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Logan S, Rouen D, Wagner R, Steel Z, Hunt C. Mental health service use and ethnicity: An analysis of service use and time to access treatment by South East Asian‐, Middle Eastern‐, and Australian‐born patients within Sydney, Australia. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shanna Logan
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia,
| | - David Rouen
- Clinic for Anxiety and Traumatic Stress, South Western Sydney Local Health District, NSW Health, Sydney, New South Wales, Australia,
| | - Renate Wagner
- Clinic for Anxiety and Traumatic Stress, South Western Sydney Local Health District, NSW Health, Sydney, New South Wales, Australia,
| | - Zachary Steel
- School of Psychiatry, UNSW (University of New South Wales), Sydney, New South Wales, Australia,
| | - Caroline Hunt
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia,
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Kartal D, Alkemade N, Kiropoulos L. Trauma and Mental Health in Resettled Refugees: Mediating Effect of Host Language Acquisition on Posttraumatic Stress Disorder, Depressive and Anxiety Symptoms. Transcult Psychiatry 2019; 56:3-23. [PMID: 30117781 DOI: 10.1177/1363461518789538] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the relationship between traumatic exposure, host language acquisition and mental health (posttraumatic stress, depressive and anxiety symptoms) in long-term resettled refugees. Participants included a community sample of Bosnian refugees ( N = 138, 55% male, mean age of 40 years old) that had resettled in Australia and Austria on average 18 years prior. Two mediation models were tested based on two competing theories. Model A examined whether language acquisition mediates the relationship between traumatic exposure and mental health problems experienced by refugees. Model B examined whether mental health symptoms mediate the relationship between exposure to traumatic events and the acquisition of host language. Model A fit the data well (CFI = 1.00, SRMR = .017, RMSEA < .001, χ2 p = .526), while Model B was rejected as an acceptable model for the data (CFI = .556, SRMR = .136, RMSEA = .352). In Model A, the indirect pathway from trauma to mental health via language acquisition was significant for PTSD ( β = .067, p = .028) and anxiety symptoms ( β = .063, p = .026) but not depression symptoms ( β = .048, p = .071). Intervention strategies aimed at improving host language acquisition may be important not only in successful adaptation to daily living in the host country, but also to improve the mental health of traumatized refugees.
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Roberts T, Miguel Esponda G, Krupchanka D, Shidhaye R, Patel V, Rathod S. Factors associated with health service utilisation for common mental disorders: a systematic review. BMC Psychiatry 2018; 18:262. [PMID: 30134869 PMCID: PMC6104009 DOI: 10.1186/s12888-018-1837-1] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC). METHODS We searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using "best fit framework synthesis", with reference to the Andersen socio-behavioural model. RESULTS Fifty two studies met inclusion criteria. 46 (88%) were from HIC. Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies. Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported. Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services. There was a lack of research from LMIC and on contextual level factors. CONCLUSION In HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that "treatment gap" statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors. TRIAL REGISTRATION PROSPERO registration number: 42016046551 .
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Affiliation(s)
- Tessa Roberts
- Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Georgina Miguel Esponda
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Dzmitry Krupchanka
- grid.447902.cDepartment of Social Psychiatry, National Institute of Mental Health, Prague, Czech Republic ,0000 0001 2322 4988grid.8591.5Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Rahul Shidhaye
- 0000 0004 1761 0198grid.415361.4Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India ,0000 0001 0481 6099grid.5012.6Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Vikram Patel
- 000000041936754Xgrid.38142.3cDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Sujit Rathod
- 0000 0004 0425 469Xgrid.8991.9Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Mollah TN, Antoniades J, Lafeer FI, Brijnath B. How do mental health practitioners operationalise cultural competency in everyday practice? A qualitative analysis. BMC Health Serv Res 2018; 18:480. [PMID: 29925366 PMCID: PMC6011345 DOI: 10.1186/s12913-018-3296-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite continued policy and research emphasis to deliver culturally competent mental healthcare, there is: (1) limited evidence about what frontline practitioners consider to be culturally competent care and; (2) what helps or hinders them in delivering such care in their everyday practice. The aims of this article are to address these gaps. METHODS Qualitative in-depth interviews were conducted with 20 mental health practitioners working with immigrant patients to explore their understandings and experiences of culturally competent care. Interviews were conducted between September 2015 and February 2016 in the state of Victoria, Australia. Data were thematically analysed. RESULTS There were common understandings of cultural competence but its operationalisation differed by profession, health setting, locality, and years of experience; urban psychiatrists were more functional in their approach and authoritarian in their communication with patients compared to allied health staff in non-specialist mental health settings, in rural areas, with less years of experience. Different methods of operationalising cultural competence translated into complex ways of building cultural concordance with patients, also influenced by health practitioners' own cultural background and cultural exposures. Limited access to interpreters and organisational apathy remain barriers to promoting cultural competency whereas organisational support, personal motivation, and professional resilience remain critical facilitators to sustaining cultural competency in everyday practice. CONCLUSION While there is need for widespread cultural competence teaching to all mental health professionals, this training must be specific to different professional needs, health settings, and localities of practice (rural or urban). Experiential teaching at tertiary level or professional development programs may provide an avenue to improve the status quo but a 'one-size-fits-all' model is unlikely to work.
