Depression and demoralization among Russian-Jewish immigrants in primary care

Religiosity, perceived anti-Semitism, xenophobia and mental health: Experiences of Jewish immigrants from the former Soviet Union in Austria and Germany

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 symptoms of depression 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.

HIV and AIDS in Older Adults: Neuropsychiatric Changes

PURPOSE OF REVIEW

Patients diagnosed with HIV can now survive well into their old age. Aging with HIV is not only associated with comorbid medical illnesses but also with neuropsychiatric conditions that can range from cognitive changes to severe behavioral manifestations. This paper reviews mood, anxiety, and cognitive changes in older patients with HIV, as well as some of the treatment challenges in this population.

RECENT FINDINGS

Most recent findings show that untreated HIV illness over a long period of time may further worsen both preexisting neuropsychiatric illness and may cause new onset behavioral and cognitive symptoms. HIV induces immune phenotypic changes that have been compared to accelerated aging Low CD 4 counts and high viral counts are indicative of poor prognosis. Evaluation for potential HIV infections may be overlooked in older adults and require screening. Older adults experience accelerated CD4 cell loss. Older adults endorsing new onset mood or cognitive changes must be screened for HIV infection. New onset neurobehavioral symptoms should be carefully screened for and treated simultaneously in patients with HIV infection.

Epidemiology of depression among displaced people: A systematic review and meta-analysis

INTRODUCTION

Displaced people are prone to develop mental health problems due to resettlement in new environments, traumatic events and forced migration. Depression is a mental health problem repeatedly observed among displaced people such as refugees, migrants, asylum seekers and internally displaced persons (IDPs). Therefore, estimating the global pooled prevalence of depression as well as pinpointing its determinants may support policymakers and health care workers to mitigate the disease burden and improve the psychological well-being of displaced people.

METHODS

PubMed, EMBASE, CINAHIL, Psych-INFO, and SCOPUS databases were searched for English written relevant observational studies conducted between 1984 and 2020. The methodological quality of studies was assessed using the Newcastle Ottawa Scale (NOS). Heterogeneity across studies was checked using the Q- and I² test. Publication bias was checked by observing Funnel plot symmetry and using Egger's regression test. STATA 16 was used to combine studies using a random effect model.

RESULTS

Of the 4102 studies identified, 81 studies with an overall sample size of 53,458 were included in the current systematic review and meta-analysis. The pooled prevalence estimate of depression among displaced people was 26.4% (95% CI; 22.2-31.1). Also, three in five IDPs, one in three refugees and asylum seekers and one in four migrants suffer from depression globally. Being female migrant [AOR: 2.46 95% CI: 1.79-3.13, I²=34.5%), non-partnered marital status [AOR: 2.29, 95% CI: 1.29-3.30, I²= 0.00%], and perceived low social support [AOR: 1.76, 95% CI: 1.00-2.52, I²=34.6%] were significant determinants of depression among displaced people.

CONCLUSION

Overall, around 1 in 4 displaced people suffer from depression and exceed the prevalence of depression reported by community samples in different nations and demonstrate a need for culturally fitting and targeted responses from migrant/refugee host nations and their serving clinicians.

Assessment of Anhedonia in Adults With and Without Mental Illness: A Systematic Review and Meta-analysis

IMPORTANCE

Anhedonia, a reduced capacity for pleasure, is described for many psychiatric and neurologic conditions. However, a decade after the Research Domain Criteria launch, whether anhedonia severity differs between diagnoses is still unclear. Reference values for hedonic capacity in healthy humans are also needed.

OBJECTIVE

To generate and compare reference values for anhedonia levels in adults with and without mental illness.

DATA SOURCES

Web of Science, Scopus, PubMed, and Google Scholar were used to list all articles from January 1, 1995 to July 2, 2019, citing the scale development report of a widely used anhedonia questionnaire, the Snaith-Hamilton Pleasure Scale (SHAPS). Searches were conducted from April 5 to 11, 2018, and on July 2, 2019.

STUDY SELECTION

Studies including healthy patients and those with a verified diagnosis, assessed at baseline or in a no-treatment condition with the complete 14-item SHAPS, were included in this preregistered meta-analysis.

