How people from Chinese backgrounds make sense of and respond to the experiences of mental distress: Thematic analysis

Older Adult Mental Health: A Student-Led Project to Reduce Stigma Among Residents Living in a Publicly Supported Housing

Twenty percent of older adults report having a concern about their mental health. Mental health concerns lead to impairments in physical, mental, and social functioning and complicate the management of chronic illness. These concerns are widely underrecognized and often untreated or under-treated in community-dwelling older adults. A 6-week student-led mental health promotion initiative for older adults living in publicly supported housing was developed. The initiative included student-led weekly "mood" screenings which aimed to destigmatize mental illness and educational sessions teaching the older adults how to use iPads and access the internet and Wi-Fi. The goal of the project was to have residents engage in telehealth visits that promote mental health and improve quality of life. Ungirded by the RE-AIM framework, the initiative focused on achieving Reach by ensuring participants had sufficient knowledge and skill in using the telehealth technology and were not encumbered by mental illness stigma. The project sample of older adults living in publicly supported housing self-reported minimal depressive symptoms and demonstrated stigma toward seeking help for mental illness. Cultural implications contribute to these findings. To have a program with good Reach as delineated in the RE-AIM model, it must recognize facilitators and barriers. Integrating affordability, cultural congruency, and a social connection to community in its design together with the utilization of students during implementation may promote mental health and mitigate some of the negative health consequences.

"Looking beyond Mental Health Stigma": An Online Focus Group Study among Senior Undergraduate Nursing Students

Evidence highlights the need for professionals to be aware of their stigmatizing attitudes and discriminatory practices in order to minimize the negative impact on the people they take care of. However, nursing students' perceptions of these issues have been poorly studied. This study explores the perspective of senior undergraduate nursing students on mental health and the stigma around it, by considering a simulated case vignette of a person with a mental health problem. A descriptive qualitative approach was chosen and involved three online focus group discussions. The findings show various manifestations of stigma, both at an individual and collective level, which indicates that it is an obstacle to the wellbeing of people with mental illness. Individual manifestations of stigma concern its effect on the person with mental illness, while at the collective level they concern the family or society in general. Stigma is a multifactorial, multidimensional, and complex concept, in terms of identifying and fighting it. Thus, the strategies identified involve multiple approaches at the individual level, aimed at the patient and family, namely through education/training, communication, and relationship strategies. At the collective level, to intervene with the general population and specific groups, such as groups of young people, strategies suggested include education/training, use of the media, and contact with people with mental disorders as ways to fight stigma.

Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography

BACKGROUND

Evidence regarding the presence and persistence of ethnic inequalities in mental healthcare is well established. The reasons for these inequalities and lack of progress in diminishing them are less understood. This meta-ethnography aims to provide a new conceptual understanding of how ethnic inequalities are created and sustained; this is essential to develop effective interventions. Specifically, we sought to understand why people from ethnic minority groups are underrepresented in primary care mental health service provision and overrepresented in crisis pathways and detention.

METHODS AND FINDINGS

Following eMERGe guidelines for meta-ethnographies, we searched OpenGrey, Kings Fund, CINAHL, Medline, PsycINFO, and Social Care Online databases for qualitative articles published from database inception until October 2, 2022, using broad categories of search terms relating to "ethnicity AND (mental illness/mental health/emotional distress) AND (help-seeking/service utilisation/experience/perception/view)." We included all conceptually rich articles that used qualitative methods of data collection and analysis and excluded non-UK studies and those that focused solely on causation of mental illness. Our patient, public, and practitioner lived experience advisory group provided feedback and input on key stages of the project including search terms, research questions, data analysis, and dissemination. A total of 14,142 articles were identified; 66 met the inclusion criteria. We used reciprocal, refutational, and line of argument analytical approaches to identify convergence and divergence between studies. The synthesis showed that current models of statutory mental healthcare are experienced as a major barrier to the delivery of person-centred care to those in ethnic minority groups due to the perceived dominance of monocultural and reductionist frameworks of assessment and treatment (described as "medical" and "Eurocentric") and direct experiences of racist practice. The lack of socially oriented and holistic frameworks of knowledge and understanding in medical training and services is experienced as epistemic injustice, particularly among those who attribute their mental illness to experiences of migration, systemic racism, and complex trauma. Fear of harm, concerns about treatment suitability, and negative experiences with health providers such as racist care and medical neglect/injury contribute to avoidance of, and disengagement from, mainstream healthcare. The lack of progress in tackling ethnic inequalities is attributed to failures in coproduction and insufficient adoption of existing recommendations within services. Study limitations include insufficient recording of participant characteristics relating to generational status and social class in primary studies, which prevented exploration of these intersections.

CONCLUSIONS

In this study, we found that the delivery of safe and equitable person-centred care requires a model of mental health that is responsive to the lived experiences of people in ethnic minority groups. For the people considered in this review, this requires better alignment of mental health services with social and anti-racist models of care. Our findings suggest that intersections related to experiences of racism, migration, religion, and complex trauma might be more relevant than crude ethnic group classifications. Strategies to tackle ethnic inequalities in mental healthcare require an evaluation of individual, systemic, and structural obstacles to authentic and meaningful coproduction and implementation of existing community recommendations in services.

