Cultural identity, acculturation, and mental health among adolescents in east London's multiethnic community

Nurturing resilience in American Indian/Alaska Native preschool children: the role of cultural socialization, executive function, and neighborhood risk

Introduction

American Indian and Alaska Native (AI/AN) children possess numerous cultural assets, yet higher exposures to neighborhood risks (e.g., lack of housing, crime) may present barriers to healthy cognitive development, including executive function (EF). Cultural socialization may promote resilience and support children's early cognition, but this has not been adequately studied. The present study examined the effects of neighborhood risk and cultural socialization on EF for AI/AN preschool children.

Method

Parents/caregivers of 768 AI/AN preschoolers from the 2015 AI/AN Head Start Family and Community Experiences (FACES) Study rated neighborhood risk via two scales: "Neighborhood Problems" and "Environmental Conditions," and cultural socialization practices via two scales: cultural activities and tribal language activities. Children's EF was measured directly using the Pencil Tap Task and the Leiter-R attention subscale.

Results

Families perceived neighborhood risks as relatively low, and overall risk did not predict children's EF. However, higher average language socialization was significantly related to higher EF, as were two specific language activities (encouraging children to learn their tribal language, making sure children heard their tribal language) and two cultural activities (playing AI/AN games, participating in tribal ceremonies), controlling for neighborhood risk.

Discussion

Findings suggest some aspects of cultural socialization may promote resilience among AI/AN preschoolers by supporting early EF. Mechanisms may include increased spiritual, social, and cultural connections, and practice with EF skills during cultural games. Future research should partner with AI/AN communities to investigate culturally grounded EF interventions and reevaluate measures of neighborhood risk to promote resilience and connectedness for AI/AN children.

Association between acculturation and physician trust for internal migrants: A cross-sectional study in China

BACKGROUND

Physician trust is a critical determinant of the physician-patient relationship and is necessary for an effective health system. Few studies have investigated the association between acculturation and physician trust. Thus, this study analyzed the association between acculturation and physician trust among internal migrants in China by using a cross-sectional research design.

METHODS

Of the 2000 adult migrants selected using systematic sampling, 1330 participants were eligible. Among the eligible participants, 45.71% were female, and the mean age was 28.50 years old (standard deviation = 9.03). Multiple logistic regression was employed.

RESULTS

Our findings indicated that acculturation was significantly associated with physician trust among migrants. The length of stay (LOS), the ability of speaking Shanghainese, and the integration into daily life were identified as contributing factors for physician trust when controlling for all the covariates in the model.

CONCLUSION

We suggest that specific LOS-based targeted policies and culturally sensitive interventions can promote acculturation among Shanghai's migrants and improve their physician trust.

The Intellectual Structure of Research on Rural-to-Urban Migrants: A Bibliometric Analysis

As noted in the United Nations' Sustainable Development Goals 2030 agenda, sustainable cities "without leaving anyone behind" should take into consideration migrant groups, which may play only a marginal role but may be at the root of potential social conflicts. This study thereby promotes cross-disciplinary explorations of knowing and understanding the rural-to-urban internal migrants against the background of rapid urbanization. This study conducted a bibliometric analysis based on 2788 English language articles obtained from the Web of Science Core Collection database. As China's unique Hukou system highlights the divide between rural migrants and urban dwellers, migrant studies have extended to a diverse range of interests. We underlined the most productive sources and authors in this area and identified networks of collaboration among countries and institutions. Furthermore, we found trends in research themes and topics and research clusters through keyword-based analysis techniques. The results provide a rich source of information on the intellectual structure of the chosen domain of rural-to-urban migrants.

Effects of Bicultural Identity Integration and National Identity on COVID-19-Related Anxiety Among Ethnic Minority College Students: The Mediation Role of Power Values

PURPOSE

The current study investigated the association between bicultural identity integration (BII, incorporating BII-harmony and BII-blendedness), national identity, and anxiety related to Coronavirus disease 2019 (COVID-19) among ethnic minority college students. In addition, this research examined the mediation role of power values in the relationship between BII, national identity, and COVID-19-related anxiety.

METHODS

This cross-sectional research design made use of online surveys. Using convenience sampling, participants comprised 235 Chinese ethnic minority college students drawn from four colleges in the ethnic minority autonomous regions of China. Data were collected during June 2020. Participants mainly lived in ethnic minority communities or villages in southwest China before receiving higher education at urban campuses.

RESULTS

Correlation analysis revealed that BII-harmony, BII-blendedness, and national identity were significantly negatively correlated with COVID-19-related anxiety. Mediation model analysis showed that power values were significantly positively correlated with COVID-19-related anxiety. Power values play a mediating role in the relationship between BII-harmony, national identity, and COVID-19-related anxiety, and have an inhibitory effect on this relationship.

CONCLUSION

Our findings indicate that BII-harmony and national identity could have the function of protecting ethnic minority college students from COVID-19-related anxiety. Emphasizing individualistic personal power values could increase COVID-19-related anxiety, whereas a collectivist identity reduces anxiety. These findings could provide another perspective on psychological interventions to reduce anxiety during the COVID-19 pandemic.

Considerations for minority ethnic young people in multisystemic therapy

Research has indicated that multisystemic therapy (MST) is an effective treatment for youth with antisocial behaviours (Painter & Scannapieco, 2009). This qualitative study explored minority ethnic young peoples' experiences of MST, focusing on their understanding of their presenting difficulties and aspects of the intervention which facilitated or hindered engagement and change. Seven semi-structured interviews were conducted with London-based young people who had taken part in MST. A constructivist version of grounded theory analysis was employed. Culture-specific theoretical codes emerged; understanding the family culture and the practitioner acting as a cultural broker, consideration of acculturation differences within the family, exploring the young person's cultural identity and reflecting on cultural differences in the therapeutic relationship. Findings suggest potential advances to MST practice to meet the needs of minority ethnic young people, including the importance of appropriate training and supervision, sensitively working with salient cultural issues such as the impact of acculturation, and consideration of the role of therapist ethnicity and culture.

Acculturation strategies, age at migration, and self-rated health: An empirical study on internal migrants in China

Berry's bidimensional acculturation model categorizes acculturation status (integration, assimilation, separation, marginalization) by preference toward host and origin cultures. According to Berry's theory, different acculturation strategies yield different health outcomes, and age at migration moderates the relationship between acculturation and health outcome. Previous research has applied this model to understand acculturation's influence on international migrants' health outcomes, but rarely for internal migrants. This research examines these relationships using a national survey on Chinese internal migrants. Using propensity score weighting, the results align with previous findings that integration strategy-using migrants reported optimal health status, separation/assimilation strategy-using migrants reported suboptimal health, and marginalization strategy-using migrants reported the worst health, suggesting the model can explain health disparities among internal migrants. Moreover, older age at migration deteriorates health outcomes and moderates health disparities among migrants employing different acculturation strategies. However, age at migration's moderating effect is significant only among inter-provincial migrants. Embracing the host society inhibits health deterioration among inter-provincial migrants with older age at migration, whereas rejecting or embracing both societies facilitates health deterioration among intra-provincial migrants.

