017.

Methods

This qualitative exploratory study was conducted in Bogor Regency, West Java Province from May to June 2017. This study involved 12 key stakeholders including family members, neighbors, community leaders, and mental health officers. In-depth interviews were conducted with family members (n = 3) who practiced pasung for patients with schizophrenia and key informant interviews of neighbors, community leaders (two household heads and one from a health cadre) (n = 3) and mental health officers of puskesmas (three midwives). Data triangulation was performed by interviewing residents and mental health workers. Content analysis was conducted and themes were identified based on valid inference and interpretation.

Results

Family members and society in general perceived that pasung is necessary for security reasons due to the patient’s aggressive behavior such as physical violence to neighbors, stealing food etc. According to community leaders, families often do not respond to patient’s request to be released from pasung. Family members had financial constraints to seek mental healthcare and were also dissatisfied with available services. Healthcare providers highlighted the poor knowledge and prevailing misconceptions about schizophrenia in the community.

Conclusion

Concurrent efforts to strengthen basic mental health services and health education regarding schizophrenia, prevalent misconceptions, and importance of timely and appropriate treatment are needed, especially in rural settings.

Comparing the mental health literacy of Chinese people in Australia, China, Hong Kong and Taiwan: Implications for mental health promotion

Using data of 200, 522, 572, and 287 Chinese from Australia, China, Hong Kong and Taiwan respectively, this study aimed at comparing the mental health literacy of Chinese people from different communities, and between Chinese communities and the Australian general public. The participants were asked questions that assessed their recognition of depression and schizophrenia. Compared with the Australians, much lower percentages of Chinese in the four Chinese communities could correctly identify depression and early schizophrenia. Commonalities in the preference for 'psychiatrist', 'psychologist', 'Chinese medical doctor', and 'Chinese traditional healer', a lack of knowledge of medications, and a higher likelihood of endorsement of traditional Chinese medicines were found among the four Chinese communities. Differences in the preference for 'general practitioner' and 'social worker', and a higher percentage of endorsement of herbal medicines were observed among the different Chinese communities. Cultural factors such as Chinese perceptions of mental illness, and socio-contextual factors such as differences in mental health care system in the four communities were offered to explain these commonalities and differences. Mental health promotion programmes for Chinese people may need to consider the above-mentioned cultural and socio-contextual factors so that specific promotion programmes can be developed.

Mental health literacy, stigma and perception of causation of mental illness among Chinese people in Taiwan

BACKGROUND

Few studies have been performed to explore mental health literacy and stigmatising attitudes towards mental illness and their relationships with causal beliefs about mental illness among Chinese people in Taiwan.

AIMS

Using a comparative approach, this study attempted to compare the mental health literacy and stigmatising attitudes of Taiwanese Chinese with those found among Australian and Japanese participants in other studies and to explore how mental health literacy and stigmatising attitudes relate to different perceptions of causes of mental illness.

METHODS

A convenience sample of 287 participants completed a battery of standardised questionnaires.

RESULTS

A much lower percentage of Taiwanese people than Australians could correctly identify depression and schizophrenia. The Taiwanese respondents rated psychiatrists and clinical psychologists as more helpful than social workers and general practitioners (GPs) and expressed more uncertainty about the usefulness of certain medications when compared to the Australian and Japanese samples. Interestingly, Taiwanese Chinese hold similarly high levels of stigma towards schizophrenia, but lower levels of stigma towards depression when compared to the Japanese respondents. Taiwanese respondents who have higher levels of mental health literacy about schizophrenia were less willing to interact with people with schizophrenia than those with lower levels of mental health literacy.

CONCLUSION

This study underlines the need for public education programmes to improve knowledge of various mental illnesses and to reduce stigmatising attitudes among Taiwanese Chinese. The aforementioned socially and culturally driven beliefs must be taken into consideration so that culturally relevant education programmes can be developed.

Mental health literacy about schizophrenia and depression: a survey among Chinese caregivers of patients with mental disorder

OBJECTIVE

To investigate the knowledge of schizophrenia and depression among caregivers of patients with mental disorder in China.