DATA EXTRACTION AND SYNTHESIS

Random-effects models were used to calculate mean SHAPS scores and 95% CIs separately for healthy participants and patients with current major depressive disorder (MDD), past/remitted MDD, bipolar disorder, schizophrenia, substance use disorders, Parkinson disease, and chronic pain. SHAPS scores were compared between groups using meta-regression, and traditional effect size meta-analyses were conducted to estimate differences in SHAPS scores between healthy and patient samples. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

MAIN OUTCOMES AND MEASURES

Self-reported anhedonia as measured by 2 different formats of the SHAPS (possible ranges, 0-14 and 14-56 points), with higher values on both scales indicating greater anhedonia symptoms.

RESULTS

In the available literature (168 articles; 16 494 participants; 8058 [49%] female participants; aged 13-72 years), patients with current MDD, schizophrenia, substance use disorder, Parkinson disease, and chronic pain scored higher on the SHAPS than healthy participants. Within the patient groups, those with current MDD scored considerably higher than all other groups. Patients with remitted MDD scored within the healthy range (g = 0.1). This pattern replicated across SHAPS scoring methods and was consistent across point estimate and effect size analyses.

CONCLUSIONS AND RELEVANCE

The findings of this meta-analysis indicate that the severity of anhedonia may differ across disorders associated with anhedonia. Whereas anhedonia in MDD affects multiple pleasure domains, patients with other conditions may experience decreased enjoyment of only a minority of life's many rewards. These findings have implications for psychiatric taxonomy development, where dimensional approaches are gaining attention. Moreover, the SHAPS reference values presented herein may be useful for researchers and clinicians assessing the efficacy of anhedonia treatments.

Do They Feel the Same Way? Health-Related Quality of Life and Satisfaction With Life in Jewish Immigrants From the Former Soviet Union in Germany and Israel

There is consensus that experiences gained during immigration have an impact on health status. However, studies comparing health-related outcomes in homogeneous groups of immigrants living in different host countries are rare. In a sample of Jewish immigrants from the Former Soviet Union (FSU) in two different host countries, Germany and Israel, possible predictors of health-related quality of life (HRQoL) and satisfaction with life (SWL) were examined. In total, 359 Jewish immigrants from the FSU living in Germany ( n = 180) and Israel ( n = 179) completed the questionnaire measuring immigration-related and sociodemographic characteristics. HRQoL was assessed via Short Form Health Survey Version 2 (SF-12v2), and SWL via Satisfaction With Life Scale (SWLS). Hierarchical linear regression models were applied for analyzing immigration-related and sociodemographic predictors of HRQoL and SWL. Participants living in Israel scored higher on HRQoL, and no differences were found concerning SWL ratings. However, no direct influences of the host country were detected by predicting HRQoL and SWL scores. In both subgroups, immigration-related factors such as perceived discrimination or level of integration were found as significant predictors. In the face of different immigration waves in the host countries, Germany and Israel, the results display similarities rather than differences between the groups concerning the sociodemographic and immigration-related predictors on HRQoL and SWL. The findings using cross-cultural analysis level underscore the need of much more detailed future research on this issue.

Adjustment disorder: A diagnosis whose time has come

BACKGROUND

Adjustment disorder is among the most frequently diagnosed mental disorders in clinical practice although it has received little academic attention and been the subject of substantial criticism over the past decades. While those suffering with adjustment disorders are often treated by mental health professionals, research interest in the origin of the disorder or the effectiveness of psychotherapeutic and medical interventions has only recently begun to emerge. This article summarizes the empirical literature published on adjustment disorder and points out current diagnostic developments in DSM-5 and ICD-11.

METHODS

Literature for this review was identified through established online search tools, including publications in English, German, and Spanish.

RESULTS

This paper reviews literature on the evolution of adjustment disorder, and highlights the current state of research with regard to genesis and treatment. Importantly, for the first time ICD-11 intends to define adjustment disorder by explicit symptom groups, unlike DSM-5.

LIMITATIONS

Publications without an English abstract were not included.