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Affiliation(s)
- Tooba Noor Mollah
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Josefine Antoniades
- Division of Social Gerontology, National Ageing Research Institute Ltd, PO Box 2127, Royal Melbourne Hospital, Melbourne, 3050, Australia
| | - Fathima Ijaza Lafeer
- Division of Social Gerontology, National Ageing Research Institute Ltd, PO Box 2127, Royal Melbourne Hospital, Melbourne, 3050, Australia
| | - Bianca Brijnath
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Australia. .,Division of Social Gerontology, National Ageing Research Institute Ltd, PO Box 2127, Royal Melbourne Hospital, Melbourne, 3050, Australia.
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Minas H, Kakuma R, Too LS, Vayani H, Orapeleng S, Prasad-Ildes R, Turner G, Procter N, Oehm D. Mental health research and evaluation in multicultural Australia: developing a culture of inclusion. Int J Ment Health Syst 2013; 7:23. [PMID: 24093216 PMCID: PMC3852843 DOI: 10.1186/1752-4458-7-23] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 09/28/2013] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Cultural and linguistic diversity is a core feature of the Australian population and a valued element of national identity. The proportion of the population that will be overseas-born is projected to be 32% by 2050. While a very active process of mental health system reform has been occurring for more than two decades - at national and state and territory levels - the challenges presented by cultural and linguistic diversity have not been effectively met. A key area in which this is particularly an issue is in the collection, analysis and reporting of mental health data that reflect the reality of population diversity. The purpose of this study was to examine: what is known about the mental health of immigrant and refugee communities in Australia; whether Australian mental health research pays adequate attention to the fact of cultural and linguistic diversity in the Australian population; and whether national mental health data collections support evidence-informed mental health policy and practice and mental health reform in multicultural Australia. METHODS The study consisted of three components - a brief review of what is known about mental health in, and mental health service use by, immigrant and refugee communities; an examination of national data collections to determine the extent to which relevant cultural variables are included in the collections; and an examination of Australian research to determine the extent to which immigrant and refugee communities are included as participants in such research. RESULTS The review of Australian research on mental health of immigrant and refugee communities and their patterns of mental health service use generated findings that are highly variable. The work is fragmented and usually small-scale. There are multiple studies of some immigrant and refugee communities and there are no studies of others. Although there is a broadly consistent pattern of lower rates of utilisation of specialist public mental health services by immigrants and refugees the absence of adequate population epidemiological data prevents judgments about whether the observed patterns constitute under-utilisation. There are virtually no data on quality of service outcomes. The examination of national data collections revealed multiple gaps in these data collections. The review of papers published in four key Australian journals to determine whether immigrants and refugees are included in mental health research studies revealed a high rate (9.1%) of specific exclusion from studies (usually due to low English fluency) and a much higher rate of general neglect of the issue of population diversity in study design and reporting. CONCLUSIONS While there are many positive statements of policy intent in relation to immigrant and refugee communities in national mental health policies and strategies there is virtually no reporting by Commonwealth or State and Territory governments of whether policies that are relevant to immigrant and refugee communities are effectively implemented. It is not possible, on the basis of the data collected, to determine whether immigrant and refugee communities are benefiting from the mental health system reforms that are being actively carried out. The majority of Australian mental health research does not adequately include immigrant and refugee samples. On the basis of the findings of this study eight strategies have been recommended that will contribute to the development of a culture of inclusion of all Australians in the national mental health research enterprise.
