1
|
Misra S, Rahman T, Ali SH, Taher MD, Mitra P. Public Health Research on Severe Mental Conditions Among Immigrant Communities in the United States: Strategies From a Qualitative Study with South Asian Immigrants in New York City. AJPM FOCUS 2025; 4:100333. [PMID: 40290863 PMCID: PMC12032897 DOI: 10.1016/j.focus.2025.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/30/2025]
Abstract
Introduction The study of severe mental conditions has primarily remained under the purview of basic and clinical research. Although global epidemiological data indicate that immigrant groups are at higher risk of these conditions, U.S. data are lacking. Qualitative studies can be an important first step to bring attention to understudied phenomena. Methods This manuscript describes strategies used to conduct semi-structured, in-depth individual interviews on experiences and perceptions of severe mental conditions among South Asian individuals with psychiatric diagnoses (n=21), family members (n=11), and clinicians (n=4) in New York City. These strategies were synthesized from the team's internal notes of adaptations during the study design and data collection, weekly debrief meetings during data analysis, and brainstorm sessions for this manuscript. Results The main results of the study are reported elsewhere. This section focuses on lessons learned to improve immigrant participant interest and engagement, including the strengths and limitations of the healthcare setting; recruitment by a multilingual South Asian psychiatrist; interviews by non-clinical South Asian researchers selected for a variety of ages, genders, and languages; and the interview process and content. Discussion Overall, these strategies show the feasibility of non-clinical researchers to collect high-quality data about severe mental conditions among immigrant communities, noting that the details of specific strategies and results will be particular to each immigrant community. Public health research on severe mental conditions is essential to understand and address the experiences of severe mental conditions among immigrant communities in the U.S.
Collapse
Affiliation(s)
- Supriya Misra
- Department of Public Health, San Francisco State University, San Francisco, CA
| | - Tasfia Rahman
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Shahmir H. Ali
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY
| | - MD Taher
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Paroma Mitra
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY
- Department of Psychiatry, NYC Health + Hospitals/Bellevue, New York, NY
| |
Collapse
|
2
|
Kitakami CS, Tiguman GMB, Vieira MEB, Aguiar PM. Factors Associated with Stigma and Beliefs About Psychotropics Among the Japanese Ancestry Population Diagnosed with Depression in Brazil. J Immigr Minor Health 2025; 27:74-84. [PMID: 39361230 DOI: 10.1007/s10903-024-01635-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2024] [Indexed: 01/31/2025]
Abstract
To analyze stigma related to depression, beliefs about psychotropics, and associated factors in a population of Japanese ancestry in Brazil. This cross-sectional study was conducted between March and June, 2022. Beliefs about psychotropics (BMQ-specific) and depression-related stigma (The Stigma Scale) were collected through an online questionnaire. Multiple linear regression analysis was performed to identify the factors associated with these dependent variables. Ninety-three respondents of Japanese ancestry completed the questionnaire. Participants were more focused on the necessity of the prescribed psychotropics than on possible adverse effects. Married individuals (β=-4.68 [95%CI -8.74, -0.63]; p = 0.024) were less concerned with their psychotropics than single individuals, while those undergoing treatment for longer years (β = 6.23 [95%CI 1.35, 11.11]; p = 0.013) perceive a greater necessity for treatment than those who started it recently. In addition, older individuals perceived less necessity for treatment (β=-5.83 [95%CI -10.76, -0.90]; p = 0.021) than younger individuals. Unemployed people (β = 12.09 [95%CI 0.47, 23.70]; p = 0.042) perceived more depression-related stigma than those employed. Aspects of Japanese cultural heritage related to depression and its treatment are still prevalent among people of Japanese ancestry in Brazil. Factors such as age, treatment duration, and marital status affects the perception of beliefs about psychotropics, whereas occupation affects the perception of stigma.
