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Krystallidou D, Temizöz Ö, Wang F, de Looper M, Di Maria E, Gattiglia N, Giani S, Hieke G, Morganti W, Pace CS, Schouten B, Braun S. Communication in refugee and migrant mental healthcare: A systematic rapid review on the needs, barriers and strategies of seekers and providers of mental health services. Health Policy 2024; 139:104949. [PMID: 38071855 DOI: 10.1016/j.healthpol.2023.104949] [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] [Received: 06/15/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 12/31/2023]
Abstract
BACKGROUND Migrants and refugees may not access mental health services due to linguistic and cultural discordance between them and health and social care professionals (HSCPs). The aim of this review is to identify the communication needs and barriers experienced by third-country nationals (TCNs), their carers, and HSCPs, as well as the strategies they use and their preferences when accessing/providing mental health services and language barriers are present. METHODS We undertook a rapid systematic review of the literature (01/01/2011 - 09/03/2022) on seeking and/or providing mental health services in linguistically discordant settings. Quality appraisal was performed, data was extracted, and evidence was reviewed and synthesised qualitatively. RESULTS 58/5,650 papers met the inclusion criteria. Both TCNs (and their carers) and HSCPs experience difficulties when seeking or providing mental health services and language barriers are present. TCNs and HSCPs prefer linguistically and culturally concordant provision of mental health services but professional interpreters are often required. However, their use is not always preferred, nor is it without problems. CONCLUSIONS Language barriers impede TCNs' access to mental health services. Improving language support options and cultural competency in mental health services is crucial to ensure that individuals from diverse linguistic and cultural backgrounds can access and/or provide high-quality mental health services.
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Affiliation(s)
- Demi Krystallidou
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom.
| | - Özlem Temizöz
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom
| | - Fang Wang
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom
| | - Melanie de Looper
- Tilburg Social and Behavioural Sciences, Centre for Care and Wellbeing (Tranzo), University of Tilburg, the Netherlands
| | - Emilio Di Maria
- Department of Health Sciences, University of Genoa, Italy; University Unit of Medical Genetics, Galliera Hospital, Genoa, Italy
| | - Nora Gattiglia
- Department of Modern Languages and Cultures, University of Genoa, Italy
| | | | - Graham Hieke
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom
| | - Wanda Morganti
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Ente Ospedaliero Galliera Hospital, Genoa, Italy
| | | | - Barbara Schouten
- Amsterdam School of Communication Research (ASCoR)/Centre for Urban Mental Health, University of Amsterdam, the Netherlands
| | - Sabine Braun
- School of Languages and Literature, Centre for Translation Studies, University of Surrey, Guildford, United Kingdom
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Allen JD, Kunicki ZJ, Greaney ML. Mental Health of Brazilian Immigrant Women: The Role of Discrimination, Social Support, and Community Strengths. J Immigr Minor Health 2023; 25:1016-1024. [PMID: 37191876 PMCID: PMC10185951 DOI: 10.1007/s10903-023-01485-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/17/2023]
Abstract
Little is known about the mental health status of Brazilians living in the U.S. We assessed the prevalence and correlates of depression to guide the development of culturally relevant community-based mental health interventions. An online survey was conducted between July and August 2020 among a sample of Brazilian women living in the U.S. (age 18 and over, born in Brazil, English or Portuguese speaking) recruited through Brazilian social media pages and community organizations. The survey assessed depression using the Center for Epidemiological Study Depression Scale (CES-D-10), the Everyday Discrimination Scale (EDS), the Oslo Social Support Scale (OSSS), and community strengths (CS). We first assessed the correlation between CES-D-10 scores and EDS, OSSS, and CS. We found that half of the participants (52.2%) had CES-D-10 scores of 10 or greater, indicating the presence of depressive symptomatology. In a multivariable model controlling for significant covariates (age, time lived in U.S.), EDS was positively associated with CES-D-10 scores (β = 0.64, 95% CI = 0.45, 0.83), while OSSS was negatively associated with CES-D-10 scores (β = -0.53, 95% C I= -0.80, -0.27). No statistically significant relationship was observed between CES-D-10 and CS scores. In this sample of Brazilian immigrant women, depressive symptomatology was highly prevalent, and experiences of discrimination were associated with increased symptoms of depression. There is a need to understand and address mental health in Brazilian immigrant women.