CONCLUSIONS

Key directions for future research include investigating the concordance of the ICD-11 and DSM-5 concepts and the effect that the diverging conceptualizations may have. Risk and protective factors specific to AD should be identified and the biological underpinnings of the disorder should be explored. Finally, given the high prevalence of AD in certain clinical settings effective disorder-specific interventions should be developed and evaluated.

Unmet need for treatment of depression among immigrants from the former USSR in the US: A primary care study

The stress of immigration can increase risk for major depressive disorder (MDD), while cultural factors can contribute to difficulty in diagnosis and treatment of MDD among immigrant populations. Consequently, immigrants are less likely to have their treatment needs met. Our goal was to assess the unmet need for the diagnosis and treatment of depression among immigrants from the former USSR-a large immigrant group in the US-as well as demographic characteristics and immigration history associated with depression. We conducted a survey in an urban primary care clinic using measures of MDD symptoms (Patient Health Questionnaire-9), functioning, and treatment history among 102 Russian-speaking immigrants. Current moderate-to-severe symptoms of MDD were reported by 26.5% of participants with 33.3% of the symptomatic patients reporting suicidal ideation. Among participants with probable MDD, 63.0% reported not receiving mental health treatment and 59.3% never being diagnosed with MDD. The rates of untreated depression did not vary by gender nor did they diminish with prolonged stay in the US. Results suggest that undiagnosed and untreated depression is highly prevalent in this immigrant group.

Demoralisation syndrome does not explain the psychological profile of community-based asylum-seekers

BACKGROUND

Demoralisation syndrome (DS) has been advanced as a construct that features hopelessness, meaninglessness, and existential distress. Demoralisation and DS have predominantly been considered secondary only to illness; hence there is scant research on demoralisation or DS in populations affected by extreme environmental stress.

AIMS

The current study aimed to determine the prevalence of demoralisation, its predictors, and the relevance of DS in a community-based forced-migrant population.

METHOD

A convenience sample of 131 adult asylum-seekers (n=98) and refugees (n=33) without recognised mental disorders in Melbourne, Australia, were assessed cross-sectionally on posttraumatic stress, anxiety, depression, post-migration stress, and demoralisation. Socio-demographic data were analysed with relevant clinical data. Predictive aims were investigated using bivariate statistical tests and exploratory aims were investigated using correlational and linear regression analyses.

RESULTS

Seventy nine percent of the sample met criteria for demoralisation (asylum-seekers=83%; refugees=66%), with asylum-seekers being 2.55 (95% C.I.=1.03-6.32, Z=2.03, p=.04) times more likely to be demoralised than refugees. No relationship between demoralisation and time in the refugee determination process emerged. The regression model explained 47.5% of variance in demoralisation scores for the total sample F(9,111)=13.07, p<.0001, with MDD and anxiety score making unique significant contributions.

CONCLUSIONS

Demoralisation was widespread through the asylum-seeker and refugee population and its prevalence was attributable to a range of social and psychiatric factors. However, DS had little explanatory power for psychiatric morbidity, which was more suggestive of a pan-distress symptom complex.

Relying on what they know: older Slavic emigres managing chronic health conditions

As the U.S. population ages and becomes increasingly diverse, health care professionals need to recognize the role of culture and life course in managing chronic health conditions. Older émigrés, in particular, face daunting challenges learning to navigate a new language, country, and health care system. In this focused ethnography, data collection included 16 months of participant observation and interviews with 28 Slavic participants (older émigrés, family caregivers, and key informants). Participants shared beliefs about the causes of chronic conditions, described treatments used, identified barriers to care, and expressed their expectations of U.S. health care providers. The findings provide insight into older émigrés' explanatory models of health, which can be used by health care providers to improve health care delivery to this underserved population.

Level of distress, somatisation and beliefs on health-disease in newly arrived immigrant patients attended in primary care centres in Catalonia and definition of professional competences for their most effective management: PROMISE Project

Background

Newly arrived immigrant patients who frequently use primary health care resources have difficulties in verbal communication. Also, they have a system of beliefs related to health and disease that makes difficult for health care professionals to comprehend their reasons for consultation, especially when consulting for somatic manifestations. Consequently, this is an important barrier to achieve optimum care to these groups. The current project has two main objectives: 1. To define the different stressors, the level of distress perceived, and its impact in terms of discomfort and somatisation affecting the main communities of immigrants in our area, and 2. To identify the characteristics of cross-cultural competence of primary health care professionals to best approach these reasons for consultation.