"I'm not a freshi": Culture shock, puberty and growing up as British-Bangladeshi girls

Early puberty is a risk factor for adult diseases and biomedical and psychosocial research implicate growth (in height and weight) and stress as modifiable drivers of early puberty. Seldom have studies examined these drivers simultaneously or concurrently using quantitative and qualitative methods. Within the context of migration, we used mixed-methods to compare growth, stress and puberty in a study of 488 girls, aged 5–16, who were either Bangladeshi, first-generation migrant to the UK, second-generation migrant, or white British (conducted between 2009 and 2011). Using a biocultural framework, we asked the questions: 1) Does migration accelerate pubertal processes? 2) What biocultural markers are associated with migration? 3) What biocultural markers are associated with puberty? Girls self-reported pubertal stage, recalled 24-h dietary intake, and answered questions relating to dress, food, and ethnic identity. We collected anthropometrics and assayed saliva specimens for dehydroepiandrosterone-sulfate (DHEA-S) to assess adrenarcheal status. Our findings demonstrate that first-generation migrants had earlier puberty than second-generation migrants and Bangladeshi girls. British style of dress did not increase with migration, while dietary choices did, which were reflected in increasing body mass index. However, the widely-used phrase, “I'm proud of my religion, but not my culture” demonstrated that ethnic identity was aligned more with Islamic religion than ‘Bangladeshi culture.’ This was epitomized by wearing the hijab, but denial of eating rice. The social correlates of puberty, such as ‘practicing’ wearing the hijab and becoming ‘dedicated to the scarf,’ occurred at the same ages as adrenarche and menarche, respectively, among first-generation girls. We suggest that the rejection of ‘Bangladeshi culture’ might be a source of psychosocial stress for first-generation girls, and this may explain elevated DHEA-S levels and early puberty compared to their second-generation counterparts. Our results support a biocultural model of adolescence, a period for biological embedding of culture, when biological and psychosocial factors adjust developmental timing with potential positive and negative implications for long-term health.

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Compares puberty in migrant Bangladeshi girls in the UK using mixed-methods.

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Argues that stigma may explain early maturation in first-generation migrants.

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Reveals overlapping ages of biological and cultural puberty in migrant girls.

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Generates new biocultural hypotheses via hormonal, growth and social stigma data.

Social integration, perceived stress, locus of control, and psychological wellbeing among chinese emerging adult migrants: A conditional process analysis

BACKGROUND

This study investigated the underlying determinants of the relationship between social integration and three dimensions of psychological wellbeing in a nationally representative sample of emerging adult migrants in China.

METHODS

Data on 6,084 migrants aged 18-29 years in the 2014 China Migrants Dynamic Survey were analyzed. A conditional process analysis tested hypotheses regarding the influence of social integration on self-rated health, life satisfaction, and mental illness. Perceived stress was tested as a mediator, and the locus of control was tested as a moderator.

RESULTS

Social integration negatively related to mental illness (β= -0.10, p < 0.001), and it positively related to self-rated health (β = 0.24, p < 0.001) and life satisfaction (β = 0.14, p < 0.001). Perceived stress had significant mediating effects on the influence of social integration on the dimensions of psychological wellbeing. The locus of control not only moderated the influence of social integration on perceived stress (β = -0.02, p < 0.05), it moderated the influence of perceived stress on the mental illness dimension of psychological wellbeing (β = -0.03, p < 0.001).

LIMITATIONS

The cross-sectional design impeded the ability to draw causal inferences.

CONCLUSIONS

Social integration was a key predictor of psychological wellbeing among emerging adult migrants in China. Perceived stress significantly mediated that relationship. The locus of control moderated the indirect effect of social integration on psychological wellbeing by weakening the buffering effect of social integration on perceived stress. Furthermore, the locus of control also buffered the negative effects of perceived stress.

Association of maternal ethnicity and urbanicity on severe pediatric disease: a nationwide cohort study

BACKGROUND

A healthy migrant effect on birth outcomes has been reported, however, whether this protective effect persists throughout childhood is unknown. The effect of urbanicity on child health among an immigrant population is unclear. The objective of this study was to compare the incidence rate and cumulative incidence of severe diseases among urban children of Taiwan-born mothers, rural children of Taiwan-born mothers, urban children of foreign-born mothers, and rural children of foreign-born mothers.

METHODS

A nationwide cohort study was conducted for children born in Taiwan during 2004-2011 and follow-up till age 4 to 11 years old by linkage the Taiwan Birth Registry 2004-2011, Taiwan Death Registry 2004-2015, and National Health Insurance Research Database 2004-2015. Cox proportional hazards model (multivariable) was used to examine differences among the four study groups.

RESULTS

There were 682,982 urban children of Taiwan-born mothers, 662,818 rural children of Taiwan-born mothers, 61,570 urban children of foreign-born mothers, 87,473 rural children of foreign-born mothers. Children of foreign-born mothers had a lower incidence of vasculitis, mainly Kawasaki disease. The incidences of congenital disorders did not differ between children of foreign-born mothers and children of Taiwan-born mothers. The incidence of psychotic disorders was higher in urban children. However, children in rural areas had a higher incidence of major trauma/burn and a higher mortality rate.

CONCLUSIONS

A healthy migrant effect was only seen for Kawasaki disease. The mental health of urban children born to immigrant mothers warrants concern.

Mental health and ethnic density among adolescents in England: A cross-sectional study

This paper determines the association of neighbourhood ethnic density on adolescent mental health and its interplay with ethnic minority status and neighbourhood deprivation. 4145 cross-sectional responses to the 2009-2011 UK Household Longitudinal Study (UKHLS) youth self-completion questionnaire for youths aged 10-15 living in England were combined with household responses to the household UKHLS interview and 2011 Census data. Regression models were used to predict a Strengths and Difficulties Questionnaire (SDQ) score (range 0-40) with higher values indicating worse mental health. Ethnic density was operationalised using two distinct measures: co-ethnic density and diversity index. There was no difference in the mental health of ethnic minority youths by whether they lived in neighbourhoods of differing levels of ethnic density or neighbourhood deprivation. White British youths had poorer mental health when living in deprived neighbourhoods where their ethnic group was the vast majority. The difference compared to all other neighbourhoods was two points on the SDQ score. Interventions should seek to encourage adolescents living in white-working class neighbourhoods to explore ethnic diversity to determine whether it improves their mental health.