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Affiliation(s)
- Jennifer D Allen
- Department of Community Health, Tufts University School of Arts and Sciences, 574 Boston Avenue, Medford, MA, 02155, USA.
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard Box G-BH, Providence, RI, USA
| | - Mary L Greaney
- Department of Health Studies, University of Rhode Island, 25 West Independence Way, Kingston, RI, USA
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Increasing Diversity in Radiology and Molecular Imaging: Current Challenges. Mol Imaging Biol 2021; 23:625-638. [PMID: 33903986 PMCID: PMC8074707 DOI: 10.1007/s11307-021-01610-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/05/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
This paper summarizes the 2020 Diversity in Radiology and Molecular Imaging: What We Need to Know Conference, a three-day virtual conference held September 9–11, 2020. The World Molecular Imaging Society (WMIS) and Stanford University jointly organized this event to provide a forum for WMIS members and affiliates worldwide to openly discuss issues pertaining to diversity in science, technology, engineering, and mathematics (STEM). The participants discussed three main conference themes, “racial diversity in STEM,” “women in STEM,” and “global health,” which were discussed through seven plenary lectures, twelve scientific presentations, and nine roundtable discussions, respectively. Breakout sessions were designed to flip the classroom and seek input from attendees on important topics such as increasing the representation of underrepresented minority (URM) members and women in STEM, generating pipeline programs in the fields of molecular imaging, supporting existing URM and women members in their career pursuits, developing mechanisms to effectively address microaggressions, providing leadership opportunities for URM and women STEM members, improving global health research, and developing strategies to advance culturally competent healthcare.
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Daldrup-Link HE, Esposito G, Bhujwalla ZM. Challenges and Initiatives in Diversity, Equity and Inclusion in Cancer Molecular Imaging. Front Oncol 2021; 11:638692. [PMID: 33898312 PMCID: PMC8062743 DOI: 10.3389/fonc.2021.638692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
A diverse biomedical workforce is essential to achieve excellence in patient care, clinical translational, and basic research. Diversity, equity, and inclusion challenges in cancer molecular represent a combination of the challenges facing the science, technology, engineering, and mathematics (STEM) field, and challenges in Radiology and Nuclear Medicine. Although there is a growing awareness of conscious and unconscious bias that negatively affect the cancer imaging world, many challenges remain such as overcoming barriers to entry into the pipeline, avoiding program dropout, and providing long-term career prospect. The COVID-19 pandemic has resulted in a significant setback and further highlighted problems faced by women and underrepresented minorities. In this perspective, we have identified some of the challenges faced and highlighted ongoing and future initiatives to address these challenges.
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Affiliation(s)
- Heike E Daldrup-Link
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| | - Giuseppe Esposito
- Department of Radiology, Georgetown University Hospital, Washington, DC, United States
| | - Zaver M Bhujwalla
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Cano-Ibáñez N, Zolfaghari Y, Amezcua-Prieto C, Khan KS. Physician-Patient Language Discordance and Poor Health Outcomes: A Systematic Scoping Review. Front Public Health 2021; 9:629041. [PMID: 33816420 PMCID: PMC8017287 DOI: 10.3389/fpubh.2021.629041] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/08/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: This systematic review assessed whether physician-patient language concordance, compared with discordance, is associated with better health outcomes. Methods: A systematic literature search was conducted, without language restrictions, using PubMed, EMBASE, Web of Science, and PsycINFO, from inception to July 2020. We included studies that evaluated the effects of physician-patient language concordance on health outcomes. Articles were screened, selected, and data-extracted in duplicate. Review protocol was prospectively registered (PROSPERO, CRD42020157229). Results: There were 541 citations identified through databases and eight citations through reverse search and Google Scholar. A total of 15 articles (84,750 participants) were included reporting outcomes within five domains: diabetes care (four studies), inpatient care (five studies), cancer screening (three studies), healthcare counseling (two studies), and mental health care (one study). Ten studies were of good quality, four were fair, and one was poor, according to the modified Newcastle-Ottawa Scale. Eight studies (53%) showed a significant negative association between language discordance and at least one clinical outcome. Five studies (33%) found no association. Conclusion: Over half the evidence collated showed that physician-patient language concordance was associated with better health clinical outcomes.