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Affiliation(s)
- Harry Minas
- Centre for International Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Victorian Transcultural Mental Health, St Vincent’s Hospital Melbourne, Melbourne, Australia
- Mental Health in Multicultural Australia, Brisbane, Australia
| | - Ritsuko Kakuma
- Centre for International Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Lay San Too
- Centre for International Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Mental Health in Multicultural Australia, Brisbane, Australia
| | - Hamza Vayani
- Mental Health in Multicultural Australia, Brisbane, Australia
| | | | - Rita Prasad-Ildes
- Mental Health in Multicultural Australia, Brisbane, Australia
- Queensland Transcultural Mental Health Centre, Metro South Hospital and Health Service, Brisbane, Australia
| | - Greg Turner
- Mental Health in Multicultural Australia, Brisbane, Australia
- Queensland Transcultural Mental Health Centre, Metro South Hospital and Health Service, Brisbane, Australia
| | - Nicholas Procter
- Mental Health in Multicultural Australia, Brisbane, Australia
- University of South Australia, Adelaide, Australia
| | - Daryl Oehm
- Victorian Transcultural Mental Health, St Vincent’s Hospital Melbourne, Melbourne, Australia
- Mental Health in Multicultural Australia, Brisbane, Australia
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Maheshwari R, Steel Z. Mental health, service use and social capital among Indian-Australians: findings of a wellbeing survey. Australas Psychiatry 2012; 20:384-9. [PMID: 23018117 DOI: 10.1177/1039856212458980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Indian-Australians represent a distinct immigrant group both demographically and culturally. Yet, despite an expanding body of research on transcultural mental health in Australia, there is a paucity of studies regarding mental health of Indian-Australians. This paper explores the extent of psychological morbidity and related service use in a representative sample of Indian-Australians. It further examines the association of mental health with social participation and networking in this ethnic community. METHOD Measures to assess current levels of psychological distress, functional disability, service use, and social capital were administered in a random sample of 71 Indian-Australian family groups living in Sydney. RESULTS Amongst participants, 15% reported high to very high levels of psychological distress. Psychological distress was associated with increased days of functional disability and higher levels of functional impairment, and an increased likelihood of a GP consultation. However, 91% of participants with identifiable mental health needs did not seek any mental health consultation. Social capital was not found to be a significant predictor of psychological health or service use in this sample. CONCLUSION Psychological morbidity in the Indian-Australian community is associated with high levels of functional disability, both in number of days and extent of severity, but only a small proportion seeks mental health help.
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Affiliation(s)
- Rajesh Maheshwari
- Concord Centre for Mental Health, School of Psychiatry, University of New South Wales and NSW Institute of Psychiatry, Sydney, NSW, Australia.
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Ou L, Chen J, Hillman K. Health services utilisation disparities between English speaking and non-English speaking background Australian infants. BMC Public Health 2010; 10:182. [PMID: 20374663 PMCID: PMC2858120 DOI: 10.1186/1471-2458-10-182] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 04/08/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine the differences in health services utilisation and the associated risk factors between infants from non-English speaking background (NESB) and English speaking background (ESB) within Australia. METHODS We analysed data from a national representative longitudinal study, the Longitudinal Study of Australian Children (LSAC) which started in 2004. We used survey logistic regression coupled with survey multiple linear regression to examine the factors associated with health services utilisation. RESULTS Similar health status was observed between the two groups. In comparison to ESB infants, NESB infants were significantly less likely to use the following health services: maternal and child health centres or help lines (odds ratio [OR] 0.56; 95% confidence intervals [CI], 0.40-0.79); maternal and child health nurse visits (OR 0.68; 95% CI, 0.49-0.95); general practitioners (GPs) (OR 0.58; 95% CI, 0.40-0.83); and hospital outpatient clinics (OR 0.54; 95% CI, 0.31-0.93). Multivariate analysis results showed that the disparities could not be fully explained by the socioeconomic status and language barriers. The association between English proficiency and the service utilised was absent once the NESB was taken into account. Maternal characteristics, family size and income, private health insurance and region of residence were the key factors associated with health services utilisation. CONCLUSIONS NESB infants accessed significantly less of the four most frequently used health services compared with ESB infants. Maternal characteristics and family socioeconomic status were linked to health services utilisation. The gaps in health services utilisation between NESB and ESB infants with regard to the use of maternal and child health centres or phone help, maternal and child health nurse visits, GPs and paediatricians require appropriate policy attentions and interventions.