Collapse
Affiliation(s)
- Caroline Shizue Kitakami
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 580 - Conj. das Quimicas - Bloco 13 - Cidade Universitaria Butanta, São Paulo, Brazil
| | | | | | - Patricia Melo Aguiar
- Department of Pharmacy, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes, 580 - Conj. das Quimicas - Bloco 13 - Cidade Universitaria Butanta, São Paulo, Brazil.
| |
Collapse
|
3
|
Mohsin F, Aravala S, Rahman T, Ali SH, Taher MD, Mitra P, Misra S. Psychiatric Healthcare Experiences of South Asian Patients with Severe Mental Illness Diagnoses and Their Families in New York City: A Qualitative Study. Community Ment Health J 2025; 61:39-49. [PMID: 39046623 DOI: 10.1007/s10597-024-01323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/11/2024] [Indexed: 07/25/2024]
Abstract
South Asians (SAs) underutilize mental health services compared to many racial and ethnic groups in the United States (US), yet there is limited research on the experiences of SAs living with severe mental illness (SMI). This study examined psychiatric healthcare experiences of SA patients with SMI diagnoses (e.g., severe depression, bipolar disorder, schizophrenia) in New York City. Data collection included semi-structured interviews with 36 participants (21 patients, 11 family members, 4 clinicians). Data was managed in NVivo. Two pairs of SA researchers conducted thematic analysis. Limited mental health knowledge led to delayed care for SAs due to a low perceived need for help. Ease of access, linguistic resources, patient-provider relationships, and family involvement influenced psychiatric healthcare experiences. Prescribed medications, self-motivation, communication, and religious practices were factors aiding symptom management and recovery. Findings highlight the need for improving psychiatric healthcare access and culturally-salient mental health education for SA communities.
Collapse
Affiliation(s)
- Farhan Mohsin
- NYU Grossman School of Medicine, Institute for Excellence in Health Equity, 180 Madison Ave, New York, NY, 10016, USA
| | - Sai Aravala
- NYU School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Tasfia Rahman
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Shahmir H Ali
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - M D Taher
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
| | - Paroma Mitra
- Department of Psychiatry, NYC Health + Hospitals/Bellevue, 462 First Avenue, New York, NY, 10016, USA
- Department of Psychiatry at NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Supriya Misra
- Department of Public Health, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA.
| |
Collapse
|
4
|
Misra S, Jackson VW, Chong J, Choe K, Tay C, Wong J, Yang LH. Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 68:486-512. [PMID: 33811676 DOI: 10.1002/ajcp.12516] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Stigma is integral to understanding mental health disparities among racial and ethnic minority groups in the United States. We conducted a systematic review to identify empirical studies on cultural aspects of mental illness stigma (public, structural, affiliative, self) among three racial and ethnic minority groups (Asian Americans, Black Americans, Latinx Americans) from 1990 to 2019, yielding 97 articles. In comparison studies (N = 25), racial and ethnic minority groups often expressed greater public and/or self-stigma than White American groups. In within-group studies (N = 65; Asian American, n = 21; Black American, n = 18; Latinx American; n = 26), which were primarily qualitative (73%), four major cultural themes emerged: 1) service barriers including access and quality (structural stigma); 2) family experiences including concealment for family's sake, fear of being a burden, and stigma extending to family (affiliative stigma); 3) lack of knowledge about mental illness and specific cultural beliefs (public stigma); and 4) negative emotional responses and coping (self-stigma). These findings confirmed stigma has both similar and unique cultural aspects across groups. Despite this, few studies tested stigma reduction interventions (N = 7). These cultural insights can inform contextual change at the health systems and community levels to reduce stigma, and empowerment at the interpersonal and individual levels to resist stigma.
Collapse
Affiliation(s)
- Supriya Misra
- San Francisco State University, San Francisco, CA, USA
| | | | - Jeanette Chong
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karen Choe
- Teachers College, Columbia University, New York, NY, USA
| | - Charisse Tay
- Teachers College, Columbia University, New York, NY, USA
| | - Jazmine Wong
- New York University Langone Health, New York, NY, USA
| | - Lawrence H Yang
- New York University School of Global Public Health, New York, NY, USA
- Columbia Mailman School of Public Health, New York, NY, USA
| |
Collapse
|
5
|
Gill BK, Cant R, Lam L, Cooper S, Lou VWQ. Non-pharmacological depression therapies for older Chinese adults: A systematic review & meta-analysis. Arch Gerontol Geriatr 2020; 88:104037. [PMID: 32135393 DOI: 10.1016/j.archger.2020.104037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE To conduct a systematic review of randomized controlled trials to evaluate the evidence for the use of non-pharmacological depression therapies in older Chinese adults. MATERIALS AND METHODS The population was individuals of Chinese extraction over the age of 60 who meet the criteria for depression. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Six healthcare databases were systematically searched for publications to the end date July 2018. Included study variables were extracted and methodological quality assessments were performed. Ten studies reported sufficient data for meta-analysis. RESULTS Fifteen experimental and quasi-experimental studies fulfilled the selection criteria (N = 904 participants). Twelve studies provided sufficient data to evaluate the therapies using Effect Size (ES) (Cohen'sd); ranged from low to high. In the Qigong studies ES varied d = 0.31-0.81, Reminiscence d = 0.20-2.37, and for single studies of Tai Chi d = 1.7 and for Life Story d = 1.46. From the meta-analyses, Qigong was the only treatment that had a significant effect on the severity of depression (Z = -4.47, p < 0.01) with acceptable statistical heterogeneity between studies (I2 = 52 %). CONCLUSION Overall, there was a large methodological heterogeneity between studies attributed to differing treatments, duration and designs. Reminiscence and Life Story showed an overall effect from a range of measures, as did the exercise therapies Qigong and Tai Chi. Qigong was the only therapy having a significant effect on depression. This therapy may be useful to alleviate depression due to the group and social interaction.
