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Kreienbrinck A, Hanft-Robert S, Mösko M. Usability of technological tools to overcome language barriers in health care: a scoping review protocol. BMJ Open 2024; 14:e079814. [PMID: 38458787 DOI: 10.1136/bmjopen-2023-079814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION In many healthcare contexts globally, where the languages of care providers and patients do not match, miscommunication or non-communication can lead to inaccurate diagnoses and subpar treatment outcomes. In order to bridge these language barriers, a range of informal practices are used, such as family members or staff acting as interpreters, 'receptive multilingualism' or machine translation. The development and use of technological tools are increasing, but factors such as translation quality for complex health-related texts vary widely between languages. The objective of this scoping review is to (1) identify and describe the technological tools used in direct patient-provider communication to overcome a language barrier in a healthcare setting, (2) identify how the usability of these tools was evaluated and (3) assess the usability of the technological tools. METHODS AND ANALYSIS The scoping review will follow the Joanna Briggs Institute methodology. A search strategy using variations of the keywords 'technological tools', 'language barrier' and 'healthcare' will be applied in the following databases and research platforms: PubMed, PsycArticle, Scopus, EBSCOhost, ProQuest and Web of Science. All literature where individuals use a technological tool to overcome a language barrier in a healthcare context will be included and exported into the screening assistant software Rayyan. The search will be limited to articles written in German or English. Two independent reviewers will screen the articles, and all relevant extracted data will be presented in a descriptive summary. ETHICS AND DISSEMINATION This scoping review does not require ethical approval, as the study's methodology consists of collecting data from publicly available sources. The findings will be disseminated through publication in an open-access, peer-reviewed journal and presentations at scientific conferences. The scoping review results will also guide future research in a multinational project investigating multilingualism in providing (mental) healthcare to migrants.
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Affiliation(s)
- Annika Kreienbrinck
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Applied Human Sciences, Magdeburg-Stendal University of Applied Sciences, Stendal, Germany
| | - Saskia Hanft-Robert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mike Mösko
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Applied Human Sciences, Magdeburg-Stendal University of Applied Sciences, Stendal, Germany
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Guessoum SB, Minassian S, de Staël P, Touhami F, DiGiovanni M, Radjack R, Moro MR, Benoit L. Multimodal co-therapy for unaccompanied minors: a qualitative study. Child Adolesc Psychiatry Ment Health 2022; 16:81. [PMID: 36344979 PMCID: PMC9641960 DOI: 10.1186/s13034-022-00518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Unaccompanied refugee minors-or unaccompanied minors-are children and adolescents who have been separated from parents and other relatives and are not being cared for by an adult. Unaccompanied minors are a vulnerable population, with numerous stressors and complex psychiatric symptoms necessitating specialized mental health care. This study explores patients' experiences of a Multimodal Co-Therapy for Unaccompanied Minors (MUCTUM), which encompasses cultural, biological, narrative & institutional approaches to care. METHODS MUCTUM is a co-therapy program for unaccompanied minors, with a psychiatrist, psychologist, native-language interpreter, and caseworker for each patient. In this qualitative study, we interviewed adolescents about their experiences with MUCTUM and analyzed these semi-structured interviews using a phenomenological framework (Interpretative Phenomenological Analysis). RESULTS Qualitative analysis of 16 interviews discovered that unaccompanied minors felt misunderstood before participating in MUCTUM, describing a sense of strangeness and loneliness in relation to psychiatric symptoms. Several youths experienced triple stigmatization: of being unaccompanied minors, of suffering from psychotrauma, and of being mental health patients. We further describe three overarching domains that inform on MUCTUM support to unaccompanied minors: (1) A safe space for unaccompanied minors; (2) Helpful interventions during therapy; and (3) Narrating one's story can "set us free" if guided carefully by care providers. CONCLUSION This study suggests that MUCTUM therapy may efficiently support unaccompanied minors' mental health by acknowledging their hierarchy of needs. Psychotherapeutic strategies include creating a safe place, providing culturally appropriate care and patient-centered therapy, addressing concrete problems, supporting relationships, and making use of limited reparenting in therapy. Delayed and progressive inquiry about traumatic events may be beneficial. Replication of these findings and their field application is warranted.