Impact of acculturation and psychological adjustment on mental health among migrant adolescents in Guangzhou, China: a cross-sectional questionnaire study

OBJECTIVES

The aim of this study was to examine the pathway and associations among acculturation (ie, language, social interaction and lifestyle), psychological adjustment and mental health of internal migrant adolescents in China.

DESIGN

Cross-sectional questionnaire study.

SETTING

Six private migrant junior high schools located in Tianhe and Baiyun districts in Guangzhou were chosen as the study sites.

PARTICIPANTS

A total of 1122 migrant adolescents aged 11-17 years old completed the study.

MAIN OUTCOME MEASURES

Mental health was measured by using the Social Anxiety Scale for Children (SASC) and major depression disorder (MDD) in a Brief Child and Family Phone Interview. Acculturation and psychological adjustment were measured by a self-designed and verified questionnaire. Multiple regression models and structural equation models were performed to analyse the association among acculturation, psychological adjustment and mental health while controlling for participant demographic characteristics.

RESULTS

The average MDD score for boys was 8.78 (SD=2.17) and for girls was 8.56 (SD=2.22), while the average SASC score for boys was 14.67 (SD=3.72) and for girls was 13.41 (SD=4.01). Psychological adjustment had a direct positive effect on MDD (p<0.001, β=0.30) and SASC (p<0.001, β=0.28), and it was the key variable fully mediating the impact of acculturation components on MDD and partly mediating the impact of acculturation on SASC, whereas lifestyle showed a direct negative effect (p=0.003, β=-0.17) on SASC. Of the three acculturation components, lifestyle had the strongest influence on psychological adjustment (p<0.001, β=0.37 and 0.51), followed by social interaction (p<0.001, β=0.24 and 0.13) and language (p<0.001, β=0.17 and 0.11).

CONCLUSIONS

The association between acculturation and the mental health of internal migrant adolescents was complex and could be mediated by psychological adjustment. Interventions such as promoting local language and social interaction are needed to enhance psychological adjustment and further improve the mental health of migrant adolescents.

Global cities and cultural diversity: challenges and opportunities for young people's nutrition

Childhood obesity is a common concern across global cities and threatens sustainable urban development. Initiatives to improve nutrition and encourage physical exercise are promising but are yet to exert significant influence on prevention. Childhood obesity in London is associated with distinct ethnic and socio-economic patterns. Ethnic inequalities in health-related behaviour endure, underpinned by inequalities in employment, housing, access to welfare services, and discrimination. Addressing these growing concerns requires a clearer understanding of the socio-cultural, environmental and economic contexts of urban living that promote obesity. We explore opportunities for prevention using asset based-approaches to nutritional health and well-being, with a particular focus on adolescents from diverse ethnic backgrounds living in London. We focus on the important role that community engagement and multi-sectoral partnership play in improving the nutritional outcomes of London's children. London's children and adolescents grow up in the rich cultural mix of a global city where local streets are characterised by diversity in ethnicities, languages, religions, foods, and customs, creating complex and fluid identities. Growing up with such everyday diversity we argue can enhance the quality of life for London's children and strengthen their social capital. The Determinants of young Adult Social well-being and Health longitudinal study of about 6500 of London's young people demonstrated the positive impact of cultural diversity. Born to parents from over a hundred countries and exposed to multi-lingual households and religious practices, they demonstrated strong psychological resilience and sense of pride from cultural straddling, despite material disadvantage and discrimination. Supporting the potential contribution of such socio-cultural assets is in keeping with the values of social justice and equitable and sustainable development. Our work signals the importance of community engagement and multisectoral partnerships, involving, for example, schools and faith-based organisations, to improve the nutrition of London's children.

Bullying, Social Support, and Psychological Distress: Findings From RELACHS Cohorts of East London's White British and Bangladeshi Adolescents

PURPOSE

The purpose of the study is to test whether bullying in adolescents relates to poor mental health and whether social support mitigated this effect.

METHODS

In 2001, 28 schools in East London were randomly selected for surveys of two representative mixed ability classes: year 7 (11-12 years) and year 9 (13-14 years). Repeated measures were obtained from the same pupils 2 years later, using the Strengths and Difficulties Questionnaire (total difficulties score [TDS]) as a measure of psychological distress. A simple one-level random intercepts model with measurements nested within pupils was used to investigate the effects of bullying and social support from friends and family on TDS. We also assessed whether culturally congruent friendships offered a mental health advantage.

RESULTS

Bullying was associated with a higher mean TDS (coefficient, 95% confidence interval: White British: 2.15, 1.41-2.88; Bangladeshi: 1.65, .91-2.4); a high level of family social support was associated with a lower TDS (White British: -2.36, -3.33 to -1.39; Bangladeshi: -2.34, -3.15 to -.149). Social support from friends was helpful for White British adolescents (-1.06, -2.07 to -.04). Culturally congruent friendships offered no general advantage.

CONCLUSION

Bullying is associated with psychological distress; family social support is independently associated with less psychological distress.

Ethnic density and risk of mental ill health - The case of religious sectarianism in Northern Ireland: A population data linkage study

An ethnic group that lives in a neighbourhood in which it is in the minority, termed 'lower ethnic density,' tends to report a higher incidence of mental ill-health. This population-based study investigated for the first time the existence of an own-group density effect among Catholic and Protestant communities in Northern Ireland. The entire Northern Ireland born Catholic and Protestant working age (n = 1, 004,060) enumerated population in the 2011 Census of Northern Ireland were included in the study via administrative data-linkage methodology. Catholics had a greater likelihood of reporting mental ill health in neighbourhoods with the largest proportion of Catholics (OR = 1.25, 95%CI 1.07-1.47), whereas mental health among Protestants was not associated with neighbourhood proportion of Protestants, after adjusting for socio-economic status and neighbourhood deprivation. The results indicate that a complex relationship exists between group identity, population composition of ethnic and religious groups and prevalence of community mental health.

Mental distress and associated factors among undergraduate students at the University of Hargeisa, Somaliland: a cross-sectional study

Background

Mental distress is a common finding among University students. Empirical research has confirmed that the University student population has a higher prevalence of mental disorder than the general population. However, no previous study has examined the mental health conditions of students in Somaliland.

Methods

An institution based cross-sectional study was conducted on a sample of 570 undergraduate students at the University of Hargeisa in October, 2013. Study subjects were selected using a stratified random sampling. The Self-reporting questionnaire (SRQ-20) was used to assess mental distress. Multiple logistic regression analysis was carried out to identify factors independently associated with mental distress.