Collapse
Affiliation(s)
- Baljit Kaur Gill
- School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong.
| | - Robyn Cant
- School of Nursing and Healthcare Professions, Federation University, Victoria, Australia
| | - Louisa Lam
- School of Nursing and Healthcare Professions, Federation University, Victoria, Australia
| | - Simon Cooper
- School of Nursing and Healthcare Professions, Federation University, Victoria, Australia
| | - Vivian Wei Qun Lou
- School of Social Work and Social Administration, The University of Hong Kong, Hong Kong; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| |
Collapse
|
6
|
Liu CH, Li H, Wu E, Tung ES, Hahm HC. Parent perceptions of mental illness in Chinese American youth. Asian J Psychiatr 2020; 47:101857. [PMID: 31715469 PMCID: PMC7056581 DOI: 10.1016/j.ajp.2019.101857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although parents are often the first to facilitate help-seeking in their children, parental perceptions regarding mental health serve as a significant barrier to the access of mental health services. This study examined mental health perceptions held by Chinese immigrant parents of youth. METHODS Eighteen parents (13 female, 5 male), who identified as having children between the ages of 13 and 21 years, participated in audio-recorded interviews using five vignettes depicting depression with and without a somatic emphasis, schizophrenia with paranoid features, attenuated psychosis syndrome, and social anxiety in youth. Questions about potential causes, likely diagnosis, and health-seeking behaviors in relation to these vignettes were asked. Interviews were analyzed for themes using a deductive-inductive hybrid approach, informed by the explanatory models that have shed light on Asian perceptions of mental illness and approaches to help-seeking. RESULTS While Asian groups are often considered as lacking in mental health knowledge, we found that Chinese immigrant parents were comfortable with psychological terminology as it pertained to identifying causes and describing supportive strategies and the seeking of Western-based providers. However, the majority of Chinese immigrant parent respondents did not easily note suicidality. Furthermore, respondents did not consider social anxiety as a major mental health issue among Chinese immigrant parents and attributed social anxiety to personality or cultural differences. DISCUSSION These findings provide an understanding of how Chinese immigrant parents conceptualize mental illness and help-seeking, which may be helpful for providers when working with Chinese immigrant parents of children that have a mental health concern.
Collapse
Affiliation(s)
- Cindy H Liu
- Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | - Huijun Li
- Florida A&M University, 1601 S. Martin Luther King Jr Blvd, Tallahassee, FL 32307, USA.
| | - Emily Wu
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
| | - Esther S Tung
- Department of Psychology, Boston University, 900 Commonwealth Ave. Floor 2, Boston, MA 02215, USA.
| | - Hyeouk C Hahm
- School of Social Work, Boston University, 264 Bay State Road, Boston, MA 02215, USA.
| |
Collapse
|
7
|
Becker TD, Ho-Foster AR, Poku OB, Marobela S, Mehta H, Cao DTX, Yang LS, Blank LI, Dipatane VI, Moeng LR, Molebatsi K, Eisenberg MM, Barg FK, Blank MB, Opondo PR, Yang LH. "It's When the Trees Blossom": Explanatory Beliefs, Stigma, and Mental Illness in the Context of HIV in Botswana. QUALITATIVE HEALTH RESEARCH 2019; 29:1566-1580. [PMID: 30739566 PMCID: PMC7577021 DOI: 10.1177/1049732319827523] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Mental illness is a common comorbidity of HIV and complicates treatment. In Botswana, stigma impedes treatment of mental illness. We examined explanatory beliefs about mental illness, stigma, and interactions between HIV and mental illness among 42 adults, from HIV clinic and community settings, via thematic analysis of interviews. Respondents endorse witchcraft as a predominant causal belief, in addition to drug abuse and effects of HIV. Respondents describe mental illness as occurring "when the trees blossom," underscoring a conceptualization of it as seasonal, chronic, and often incurable and as worse than HIV. Consequently, people experiencing mental illness (PEMI) are stereotyped as dangerous, untrustworthy, and cognitively impaired and discriminated against in the workplace, relationships, and sexually, increasing vulnerability to HIV. Clinical services that address local beliefs and unique vulnerabilities of PEMI to HIV, integration with peer support and traditional healers, and rehabilitation may best address the syndemic by facilitating culturally consistent recovery-oriented care.