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Affiliation(s)
- Sélim Benjamin Guessoum
- Department of Child and Adolescent Psychiatry, Assistance Publique - Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014, Paris, France. .,Université Paris Cité, PCPP, Paris, France. .,Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France.
| | - Sevan Minassian
- grid.508487.60000 0004 7885 7602Université Paris Cité, PCPP, Paris, France
| | - Pauline de Staël
- grid.411784.f0000 0001 0274 3893Department of Child and Adolescent Psychiatry, Assistance Publique ‐ Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014 Paris, France
| | - Fatima Touhami
- grid.508487.60000 0004 7885 7602Université Paris Cité, PCPP, Paris, France
| | - Madeline DiGiovanni
- grid.47100.320000000419368710Child Study Center, Yale School of Medicine, New Haven, USA
| | - Rahmeth Radjack
- grid.411784.f0000 0001 0274 3893Department of Child and Adolescent Psychiatry, Assistance Publique ‐ Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, PCPP, Paris, France ,grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France
| | - Marie Rose Moro
- grid.411784.f0000 0001 0274 3893Department of Child and Adolescent Psychiatry, Assistance Publique ‐ Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Université Paris Cité, PCPP, Paris, France ,grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France
| | - Laelia Benoit
- grid.411784.f0000 0001 0274 3893Department of Child and Adolescent Psychiatry, Assistance Publique ‐ Hôpitaux de Paris (APHP), Cochin University Hospital, 97 Boulevard Port-Royal, 75014 Paris, France ,grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Team DevPsy, Villejuif, France ,grid.47100.320000000419368710Child Study Center, Yale School of Medicine, New Haven, USA
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Garb HN. Race bias and gender bias in the diagnosis of psychological disorders. Clin Psychol Rev 2021; 90:102087. [PMID: 34655834 DOI: 10.1016/j.cpr.2021.102087] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/16/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
Bias is said to occur when validity is better for one group than another (e.g., when diagnoses are more valid for male or female clients). This article provides (a) a methodological critique of studies on race bias and gender bias in diagnosis and (b) a narrative review of results from studies with good internal validity. The results suggest that race bias occurs for the diagnosis of conduct disorder, antisocial personality disorder, comorbid substance abuse and mood disorders, eating disorders, posttraumatic stress disorder, and the differential diagnosis of schizophrenia and psychotic affective disorders. Other results suggest that gender bias occurs for the diagnosis of autism spectrum disorder, attention deficit hyperactivity disorder, conduct disorder, and antisocial and histrionic personality disorders. The way that symptoms are expressed (e.g., Black cultural expressions of depression) appears to have a significant effect on diagnoses. It may be possible to decrease bias by expanding the use of (a) mental health screening, (b) self-report measures including some psychological tests, (c) structured interviews, and (d) statistical prediction rules. Finally, evidence exists that (a) the diagnosis of personality disorders should be made using dimensional ratings and (b) training in cultural diversity and debiasing strategies should be provided to mental health professionals.
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Affiliation(s)
- Howard N Garb
- Joint Base San Antonio-Lackland, San Antonio, TX, United States of America.
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Erkoreka L, Ozamiz-Etxebarria N, Ruiz O, Ballesteros J. Assessment of Psychiatric Symptomatology in Bilingual Psychotic Patients: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114137. [PMID: 32531946 PMCID: PMC7312010 DOI: 10.3390/ijerph17114137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Abstract
Language plays an important role in psychiatric conditions. Language disturbances are core symptoms of psychiatric ailments, and language is the main diagnostic tool to assess psychopathological severity. Although the importance of language in psychiatry, the effect of bilingualism, and more specifically of using the mother language or a later acquired language at the time of assessing psychotic symptoms, has been scarcely studied and, thus, remains unclear. We conducted a systematic review and meta-analysis to ascertain whether differences exist in the severity of psychopathology in psychotic patients when assessed either in the mother language or in an acquired language. Of 3121 retrieved references from three databases (PsycINFO, MEDLINE, Embase) and complementary searches, four studies—including 283 psychotic patients—were included in the review. The meta-analytical combined effect suggested that more overall symptomatology is detected when clinical assessment is conducted in the mother language rather than in the acquired language (very low quality evidence, random effects model standardized mean difference (SMD) 0.44, 95% CI = 0.19 to 0.69, p value = 0.0006, I2 = 90%). Considering the growing migration flows and the increasing number of bilingual people in the world population, the effect of the chosen language at the time of conducting psychopathological assessments of psychotic patients is a clinically relevant issue. Based on our findings, we recommend that clinical interviews with bilingual psychotic patients should be conducted, when feasible, in the patient’s mother language.