METHOD

A convenience sample of 402 caregivers at the Department of Psychiatry of a general hospital in China was investigated (response rate 95.7%), using vignettes based investigation methodology.

RESULTS

The number of caregivers using the term "depression" to describe the depression vignette was 43.6%, which was significantly higher than the number of caregivers using the term "schizophrenia" to describe the schizophrenia one (28.5%). A high percentage of caregivers believed that "psychiatrist", "psychologist" and "close family members" would be helpful, and the top three most helpful interventions were "becoming more physically active", "getting out and learning more" and "receiving psychotherapy". The number of caregivers endorsed "antipsychotics" and "antidepressants" as helpful for the schizophrenia and the depression vignettes were 82.0 and 80.7%, respectively. Regarding the causes of mental illness, items related to psychosocial factors, including "daily problems" and "work or financial problems", and "weakness of character" were highly rated, with half considered genetic or chemical imbalance causes.

CONCLUSION

Caregivers expressed a high knowledge about treatments and interventions of mental disorders. But there are still some areas, particularly regarding the recognition and causes of mental disorders, that are in need of improvement. This is particularly the case for schizophrenia.

Barriers of Chinese primary care attenders to seeking help for psychological distress in Hong Kong

BACKGROUND

Most of the previous studies on help seeking for psychological distress were derived from Western countries. This study investigated the barriers to help-seeking for psychological distress among Chinese primary care attenders in Hong Kong.

METHODS

Nine focus groups and 6 individual interviews were conducted among Chinese primary care attenders with/without known distress, patients' significant others and the general public. The identified barriers were investigated in a questionnaire survey with data from 1626 primary care attenders recruited from 13 private clinics and 6 public clinics.

RESULTS

Worries about side effects of drugs (79.9%, 95% CI:(77.9%, 81.8%)) and drug dependency (74.7%, 95% CI:(72.5%, 76.8%)) were rated as the top barriers in the survey. Qualitative interviews found both worries and actual experience of the side effects of drugs, which weakened patients' trust in the treatment. Factor analysis on all barrier items suggested three factors: 1) worries of treatment, 2) uncertainties on primary care physicians' capacity, 3) public's limited knowledge on distress and sources of help. Distress level, education level and age were associated with factor 1, whereas distress level and healthcare setting were associated with the other two factors. Qualitative interviews revealed that not having a regular primary care physician in the public setting discouraged disclosure of psychological problems.

LIMITATIONS

The findings were based on self-reported data from the respondents. Hong Kong is influenced by a mixed Chinese and Western culture.

CONCLUSIONS

Relevant public education in a Chinese context should target at reducing patients' worries of drug treatment and strengthening the image of primary care physicians as a feasible source of help.

Experiences of Chinese migrants caring for family members with schizophrenia in Australia

Little is known about the experience of Chinese migrants to Australia who are caring for a person with schizophrenia. The research was exploratory in nature, providing information on the health, help-seeking behaviors, burden, and caring experiences of Chinese carers of people with schizophrenia in Melbourne. Ethnic Chinese carers of people with schizophrenia were recruited. Health care or social service professionals were also interviewed to understand the context of Chinese migrants in seeking help for mental health problems and caring for someone with psychiatric illness. Recommendations for Chinese migrants facing mental health problems and challenges for social work practice are described.

Public knowledge and beliefs about depression among urban and rural Chinese in Malaysia

The study compared knowledge and beliefs about depression among urban and rural Chinese in a Malaysian sample. A total of 409 participants were asked to identify cases of depression varying in intensity from two vignettes and rate their beliefs regarding a list of possible causes and treatments for depression. The urban Chinese were more likely to identify depression as the problem in the vignette. Beliefs about causes of depression were factored into five components, whereas beliefs about treatment for depression factored into four components. The results indicated that the causes most strongly endorsed were stress and pressure, and standard treatments rated the highest as treatments for depression. Overall, depression literacy was moderate for Chinese Malaysians. The results are discussed in relation to Chinese cultural beliefs about depression. Limitations of this preliminary study were acknowledged.