Methods/Design

It will be a transversal, observational, multicentre, qualitative-quantitative study in a sample of 980 people from the five main non-European Union immigrant communities residing in Catalonia: Maghrebis, Sub-Saharans, Andean South Americans, Hindustanis, and Chinese. Sociodemographic data, level of distress, information on the different stressors and their somatic manifestations will be collected in specific questionnaires. Through a semi-structured interview and qualitative methodology, it will be studied the relation between somatic manifestations and particular beliefs of each group and how these are associated with the processes of disease and seeking for care. A qualitative methodology based on individual interviews centred on critical incidents, focal groups and in situ questionnaires will be used to study the cross-cultural competences of the professionals.

Discussion

It is expected a high level of chronic stress associated with the level of somatisations in the different non-European Union immigrant communities. The results will provide better knowledge of these populations and will improve the comprehension and the efficacy of the health care providers in prevention, communication, care management and management of resources.

Demoralization and depression in patients with advanced cancer: validation of the German version of the demoralization scale

CONTEXT

The concept of demoralization has been widely used to describe states of existential distress and a self-perceived incapacity to deal effectively with a specific stressful situation.

OBJECTIVES

To evaluate the psychometric properties of the German adaptation of the Demoralization Scale (DS) in patients with advanced cancer.

METHODS

Participants with heterogeneous tumor sites were recruited in several treatment and rehabilitation facilities. Concurrent and divergent validity of the DS was analyzed through associations with and group differences between measures of distress, depression, anxiety, and meaning-related life attitudes.

RESULTS

From a total sample of 1102 patients, 516 individuals (45%) with advanced cancer were enrolled (male 53%, median age 58 years [range 18-88], breast cancer 21%, prostate cancer 17%). The total mean score of the DS was 29.8 (SD=10.41). Four factors were extracted by exploratory factor analysis, which accounted for 59% of the variation (Cronbach α=0.84): loss of meaning and purpose (α=0.88), disheartenment (α=0.88), dysphoria (α=0.80), and sense of failure (α=0.76). DS dimensions shared between 12% and 62% of the variance. Demoralization was significantly associated with anxiety (r=0.71), depression (r=0.61), and distress (r=0.42). Fifty-seven percent of patients had high distress, 24% depression, and 11% high anxiety. According to different cutoff values, between 16% and 39% were seriously demoralized and 73% had moderate levels of demoralization. Between 5% and 20% of patients were seriously demoralized but not clinically depressed; 60% of patients with moderate levels of demoralization had no depression.

CONCLUSION

Results provide further evidence that the DS is a valid and reliable instrument of high clinical relevance in patients with advanced cancer.

Anhedonia and pessimism in hospitalized depressed adolescents

This longitudinal study investigates whether anhedonia and pessimistic attributional style represent a clinical state or a trait in hospitalized depressed adolescents. 81 consecutive adolescent inpatients were screened with the Beck Depression Inventory (BDI) and the clinician-rated Major Depressive Disorder (MDD) criteria sheet. 51 patients with BDI score ≥10 and/or ≥4 symptoms on MDD criteria sheet were assessed at Time 1 upon admission, with 39 patients (78%) assessed at discharge (Time 2) with the Pleasure Scale for Children and Children's Attributional Style Questionnaire-Revised. Anhedonia and pessimism at admission were associated with BDI scores at admission and discharge as well as number of depressive symptoms and depression severity. MDD diagnosis was associated with anhedonia, but not with pessimism. Pessimism-but not anhedonia-improved significantly by discharge. Results suggest that while some adolescents exhibit enduring anhedonia, pessimistic attributional style appears to be a concomitant feature of an acute depressive state.