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Affiliation(s)
- Leire Erkoreka
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; (L.E.); (J.B.)
- Department of Psychiatry, Galdakao-Usansolo Hospital, Osakidetza Basque Health Service, 48960 Galdakao, Spain
- Department of Mental Health, BioCruces-Bizkaia Health Research Institute, 48903 Barakaldo, Spain;
| | - Naiara Ozamiz-Etxebarria
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; (L.E.); (J.B.)
- Correspondence:
| | - Onintze Ruiz
- Department of Mental Health, BioCruces-Bizkaia Health Research Institute, 48903 Barakaldo, Spain;
| | - Javier Ballesteros
- Department of Neurosciences, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; (L.E.); (J.B.)
- Department of Mental Health, BioCruces-Bizkaia Health Research Institute, 48903 Barakaldo, Spain;
- CIBERSAM, 48940 Leioa, Spain
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Fossion P, Servais L, Rejas MC, Ledoux Y, Pelc I, Minner P. Psychosis, migration and social environment: an age-and-gender controlled study. Eur Psychiatry 2020; 19:338-43. [PMID: 15363471 DOI: 10.1016/j.eurpsy.2004.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AbstractPurposeAdverse social experiences are frequently invoked to explain the higher rate of psychosis among migrant groups. The aim of the present study was to establish the socio-environmental factors distinguishing migrant psychotic patients from autochthonous patients.Subjects and methodWe conducted a cross-sectional survey involving 341 migrant psychotic patients matched for age and gender with 341 autochthonous psychotic patients.ResultsMigrant patients lived more often with their parental family, were less often enrolled with a referral psychiatrist, presented a lower rate of employment, a lower percentage of alcohol misuse and of suicide attempts.DiscussionOur findings add to the growing body of results showing that more attention needs to be focused on socio-environmental variables in psychosis research. However, several limitations have to be taken into account, particularly with regard to selection biases and age of onset of the psychotic illness.ConclusionOur results are compatible with the hypothesis that unemployment is a contributing factor in the risk for psychosis among migrant groups. Migrants’ families are an important keystone in the mental health care process of their sick relatives. Our service models need to be adapted with the aim to make the treatment easier for migrant patients.
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Affiliation(s)
- P Fossion
- Department of Psychiatry, Brugmann University Hospital, CHU Brugmann, 4, place Van Gehuchten, 1020 Brussels, Belgium.
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Durbin A, Jung JKH, Chung H, Lin E, Balogh R, Lunsky Y. Prevalence of intellectual and developmental disabilities among first generation adult newcomers, and the health and health service use of this group: A retrospective cohort study. PLoS One 2019; 14:e0215804. [PMID: 31220086 PMCID: PMC6586270 DOI: 10.1371/journal.pone.0215804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 04/09/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Attention to research and planning are increasingly being devoted to newcomer health, but the needs of newcomers with disabilities remain largely unknown. This information is difficult to determine since population-level data are rarely available on newcomers or on people with intellectual and developmental disabilities (IDD), although in Ontario, Canada these databases are accessible. This study compared the prevalence of IDD among first generation adult newcomers to adult non-newcomers in Ontario, and assessed how having IDD affected the health profile and health service use of newcomers. METHODS This population-based retrospective cohort study of adults aged 19-65 in 2010 used linked health and social services administrative data. Prevalence of IDD among newcomers (n = 1,649,633) and non-newcomers (n = 6,880,196) was compared. Among newcomers, those with IDD (n = 2,830) and without IDD (n = 1,646,803) were compared in terms of health conditions, and community and hospital service use. RESULTS Prevalence of IDD was lower in newcomers than non-newcomers (171.6 versus 898.3 per 100,000 adults, p<0.0001). Among newcomers, those with IDD were more likely than those without IDD to have comorbid physical health disorders, non-psychotic, psychotic and substance use disorders. Newcomers with IDD were also more likely to have psychiatry visits, and frequent emergency department visits and hospitalizations. CONCLUSION First generation adult newcomers have lower rates of IDD than non-newcomers. How much of this difference is attributable to admission policies that exclude people expected to be high health service users versus how much is attributable to our methodological approach is unknown. Finding more medical and psychiatric comorbidity, and more health service use among newcomers with IDD compared to newcomers without IDD is consistent with patterns observed in adults with IDD more generally. To inform polices that support newcomers with IDD future research should investigate reasons for the prevalence finding, barriers and facilitators to timely health care access, and pathways to care.