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Affiliation(s)
- Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada, Spain.,Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Yasmin Zolfaghari
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, United Kingdom
| | - Carmen Amezcua-Prieto
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada, Spain.,Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada, Spain
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Understanding Health Priorities, Behaviors, and Service Utilization Among Brazilian Immigrant Women: Implications for Designing Community-Based Interventions. J Racial Ethn Health Disparities 2021; 9:135-145. [PMID: 33403650 PMCID: PMC7785287 DOI: 10.1007/s40615-020-00936-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/28/2022]
Abstract
Brazilians represent a growing proportion of immigrants in the USA. Little is known about their health or healthcare utilization after their arrival. This study aimed to gather formative data to understand the needs of Brazilian immigrant women to guide public health interventions. We conducted five focus groups with Brazilian women born in Brazil (n = 47) and 13 key informant interviews with representatives from Brazilian-serving organizations. Participants were recruited from churches and social service organizations in the Greater Boston area. Findings revealed that mental health was the most pressing health priority; many attributed high levels of anxiety and depression to worries about undocumented status, separation from social networks, and strenuous work schedules. Occupational health issues were frequently mentioned, including musculoskeletal complaints, skin rashes, and respiratory problems. Domestic violence was also a concern, and many women feared reporting to police due to undocumented status. Most reported good access to medical care and described the quality of healthcare services as superior to that available in Brazil. However, many reported challenges with interpersonal communication with providers, dissatisfaction with a perceived unwillingness from providers to order medical tests or prescribe treatment, and limited access to mental health services. There was agreement that effective intervention strategies should use social media, radio, and group education in churches.
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Falgas-Bague I, Wang Y, Banerjee S, Ali N, DiMarzio K, Palao Vidal D, Alegría M. Predictors of Adherence to Treatment in Behavioral Health Therapy for Latino Immigrants: The Importance of Trust. Front Psychiatry 2019; 10:817. [PMID: 31780971 PMCID: PMC6856783 DOI: 10.3389/fpsyt.2019.00817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/16/2019] [Indexed: 11/15/2022] Open
Abstract
A complex array of barriers to care influence patients' adherence to behavioral healthcare services. Understanding barriers to care is critical to ensure sufficient dosage of treatment. This study assessed the influence of perceived barriers on Latino migrants' prospective adherence to treatment for co-occurring mental health and substance use disorders as part of a clinical trial. Eligible participants (18-70 years-old) were recruited from community-based settings and classified according to their intervention session attendance. Baseline assessments included socio-demographic factors, clinical characteristics (i.e., depression, anxiety, post-traumatic stress disorder, substance use), psychosocial and cultural factors (i.e., ethnic identity, health literacy, discrimination), and perceived attitudinal and structural barriers to care. Treatment involved 10-sessions of cognitive-behavioral therapy, psychoeducation, and mindfulness (Integrated Intervention for Dual problems and Early Action) and emphasized participant's engagement in treatment. We used multinomial logistic regression models to examine the association between barriers to care reported at baseline, sociodemographic characteristics, psychosocial and cultural factors, clinical factors, and treatment adherence. Mistrust in previous behavioral health treatment(s) was the reported barrier significantly associated with completion of the program after adjusting for clinical, psychosocial, and cultural factors, with those expressing mistrust in previous treatment(s) showing higher rates of completion compared to those who did not report this barrier. Evidence-based and culturally-tailored interventions provided by ethnically matched providers may overcome cultural mistrust and increase adherence to behavioral health care among Latino immigrants.