Sociotropy and Autonomy Vulnerabilities to Depressed Mood

The current study examines whether sociotropy and autonomy traits prospectively predict depressed mood following daily events in young adults and considers whether relationships between personality, daily events, and mood differ by cultural context. Samples in Metropolitan France ( n = 99) and Reunion Island ( n = 70) participated in identical ambulatory monitoring procedures over a 1-week period and were assessed relative to cultural variables and additional psychological vulnerabilities known to influence depression or stress reactivity. Sociotropy heightened depressed mood responses to negative interpersonal events in Metropolitan France but not in Reunion Island. This finding was replicated when a continuous measure of cultural investment replaced geographic location. Contrary to Beck’s theory, there was no evidence that autonomy moderated the relationship between subjective achievement events and depressed mood at either site. The results are discussed in terms of the cultural specificity of cognitive vulnerability-stress theories of depression, as well as their usefulness for explaining normal mood variance in daily life.

Perceived insomnia, anxiety, and depression among older Russian immigrants

There are few data on the relationships of anxiety and depression to insomnia among immigrants in the United States. Observations of high rates of symptoms of these associated conditions among older Russians indicate the need to focus clinical attention on this population. Relationships of self-reported depression and anxiety to insomnia complaints were investigated in a community-based sample of older Russian immigrants. Volunteers (N=307) were urban community-residing Russians (ages 50 to 95 years; 54% women). Surveys were conducted in a semistructured environment by bilingual educators in various community centers. 93% reported a major health problem, 83% experienced pain, and 62% had problems engaging in daily activities. Of the sample, 61% reported an insomnia complaint, and 43% considered depression and/or anxiety to be a major impairment. Logistic regression analysis showed that insomnia was the most important predictor of perceived anxiety and depression; the corresponding multivariate-adjusted odds ratio was 4.37. Insomnia complaints and perceptions of depression and anxiety among older Russians may have a synergistic effect. Both patients and primary-care physicians should be better educated regarding the recognition of barriers limiting access to adequate health care among older Russians.

[Diagnosis of depression in Sub-Saharan immigrants]

OBJECTIVE

The migratory process, its social-demographic characteristics, and the lack of integration into the social and health networks of Sub-Saharan immigrants could favour an increase in mental health-related pathology. The objective is to find the prevalence of depression among this population and its risk factors.

DESIGN

Cross-sectional, descriptive survey.

SETTING

Community of Madrid, Spain.

PARTICIPANTS

Sub-Saharan immigrants over 18 years old who attended 2 "Health Care Programmes for immigrants in the Community of Madrid" between August 2003 and February 2004.

MEASUREMENTS

Semi-structured interviews (DSM-IV criteria) conducted by trained staff and the Beck Depression Inventory were used to diagnose depression.

RESULTS

Of 606 Sub-Saharan immigrants, 55.45% were men. Average age was 27 +/- 6.61. Depression diagnosis was 5.4% (95% CI, 3.78-7.56). There was greater risk of depression among those immigrants who had lived in Spain for over 2 years (13.1%), among those who had children (10.7%), and among those with certain health problems, such as muscle and skeletal trouble (18.9%), gastro-intestinal problems (18.8%), neurology problems (17.4%), dermatology problems (20.5%) and fatigue (70.6%). Six percent of immigrants with depression took pharmacological treatment.

CONCLUSIONS

The prevalence of depression among Sub-Saharan immigrants is similar to that of the native population. There is an increase as they stay longer in our country, probably due to their social and economic situation, which over time can act as a chronic stress factor. The other main fact is the lack of treatment of immigrants diagnosed with depression.

Socio-demographic and clinical features associated with demoralization in medically ill in-patients

INTRODUCTION

In the present study we tried to identify which socio-demographic and clinical characteristics are associated with demoralization in medically ill in-patients.

METHOD

Patients (n. 296), consecutively admitted to medical wards in a 120 day period, were evaluated with the Demoralization Scale of the Psychiatric Epidemiological Research Interview (PERI-D) to assess demoralization , with the Mini International Neuropsychiatric Interview (MINI) to assess mental disorders (DSM-IV), with the Brief Disability Questionnaire for the evaluation of the functional disability, with the Duke Severity of Illness to assess severity of the medical illness. Moreover, the family support and threatening life events were also evaluated.