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Affiliation(s)
- Lixin Ou
- Simpson Centre for Health Services Research, University of New South Wales, Sydney, Australia.
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Chen AW, Kazanjian A, Wong H. Why do Chinese Canadians not consult mental health services: health status, language or culture? Transcult Psychiatry 2009; 46:623-41. [PMID: 20028680 DOI: 10.1177/1363461509351374] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Data from the Canadian Community Health Survey Cycle 1.1 showed that Chinese immigrants to Canada and Chinese individuals born in Canada were less likely than other Canadians to have contacted a health professional for mental health reasons in the previous year in the province of British Columbia. The difference persisted among individuals at moderate to high risk for depressive episode. Both immigrant and Canadian-born Chinese showed similar characteristics of mental health service use. The demographic and health factors that significantly affected their likelihood to consult mental health services included Chinese language ability, restriction in daily activities, frequency of medical consultations, and depression score. Notwithstanding lower levels of mental illness in ethnic Chinese communities, culture emerged as a major factor explaining differences in mental health consultation between Chinese and non-Chinese Canadians.
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Affiliation(s)
- Alice W Chen
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, #2431-515 West Hastings Street, Vancouver, BC V6B5K3, Canada.
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Blignault I, Ponzio V, Rong Y, Eisenbruch M. A qualitative study of barriers to mental health services utilisation among migrants from mainland China in south-east Sydney. Int J Soc Psychiatry 2008; 54:180-90. [PMID: 18488410 DOI: 10.1177/0020764007085872] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chinese-language speakers comprise the largest non-English speaking population in Australia but they have among the lowest rates of mental health services utilisation. MATERIAL A bilingual (Mandarin/English) researcher conducted in-depth interviews with China-born mental health patients and members of the general community, and mental health service providers. DISCUSSION Participants identified several factors that limit access to mental healthcare as well as the quality of care received: mental health literacy, communication difficulties, stigma, confidentiality concerns, service constraints and discrimination. Cross-cultural communication was not just a matter of hearing individual words but also appreciating idioms and cultural and social references. CONCLUSION Findings have implications for the prevention and treatment of mental disorders among migrants from China, and caution against assuming heterogeneity within ethnic groups. Mental health services must become more culturally competent in their attempts to engage the target group and to deliver both acute and continuing care.
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Affiliation(s)
- Ilse Blignault
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
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Steel Z, McDonald R, Silove D, Bauman A, Sandford P, Herron J, Minas IH. Pathways to the first contact with specialist mental health care. Aust N Z J Psychiatry 2006; 40:347-54. [PMID: 16620317 DOI: 10.1080/j.1440-1614.2006.01801.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the pathways to mental health care followed by patients presenting for the first time to community- and hospital-based services and the degree to which individual characteristics, cultural background, illness type, severity and service-related variables influence the time and pathways taken to reach care. METHOD One hundred and forty-six consecutive Australian-born, Asian and Arabic-speaking patients making their first lifetime contact with mental health services in two area health regions were included. Symptom severity was assessed using the Health of the Nations Outcome Scales. Illness explanatory models, social support, English-language proficiency and acculturation were also assessed. RESULTS An average of three professional consultations were made prior to first contact with public mental health services. Family physicians occupied a pivotal role in the help-seeking pathway with 53% of patients consulting a general practitioner. The median time taken to reach specialist mental health services was 6 months, with significantly shorter time for patients with psychotic disorders. Individual variables such as gender, social support, ethnicity and English fluency were not associated with delays in receiving public mental health care. Ethnicity was associated with lower utilization of allied health professionals. CONCLUSIONS The data suggest that social and cultural factors influence the range of professionals consulted by those with a mental illness but do not delay their presentation to public mental health services.
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Affiliation(s)
- Zachary Steel
- Center for Population Mental Health Research, Psychiatry Research & Teaching Unit, Liverpool Hospital, New South Wales, and School of Public Health, University of Sydney, Australia.