Collapse
Affiliation(s)
| | - Ari R Ho-Foster
- 1 University of Pennsylvania, Philadelphia, Pennsylvania, USA
- 2 Botswana-UPenn Partnership, Gaborone, Botswana
| | | | | | | | | | - Lyla S Yang
- 5 Columbia University, New York City, New York, USA
| | - Lilo I Blank
- 6 University of Rochester, Rochester, New York, USA
| | - Vincent Ikageng Dipatane
- 7 Princess Marina Hospital, Gaborone, Botswana
- 8 Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Letumile Rogers Moeng
- 7 Princess Marina Hospital, Gaborone, Botswana
- 8 Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | | | | | - Frances K Barg
- 1 University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael B Blank
- 1 University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Philip Renison Opondo
- 1 University of Pennsylvania, Philadelphia, Pennsylvania, USA
- 9 University of Botswana School of Medicine, Gaborone, Botswana
| | - Lawrence H Yang
- 5 Columbia University, New York City, New York, USA
- 10 New York University, New York City, New York, USA
| |
Collapse
|
8
|
Huang D, Yang LH, Pescosolido BA. Understanding the public's profile of mental health literacy in China: a nationwide study. BMC Psychiatry 2019; 19:20. [PMID: 30642305 PMCID: PMC6332702 DOI: 10.1186/s12888-018-1980-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 12/11/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND In the wake of China's massive economic development, attention has only recently turned to the enormous treatment gap that exists for mental health problems. Our study is the first comprehensive, national examination of the levels and correlates of the public's ability to recognize mental illness in the community and suggest sources of help, setting a baseline to assess contemporary Chinese efforts. METHODS Data were collected in China as part of the Stigma in Global Context - Mental Health Study (SGC-MHS) through face-to-face interviews using vignettes meeting clinical criteria for schizophrenia and major depression. Our analysis targets the Han Chinese participants (n = 1812). Differences in the recognition of mental health problems were assessed using a chi-square test and further stratified by vignette illness type and urban vs. rural residence. Adjusted regression models estimated the effects of each predictor towards the endorsement three types of help-seeking: medical doctor, psychiatrist, and mental health professional. RESULTS As expected, recognition of mental health problems is low; it is better for depression and most accurate in urban areas. Perceived severity increases endorsement of the need for care and for treatment by all provider types. Recognition of a mental health problem specifically decreases endorsement of medical doctors while increasing recommendations for psychiatrists and mental health professionals. Neurobiological attributions decrease recommendations for mental health professionals as opposed to general or specialty physicians. CONCLUSIONS Continued efforts are needed in China to promote mental illness recognition within rural areas, and of schizophrenia specifically. Promoting recognition of mental illness, while balancing the special challenges among individuals who understand the neurobiological roots of mental illness, may constitute a key strategy to reduce the sizeable mental health treatment gap in China.
