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Hoshmand S, Knegtering H, Spoelstra SK. Cultural competence of mental health practitioners in the Netherlands. Int J Soc Psychiatry 2024; 70:282-288. [PMID: 37874035 DOI: 10.1177/00207640231206062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND The importance of providing mental health from a transcultural perspective in establishing a therapeutic alliance is recognized. However, it is currently unknown how many mental health practitioners in the Netherlands feel capable of providing mental healthcare from a transcultural perspective, or if they are familiar with the Cultural Formulation Interview (CFI). The CFI is a tool used in mental health care to gather culturally relevant patient information, enhancing cultural sensitivity in treatment. It is also unknown if there is a difference between psychiatrist and psychiatry residents in terms of their cultural competence. AIMS This study aimed to assess the self-appraised cultural competence of Dutch psychiatrist and psychiatry residents, including their knowledge of the CFI, and the need for further training. METHODS A cross-sectional study was conducted among psychiatrists and psychiatry residents by means of an online questionnaire. RESULTS Ninety-seven mental health practitioners completed the questionnaire. Of the psychiatrists 70% and of the residents 76% reported that treating patients from cultural backgrounds different from their own background is challenging. Only 44% of psychiatrists and 34% of residents considered themselves sufficiently culturally competent, and 56% and 47% respectively, were uninformed about the CFI. The majority of psychiatrists and residents (70 vs 84%) indicated a need for more training in cultural competence. CONCLUSION The majority of psychiatrists and residents in The Netherlands considered treating patients from different cultural backgrounds a challenge, reported feeling insufficiently culturally competent, lacked experience with the cultural formulation interview and reported a need for more training in cultural competence.
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Affiliation(s)
- S Hoshmand
- Lentis Psychiatric institute, Groningen, The Netherlands
| | - H Knegtering
- Lentis Psychiatric institute, Groningen, The Netherlands
- University Medical Center Groningen, University of Groningen, Rob Giel Research Center, Groningen, The Netherlands
| | - S K Spoelstra
- Addiction care North Netherlands, Groningen, The Netherlands
- NHL Stenden Hogeschool, Leeuwarden, The Netherlands
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2
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Aggarwal NK, Chen D, Lewis-Fernández R. Eliciting social stressors, supports, and determinants of health through the DSM-5 cultural formulation interview. Front Psychiatry 2023; 14:1148170. [PMID: 37056400 PMCID: PMC10086136 DOI: 10.3389/fpsyt.2023.1148170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/09/2023] [Indexed: 04/15/2023] Open
Abstract
Objective As recognition of the importance of social determinants of mental health has increased, the limitations of clinical competence-enhancing interventions that do not emphasize this approach have emerged. The Cultural Formulation Interview (CFI) is a cultural competence intervention that emerges from a confluence of social medicine and medical anthropology traditions. Limited research has examined how patients respond to CFI questions on social-structural aspects of illness and care to assess whether the CFI adequately elicits information on social determinants of mental health. Methods Patients' responses during a first intake appointment to three CFI questions on social stressors, supports, or barriers to care from 27 patient-clinician dyads are analyzed through qualitative content analysis. The data come from a hyper-diverse clinical setting in Queens, New York, where no ethnoracial group has a majority and all patient-clinician dyads reflect cross-cultural interactions. Results At least one social determinant was coded in 89 of all cases, and nearly 44% included themes related to multiple determinants of health. The most-commonly coded theme was social relationships (n = 21), followed by financial instability (n = 7), stigma (n = 5), housing instability (n = 2), and poor access to healthcare, involvement in the criminal justice system, employment instability, area-level poverty, and immigration policies (n = 1 each). Conclusion Our work shows that social determinants of mental health can be elicited through the CFI. Future work should examine how this information is included in clinicians' formulations and whether the cultural formulation approach would benefit from additional revision to facilitate assessment of socio-structural factors.