Results

The point prevalence of mental distress was found to be 19.8%. Mental distress was associated with being female (AOR = 3.52, 95% CI 1.94, 6.39), having a monthly income of 100 United States dollars (USD) or less (AOR = 2.19, 95% CI 1.12, 4.28), and not having a satisfying relationship with the family (AOR = 11.52, 95% CI 3.18, 41.72) and friends (AOR = 7.33, 95% CI 2.83, 18.93). Nearly one in five students (18.6%) has been using Khat in the previous 12 months. Khat use was also associated with greater likelihood of mental distress (AOR = 2.87, 95% CI 1.26, 6.56). In addition, financial difficulties and the poor prospect of finding a job were common sources of stress among the students.

Conclusions

A significant proportion of the students at the University of Hargeisa suffer from mental distress which might have a detrimental effect on their academic performance. The mental health needs of the University students require attention with special emphasis on female students, students experiencing financial hardships, students who use Khat and those who have interpersonal problems.

The Relationship of Acculturation Strategies to Resilience: The Moderating Impact of Social Support among Qiang Ethnicity following the 2008 Chinese Earthquake

International research has mostly confirmed the positive association between acculturation strategies and resilience in ethnic groups, but the mediating and moderating mechanisms underlying the relationships are still under-investigated. The present study aimed to investigate the associations between acculturation strategies (based on two cultural identities) and resilience of 898 Qiang ethnicity volunteers (mean age = 29.5), especially exploring the mediating and moderating effects of personality, spiritual belief and social support on the relationship between acculturation strategy (using two cultural identities as latent variables in model analysis) and resilience following the occurrence of 2008 Wenchuan earthquake in Sichuan, taking such mechanisms into account. Results were as follows: (1) All variable presented significant positive correlations; (2) Consistent with the mediating hypotheses, personality and spiritual beliefs played a partial mediating role in the relationship between two cultural identities and resilience; (3) High or low level of perceived social support had a moderating effect on cultural identities and resilience; (4) The integration strategy was the most optimal style to promote the development of resilience, but marginalization was the least effective style.

The asthma-anxiety connection

BACKGROUND

The literature reports a significant association between various mental disorders and asthma, in particular depression and/or anxiety, with some more robust data regarding anxiety disorders. However, the nature of this association remains largely unclear.

OBJECTIVES

(1) To test the hypothesis of a specific association of anxiety and depressive disorder (according to the DSM-IV) with asthma and (2) to test the bidirectional hypothesis of causality between asthma and psychiatric disorders.

METHODS

Ninety-six adults were compared with 96 control subjects matched according to main socio-demographic variables (i.e., gender, age, marital status, cohabiting/non-cohabiting, and BMI). Subjects with asthma were divided according to GINA and ACT classifications. All subjects underwent Structured Clinical Interviews for DSM-IV Axis I (SCID-I) diagnosis.

RESULTS

Significant association between asthma and lifetime anxiety disorders emerged (OR 3.03; p = 0.003); no significant association with other psychiatric diagnosis emerged. Moreover, lifetime and current anxiety were associated with asthma severity levels (p < 0.01 and p = 0.001 based on age). Asthma preceded anxiety in 48% of cases; in 52% of cases, anxiety preceded asthma, without significant group differences. The risk of asthma, particularly of severe, uncontrolled forms (p < 0.01), resulted higher in lifetime anxiety disorder patients (p = 0.003 and p = 0.001 based on age at onset). Current anxiety increased the risk of asthma, and that of an uncontrolled form (p < 0.05). Asthma increased the risk of lifetime anxiety disorders (p = 0.002 and p = 0.018 using ages). Intermittent asthma increased the risk of lifetime and current anxiety disorders (p < 0.01).

CONCLUSIONS

Anxiety disorders, in particular Lifetime Anxiety Disorders, represent the only psychiatric disorder significantly associated with asthma, with a possible bidirectional, anxiety-asthma relationship, each of which can be caused or result from the other.

Impact of Globalisation on Mental Health in Low- and Middle-income Countries

The paper presents a critical review of core social and psychological determinants of mental health from a life-course perspective which operate at micro (individual) and macro (societal–structural) levels in the context of globalisation using the World Health Organization–Commission on Social Determinants of Health conceptual framework. It analyses how globalisation-induced changes implicate social and psychological variables that impact upon inequities in mental health and well-being. Mental health outcomes relating to four core determinants—deepening poverty and inequalities, migrations, rapid and uncontrollable socio-cultural value change and identity diffusion—are focused on. The overall evidence shows that these core determinants have pernicious effects on mental health and well-being often leading to common mental disorders (CMDs). Mental health protection and promotion efforts necessitate multisectoral, holistic, culturally responsible actions that equip people and communities to cope better with stressors created by the globalised world.

Validation study of HSCL-10, HSCL-6, WHO-5 and 3-key questions in 14-16 year ethnic minority adolescents

BACKGROUND

There is a lack of validated instruments for detection of depression in ethnic minority adolescent patients in primary care. This study aimed to compare a subgroup of the bilingual, ethnic minority adolescents with the rest of the population using Hscl-10, Hscl-6, WHO-5 and 3-Key Questions for detection of depression in primary care.

METHOD

This is a cross-sectional, multicenter study conducted in General Practice in Norway and Denmark. A minor bilingual non-aggregated heterogenic ethnic minority group from non-European countries was compared with a major ethnic group of Norwegian/Danish adolescents. Participants completed questionnaires which were either mailed to them or found on our website. The Composite International Diagnostic Interview was used as gold standard. Depression classified by the International Classification of Diseases - 10. The Internal and external validity of the four questionnaires were examined. Optimal cut-off point for major depressive disorder was calculated using the Youden Index.

RESULTS

294 (77%) were interviewed; mean age was 15 years. The ethnic group comprised 44 (64% girls and 36% boys). Chronbach's alpha was above 0. 70 and area under curve was 0.80 or above for all instruments in the ethnic minority group. Cut-off points for major depressive disorder had sensitivities of 81% (Hscl-10), 82% (Hscl-6), 91% (Who-5) and 81% (3-key questions) in the ethnic minority group. Corresponding specificities were 80% (Hscl-10), 77% (Hscl-6), 80% (Who-5) and 67% (3-key questions). Cut-off points were the same Hscl-10, Who-5, the 3-key questions but differed for Hscl-6.

CONCLUSION

Hscl-10, Hscl-6, WHO-5 and 3-key questions seem to be valid instruments for detection of depression in bilingual, ethnic minority adolescents in primary care.

The Determinants of young Adult Social well-being and Health (DASH) study: diversity, psychosocial determinants and health

PURPOSE

The Determinants of young Adult Social well-being and Health longitudinal study draws on life-course models to understand ethnic differences in health. A key hypothesis relates to the role of psychosocial factors in nurturing the health and well-being of ethnic minorities growing up in the UK. We report the effects of culturally patterned exposures in childhood.

METHODS

In 2002/2003, 6643 11-13 year olds in London, ~80 % ethnic minorities, participated in the baseline survey. In 2005/2006, 4782 were followed-up. In 2012-2014, 665 took part in a pilot follow-up aged 21-23 years, including 42 qualitative interviews. Measures of socioeconomic and psychosocial factors and health were collected.