Collapse
Affiliation(s)
- Debbie Huang
- 0000000419368729grid.21729.3fMailman School of Public Health, Columbia University, 722 W. 168th St., New York, NY 10032 USA
| | - Lawrence H. Yang
- 0000000419368729grid.21729.3fMailman School of Public Health, Columbia University, 722 W. 168th St., New York, NY 10032 USA ,0000 0004 1936 8753grid.137628.9New York University College of Global Public Health, 715 Broadway, Room 1212, New York, NY 10003 USA
| | - Bernice A. Pescosolido
- 0000 0001 0790 959Xgrid.411377.7Department of Sociology, Indiana University, 1022 E Third St, Bloomington, IN 47405 USA
| |
Collapse
|
9
|
Chang CC, Su JA, Chang KC, Lin CY, Koschorke M, Thornicroft G. Perceived stigma of caregivers: Psychometric evaluation for Devaluation of Consumer Families Scale. Int J Clin Health Psychol 2018; 18:170-178. [PMID: 30487922 PMCID: PMC6225041 DOI: 10.1016/j.ijchp.2017.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/14/2017] [Indexed: 11/19/2022] Open
Abstract
Background/Objective: The Devaluation of Consumer Families Scale (DCFS) is commonly used to measure perceived stigma towards family members of people with mental illness. However, its factorial structure has never been confirmed using confirmatory factor analysis (CFA). This study aimed to test the psychometric properties of the DCFS Taiwan version (DCFS-TW). Method: Family caregivers (N=511) completed the DCFS-TW (97 completed the DCFS again after 2 to 4 weeks) and other instruments. CFA, test-retest reliability, internal consistency, concurrent validity, and known-group validity were analyzed. Results: The three-factor structure of the DCFS-TW performed better than the one-factor structure. Test-retest reliability (r = .66) and internal consistency were satisfactory (α = .85); concurrent validity (absolute r = .20 to .58) was acceptable; known-group validity was supported by the significantly different DCFS-TW scores in clinical characteristics (had been vs. had not been hospitalized; had been vs. had not been compulsorily admitted). Conclusions: The DCFS-TW has decent psychometric properties and is suitable for health professionals to measure perceived stigma towards family members of people with mental illness.
Collapse
Affiliation(s)
- Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan
| | - Jian-An Su
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital at Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Mirja Koschorke
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Graham Thornicroft
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
10
|
Shi-Jie F, Hong-Mei G, Li W, Bin-Hong W, Yi-Ru F, Gang W, Tian-Mei S. Perceptions of stigma and its correlates among patients with major depressive disorder: A multicenter survey from China. Asia Pac Psychiatry 2017; 9. [PMID: 27807927 DOI: 10.1111/appy.12260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 08/10/2016] [Accepted: 09/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The stigma of major depressive disorder (MDD) is an important public health problem. This study evaluated stigma in MDD patients in China using explanatory model interview catalogue (EMIC) questionnaire and the demographic and clinical symptom factors associated with the stigma of these patients. METHODS A total of 158 MDD patients from domestic 3 mental health centers were surveyed. We used the EMIC questionnaire to assess stigma of these patients, Montgomery and Asberg depression rating scale (MADRS) to assess depressive severity, self-reporting inventory (SCL-90) to assess mental health level, Sheehan disability scale (SDS) to assess social function, and fatigue severity scale (FSS) to assess degree of fatigue. RESULTS The stigma scores were significantly higher in the 18- to 30-year-old (z = 2.875, P = .024) and 31- to 40-year-old (z = 3.204, P = .008) groups than the 51- to 65-year-old group; in the full-time employment group than the retired group (z = 3.163, P = .016). The stigma scores exhibited significant negative correlation with age (r = -0.169, P = .034) but positive correlations with the scores of MADRS (r = .212, P = .007), total scores (r = .273, P = .001) and subscales of interpersonal sensitivity (r = .233, P = .003), depression (r = .336, P < .001), and anxiety (r = .228, P = .004) of SCL-90, scores of FSS (r = .230, P = .004), and SDS (r = .254, P = .001). Multivariate regression analysis revealed that depression subscale of SCL-90 and FSS were independently correlated with stigma. CONCLUSION The age, employment status, fatigue, and depressive severity are closely associated with the perceived stigma of MDD patients and may be important factors considered for stigma interventions of MDD in China.
Collapse
Affiliation(s)
- Feng Shi-Jie
- Psychiatric department, Shanxi Mental Health Center (Taiyuan Psychiatric Hospital), Taiyuan, China
| | - Gao Hong-Mei
- Psychiatric department, Shanxi Mental Health Center (Taiyuan Psychiatric Hospital), Taiyuan, China
| | - Wang Li
- Peking University the Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Health Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Wang Bin-Hong
- Psychiatric department, Shanxi Mental Health Center (Taiyuan Psychiatric Hospital), Taiyuan, China
| | - Fang Yi-Ru
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wang Gang
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Si Tian-Mei
- Peking University the Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Health Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| |
Collapse
|
11
|
Cheng ZH, Tu MC, Yang LH. Experiences of Social Support Among Chinese Immigrant Mental Health Consumers with Psychosis. Community Ment Health J 2016; 52:643-50. [PMID: 27100866 DOI: 10.1007/s10597-016-0008-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
Limited research has investigated how culture impacts expressions of social support, which is crucial in developing culturally sensitive care. Using a classification based on theories of social support, we examined the social support experiences of 49 Chinese immigrant mental health consumers with psychosis, paying particular attention to frequency and sources. We found that the most common forms of social support were belonging and companionship, perceived emotional support, social control, and perceived instrumental support, while self-esteem and sense of mastery were the least common forms. Family and friends were the main sources of support. These results demonstrate the influence of Confucian values of renqing (or fulfillment of relational obligations) and guanxi (or social networks) and the negative effects of stigma in diminishing the social standing of these consumers by compromising 'personhood.' Clinical implications for increasing the cultural competency of clinicians and improving the mental health outcomes of Chinese immigrants are discussed.