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Affiliation(s)
- Anna Durbin
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, 1 King’s College Cir., Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - James K. H. Jung
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, W., Toronto, Ontario, Canada
| | | | - Elizabeth Lin
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Robert Balogh
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Yona Lunsky
- Department of Psychiatry, University of Toronto, 1 King’s College Cir., Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, W., Toronto, Ontario, Canada
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Tzur Bitan D, Grossman Giron A, Alon G, Mendlovic S, Bloch Y, Segev A. Attitudes of mental health clinicians toward perceived inaccuracy of a schizophrenia diagnosis in routine clinical practice. BMC Psychiatry 2018; 18:317. [PMID: 30261851 PMCID: PMC6161382 DOI: 10.1186/s12888-018-1897-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/18/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mental health clinicians have previously been reported to express reservations regarding the utility and accuracy of the psychiatric classification systems. In this study we aimed to examine clinicians' experiences with instances of perceived inaccuracy of a schizophrenia diagnosis. METHODS Mental health clinicians (N = 175) participated in an online survey assessing prevalence and perceived reasons for inaccuracies of a schizophrenia diagnosis. Respondents included psychiatric ward directors (13.1%), senior psychiatrists and psychologists (40.5%), and psychiatry and clinical psychology residents (36%). RESULTS Fifty-three percent of respondents reported encountering instances where a schizophrenia diagnosis was assigned even though clinical presentation did not match diagnostic criteria. Seventy-three percent of senior psychiatrists in a position to determine a diagnosis declared assigning schizophrenia even when controversial among clinical staff, and 15% of them declared doing so frequently. The likelihood of frequently assigning a schizophrenia diagnosis even when clearly controversial was predicted by the perception that an inaccurate diagnosis is assigned due to the presence of negative symptoms (OR 2.20, 95% CI 1.04-4.66, p = 0.039) and due to patient-related factors, such as the need to facilitate rehabilitation (OR 1.77, 95% CI 1.07-2.90, p = 0.024). CONCLUSIONS Although a schizophrenia diagnosis is considered relatively stable and clear, our study indicates that, in clinical practice, the assignment of this diagnosis is frequently controversial. These controversies are associated with the perception that an inaccurate diagnosis is assigned due to diagnostic considerations, or due to the possibility that patients might benefit from such a diagnosis. Implications and limitations for psychiatric practice and discourse are discussed.
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Affiliation(s)
- Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ramat Hagolan 65th st, 4070000, Ariel, Israel.,Shalvata Mental Health Center, 13th Alyat Hanoar st, POB 94, 45100, Hod Hasharon, Israel
| | - Ariella Grossman Giron
- Department of Behavioral Sciences, Ariel University, Ramat Hagolan 65th st, 4070000, Ariel, Israel.,Shalvata Mental Health Center, 13th Alyat Hanoar st, POB 94, 45100, Hod Hasharon, Israel
| | - Gady Alon
- Shalvata Mental Health Center, 13th Alyat Hanoar st, POB 94, 45100, Hod Hasharon, Israel.,Sackler School of Medicine, Tel Aviv University, POB 39040, 69978, Tel Aviv, Israel
| | - Shlomo Mendlovic
- Shalvata Mental Health Center, 13th Alyat Hanoar st, POB 94, 45100, Hod Hasharon, Israel.,Sackler School of Medicine, Tel Aviv University, POB 39040, 69978, Tel Aviv, Israel
| | - Yuval Bloch
- Shalvata Mental Health Center, 13th Alyat Hanoar st, POB 94, 45100, Hod Hasharon, Israel.,Sackler School of Medicine, Tel Aviv University, POB 39040, 69978, Tel Aviv, Israel
| | - Aviv Segev
- Shalvata Mental Health Center, 13th Alyat Hanoar st, POB 94, 45100, Hod Hasharon, Israel. .,Sackler School of Medicine, Tel Aviv University, POB 39040, 69978, Tel Aviv, Israel.