RESULTS

Ethnic minority adolescents reported better mental health than White British, despite more adversity (e.g. economic disadvantage, racism). It is unclear what explains this resilience but findings support a role for cultural factors. Racism was an adverse influence on mental health, while family care and connectedness, religious involvement and ethnic diversity of friendships were protective. While mental health resilience was a feature throughout adolescence, a less positive picture emerged for cardio-respiratory health. Both, mental health and cultural factors played a role. These patterns largely endured in early 20s with family support reducing stressful transitions to adulthood. Education levels, however, signal potential for socio-economic parity across ethnic groups.

The influence of acculturation, medical mistrust, and perceived discrimination on knowledge about blood donation and blood donation status

AIM

The aim of this research was to assess whether perceived discrimination, the level of acculturation, and medical mistrust are associated with knowledge about blood donation processes and blood donation status.

METHODS

This cross-sectional study involved 425 African migrants recruited in Melbourne and Adelaide, Australia. Participants were surveyed face-to-face using bilingual workers to maximize the inclusion across different levels of literacy in the community.

RESULTS

In the adjusted model, the scores for knowledge about blood donation were positively associated with a longer stay in Australia (β = 0.12, p = 0.001), significantly higher among those with a tertiary education (β = 0.75; p = 0.049), those who came from rural areas (β = 1.54, p = 0.015), and Christians (β = 1.83, p < 0.01) but significantly lower among those from the western African region (β = -1.10, p = 0.032). Scores for knowledge about blood donation were lower among those who were marginalized (β = -1.01, p = 0.026). Medical mistrust and perceived discrimination were not associated with knowledge about blood donation. Participants who were traditionally orientated were 69% less likely to have ever given blood than those who were bicultural or integrated (odds ratio [OR]: 0.31, p = 0.044), whereas the effects of perceived discrimination and medical mistrust were not significant. We also examined whether to restrict the analysis to those who had given blood in Australia postmigration and found that the level of acculturation and medical mistrust were not significant but that perceived discrimination, especially personal discrimination, mattered (OR = 0.63, p = 0.005).

CONCLUSION

Efforts to increase blood donation among African migrants need to address the issues related to perceived personal discrimination as an important intervention target.

At the crossroads of anthropology and epidemiology: current research in cultural psychiatry in the UK

Cultural psychiatry research in the UK comprises a broad range of diverse methodologies, academic disciplines, and subject areas. Methodologies range from epidemiological to anthropological/ethnographic to health services research; mixed methods research is becoming increasingly popular, as are public health and health promotional topics. After briefly outlining the history of cultural psychiatry in the UK we will discuss contemporary research. Prominent themes include: the epidemiology of schizophrenia among Africans/Afro-Caribbeans, migration and mental health, racism and mental health, cultural identity, pathways to care, explanatory models of mental illness, cultural competence, and the subjective experiences of healthcare provision among specific ethnic groups such as Bangladeshis and Pakistanis. Another strand of research that is attracting increasing academic attention focuses upon the relationship between religion, spirituality, and mental health, in particular, the phenomenology of religious experience and its mental health ramifications, as well as recent work examining the complex links between theology and psychiatry. The paper ends by appraising the contributions of British cultural psychiatrists to the discipline of cultural psychiatry and suggesting promising areas for future research.

How do adolescents talk about self-harm: a qualitative study of disclosure in an ethnically diverse urban population in England

Background

Self-harm is prevalent in adolescence. It is often a behaviour without verbal expression, seeking relief from a distressed state of mind. As most adolescents who self-harm do not seek help, the nature of adolescent self-harm and reasons for not disclosing it are a public health concern. This study aims to increase understanding about how adolescents in the community speak about self-harm; exploring their attitudes towards and experiences of disclosure and help-seeking.

Methods

This study involved 30 qualitative individual interviews with ethnically diverse adolescents aged 15–16 years (24 females, 6 males), investigating their views on coping with stress, self-harm and help-seeking, within their own social context in multicultural East London. Ten participants had never self-harmed, nine had self-harmed on one occasion and 11 had self-harmed repeatedly. Verbatim accounts were transcribed and subjected to content and thematic analysis using a framework approach.

Results

Self-harm was described as a complex and varied behaviour. Most participants who had self-harmed expressed reluctance to talk about it and many had difficulty understanding self-harm in others. Some participants normalised self-harm and did not wish to accept offers of help, particularly if their self-harm had been secretive and ‘discovered’, leading to their referral to more formal help from others. Disclosure was viewed more positively with hindsight by some participants who had received help. If help was sought, adolescents desired respect, and for their problems, feelings and opinions to be noticed and considered alongside receiving treatment for injuries. Mixed responses to disclosure from peers, family and initial sources of help may influence subsequent behaviour and deter presentation to services.

Conclusions

This study provides insight into the subjective experience of self-harm, disclosure and help-seeking from a young, ethnically diverse community sample. Accounts highlighted the value of examining self-harm in the context of each adolescent’s day-to-day life. These accounts emphasised the need for support from others and increasing awareness about appropriate responses to adolescent self-harm and accessible sources of help for adolescents.

Sexual orientation and self-reported mood disorder diagnosis among Canadian adults

BACKGROUND

The prevalence and correlates of mood disorders among people who self-identify as lesbian, gay or bisexual (LGB) are not well understood. Therefore, the current analysis was undertaken to estimate the prevalence and correlates of self-reported mood disorders among a nationally representative sample of Canadian adults (ages 18 to 59 years). Stratified analyses by age and sex were also performed.

METHODS

Using data from the 2007-2008 Canadian Community Health Survey, logistic regression techniques were used to determine whether sexual orientation was associated with self-reported mood disorders.

RESULTS

Among respondents who identified as LGB, 17.1% self-reported having a current mood disorder while 6.9% of heterosexuals reported having a current mood disorder. After adjusting for potential confounders, LGB-respondents remained more likely to report mood disorder as compared to heterosexual respondents (AOR: 2.93; 95% CI: 2.55-3.37). Gay and bisexual males were at elevated odds of reporting mood disorders (3.48; 95% CI: 2.81-4.31), compared to heterosexual males. Young LGB respondents (ages 18-29) had higher odds (3.75; 95% CI: 2.96-4.74), compared to same-age heterosexuals.

CONCLUSIONS

These results demonstrate elevated prevalence of mood disorders among LGB survey respondents compared to heterosexual respondents. Interventions and programming are needed to promote the mental health and well being of people who identify as LGB, especially those who belong to particular subgroups (e.g., men who are gay or bisexual; young people who are LGB).