Collapse
Affiliation(s)
| | - Ming-Che Tu
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Lawrence Hsin Yang
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| |
Collapse
|
12
|
Kaiser BN, Kohrt BA, Wagenaar BH, Kramer MR, McLean KE, Hagaman AK, Khoury NM, Keys HM. Scale properties of the Kreyòl Distress Idioms (KDI) screener: association of an ethnographically-developed instrument with depression, anxiety, and sociocultural risk factors in rural Haiti. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/17542863.2015.1015580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
13
|
Yang L, Lo G, Tu M, Wu O, Anglin D, Saw A, Chen FP. Effects of Increased Psychiatric Treatment Contact and Acculturation on the Causal Beliefs of Chinese Immigrant Relatives of Individuals with Psychosis. JOURNAL OF IMMIGRANT & REFUGEE STUDIES 2015; 13:19-39. [PMID: 27127454 PMCID: PMC4846303 DOI: 10.1080/15562948.2013.856509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Encounters with Western psychiatric treatment and acculturation may influence causal beliefs of psychiatric illness endorsed by Chinese immigrant relatives, thus affecting help-seeking. We examined causal beliefs held by forty-six Chinese immigrant relatives and found that greater acculturation was associated with an increased number of causal beliefs. Further, as Western psychiatric treatment and acculturation increased, causal models expanded to incorporate biological/physical causes. However, frequency of Chinese immigrant relatives' endorsing spiritual beliefs did not appear to change with acculturation. Clinicians might thus account for spiritual beliefs in treatment even after acculturation increases and biological causal models proliferate.
Collapse
Affiliation(s)
- Lawrence Yang
- Columbia University Department of Epidemiology, Assistant Professor, 722 West 168 Street, Room 1610, Columbia University, New York, NY 10032
| | - Graciete Lo
- National Center on Post-Traumatic Stress Disorder- University of Hawaii
| | - Ming Tu
- New York University Counseling Psychology Program
| | - Olivia Wu
- Long Island University Clinical Psychology Program
| | - Deidre Anglin
- City University of New York Department of Psychology
| | - Anne Saw
- University of California, Davis, School of Medicine
| | | |
Collapse
|
14
|
Cheng ZH, Tu MC, Li VA, Chang RW, Yang LH. Experiences of Social and Structural Forms of Stigma Among Chinese Immigrant Consumers with Psychosis. J Immigr Minor Health 2015; 17:1723-31. [DOI: 10.1007/s10903-015-0167-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
15
|
Yang LH, Lai GY, Tu M, Luo M, Wonpat-Borja A, Jackson VW, Lewis-Fernández R, Dixon L. A brief anti-stigma intervention for Chinese immigrant caregivers of individuals with psychosis: adaptation and initial findings. Transcult Psychiatry 2014; 51:139-57. [PMID: 24318864 PMCID: PMC3993525 DOI: 10.1177/1363461513512015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mental illness stigma has adverse effects on both the caregivers' psychological well-being and the effectiveness of care that consumers receive. While anti-stigma interventions for family caregivers from Western settings have recently shown efficacy, these interventions may not be equally applicable across culturally diverse groups. Specifically, Chinese immigrant caregivers experience heightened internalized stigma, which predisposes the adoption of harmful coping strategies and reduced quality of social networks. We present an anti-stigma intervention based on a peer-family group format, co-led by a clinician and a trained family caregiver, to counter stigma among Chinese immigrants. Data are presented from a brief intervention administered to a pilot sample of 11 Chinese immigrant caregivers that provides: psychoeducation, strategies to counter experienced discrimination, and techniques to resist internalized stigma. Case vignettes illustrate implementation of this intervention, and how the peer-family format via interactive contact counteracts internalized stereotypes, encourages adaptive coping strategies, and reinvigorates social networks. Quantitative results further suggest preliminary efficacy in reducing internalized stigma for caregivers who evidenced at least some prior internalized stigma. This study constitutes an initial but important step towards reducing mental illness stigma among Asian Americans, for whom stigma has played a powerful role in the delay and underuse of treatment.