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"What We Have Here is a Failure to Communicate": Association of Preferred Language With the Rate of Psychiatric Consultation. PSYCHOSOMATICS 2017; 58:421-426. [PMID: 28413091 DOI: 10.1016/j.psym.2017.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND In the United States, people with limited English proficiency (LEP) receive poorer medical care than those proficient in English. Few studies demonstrate how linguistic barriers complicate psychiatric care; in consultation-liaison (C-L) psychiatry, there are no published data about care disparities for patients with LEP or for whom English is not the preferred language (PL). OBJECTIVE We sought to determine if PL affects the psychiatric consultation rate. METHODS Among adult patients admitted during 1 year to a large urban academic medical center, we compared psychiatric consultation rates in English PL patients with non-English PL patients. PL was ascertained from demographics during the medical record. The occurrence of psychiatric consultation was ascertained from C-L service logs. RESULTS There were 54,534 admissions: the no-consultation group (N = 53,196) and the consultation group (N = 1,398). English as PL was more common in the consult group (72.0% of consult group, 62.0% of no-consult group, χ2 = 92.98, p < 0.0001). Spanish speakers were underrepresented in the consult group (14.2% of consult, 25.8% of no-consult, χ2 = 98.78, p < 0.0001). CONCLUSION Primary teams requested more consultations for patients whose PL was English than for patients with other PLs, suggesting that psychiatric needs of patients with non-English PL may be unaddressed. This is the first study to demonstrate a disproportionately low rate of general hospital psychiatric consultations in this population. Further study is necessary to confirm and understand this disparity. We recommend routine use of professional interpreters and low threshold for consultation in patients with non-English PL.
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Zandi T, Havenaar JM, Laan W, Kahn RS, Brink WVD. Effects of a culturally sensitive assessment on symptom profiles in native Dutch and Moroccan patients with a first psychosis referral. Transcult Psychiatry 2016; 53:45-59. [PMID: 25851336 DOI: 10.1177/1363461515577288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies have reported a higher incidence of psychosis in Moroccan immigrants in the Netherlands than among native-born residents. However, this disparity was substantially attenuated when cultural differences in symptom presentation were taken into account. To better understand the impact of different diagnostic procedures on incidence rates, we examined the effects of the use of a culturally sensitive diagnostic interview, compared to a standard semi-structured diagnostic interview, on symptom profiles among Moroccan immigrant and native Dutch patients in the Netherlands. A total of 26 Dutch and 26 Moroccan patients referred with a possible first psychosis diagnosis were interviewed twice: once with the standard version and once with a culturally adapted version of the Comprehensive Assessment of Symptoms and History questionnaire (CASH and CASH-CS, respectively). Among native Dutch patients, symptoms profiles based on CASH and CASH-CS interviews were very similar. By contrast, among Moroccan immigrant patients, symptom profiles based on CASH and CASH-CS interviews differed substantially, with more mania symptoms (+30%; p < .05) and fewer delusions (-31%; p < .05) reported when using the CASH-CS. These results suggest that the over-diagnosis of schizophrenia in Moroccan immigrants with a first psychosis referral may be related to a tendency to under-detect mood symptoms and over-detect positive psychotic symptoms when a standard diagnostic procedure is used. This bias may be corrected, at least in part, by the use of a culturally sensitive interview instrument such as the CASH- CS.
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Bäärnhielm S, Åberg Wistedt A, Rosso MS. Revising psychiatric diagnostic categorisation of immigrant patients after using the Cultural Formulation in DSM-IV. Transcult Psychiatry 2015; 52:287-310. [PMID: 25492265 DOI: 10.1177/1363461514560657] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study evaluated the use of the Outline for Cultural Formulation (OCF) from the DSM-IV in the diagnosis of immigrants and refugee patients at an outpatient psychiatric clinic in Sweden. Using the OCF in conjunction with standard diagnostic procedures led to major revisions of diagnoses for 56.5% of patients. Anxiety disorders, especially PTSD, constitute the disorder group in which the most changes were made. In order to understand how information from the OCF interview led clinicians to revise diagnoses, data from clinical discussions were analysed through qualitative content analysis. This revealed four major themes related to the reevaluation, and at times confirmation, of given clinical psychiatric diagnoses: new information; expression of distress in emotional language; expression of distress in relation to life experiences; and improved understanding of the patient's suffering. The findings suggest that the OCF may be useful for: (a) formulating culture in relation to illness experiences, (b) contextualising diagnostic categorisation, and (c) improving overall understanding of the patient that may facilitate individualised planning of treatment and therapy.