Adolescence and the social determinants of health

The health of adolescents is strongly affected by social factors at personal, family, community, and national levels. Nations present young people with structures of opportunity as they grow up. Since health and health behaviours correspond strongly from adolescence into adult life, the way that these social determinants affect adolescent health are crucial to the health of the whole population and the economic development of nations. During adolescence, developmental effects related to puberty and brain development lead to new sets of behaviours and capacities that enable transitions in family, peer, and educational domains, and in health behaviours. These transitions modify childhood trajectories towards health and wellbeing and are modified by economic and social factors within countries, leading to inequalities. We review existing data on the effects of social determinants on health in adolescence, and present findings from country-level ecological analyses on the health of young people aged 10-24 years. The strongest determinants of adolescent health worldwide are structural factors such as national wealth, income inequality, and access to education. Furthermore, safe and supportive families, safe and supportive schools, together with positive and supportive peers are crucial to helping young people develop to their full potential and attain the best health in the transition to adulthood. Improving adolescent health worldwide requires improving young people's daily life with families and peers and in schools, addressing risk and protective factors in the social environment at a population level, and focusing on factors that are protective across various health outcomes. The most effective interventions are probably structural changes to improve access to education and employment for young people and to reduce the risk of transport-related injury.

Does cultural integration explain a mental health advantage for adolescents?

BACKGROUND

A mental health advantage has been observed among adolescents in urban areas. This prospective study tests whether cultural integration measured by cross-cultural friendships explains a mental health advantage for adolescents.

METHODS

A prospective cohort of adolescents was recruited from 51 secondary schools in 10 London boroughs. Cultural identity was assessed by friendship choices within and across ethnic groups. Cultural integration is one of four categories of cultural identity. Using gender-specific linear-mixed models we tested whether cultural integration explained a mental health advantage, and whether gender and age were influential. Demographic and other relevant factors, such as ethnic group, socio-economic status, family structure, parenting styles and perceived racism were also measured and entered into the models. Mental health was measured by the Strengths and Difficulties Questionnaire as a 'total difficulties score' and by classification as a 'probable clinical case'.

RESULTS

A total of 6643 pupils in first and second years of secondary school (ages 11-13 years) took part in the baseline survey (2003/04) and 4785 took part in the follow-up survey in 2005-06. Overall mental health improved with age, more so in male rather than female students. Cultural integration (friendships with own and other ethnic groups) was associated with the lowest levels of mental health problems especially among male students. This effect was sustained irrespective of age, ethnicity and other potential explanatory variables. There was a mental health advantage among specific ethnic groups: Black Caribbean and Black African male students (Nigerian/Ghanaian origin) and female Indian students. This was not fully explained by cultural integration, although cultural integration was independently associated with better mental health.

CONCLUSIONS

Cultural integration was associated with better mental health, independent of the mental health advantage found among specific ethnic groups: Black Caribbean and some Black African male students and female Indian students.

Sudanese Adolescent Refugees: Acculturation and Acculturative Stress

This study explored acculturation and acculturative stress in Sudanese adolescent refugees living in Brisbane. Twenty Sudanese adolescents participated in semi-structured interviews which revealed that the main source of acculturative stress was related to concern over English language proficiency, issues of parental control and conflicting cultural rules. However, optimism for the future was also evident in all the interviews. The results suggested the need for culture specific counselling practices and ongoing English language and cultural support for Sudanese refugee children in mainstream schools.

Predictors of psychopathology among Nigerian adolescents: the role of psychosocial, demographics, personality and medical condition reports domains

BACKGROUND

Psychopathology among adolescents has become a global concern in the last decade.

OBJECTIVE

The aim of this study was to identify the predictors of psychopathology among adolescents in Ibadan region using a multi-theoretical approach.

METHODS

Eight hundred and eighty-nine (889) male and female adolescents drawn from different parts of Ibadan region of the South-West Nigeria, participated in the study. The study is a cross-sectional survey and adopted an ex-post facto design. A questionnaire divided into six sections, with two versions was used for data collection. Analysis of data involved multiple/stepwise regressions, F-test & T-test. SPSS 10.0 computer programme was utilized for all analyses.

RESULTS

Data showed that all the predictors jointly contributed 37% (P<0.0001) to the prediction of reported psychopathology. The domains of psychosocial, personality, demographic and medical condition reports all independently and significantly predicted psychopathology among the adolescents but psychosocial domain had the highest contribution of 16% (P<0.0001). Prevalence rate for psychopathology among the sampled adolescents was 0.152 (15.2%) at the criteria of one standard deviation above the mean.

CONCLUSION

It is concluded that a multi-theoretical approach to the understanding of psychopathology among adolescents will be more appropriate in the Nigerian community. Results have implication for further assessment and treatments. Parents are advised to report any behavioural dysfunction observed in their wards to experts early enough to avoid degeneration to greater psychopathology in the later years.

Cultural psychiatry and epidemiology: researching the means, methods and meanings

This article describes my developing interest in cultural psychiatry. This is both a challenging and yet a privileged opportunity to reflect on my research and clinical work over the last 25 years. I describe cultural and interpersonal influences on my thinking and interests, and the development of my research career moving from health services research of specialist services, to primary care research to public mental health research. Specifically, social and cultural influences on risks and responses to mental illness are discussed, as are pathways to care, the recognition of mental illness, and public health and cultural psychiatry research.

Acculturation and psychological distress among non-Western Muslim migrants--a population-based survey

BACKGROUND

Political and social developments point at increasing marginalization of Muslim migrants, but little is known about its consequences for the mental health of this particular group.

AIM

To explore the relationship between acculturation and psychological distress among first-generation Muslim migrants from Turkey and Morocco in the Netherlands.

METHODS

A cross-sectional study. Respondents were interviewed in their preferred language. Acculturation was measured with the Lowlands Acculturation Scale (LAS) and psychological distress with the Kessler Psychological Distress Scale (K10). Data were complete for 321 subjects and analyzed with multivariate linear regression.

RESULTS

Less skills for living in Dutch society was associated with distress (p = 0.032). Feelings of loss were related to distress among Moroccans (p = 0.037). There was an interaction between traditionalism and ethnic background (p = 0.037); traditionalism was related to less distress among Moroccans (p = 0.020), but not among Turkish. Finally, there was an interaction by gender among Turks (p = 0.029); conservative norms and values seemed to be related to distress among men (p = 0.062), not women.

CONCLUSION

Successful contact and participation in Dutch society, and maintenance of heritage culture and identity were moderately associated with less psychological distress. Improving mastery of the dominant language in host societies, and allowing migrants to preserve their traditions, might be effective measures in improving the mental well-being of migrants.