Family understanding and communication about an adult relative's mental health problem: A systematic narrative review

WHAT IS KNOWN ON THE SUBJECT?: Adults who support an adult family member with a severe and enduring mental health problem often experience carer burden. Over time, this often negatively affects their mental and physical health and social well-being. Understanding and communicating about mental health problems in families can help to improve resilience and coping among both adults and children. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: We conducted a review of studies looking at how adult relatives understand and communicate about an adult family member's mental health problem. The findings highlight that how relatives make sense of MHP is related to historical family relationships, their mental health literacy and whether they see themselves as a "carer" or not. The findings also show that little research to date has explored how adult relatives talk with children about their parent's difficulties, and how the adults' understanding might affect what children learn about the MHP. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a research gap to be addressed regarding family communication with children about parental mental health problems. This knowledge gap likely impacts family-focused mental health nursing and therapy provision. Mental health nursing, therapeutic and support workers and advocates are ideally positioned to assist relatives with improving their mental health literacy and confidence communicating about mental health, and to promote inclusion of relatives and children in interventions. ABSTRACT: Introduction Relatives are profoundly affected by an adult family member's severe and enduring mental health problem (MHP). The burdens of caring impact on adult relatives' emotional, physical and social well-being. How relatives make meaning and communicate about the MHP is thought to affect family talk about mental health, and this can impact family coping and well-being. Aim No review has yet drawn together research about how adult relatives of people with severe and enduring MHP make meaning and communicate about their relatives' difficulties. We aimed to address this gap. Method We conducted a systematic review of peer-reviewed primary research. SCOPUS, PubMed, Psychnet, SCIE, Cochrane and CINAHL+ databases were searched. Results Nineteen papers qualified for inclusion. Findings are organized under four themes: making meaning about the MHP and affected individual; conceptualizing the self in the presence of the MHP; meaning-making processes underlying relatives' well-being outcomes; and relatives' perspectives on family talk about the MHP. Discussion Historical relationships, caregiver identity and mental health literacy moderate relatives' understanding and talk about the MHP. Implications for practice Psychoeducation and communication support for relatives should be provided by mental health practitioners. Future research should address familial communication about MHP, including with children.

Mental health and psychosocial problems among Chinese left-behind children: A cross-sectional comparative study

BACKGROUND

Separation from migrant parents threatens the mental health of approximately 61 million left-behind children (LBC) in China. This study compared the prevalence of mental health and psychosocial problems between LBC and controls in Sichuan province, China.

METHODS

We randomly recruited LBC and adolescents aged 12-16 years old from 16 rural high schools in 8 counties in Sichuan province. We compared frequency of school bullying, self-esteem, panic symptoms, depression and severe psychological distress(SPD) between LBC and controls from the same schools. These variables were assessed through face-to-face interviews and self-report questionnaires.

RESULTS

The prevalence of mental health problems was 43.4% among LBC(n = 1663) but 30.8% among controls(n = 1683), and the prevalence of specific psychological symptoms was also higher among LBC: SPD, 12.1% vs. 4.8%; panic, 32.4% vs. 22.1%; and depressive symptoms, 26.5% vs. 16.3%. Low self-esteem was more prevalent among LBC(26.6% vs. 18.2%) as was severe school bullying(18.5% vs. 11.3%). Among LBC, low self-esteem was associated with an increased risk of depression or SPD, and school bullying was a significant predictor of depression, panic symptoms and SPD. Low self-esteem and depression increased with longer separation from parents, and this risk was higher when the primary caregivers were LBC themselves or relatives compared to single parents or grandparents.

LIMITATION

LBC misbehavior, such as internet addiction, smoking and drinking, may also explain our findings; these factors need to be explored in future studies.

CONCLUSION

Our results highlight the urgent need for school-based and targeted interventions for LBC to prevent negative mental health outcomes.

The Role of the Social Network in Access to Psychosocial Services for Migrant Elderly-A Qualitative Study

Background: Despite high prevalence of mental problems among elderly migrants in The Netherlands, the use of psychosocial care services by this group is low. Scientific evidence points at the crucial role of social support for mental health and the use of psychosocial services. We therefore explored the role of social networks in the access to psychosocial care among elderly migrants in The Netherlands. Methods: A qualitative study was conducted using semi-structured group interviews and individual interviews. The eight group and eleven individual interviews (respectively n = 58 and n = 11) were conducted in The Netherlands with Turkish, Moroccan, Surinamese, and Dutch elderly. The data were analysed through coding and comparing fragments and recognizing patterns. Results: Support of the social network is important to navigate to psychosocial care and is most frequently provided by children. However, the social network of elderly migrants is generally not able to meet the needs of the elderly. This is mostly due to poor mental health literacy of the social network, taboo, and stigma around mental illness and the busy lives of the social network members. Conclusions: Strategies to address help-seeking barriers should consider mental health literacy in elderly migrants as well as their social networks, and counteract taboos and stigma of mental health problems.