RESULTS

A significant effect in increasing the demoralization score was observed for presence of Major Depression or Adjustment Disorder, poor family support, severity of functional disability, number of threatening life events in the past year and female gender.

CONCLUSION

Major Depression needs to be recognized in demoralized medically ill in-patients, because it is one of the most important conditions associated with demoralization, which successfully responds to adequate treatment.

Demoralisation--a useful conceptualisation of non-specific psychological distress among refugees attending mental health services

BACKGROUND

While it is recognised that many refugee and migrant clients present at mental health services with non-specific psychological distress little is known about successful intervention strategies.

AIMS

The aim of this study was to systematically review clinical files to determine the degree of 'demoralisation' symptoms among a sample of refugee and migrant clients attending a community-based mental health service.

METHOD

Sixty-four closed cases were reviewed using a specifically designed case review sheet as a checklist which included diagnostic criteria for a Demoralisation Syndrome.

RESULTS

The findings indicated that while many of the refugee and migrant clients had attracted a diagnosis of major depressive disorder, in the main they did not benefit from a normal course of treatment. Further analysis suggested that demoralisation may be a preferable concept for many of these clients rather than affective disorder. This finding suggests that demoralisation may be a different construct than low mood or depression.

CONCLUSIONS

The findings add support to the concept that demoralisation could be a distinct diagnostic entity in its own right that may be useful to clinicians attending refugee and migrant clients.

East-west health divide and east-west migration: Self-reported health of immigrants from Eastern Europe and the former Soviet Union in Sweden

AIM

Research on the east-west health divide has provided extensive evidence of poorer health in Eastern Europe and the former Soviet Union than in Western Europe. This study focuses on immigrants from Eastern to Western Europe and analyses whether they have an increased risk of self-reported poor health compared with the host population and what determines that.

METHODS

This cross-sectional study is based on 373 immigrants from Poland, other East European countries, and the former Soviet Union, aged 25-84, who arrived in Sweden after 1944 and were interviewed during 1993-2000 along with their 35,711 Swedish counterparts.

RESULTS

Age- and sex-adjusted unconditional logistic regression showed in general a 92% higher risk of reporting poor health among immigrants than among Swedish-born respondents. The risk also persisted after adjustment for several potential confounders (living singly, having a poor social network, low socioeconomic status, and smoking) and after an additional adjustment for acculturation (language at home), and years in Sweden.

CONCLUSIONS

Being born in Eastern Europe or the former Soviet Union was an independent risk factor for reporting poor health. It is therefore suggested that it is important for primary and public care services to be aware of the health status and needs of immigrants from these countries.

Psychological and mental illness among elder immigrants from the former Soviet Union

The study examined the cultural context of psychological illness among elder immigrants from the former Soviet Union (FSU). Kleinman's (1980) explanatory model of illness and Leininger's theory of culture care (1997) provided the conceptual framework for the study. Participant Observations were conducted in an Adult Day Care Center and Senior Housing. Twenty-three key informants and 10 general informants participated. The social and historical context of the FSU influenced the meaning, attitudes, expressions, and coping strategies toward psychological and mental illness. Cultural stigma influenced the attribution of cause, somatic expression of symptoms, and attitudes toward seeking professional help. Psychological illness was unrecognized, whereas mental illness was viewed as lack of dusha (inner strength and moral character). Group differences were evident with ethnicity as a significant influence in symptom recognition, expression, and attitude toward seeking professional help.

Acculturation, social alienation, and depressed mood in midlife women from the former Soviet Union

Level of acculturation has been linked to depressed mood in studies across culturally diverse immigrant groups. The purpose of this study was to determine the effects of acculturation, social alienation, personal and family stress, and demographic characteristics on depressed mood in midlife immigrant women from the former Soviet Union. Structural equation modeling showed that higher acculturation scores, measured by English language and American behavior, were indirectly related to lower scores for depressed mood. Higher acculturation levels promoted mental health indirectly by reducing social alienation and, subsequently, lowering family and personal stress, both of which had direct relationships to symptoms of depression. These findings support the ecological framework that guided our research and point to the importance of focusing on contextual factors in developing interventions for new immigrants.