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Affiliation(s)
- Sofie Bäärnhielm
- Transcultural Centre, Stockholm County CouncilKarolinska Insitutet
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Braca M, Berardi D, Mencacci E, Belvederi Murri M, Mimmi S, Allegri F, Mazzi F, Menchetti M, Tarricone I. Understanding psychopathology in migrants: a mixed categorical-dimensional approach. Int J Soc Psychiatry 2014; 60:243-53. [PMID: 23733828 DOI: 10.1177/0020764013484237] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Literature on mental disorders in migrants is constantly increasing. Only a few studies describe psychopathological dimensions in migrants over their nosographic diagnoses; however, there is a growing literature about the greater utility of a categorical-dimensional approach, rather than a solely categorical approach, in the understanding of mental disorders. The aim of this paper is to describe the phenomenology of mental disorders in migrants referred to the Transcultural Psychiatric Team of Bologna (BoTPT), by analysing the psychopathological dimensions that underlie their clinical diagnoses. METHODS We recruited all migrants who attended the BoTPT between May 1999 and July 2009. The psychopathological assessment was conducted with the Association for Methodology and Documentation in Psychiatry (AMDP) and clinical diagnoses were formulated according to ICD-10. We proceeded through a two-step analysis: (1) comparing the prevalence rates of psychopathological symptoms across diagnoses; then (2) conducting a factor analysis to assess how those symptoms configure psychopathological dimensions and how these dimensions underlie clinical diagnoses. RESULTS As expected, we found significant associations between diagnoses and the prevalence of their core psychopathological symptoms. Factor analysis revealed a strong polymorphism of the psychopathological presentation of mental disorders and unexpectedly showed that in each diagnostic cluster, the first extracted factor was not composed of core symptoms. CONCLUSIONS A mixed categorical-dimensional approach seems to improve the description of the psychopathology among migrants, as it adds relevant information regarding psychopathological dimensions useful to the understanding of the peculiar clinical expressivity of our patients.
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Affiliation(s)
- Mauro Braca
- 1Bologna Transcultural Psychiatric Team (BoTPT), Department of Medical and Surgical Sciences, University of Bologna, Italy
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Kotwal AA. Physical and psychological health of first and second generation Turkish immigrants in Germany. Am J Hum Biol 2010; 22:538-45. [DOI: 10.1002/ajhb.21044] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Zandi T, Havenaar JM, Limburg-Okken AG, van Es H, Sidali S, Kadri N, van den Brink W, Kahn RS. The need for culture sensitive diagnostic procedures: a study among psychotic patients in Morocco. Soc Psychiatry Psychiatr Epidemiol 2008; 43:244-50. [PMID: 18060339 DOI: 10.1007/s00127-007-0290-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Accepted: 11/05/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We examine the procedural validity of a standardized instrument for the diagnosis of psychotic disorders in Morocco. METHOD Twenty-nine patients from Casablanca, Morocco, with a psychotic or mood disorder were examined using the Comprehensive Assessment of Symptoms and History (CASH) an adapted version using cultural formulation to make the instrument more culturally sensitive (CASH-CS). Chance corrected agreement was calculated between diagnoses based on these two versions of CASH and independent clinical diagnoses according to local psychiatrists. RESULTS Agreement for traditional CASH versus clinical diagnosis and for CASH versus CASH-CS was low (kappa = -0.19; SD 0.16 and kappa = 0.21; SD 0.16, respectively). De CASH-CS, showed good agreement with clinical diagnosis (kappa = 0.79; SD 0.11). CONCLUSION Standardized instruments for the assessment of psychosis such as the CASH may be liable to cultural misinterpretations. This may be relevant to the interpretation of the high incidence rates of schizophrenia among immigrants. SIGNIFICANT OUTCOMES Agreement between a culturally naïve version of a standardized diagnostic instrument for the assessment of psychosis and clinical diagnosis by Moroccan psychiatrists is poor. Adding additional probes and decision rules based on cultural formulation improves agreement with clinical diagnosis significantly. LIMITATIONS The study was conducted in a small sample. Both versions of CASH were administered by the same interviewer in a single interview session.