Depression literacy among Chinese in Shanghai, China: a comparison with Chinese-speaking Australians in Melbourne and Chinese in Hong Kong

OBJECTIVE

The study reported in this paper was aimed at developing understanding of depression-related knowledge and preferences surrounding professional help, medication, and treatment methods among Chinese living in Shanghai, China.

METHODS

A multi-stage cluster sampling method in which participants were taken from 6 of the 20 districts in Shanghai was adopted for this study. The 522 Shanghai Chinese participants were presented with a vignette describing an individual with depression before being asked questions designed to assess both their understanding of depression and their preferences surrounding professional help, medication, and treatment methods. A comparative approach was adopted to identify similarities and differences between our findings and those of two previous studies on the mental health literacy of Chinese living in Melbourne, Australia, and Hong Kong, respectively.

RESULTS

A similarly low percentage of Chinese people in each of Shanghai, Hong Kong, and Australia recognized depression. Fewer Shanghai Chinese than Chinese living in Hong Kong and Australia ascribed the 'anxiety/stress' label to the depression vignette and endorsed professionals and informal network members as helpful. Although a far lower percentage of Shanghai Chinese endorsed the use of counseling professionals, a much higher percentage of the same group endorsed Chinese medical doctors and herbal medication. A lower percentage of Shanghai Chinese endorsed 'lifestyle changes' as a strategy for combating depression than did Chinese subjects living in Australia and Hong Kong. On the other hand, a higher percentage of Shanghai residents endorsed psychiatric treatment and the traditional Chinese practices of 'eating nutritious food/taking supplements' and 'qigong' than among the other two groups of Chinese.

CONCLUSIONS

This study underlines the need for campaigns aimed at improving the mental health literacy of Chinese in Shanghai. Such campaigns must take into consideration the socially and culturally driven beliefs to facilitate the development of specific education programs.

'English leaflets are not meant for me': a qualitative approach to explore oral health literacy in Chinese mothers in Southwestern Sydney, Australia

OBJECTIVES

The aim of this study was to record the views of Chinese mothers living in southwestern Sydney on the value of commonly used dental health education materials that gave behavioural advice on looking after the oral health of young children.

METHODS

This qualitative study was nested within a large cohort study in south-western Sydney. Chinese-speaking mothers (n = 27) with young children were approached for a face-to-face, semi-structured interview at their home. Two dental leaflets in English that gave behavioural advice on monitoring young children's oral health were sent to each mother prior to interview. On the day of the interview, mothers were also given translated versions of the leaflets for comparison. Interviews were recorded and subsequently transcribed verbatim. Transcripts were analysed by thematic coding.

RESULTS

Mothers reported that the leaflets were not tailored to match the different levels of English literacy within the Chinese community, and participants favoured health information material written in their first language with the use of illustrations. However, translations had to take account of the Chinese culture, as some of the advice in the leaflets presented did not reflect Chinese family values. Mothers also felt that the information should be more specific to provide a better understanding of the rationale for changing or implementing a different behaviour.

CONCLUSIONS

Dental health information literature for Chinese people should not be translated directly from those intended for an English-speaking audience, but should reflect Chinese culture-specific advice such as examples of the type and amount of foods to be given during early years of life. Supportive illustrations were also preferred.

Gender differences in mental health literacy among Chinese-speaking Australians in Melbourne, Australia

OBJECTIVE

This study attempted to understand gender differences in knowledge of mental illness, preference for professional help, and medications and treatment methods among Australians of Chinese-speaking background.

METHODS

This study adopted a cluster convenience sampling method in which subjects were taken from the four major areas in cosmopolitan Melbourne where most Chinese people are living. A total of 200 Chinese-speaking Australians participated in the study. They were presented with two vignettes describing an individual with acute depression or acute schizophrenia and then questions were asked to assess their understanding of the conditions, preference for professional help, medications and treatment methods.