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Affiliation(s)
- Neil Krishan Aggarwal
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, United States
- *Correspondence: Neil Krishan Aggarwal,
| | - Daniel Chen
- Department of Psychiatry, Flushing Hospital Medical Center, Flushing, NY, United States
| | - Roberto Lewis-Fernández
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, United States
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3
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Jones-Lavallée A, Bernard G, Taing J, Leanza Y. The State of Current Knowledge on the Cultural Formulation Interview: A Scoping Review. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-10009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Lindberg LG, Carlsson J, Kristiansen M, Skammeritz S, Johansen KS. The Cultural Formulation Interview-Generating distance or alliance? A qualitative study of practice changes in Danish mental healthcare. Transcult Psychiatry 2022; 59:740-755. [PMID: 35331059 DOI: 10.1177/13634615211065617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article presents provider experiences with the Cultural Formulation Interview (CFI) in Danish mental healthcare for migrant patients. Semi-structured interviews with 17 providers and 20 recorded CFI sessions were analyzed with a constructivist grounded theory approach. Based on our empirical material, we endorse the CFI's ability to facilitate working alliance and a profound and contextually situated understanding of the patient. Further, the CFI supported less-experienced providers in investigating cultural issues. Conversely, we found that CFI questions about cultural identity and background evoked notions of distance and 'othering' in the encounter. Nine providers had felt discomfort and professional insecurity when the CFI compelled them to introduce explanatory frameworks of culture in the mental health assessment. Eleven providers had experienced that the abstract nature of the questions inhibited patient responses or led to short and stereotypical descriptions, which had limited analytical value. We describe the contradictory CFI experiences of alliance versus distance at three levels: 1) at the CFI instrument level; 2) at the organizational level; and 3) at the contextual and structural level. We demonstrate benefits and pitfalls of using the CFI with migrants in Denmark, which is an example of a European healthcare context where cultural consultation is not an integrated concept in health education programs and where the notion of culture is contentious due to negative political rhetoric on multiculturalism.We suggest that the CFI should be introduced with thorough training; focus on fidelity; and supervision in the clinical application and understanding of the concept of culture.
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Affiliation(s)
- Laura Glahder Lindberg
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Aging, University of Copenhagen, Denmark
| | - Signe Skammeritz
- Competence Centre for Transcultural Psychiatry, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Katrine Schepelern Johansen
- Competence Centre for Dual Diagnosis, Mental Health Center Sct Hans, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
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5
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Medical Mistrust in Perinatal Mental Health. Harv Rev Psychiatry 2022; 30:238-247. [PMID: 35849741 DOI: 10.1097/hrp.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Despite the advancement of telemedicine and recent innovations in treatment, minoritized women continue to bear a disproportionate burden of pregnancy-related psychiatric conditions and complications, which the pandemic has further exacerbated. Research demonstrates that medical mistrust and systemic racism play central roles in the underutilization of services by racially and ethnically diverse women during pregnancy and postpartum. To effectively address these disparities, it is imperative to understand the drivers of medical mistrust in perinatal health care systems. This Perspectives article describes the historical context of medical mistrust in psychiatric and obstetric health systems and offers solutions to mitigate mistrust and the impact of systemic racism on perinatal care.