Collapse
|
16
|
Yang LH, Chen FP, Sia KJ, Lam J, Lam K, Ngo H, Lee S, Kleinman A, Good B. “What matters most:” A cultural mechanism moderating structural vulnerability and moral experience of mental illness stigma. Soc Sci Med 2014; 103:84-93. [DOI: 10.1016/j.socscimed.2013.09.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 09/08/2013] [Accepted: 09/09/2013] [Indexed: 11/25/2022]
|
17
|
Yang LH, Lo G, WonPat-Borja AJ, Singla DR, Link BG, Phillips MR. Effects of labeling and interpersonal contact upon attitudes towards schizophrenia: implications for reducing mental illness stigma in urban China. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1459-73. [PMID: 22075964 PMCID: PMC3697873 DOI: 10.1007/s00127-011-0452-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Accepted: 10/31/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE As mental illness stigma contributes to poor outcomes for schizophrenia in China, locating strategies to reduce public stigma is imperative. It is currently unknown whether diagnostic labeling and contact with different help-seeking sources increase or decrease public stigma in China. Further, it remains unresolved whether prior personal contact acts to reduce stigma in this context. Advancing understanding of these processes may facilitate stigma-reduction strategies. METHODS We administered an experimental vignette randomly assigning one of four labeling conditions to respondents to assess social distance towards a psychotic vignette individual in a sample of 160 Northern, urban Chinese community respondents. RESULTS As expected, respondents given a "non-psychiatric, indigenous label" + "lay help-seeking" condition endorsed the least social distance. Unexpectedly, the labeling condition with a "psychiatric diagnostic label" + "lay help-seeking" condition elicited the greatest social distance. Unlike Western studies, personal contact did not independently decrease community stigma. However, prior contact reduced social distance to a greater extent in the labeling condition with a "non-psychiatric, indigenous label" + "lay help-seeking" condition when compared with all other labeling conditions. CONCLUSION The results indicate that cultural idioms do provide some protection from stigma, but only among respondents who are already familiar with what mental illness is. Our finding that the condition that depicted untreated psychosis elicited the greatest amount of stigma, while the "treated psychosis" condition was viewed relatively benignly in China, suggests that improved access to mental health services in urban China has the potential to decrease public stigma via labeling mechanisms.
Collapse
Affiliation(s)
- Lawrence H Yang
- Department of Epidemiology, Columbia University, 722 West 168th Street, Room 1610, New York, NY 10032, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Yang LH, Wonpat-Borja AJ. Causal Beliefs and Effects upon Mental Illness Identification Among Chinese Immigrant Relatives of Individuals with Psychosis. Community Ment Health J 2012; 48:471-6. [PMID: 22075770 PMCID: PMC3685724 DOI: 10.1007/s10597-011-9464-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Accepted: 10/17/2011] [Indexed: 10/15/2022]
Abstract
Identifying factors that facilitate treatment for psychotic disorders among Chinese-immigrants is crucial due to delayed treatment use. Identifying causal beliefs held by relatives that might predict identification of 'mental illness' as opposed to other 'indigenous labels' may promote more effective mental health service use. We examine what effects beliefs of 'physical causes' and other non-biomedical causal beliefs ('general social causes', and 'indigenous Chinese beliefs' or culture-specific epistemologies of illness) might have on mental illness identification. Forty-nine relatives of Chinese-immigrant consumers with psychosis were sampled. Higher endorsement of 'physical causes' was associated with mental illness labeling. However among the non-biomedical causal beliefs, 'general social causes' demonstrated no relationship with mental illness identification, while endorsement of 'indigenous Chinese beliefs' showed a negative relationship. Effective treatment- and community-based psychoeducation, in addition to emphasizing biomedical models, might integrate indigenous Chinese epistemologies of illness to facilitate rapid identification of psychotic disorders and promote treatment use.