Demographic characteristics, menopausal status, and depression in midlife immigrant women

The purpose of this cross-sectional analysis is to examine symptoms of depressed mood in relation to age, menopausal status, and length of residence in the United States in midlife women who are recent immigrants from the former Soviet Union. Data for this analysis are from a longitudinal study of the impact of acculturation on postimmigration health status and psychological well-being. The mean score for the Center for Epidemiological Studies-Depression (CES-D) scale was 23.56, with 77.3% of the women obtaining a score greater than the usual screening cutoff score for referral. Women taking antidepressant medications had a mean score of 30.52. CES-D scores varied significantly by age group. The lowest CES-D scores were reported by women aged 40-50, and women aged 55-60 had significantly higher scores than younger women and those over 65 years old. Total CES-D scores did not vary significantly by length of residence in United States or use of hormone therapy. Regression analysis indicated that even when use of antidepressant medication was held constant, age and residence in the United States were significant independent contributors to CES-D score: women who were older, had lived fewer years in the United States, and those who took antidepressants had higher CES-D scores. Cultural and immigration-related explanations for high scores on the depression scale are suggested.

Is There a Universal Positivity Bias in Attributions? A Meta-Analytic Review of Individual, Developmental, and Cultural Differences in the Self-Serving Attributional Bias

Researchers have suggested the presence of a self-serving attributional bias, with people making more internal, stable, and global attributions for positive events than for negative events. This study examined the magnitude, ubiquity, and adaptiveness of this bias. The authors conducted a meta-analysis of 266 studies, yielding 503 independent effect sizes. The average d was 0.96, indicating a large bias. The bias was present in nearly all samples. There were significant age differences, with children and older adults displaying the largest biases. Asian samples displayed significantly smaller biases (d = 0.30) than U.S. (d = 1.05) or Western (d = 0.70) samples. Psychopathology was associated with a significantly attenuated bias (d = 0.48) compared with samples without psychopathology (d = 1.28) and community samples (d = 1.08). The bias was smallest for samples with depression (0.21), anxiety (0.46), and attention-deficit/hyperactivity disorder (0.55). Findings confirm that the self-serving attributional bias is pervasive in the general population but demonstrates significant variability across age, culture, and psychopathology.

Demoralization: its phenomenology and importance

OBJECTIVE

Demoralization, as described by Jerome Frank, is experienced as a persistent inability to cope, together with associated feelings of helplessness, hopelessness, meaninglessness, subjective incompetence and diminished self-esteem. It is arguably the main reason people seek psychiatric treatment, yet is a concept largely ignored in psychiatry. The aim here is to review and summarize the literature pertaining to demoralization in order to examine the validity of the construct.

METHOD

A narrative review of demoralization and the related concepts of hope, hopelessness, and meaning is presented, drawing on a range of empirical and observational studies in the medical and psychiatric literature.

RESULTS

An examination of the concepts of the 'Giving Up-Given Up' syndrome (George Engel), 'suffering' (Eric Cassell), and demoralization (Jerome Frank), demonstrate considerable convergence of ideas. Demoralization has been commonly observed in the medically and psychiatrically ill and is experienced as existential despair, hopelessness, helplessness, and loss of meaning and purpose in life. Although sharing symptoms of distress, demoralization is distinguished from depression by subjective incompetence in the former and anhedonia in the latter. Demoralization can occur in people who are depressed, cancer patients who are not depressed and those with schizophrenia. Hopelessness, the hallmark of demoralization, is associated with poor outcomes in physical and psychiatric illness, and importantly, with suicidal ideation and the wish to die.

CONCLUSIONS

Demoralization is an important construct with established descriptive and predictive validity. A place needs to be found for it in psychiatric nomenclature.

Demoralisation: its impact on informed consent and medical care

Demoralisation, a mental state characterised by hopelessness and meaninglessness, can be differentiated from depression in that demoralised patients can enjoy the present, their lack of hope being confined to the future. However, like severe depression, demoralisation can interfere with a person's capacity to give informed consent. Doctors and other health professionals are also subject to demoralisation, which influences medical care.