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Rohrbaugh RM, DeJong SM. The Role of the Program Director in Supporting Diversity, Equity, and Inclusion. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:264-268. [PMID: 34272722 DOI: 10.1007/s40596-021-01474-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/27/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Sandra M DeJong
- Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA
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Atkinson RB, Khubchandani JA, Chun MBJ, Reidy E, Ortega G, Bain PA, Demko C, Barreiro-Rosado J, Kent TS, Smink DS. Cultural Competency Curricula in US Graduate Medical Education: A Scoping Review. J Grad Med Educ 2022; 14:37-52. [PMID: 35222820 PMCID: PMC8848887 DOI: 10.4300/jgme-d-21-00414.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/19/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cultural competency training provides participants with knowledge and skills to improve cross-cultural communication and is required for all graduate medical education (GME) training programs. OBJECTIVE The authors sought to determine what cultural competency curricula exist specifically in GME. METHODS In April 2020, the authors performed a scoping review of the literature using a multidatabase (PubMed, Ovid, MedEdPORTAL) search strategy that included keywords relevant to GME and cultural competency. The authors extracted descriptive data about the structure, implementation, and analysis of cultural competency curricula and analyzed these data for trends. RESULTS Sixty-seven articles met criteria for inclusion, of which 61 (91%) were focused exclusively on residents. The most commonly included specialties were psychiatry (n=19, 28.4%), internal medicine (n=16, 23.9%), and pediatrics (n=15, 22.4%). The shortest intervention was a 30-minute online module, while the longest contained didactics, electives, and mentoring programs that spanned the entirety of residency training (4 years). The sample sizes of included studies ranged from 6 to 833 participants. Eight (11.9%) studies utilized OSCEs as assessment tools, while 17 (25.4%) conducted semi-structured interviews or focus groups. Four common themes were unique interventions, retention of learning, trainee evaluation of curricula, and resources required for implementation. CONCLUSIONS Wide variation exists in the design, implementation, and evaluation of cultural competency curricula for residents and fellows.
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Affiliation(s)
- Rachel B. Atkinson
- Rachel B. Atkinson, MD, is a Resident, Department of Surgery, and Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School
| | - Jasmine A. Khubchandani
- Jasmine A. Khubchandani, MD, is a Resident, Department of Surgery, and Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School
| | - Maria B. J. Chun
- Maria B. J. Chun, PhD, is a Specialist and Associate Chair in Administration and Finance, Department of Surgery, John A. Burns School of Medicine, University of Hawaii
| | - Emma Reidy
- Emma Reidy, MPH, is Senior Project Manager, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
| | - Gezzer Ortega
- Gezzer Ortega, MD, MPH, is Lead Faculty for Research and Innovation for Equitable Surgical Care, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical
| | - Paul A. Bain
- Paul A. Bain, PhD, is Reference and Instruction Librarian, Countway Library of Medicine, Harvard Medical School
| | - Caroline Demko
- Caroline Demko, is a First-Year Masters Student, Goldman School of Public Policy, University of California, Berkeley
| | - Jeenn Barreiro-Rosado
- Jeenn Barreiro-Rosado, is a Research Assistant, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
| | - Tara S. Kent
- Tara S. Kent, MD, MS, is Associate Professor of Surgery, Vice Chair for Education, and Program Director, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Douglas S. Smink
- Douglas S. Smink, MD, MPH, is Chief of Surgery, Brigham and Women's Faulkner Hospital, Associate Chair of Education and Associate Professor of Surgery, and Core Faculty, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
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8
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Kayrouz R, Schofield C, Nielssen O, Karin E, Staples L, Titov N. A Review and Clinical Practice Guideline for Health Professionals Working With Indigenous and Culturally and Linguistically Diverse (CALD) Populations During COVID-19. Front Public Health 2021; 9:584000. [PMID: 34249822 PMCID: PMC8267873 DOI: 10.3389/fpubh.2021.584000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background: As the rates of infection and mortality from COVID-19 have been higher in minority groups, the communication of health information in a way that is understood and accepted is of particular importance. Aims: To provide health professionals with a clinical practice guideline for clear and culturally sensitive communication of health information about COVID-19 to people of Indigenous and culturally and linguistically diverse (CALD) backgrounds. Assessment of Guideline Options: The authors conducted a review of the literature on health communication, and the guidelines were developed with particular reference to the SPIKES protocol of “breaking bad news” in oncology and the use of the DSM-5 Cultural Formulation Interview (CFI). Actionable Recommendations: The guideline combines two approaches, the Cultural Formulation Interview, developed for DSM-5, and the SPIKES protocol used for delivering “bad news” in oncology. The combined CFI-SPIKES protocol is a six-step clinical practice guideline that includes the following: (1) Set up (S) the interview; (2) Determine how the patient perceives the problem (P) using the Cultural Formulation Interview (CFI) to elicit the patient's cultural perception of the problem; (3) Obtain an invitation (I) from the patient to receive a diagnosis; (4) Provide the patient knowledge (K) of diagnosis in a non-technical way; (5) Address the patient's emotional reaction (E) to diagnosis; and (6) Provide the patient a summary (S) of healthcare and treatment. Conclusions and Relevance: This article presents guidelines for assessing the cultural dimensions of patients' understanding of COVID-19 and delivering diagnostic and treatment recommendations in ways that are culturally safe and responsive, such as: (a) suspending the clinician's own cultural biases to understand the explanatory models and cultural values of their CALD or Indigenous patients; (b) encouraging the use of interpreters or cultural brokers to ensure that that the message is delivered in a way that the patient can understand; and (c) encouraging CALD or Indigenous patient to take an active part in the solution and treatment adherence, to minimize transmission of COVID-19 in CALD and Indigenous communities.