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Affiliation(s)
- Tekleh Zandi
- Altrecht, Institute for Mental Health Care, Utrecht, The Netherlands.
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Bokuetenge F, Verbanck P, Pelc I, Pull CB, Fossion P. Si loin, si proche: réflexions cliniques et sociales à propos d'un cas de psychose chez un sujet migrant. ANNALES MEDICO-PSYCHOLOGIQUES 2007. [DOI: 10.1016/j.amp.2007.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Carta MG, Bernal M, Hardoy MC, Haro-Abad JM. Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1). Clin Pract Epidemiol Ment Health 2005; 1:13. [PMID: 16135246 PMCID: PMC1236945 DOI: 10.1186/1745-0179-1-13] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2005] [Accepted: 08/31/2005] [Indexed: 11/10/2022]
Abstract
BACKGROUND This paper is a part of the work of the group that carried out the report "The state of the mental health in Europe" (European Commission, DG Health and Consumer Protection, 2004) and deals with the mental health issues related to the migration in Europe. METHODS The paper tries to describe the social, demographical and political context of the emigration in Europe and tries to indicate the needs and (mental) health problems of immigrants. A review of the literature concerning mental health risk in immigrant is also carried out. The work also faces the problem of the health policy toward immigrants and the access to health care services in Europe. RESULTS Migration during the 1990s has been high and characterised by new migrations. Some countries in Europe, that have been traditionally exporters of migrants have shifted to become importers. Migration has been a key force in the demographic changes of the European population. The policy of closed borders do not stop migration, but rather seems to set up a new underclass of so-called "illegals" who are suppressed and highly exploited. In 2000 there were also 392,200 asylum applications. The reviewed literature among mental health risk in some immigrant groups in Europe concerns: 1) highest rate of schizophrenia; suicide; alcohol and drug abuse; access of psychiatric facilities; risk of anxiety and depression; mental health of EU immigrants once they returned to their country; early EU immigrants in today disadvantaged countries; refugees and mental health. Due to the different condition of migration concerning variables as: motivation to migrations (e.g. settler, refugees, gastarbeiters); distance for the host culture; ability to develop mediating structures; legal residential status it is impossible to consider "migrants" as a homogeneous group concerning the risk for mental illness. In this sense, psychosocial studies should be undertaken to identify those factors which may under given conditions, imply an increased risk of psychiatric disorders and influence seeking for psychiatric care. COMMENTS AND REMARKS: Despite in the migrants some vulnerable groups were identified with respect to health problems, in many European countries there are migrants who fall outside the existing health and social services, something which is particularly true for asylum seekers and undocumented immigrants. In order to address these deficiencies, it is necessary to provide with an adequate financing and a continuity of the grants for research into the multicultural health demand. Finally, there is to highlight the importance of adopting an integrated approach to mental health care that moves away from psychiatric care only.
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Affiliation(s)
| | - Mariola Bernal
- Unitat de Recerca i Desenvolupament, Hospital Sant Joan de Deu-SSM, Barcelona, Spain
| | | | - Josep Maria Haro-Abad
- Unitat de Recerca i Desenvolupament, Hospital Sant Joan de Deu-SSM, Barcelona, Spain
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Abstract
In two previous studies, it was observed that schizophrenic patients display increased confidence in memory errors compared with controls. The patient group displayed an increased proportion of errors in their knowledge system, quantified as the percentage of high-confident responses that are errors. The latter phenomenon has been termed knowledge corruption and is put forward as a risk factor for the emergence of delusions. In the present study, knowledge corruption was analyzed separately for different aspects of memory errors. A source-monitoring task was used, for which participants (30 schizophrenic patients with past or current paranoid ideas and 15 healthy controls) were asked to provide associates for each of 20 prime words. Later, participants were required to recognize studied words among distractor words, judge the original source, and provide a confidence rating for the most recent decision. Schizophrenic patients displayed greater confidence in memory errors compared with controls. Knowledge corruption was observed to be significantly greater in schizophrenic patients relative to controls for false-positive and false-negative judgments. It is proposed that reliance on false knowledge represents a candidate mechanism for the emergence of fixed false beliefs (i.e., delusions).