The role of acculturation in suicidal ideation among second-generation immigrant adolescents in France

This study explored the contributions of sociocultural and psychopathological factors to suicidal ideation among adolescents. A sample of 292 French high school students with an immigrant background completed a questionnaire assessing suicidal ideation, borderline personality traits, depressive symptoms, parental attachment, life events, acculturation orientations, ethnic identity, cannabis and alcohol consumption, socioeconomic status and academic failure. Although stressful life events, depressive symptoms, and individualism were risk factors, and attachment to parents a protective factor for both boys and girls, some gender differences emerged. Borderline traits (risk factor), assimilation and marginalization (both protective factors) were significant predictors only among girls.

Acculturation and use of health care services by Turkish and Moroccan migrants: a cross-sectional population-based study

BACKGROUND

There is insufficient empirical evidence which shows if and how there is an interrelation between acculturation and health care utilisation. The present study seeks to establish this evidence within first generation Turkish and Moroccan migrants, two of the largest migrant groups in present-day Western Europe.

METHODS

Data were derived from the Amsterdam Health Monitor 2004, and were complete for 358 Turkish and 288 Moroccan foreign-born migrants. Use of health services (general practitioner, outpatient specialist and health care for mental health problems) was measured by means of self-report. Acculturation was measured by a structured questionnaire grading (i) ethnic self-identification, (ii) social interaction with ethnic Dutch, (iii) communication in Dutch within one's private social network, (iv) emancipation, and (v) cultural orientation towards the public domain.

RESULTS

Acculturation was hardly associated with the use of general practitioner care. However, in case of higher adaptation to the host culture there was less uptake of outpatient specialist care among Turkish respondents (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.82-0.99) and Moroccan male respondents (OR = 0.81, 95% CI = 0.71-0.93). Conversely, there was a higher uptake of mental health care among Turkish men (OR = 0.81, 95% CI = 0.71-0.93) and women (OR = 0.81, 95% CI = 0.71-0.93). Uptake of mental health care among Moroccan respondents again appeared lower (OR = 0.74, 95% CI = 0.55-0.99). Language ability appeared to play a central role in the uptake of health care.

CONCLUSION

Some results were in accordance with the popular view that an increased participation in the host society is concomitant to an increased use of health services. However, there was heterogeneity across ethnic and gender groups, and across the domains of acculturation. Language ability appeared to play a central role. Further research needs to explore this heterogeneity into more detail. Also, other cultural and/or contextual aspects that influence the use of health services require further identification.

Culture and psychiatric symptoms in Puerto Rican children: longitudinal results from one ethnic group in two contexts

BACKGROUND

The development of youth psychopathology may be associated with direct and continuous contact with a different culture (acculturation) and to distress related to this process (cultural stress). We examine cultural experiences of Puerto Rican families in relation to youth psychiatric symptoms in two different contexts: one in which migrant Puerto Ricans reside on the mainland as an ethnic minority and another in which they reside in their place of origin.

METHODS

SAMPLE

Probability samples of 10- to 13-year-old youth of Puerto Rican background living in the South Bronx, New York City (SB) and in the San Juan Metropolitan area in Puerto Rico (PR) (N = 1,271) were followed over time. measures: Three assessments of internalizing psychiatric symptoms (elicited through the DISC-IV) and of antisocial behaviors (ASB) quantified through a six-point index were carried out. Independent variables included scales of adult and child acculturation and cultural stress, and other putative correlates.

DATA ANALYSIS

Within each study site, multilevel linear regression models were examined.

RESULTS

Parental acculturation was associated with ASB in youth at both sites, but youth acculturation itself was not related to psychiatric symptoms. At both contexts, cultural stress was a more consistent correlate of youth psychiatric symptoms than acculturation after controlling for nativity, maternal education, child gender, stressful life events and parental psychopathology. However, the strength of the youth cultural stress association decreased over time.

CONCLUSION

The association between cultural factors and child psychiatric symptoms is not restricted to contexts where an ethnic group is a minority.

Non-traditional lifestyles and prevalence of mental disorders in adolescents in Goa, India

BACKGROUND

Adolescents comprise a fifth of the population of India, but there is little research on their mental health. We conducted an epidemiological study in the state of Goa to describe the current prevalence of mental disorders and its correlates among adolescents aged between 12 and 16 years.

AIMS

To estimate the prevalence and correlates of mental disorders in adolescents.

METHOD

Population-based survey of all eligible adolescents from six urban wards and four rural communities which were randomly selected. We used a Konkani translation of the Development and Well-Being Assessment to diagnose current DSM-IV emotional and behavioural disorders. All adolescents were also interviewed on socio-economic factors, education, neighbourhood, parental relations, peer and sexual relationships, violence and substance use.

RESULTS

Out of 2,684 eligible adolescents, 2,048 completed the study. The current prevalence of any DSM-IV diagnosis was 1.81%; 95% CI 1.27-2.48. The most common diagnoses were anxiety disorders (1.0%), depressive disorder (0.5%), behavioural disorder (0.4%) and attention-deficit hyperactivity disorder (0.2%). Adolescents from urban areas and girls who faced gender discrimination had higher prevalence. The final multivariate model found an independent association of mental disorders with an outgoing 'non-traditional' lifestyle (frequent partying, going to the cinema, shopping for fun and having a boyfriend or girlfriend), difficulties with studies, lack of safety in the neighbourhood, a history of physical or verbal abuse and tobacco use. Having one's family as the primary source of social support was associated with lower prevalence of mental disorders.

CONCLUSIONS

The current prevalence of mental disorders in adolescents in our study was very low compared with studies in other countries. Strong family support was a critical factor associated with low prevalence of mental disorders, while factors indicative of adoption of a non-traditional lifestyle were associated with an increased prevalence.

Egyptian families caring for a relative with mental illness: a hermeneutic study

The care of people with mental illness often rests with their families. The way families manage this experience has been explored widely in the literature; however, the added complexity of migration has been given little attention. The difficulty of conducting research with people from non-English-speaking backgrounds often precludes their voices and experiences from being heard, further compounding marginalization and misunderstanding of their needs. The aim of this study was to understand the experience of Egyptian families caring for a relative with mental illness in Australia. Seven participants from Egyptian background, caring for a relative with mental illness, were included in this study. A hermeneutic phenomenological approach, informed by the work of Heidegger, was used. Data were collected through in-depth audio-taped interviews conducted in the Arabic language, which were then translated and transcribed in English. Data analysis revealed five themes: Why did it happen? How do I protect my loved ones? What has it done to me? What has it done to us? How do I survive? Findings of the study have the potential to raise health-care professionals' awareness of the needs of Egyptian families, their beliefs, values, and coping with mental illness.

Voices of Asian American youth: important characteristics of clinicians and clinical sites

OBJECTIVE

The purpose of this work was to explore clinician and site characteristics that are important to Chinese and Vietnamese immigrant and first-generation youth.