Collapse
Affiliation(s)
- Lawrence H. Yang
- Department of Epidemiology, School of Public Health, Columbia University, 722 West 168th Street, Room 1610, New York, NY 10032, USA,
| | - Ahtoy J. Wonpat-Borja
- Department of Epidemiology, School of Public Health, Columbia University, 722 West 168th Street, Room 1610, New York, NY 10032, USA,
| |
Collapse
|
19
|
Yang L, Chen S, Chen CM, Khan F, Forchelli G, Javitt DC. Schizophrenia, culture and neuropsychology: sensory deficits, language impairments and social functioning in Chinese-speaking schizophrenia patients. Psychol Med 2012; 42:1485-1494. [PMID: 22099474 DOI: 10.1017/s0033291711002224] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND While 20% of schizophrenia patients worldwide speak tonal languages (e.g. Mandarin), studies are limited to Western-language patients. Western-language patients show tonal deficits that are related to impaired emotional processing of speech. However, language processing is minimally affected. In contrast, in Mandarin, syllables are voiced in one of four tones, with word meaning varying accordingly. We hypothesized that Mandarin-speaking schizophrenia patients would show impairments in underlying basic auditory processing that, unlike in Western groups, would relate to deficits in word recognition and social outcomes. METHOD Altogether, 22 Mandarin-speaking schizophrenia patients and 44 matched healthy participants were recruited from New York City. The auditory tasks were: (1) tone matching; (2) distorted tunes; (3) Chinese word discrimination; (4) Chinese word identification. Social outcomes were measured by marital status, employment and most recent employment status. RESULTS Patients showed deficits in tone-matching, distorted tunes, word discrimination and word identification versus controls (all p<0.0001). Impairments in tone-matching across groups correlated with both word identification (p<0.0001) and discrimination (p<0.0001). On social outcomes, tonally impaired patients had 'lower-status' jobs overall when compared with tonally intact patients (p<0.005) and controls (p<0.0001). CONCLUSIONS Our study is the first to investigate an interaction between neuropsychology and language among Mandarin-speaking schizophrenia patients. As predicted, patients were highly impaired in both tone and auditory word processing, with these two measures significantly correlated. Tonally impaired patients showed significantly worse employment-status function than tonally intact patients, suggesting a link between sensory impairment and employment status outcome. While neuropsychological deficits appear similar cross-culturally, their consequences may be language- and culture-dependent.
Collapse
Affiliation(s)
- L Yang
- Columbia University Mailman School of Public Health, New York, NY, USA.
| | | | | | | | | | | |
Collapse
|
20
|
Lai GYC, Lo G, Ngo H, Chou Y, Yang L. Migration, Socio-cultural Factors, and Local Cultural Worlds among Fuzhounese Chinese Immigrants: Implications for Mental Health Interventions. ACTA ACUST UNITED AC 2012; 6:141-155. [PMID: 28163779 DOI: 10.1080/17542863.2012.674785] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The last two decades have seen a rapid increase of Fuzhounese immigrants (from Fujian Province, China) to the U.S. This group spurred the interest of researchers because of their new immigrant status and their demographic and sociocultural background that places them at a significant disadvantage compared with the majority of already-established Chinese immigrants. This paper synthesizes existing research on the Fuzhounese's historical/cultural and migration experiences and examines ways in which socio-cultural forces interact with post-migration stressors to impact the onset, manifestation, diagnosis, and treatment of symptoms in this group. From prior ethnographic work, we suggest that the pursuit of four core social goals plays a key role in interfering with psychiatric treatment adherence: 1) To pay off their smuggling debt (often >$80,000); 2) To send money to their natal families to improve social standing; 3) To save money for a dowry to perpetuate the familial lineage by marrying and producing offspring; and 4) To attain legal status. To offer more insight on how these core social motivations impact psychiatric disability, we present a case vignette of a Fuzhounese man diagnosed with schizophrenia. We relate his treatment issues to specific fundamental values that infuse both the lived experience of mental illness and inform clinical and community treatment strategies for this group. We also extend relevant treatment recommendations to migratory workers from other ethnic groups.
Collapse
Affiliation(s)
- Grace Ying-Chi Lai
- New York University, Silver School of Social Work, 1 Washington Square North, NY, NY, 917-428-0577
| | - Graciete Lo
- Fordham University, Dept of Psychology, 441 East Fordham Road, Bronx, NY 10458, 646-284-4551
| | - Hong Ngo
- Fordham University, Dept of Psychology, 441 East Fordham Road, Bronx, NY 10458, 973-985-5649
| | - Yuwen Chou
- Specialized Therapy Associates, LLC, 2348 Linwood Ave., # 5-I, Fort Lee, NJ 07024, 646-643-3402
| | - Lawrence Yang
- Columbia University, Department of Epidemiology, School of Public Health, NY, NY 10032, 917-686-0183
| |
Collapse
|