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Affiliation(s)
- Steffen Moritz
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie, D-20246 Hamburg, Germany
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17
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Fossion P, Ledoux Y, Valente F, Servais L, Staner L, Pelc I, Minner P. Psychiatric disorders and social characteristics among second-generation Moroccan migrants in Belgium: an age-and gender-controlled study conducted in a psychiatric emergency department. Eur Psychiatry 2002; 17:443-50. [PMID: 12504260 DOI: 10.1016/s0924-9338(02)00707-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Clinically, one of the most consistent clinical findings among migrant patients is an increase in the rate of psychosis. The aim of the present study was to confirm this finding in Belgium by comparing second-generation Moroccan migrant patients with Belgian patients, matched for the variables of age and gender. SUBJECTS AND METHOD We conducted a cross-sectional survey on 272 patients admitted in a psychiatric emergency unit during the year 1998. We used univariate and multivariate analyses to compare the two subgroups. RESULTS Multivariate analyses showed that migrant patients lived more often with their parental family and that they presented a higher rate of admission for psychotic disorders and a lower rate of employment. DISCUSSION Our findings add to the growing body of results showing increased incidence of psychosis among immigrants to European countries, but several factors have to be taken into account, particularly with regard to selection biases and differences in help-seeking behaviour and in family perception of the mental illness. CONCLUSION Our results are compatible with the hypothesis that unemployment is a contributing factor in the risk for psychosis among migrant groups. Further studies would be needed to better explain some of our results, particularly the role played by the families of migrant patients.
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Affiliation(s)
- P Fossion
- Department of Psychiatry, CHU Brugmann, 4, Place Van Gehuchten, 1020, Brussels, Belgium.
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Brune M, Haasen C, Krausz M, Yagdiran O, Bustos E, Eisenman D. Belief systems as coping factors for traumatized refugees: a pilot study. Eur Psychiatry 2002; 17:451-8. [PMID: 12504261 DOI: 10.1016/s0924-9338(02)00708-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The severity of traumatization seems to correlate with a more severe course of post-traumatic stress disorder (PTSD) (and other post-traumatic disorders), while firm belief systems have been found to be a protective factor against post-traumatic disorders. This study sought to determine the role of belief systems in the outcome of psychotherapy for traumatized refugees. The charts of 141 consecutively treated refugees were evaluated retrospectively. A firm belief system was found to be an important predictor for a better therapy outcome. The importance of a firm belief system as a coping factor, which should be used as an instrument in therapy, is discussed.
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Affiliation(s)
- Michael Brune
- Clinic for Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Martini Str. 52, Germany
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Veen N, Selten JP, Hoek HW, Feller W, van der Graaf Y, Kahn R. Use of illicit substances in a psychosis incidence cohort: a comparison among different ethnic groups in the Netherlands. Acta Psychiatr Scand 2002; 105:440-3. [PMID: 12059848 DOI: 10.1034/j.1600-0447.2002.01222.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Use of illicit substances has been suggested as an explanation for the increased incidence of psychosis among some immigrant groups. The aim of the present study is to compare the rates of illicit substance use among immigrants with a first psychosis with that among non-migrants. METHOD A population-based, first-contact incidence study in the Netherlands. Patients and key informants were interviewed about drug use in the preceding year. RESULT One hundred and eighty-one subjects were examined. Proportions of patients who misused any illicit substance were 23% for Dutch, 17% for Moroccans, 27% for Surinamese, 30% for Turkish subjects, and 33% for other immigrants. Logistic regression analysis, controlling for age and sex, showed that ethnicity did not significantly contribute to the prediction of substance misuse. CONCLUSION A higher rate of drug misuse is an unlikely explanation for the increased incidence of psychotic disorders among Moroccan and Surinamese immigrants to the Netherlands.
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Affiliation(s)
- N Veen
- Division of Psychiatry, University Medical Center, Utrecht, The Netherlands.
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