METHODS

A 3-stage mixed qualitative-quantitative design consisting of exploratory focus groups, a survey, and explanatory focus groups was used to ensure that all of the ideas were generated, prioritized, and explained by youth. Adolescents of Chinese and/or Vietnamese descent and aged 13 to 18 years were recruited in community centers and schools. In stage 1, 55 adolescents in 8 focus groups shared their views on factors that attract or deter them from seeking care. In stage 2, youth responded to a survey including 27 teen-generated items regarding clinicians and sites. In stage 3, 87 teens in 11 groups explained the top-rated items and offered suggestions on how to meet their needs. All of the stages were conducted in English, Mandarin Chinese, and Vietnamese.

RESULTS

Most of the 245 survey respondents (77%) were born in Asia, and 70% had lived in the United States for <3 years. The 27 items were divided into 6 priority ranks by the marginal homogeneity test. Clinician cleanliness and experience shared first rank. Second rank was shared by Asian teens being treated like other teens, site cleanliness, clinician honesty, and clinician friendliness and attitude. The third rank was shared by respect, privacy, completeness, clinicians explaining their actions, and lower health care costs. Interspersed among ranks 5 and 6 were items specific to the needs of Asian youth: the clinician would offer more explanation because Asian families might not ask questions; the clinician would not assume that Asian teens are drug and sex free; the clinician would understand that Asian families may use traditional healing; the clinician would not assume that Asians do not know English; adolescents would not translate for parents; and the teen would be able to choose an Asian clinician. There was little variation in ratings by age, gender, ethnicity, or socioeconomic status. However, 11 of 27 items differed by acculturation. Examples include the greater importance ascribed by more acculturated youth to not being judged, to not having to translate, and to the clinician addressing behavioral issues. Acculturation also affected the youths' views regarding confidentiality and translation.

CONCLUSIONS

Asian American adolescents value the same concerns as all adolescents: respect, honesty, competency, cleanliness, privacy, and nonjudgmental service. However, they also have unique perspectives, and youth at varying levels of acculturation differ in some of their views.

Perceptions of psychiatric care among foreign- and Swedish-born people with psychotic disorders

AIM

This paper is a report of a study to explore different perceptions of psychiatric care among foreign- and Swedish-born people with psychotic disorders.

BACKGROUND

Research from different countries reports a high-incidence of psychosis among migrants. The risk-factors discussed are social disadvantages in the new country. To understand and meet the needs of people from different countries, their perspective of psychiatric care must be illuminated and taken into consideration.

METHOD

A phenomenographic study was conducted in 2005-2006 using semi-structured interviews with a convenience sample of 12 foreign-born people and 10 Swedish-born people with psychosis.

FINDINGS

Three categories were identified: personal and family involvement in care; relating to healthcare staff; and managing illness and everyday life. Foreign-born people differed from Swedish-born people in that they struggled to attain an everyday life in Sweden, relied on healthcare staff as experts in making decisions, and had religious beliefs about mental illness. Among Swedish-born people, the need for more support to relatives and help to perform recreational activities was important.

CONCLUSION

It is important to identify individual perceptions and needs, which may be influenced by cultural origins, when caring for patients with psychosis. Previous experience of care, different ways of relating to staff, and individual needs should be identified and met with respect. Social needs should not be medicalized but taken into consideration when planning care, which illustrates the importance of multi-professional co-operation.

Mental health of young people: a global public-health challenge

Mental disorders account for a large proportion of the disease burden in young people in all societies. Most mental disorders begin during youth (12-24 years of age), although they are often first detected later in life. Poor mental health is strongly related to other health and development concerns in young people, notably lower educational achievements, substance abuse, violence, and poor reproductive and sexual health. The effectiveness of some interventions for some mental disorders in this age-group have been established, although more research is urgently needed to improve the range of affordable and feasible interventions, since most mental-health needs in young people are unmet, even in high-income countries. Key challenges to addressing mental-health needs include the shortage of mental-health professionals, the fairly low capacity and motivation of non-specialist health workers to provide quality mental-health services to young people, and the stigma associated with mental disorder. We propose a population-based, youth focused model, explicitly integrating mental health with other youth health and welfare expertise. Addressing young people's mental-health needs is crucial if they are to fulfil their potential and contribute fully to the development of their communities.

Mental hospital admission rates of immigrants in Switzerland

PURPOSE

This epidemiological study aims to assess the utilisation of inpatient psychiatric services by immigrants. Specifically, we address the question of gender-specific differences in immigrants and compare the population-based rates of males and females from different countries of origin.

METHODS

We analysed inpatient admission rates from a defined catchment area over a 6-year period by means of psychiatric register data. Poisson regression analysis was used to model effects of gender, age and country group (immigrants grouped into six categories according to their country of origin).

RESULTS

Of the total of 28,511 subjects consecutively referred to psychiatric inpatient treatment, 4,814 were foreign nationals (16.9%). Among immigrants the proportion of female inpatients (38.7%) was far lower than in the general population (45.6%; equal proportion of female-to-total among Swiss inpatients). Immigrants were 37.4 years old on average at index admission (Swiss people: 46.3 years), but there were considerable differences across country groups. We found three groups with particularly high admission rates: male immigrants originating from Turkey, Eastern European and 'Other' countries (rates >6 per 1,000 population/year). These were admitted as inpatients at far higher rates than females from the same countries. In women, there was no immigrant group utilising inpatient treatment at a higher level than Swiss females. The rates of inpatient admission in males and females was almost equal among the Swiss (4.3 per 1,000), as was the case for immigrants from Southern, Western/Northern Europe and former Yugoslavia, although on a lower level (2.26-3.15 per 1,000). Regression analysis further suggests that country effects and age effects are different for males and females, and age effects are specific to the country of origin.

DISCUSSION

These gender- and interaction effects point to inequalities in psychiatric service use in people with different migration background. Further research is needed, particularly to understand the reasons for the markedly different gender-specific utilisation of psychiatric services by some immigrant groups.

Strengths and Difficulties Questionnaire: research and clinical applications

PURPOSE OF REVIEW

To critically discuss recent findings from studies using the Strengths and Difficulties Questionnaire, in relation to different research designs and clinical purposes.

RECENT FINDINGS

A substantive body of research exists on the psychometric properties of the Strengths and Difficulties Questionnaire in different cultures. This body supports the validity and reliability of its versions for the parent, teacher and self-reporting purpose, despite some variation in cut-off scores. The Strengths and Difficulties Questionnaire is increasingly being used as a measure of child psychopathology in other types of research, that is, aetiological, longitudinal and service evaluation studies. Future studies need to address in more detail the Strengths and Difficulties Questionnaire diagnostic algorithms, added value score, impact and burden items and a preschool version.

SUMMARY

The Strengths and Difficulties Questionnaire has been established as the most widely used instrument in child mental health research. It is easy to complete, is user friendly because of its positive attributes items, allows comparisons to be made between different populations and is sensitive to change.