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Boufous S, Silove D, Bauman A, Steel Z. Disability and Health Service Utilization Associated With Psychological Distress: The Influence of Ethnicity. ACTA ACUST UNITED AC 2005; 7:171-9. [PMID: 16194002 DOI: 10.1007/s11020-005-5785-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined levels of disability and use of health services, as a result of psychological distress, across various ethnic groups after taking into account selected sociodemographic factors such as age, gender, education, and employment. We have analyzed data from the 1997-1998 New South Wales Health Survey, Australia. A telephone interview of 35,025 adults aged 16 years and over selected from each of the 17 Health Service Areas in the state. While people from non-English speaking backgrounds were more likely to suffer high levels of disability as a result of psychological distress, they were less likely to utilize health services compared to those from English speaking backgrounds. This was particularly true for those born in Southern and South-East Asia as well as the Middle East and Africa. Further research into the reasons underlying these findings for each ethnic group is warranted.
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Affiliation(s)
- Soufiane Boufous
- Faculty of Science, University of New South Wales, Sydney, Australia.
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Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet 2005; 365:1309-14. [PMID: 15823380 DOI: 10.1016/s0140-6736(05)61027-6] [Citation(s) in RCA: 1066] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND About 13 million people are classified as refugees worldwide, and many more former refugees have been granted citizenship in their new countries. However, the prevalence of post-traumatic stress disorder, major depression, or psychotic illnesses in these individuals is not known. We did a systematic review of surveys about these disorders in general refugee populations in western countries. METHODS We searched for psychiatric surveys that were based on interviews of unselected refugee populations and that included current diagnoses of post-traumatic stress disorder, major depression, psychotic illnesses, or generalised anxiety disorder. We did computer-assisted searches, scanned reference lists, searched journals, and corresponded with authors to determine prevalence rates of these mental disorders and to explore potential sources of heterogeneity, such as diagnostic criteria, sampling methods, and other characteristics. FINDINGS 20 eligible surveys provided results for 6743 adult refugees from seven countries, with substantial variation in assessment and sampling methods. In the larger studies, 9% (99% CI 8-10%) were diagnosed with post-traumatic stress disorder and 5% (4-6%) with major depression, with evidence of much psychiatric comorbidity. Five surveys of 260 refugee children from three countries yielded a prevalence of 11% (7-17%) for post-traumatic stress disorder. Larger and more rigorous surveys reported lower prevalence rates than did studies with less optimum designs, but heterogeneity persisted even in findings from the larger studies. INTERPRETATION Refugees resettled in western countries could be about ten times more likely to have post-traumatic stress disorder than age-matched general populations in those countries. Worldwide, tens of thousands of refugees and former refugees resettled in western countries probably have post-traumatic stress disorder.
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Affiliation(s)
- Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
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Ng TP, Fones CSL, Kua EH. Preference, need and utilization of mental health services, Singapore National Mental Health Survey. Aust N Z J Psychiatry 2003; 37:613-9. [PMID: 14511091 DOI: 10.1046/j.1440-1614.2003.01233.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To ascertain the extent of the community's preference, needs for and utilization of mental health services, and their socio-demographic determinants in the multi-ethnic Asian community in Singapore. The extent to which need, enabling and predisposing factors determine the likelihood to seek professional help was also examined. METHOD Data were analyzed from the Singapore National Mental Health Survey of 1996, based on a stratified random sample of 2947 Chinese, Malay and Indian subjects of the general population aged 13-64 years. RESULTS An estimated 37% of the general population indicated they would seek professional help if they experienced a serious emotional or mental problem. Although 16.9% were determined by their high general health questionnaire (GHQ) score to need mental health services, only 2.6% in the population used the services of any professional caregiver. Among persons with high GHQ scores, only 5.9% sought any professional help. Among those with a high GHQ score and who were receptive to professional help, only 10.4% actually sought professional help. General practitioners were the most commonly preferred caregiver (49.3%), and were used by 41.1% of those who sought help. Those who sought professional help were more likely to have a high GHQ score and to be inclined to seek professional help. Malays used mental health services more than Chinese, but they did not show a significantly greater prevalence of high GHQ scores, or a greater preference to seek professional help. Receptivity to professional help, high GHQ score, and Malay ethnicity were independent significant predictors of use of mental health service. CONCLUSION Need and attitudinal factors predict mental health service utilization, but they still do not explain why a large majority of the population chose not to use mental health services.
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Affiliation(s)
- Tze Pin Ng
- National University of Singapore, Department of Psychological Medicine, National University Hospital, Singapore.
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