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Affiliation(s)
- Irene Falgas-Bague
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ye Wang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Souvik Banerjee
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Naomi Ali
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Karissa DiMarzio
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Diego Palao Vidal
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Department of Mental Health, University Hospital Parc Tauli-I3PT, Sabadell, Spain
- CIBERSAM, Barcelona, Spain
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Departments of Medicine and Psychiatry, Harvard Medical School, Boston, MA, United States
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A Systematic Review of the Impact of Patient-Physician Non-English Language Concordance on Quality of Care and Outcomes. J Gen Intern Med 2019; 34:1591-1606. [PMID: 31147980 PMCID: PMC6667611 DOI: 10.1007/s11606-019-04847-5] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/08/2018] [Accepted: 01/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Approximately 25 million people in the USA are limited English proficient (LEP). When LEP patients receive care from physicians who are truly language concordant, some evidence show that language disparities are reduced, but others demonstrate worse outcomes. We conducted a systematic review of the literature to compare the impact of language-concordant care for LEP patients with that of other interventions, including professional and ad hoc interpreters. METHODS Data was collected through a systematic review of the literature using PubMed, PsycINFO, Web of Science, Cochrane Library, and EMBASE in October 2017. The literature search strategy had three main components, which were immigrant/minority status, language barrier/proficiency, and healthcare provider/patient relationship. The quality of the articles was appraised using the Downs and Black checklist. RESULTS The 33 studies were grouped by the outcome measure studied, including quality of care (subdivided into primary care, diabetes, pain management, cancer, and inpatient), satisfaction with care/communication, medical understanding, and mental health. Of the 33, 4 (6.9%) were randomized controlled trials and the remaining 29 (87.9%) were cross-sectional studies. Seventy-six percent (25/33) of the studies demonstrated that at least one of the outcomes assessed was better for patients receiving language-concordant care, while 15% (5/33) of studies demonstrated no difference in outcomes, and 9% (3/33) studies demonstrated worse outcomes in patients receiving language-concordant care. DISCUSSION The findings of this review indicate that, in the majority of situations, language-concordant care improves outcomes. Although most studies included were of good quality, none provided a standardized assessment of provider language skills. To systematically evaluate the impact of truly language-concordant care on outcomes and draw meaningful conclusions, future studies must include an assessment of clinician language proficiency. Language-concordant care offers an important way for physicians to meet the unique needs of their LEP patients.
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Handtke O, Schilgen B, Mösko M. Culturally competent healthcare - A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision. PLoS One 2019; 14:e0219971. [PMID: 31361783 PMCID: PMC6667133 DOI: 10.1371/journal.pone.0219971] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/06/2019] [Indexed: 01/18/2023] Open
Abstract
Background Culturally and linguistically diverse patients access healthcare services less than the host populations and are confronted with different barriers such as language barriers, legal restrictions or differences in health beliefs. In order to reduce these disparities, the promotion of cultural competence in healthcare organizations has been a political goal. This scoping review aims to collect components and strategies from evaluated interventions that provide culturally competent healthcare for culturally and linguistically diverse patients within healthcare organizations and to examine their effects on selected outcome measures. Thereafter, we aim to organize identified components into a model of culturally competent healthcare provisions. Methods and findings A systematic literature search was carried out using three databases (Pubmed, PsycINFO and Web of Science) to identify studies which have implemented and evaluated cultural competence interventions in healthcare facilities. PICO criteria were adapted to formulate the research question and to systematically choose relevant search terms. Sixty-seven studies implementing culturally competent healthcare interventions were included in the final synthesis. Identified strategies and components of culturally competent healthcare extracted from these studies were clustered into twenty categories, which were organized in four groups: Components of culturally competent healthcare–Individual level; Components of culturally competent healthcare–Organizational level; Strategies to implement culturally competent healthcare and Strategies to provide access to culturally competent healthcare. A model integrating the results is proposed. The overall effects on patient outcomes and utilization rates of identified components or strategies were positive but often small or not significant. Qualitative data suggest that components and strategies of culturally competent healthcare were appreciated by patients and providers. Conclusion This scoping review used a bottom-up approach to identify components and strategies of culturally competent healthcare interventions and synthesized the results in a model of culturally competent healthcare provision. Reported effects of single components or strategies are limited because most studies implemented a combination of different components and strategies simultaneously.