RESULTS

More female than male respondents could correctly identify the conditions in the two vignettes. Female participants also perceived medications to be relatively more harmful than their male counterparts. In contrast, there were significantly more males than females who adhered to traditional views on the causation of mental illness; had significantly higher percentages of endorsement of 'deal with it alone'; believed 'traditional Chinese medical doctor' and 'Chinese herbal medicines' to be helpful to the person in the schizophrenia vignette; and significantly endorsed 'psychiatric ward', 'electro-convulsive treatment', 'changing fungshui' and 'traditional Chinese worship' to be helpful for the persons in both vignettes. A combination of factors, which included age, duration of migration and traditional Chinese cultural values, were put forward to explain the above differences.

CONCLUSIONS

Campaigns to improve the mental health literacy of Chinese-speaking Australians must take into account the gender differences between male and female Chinese-speaking Australians so that culturally relevant and gender-specific education programmes can be developed.

Schizophrenia literacy among Chinese in Shanghai, China: a comparison with Chinese-speaking Australians in Melbourne and Chinese in Hong Kong

OBJECTIVE

The study reported in this paper was aimed at developing understanding of schizophrenia-related knowledge and preferences surrounding professional help, medication, and treatment methods among Chinese living in Shanghai, China.

METHOD

A multi-stage cluster sampling method in which participants were taken from six of the 20 districts in Shanghai was adopted for this study. The 522 Shanghai Chinese participants were presented with a vignette describing an individual with schizophrenia before being asked questions designed to assess both their understanding of schizophrenia and their preferences surrounding professional help, medication, and treatment methods. A comparative approach was adopted to identify similarities and differences between our findings and those of two previous studies on the mental health literacy of Chinese living in Melbourne, Australia and Hong Kong, respectively.

RESULTS

A lower percentage of Shanghai Chinese than Hong Kong Chinese and Australian Chinese could correctly identify the condition described in the vignette as a case of acute schizophrenia. Although a far lower percentage of Shanghai Chinese endorsed the use of counselling professionals, a much higher percentage of the same group endorsed Chinese medical doctors and herbal medication. A lower percentage of Shanghai Chinese endorsed 'lifestyle changes' as a strategy for dealing with schizophrenia than did Chinese subjects living in Australia and Hong Kong. On the other hand, a higher percentage of Shanghai residents endorsed psychiatric treatment and the traditional Chinese practices of 'eating nutritious food/taking supplements' than among the other two groups of Chinese.

CONCLUSIONS

This study highlights the need for educating Chinese in Shanghai to improve their schizophrenia literacy. The contents of the education programmes will need to take into consideration the socially and culturally driven beliefs that may have been influencing the knowledge and preferences of Shanghai Chinese concerning professional help, medication, and treatment methods for people suffering from schizophrenia.

Mental health first aid training for the Chinese community in Melbourne, Australia: effects on knowledge about and attitudes toward people with mental illness

Background

The aim of this study was to investigate in members of the Chinese community in Melbourne the impact of Mental Health First Aid (MHFA) training on knowledge about mental disorders and on attitudes to people with mental illness. The hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and related treatments, and decreased negative attitudes towards people with mental disorders.

Methods

Respondents were 108 participants of three MHFA training workshops for the Chinese community in Melbourne conducted by a qualified MHFA trainer. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed participants' ability to recognize a mental disorder (depression and schizophrenia) described in the vignettes, knowledge about the professional help and treatment, and negative attitudes towards people with mental illness.

Results

Between pre- and post-test there was significant improvement in the recognition of mental disorders, beliefs about treatment became more concordant with health professionals, and negative attitudes reduced.

Conclusion

The MHFA training course for general members of the Chinese community in Melbourne produced significant positive change in the level of mental health literacy and reductions in stigmatizing attitudes. The evidence from this study, together with the accumulated evidence of the benefits of MHFA training in the general Australian community, suggests that this approach should be scaled up to a level where it can have an impact on the whole of the Chinese community in Australia.