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Affiliation(s)
- Oriana Handtke
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Benjamin Schilgen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mike Mösko
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hsueh L, Hirsh AT, Maupomé G, Stewart JC. Patient-Provider Language Concordance and Health Outcomes: A Systematic Review, Evidence Map, and Research Agenda. Med Care Res Rev 2019; 78:3-23. [PMID: 31291823 DOI: 10.1177/1077558719860708] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although patient-provider language concordance has the potential to reduce health disparities for people with limited English proficiency, no previous work has synthesized this literature. Our systematic review sought to describe the characteristics of studies examining relationships between language concordance and health outcomes, summarize the nature of observed associations, and propose an evidence map and research agenda. A comprehensive search of published articles identified 38 quantitative studies for inclusion. Most studies were cross-sectional, conducted in primary care, concentrated in Western states, and focused on Spanish speakers and physician providers. Results were split between supporting a positive association versus no association of language concordance with patient behaviors, provider behaviors, interpersonal processes of care, and clinical outcomes. Several methodological limitations were identified. Based on these results, we developed an evidence map, identified knowledge gaps, and proposed a research agenda. There is a particular need for quasi-experimental longitudinal studies with well-characterized samples.
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Affiliation(s)
- Loretta Hsueh
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Adam T Hirsh
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | | | - Jesse C Stewart
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Vogel DL, Strass HA, Heath PJ, Al-Darmaki FR, Armstrong PI, Baptista MN, Brenner RE, Gonçalves M, Lannin DG, Liao HY, Mackenzie CS, Mak WWS, Rubin M, Topkaya N, Wade NG, Wang YF, Zlati A. Stigma of Seeking Psychological Services: Examining College Students Across Ten Countries/Regions. COUNSELING PSYCHOLOGIST 2017. [DOI: 10.1177/0011000016671411] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Stigma is an important barrier to seeking psychological services worldwide. Two types of stigma exist: public stigma and self-stigma. Scholars have argued that public stigma leads to self-stigma, and then self-stigma is the primary predictor of attitudes toward seeking psychological services. However, this assertion is largely limited to U.S. samples. The goal of this research was to provide a first step in understanding the relationship between public stigma, self-stigma, and attitudes toward seeking psychological services in international contexts ( N = 3,276; Australia, Brazil, Canada, Hong Kong, Portugal, Romania, Taiwan, Turkey, United Arab Emirates, and United States). Using structural equation modeling, we found that self-stigma mediated the relationship between public stigma and attitudes toward seeking services among college students in each country and region. However, differences in path strengths emphasize the need to pay attention to the role of public and self-stigma on attitudes toward seeking psychological services throughout the world.
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Affiliation(s)
| | | | | | | | | | | | | | - Marta Gonçalves
- Instituto Universitário de Lisboa (ISCTE-IUL), Cis-IUL, Lisboa, Portugal and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Mark Rubin
- The University of Newcastle, Callaghan, New South Wales, Australia
| | | | | | | | - Alina Zlati
- Open Minds–Center for Mental Health Research, Cluj-Napoca, Romania
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