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Affiliation(s)
- Rony Kayrouz
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | | | - Olav Nielssen
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia
| | - Eyal Karin
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Lauren Staples
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Nickolai Titov
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, Australia
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9
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Murphy R, Keogh B, Higgins A. An embodied distress: African asylum seekers' experiences of mental health difficulties while awaiting an asylum outcome in Ireland. Transcult Psychiatry 2021; 58:239-253. [PMID: 33103605 DOI: 10.1177/1363461520966108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The mental health of asylum seekers has attracted significant interest and examination. Quantitative studies have consistently indicated that asylum seekers experience mental distress at a higher rate than both host populations and their refugee counterparts. Qualitative insight into asylum seekers' embodied experience of mental distress is limited. This qualitative narrative study aimed to explore African asylum seekers' everyday embodied experiences of mental distress. Sixteen semi-structured one-to-one interviews were conducted with African asylum seekers who had experienced mental distress and were receiving mental health care services in Ireland. Narrative data were analysed using a holistic analysis framework of narrative form and content. Participants described their everyday endurance of relentless rumination, shame, self-loathing, anger, and mistrust, and of becoming demoralised and hopeless. Study findings indicate that asylum seekers' mental distress interweaves the physical, psychological, emotional, and social realms, thus impacting on the whole of their being. Consequences for asylum seekers include feeling anaesthetised, having a severely diminished capacity to connect and interact with their external surroundings and other people, and, for some, efforts to end their life.Examinations of, and responses to, asylum seekers' mental distress must delve beyond the confines of diagnostic categorisations and codifications of symptomology. To achieve heightened understanding and efficacious interventions, we must empathetically listen and engage with asylum seekers' narratives of distress and the socio-cultural and socio-political context they inhabit.
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10
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Einloft Brunnet A, Davanture A, Derivois D. L’évaluation psychologique en situation transculturelle : une révision de la littérature. PSYCHOLOGIE FRANCAISE 2021. [DOI: 10.1016/j.psfr.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Yager J. A Clinician's Guide to Polycultural Psychiatry. Harv Rev Psychiatry 2021; 29:159-168. [PMID: 33560691 DOI: 10.1097/hrp.0000000000000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients and families each present unique microcultures, mixing and blending numerous broadly conceptualized cultural identity groups. Within individuals and families, cultural identities are experienced and enacted as complex matrices of intersecting identities that, to varying degrees, complement, assimilate, accommodate, or clash. In these patterns, individuals' relationships to cultures are not necessarily categorically distinct ("multicultural"). Instead, they are often "polycultural," defined as partial and plural; rather than interpreting different cultural traditions as separate and independent, they are, within the lives of individuals and families, better understood as systems that interact with and influence one another.Cultural identity groups extend beyond those traditionally considered by transcultural psychiatry-that is, beyond ethnic, racial, and language groups. They encompass (in alphabetical order) educational, ethnic, extended family, gender-oriented, generational, geographic, language and dialect, organizational, physical or psychiatric disability, political, professional, racial, religious, sect, social class, and vocational identity groups, among others. Simplistic assumptions and generalities about identity groups risk cultural stereotyping that may negatively bias clinical assessments. Therefore, practitioners striving for cultural sensitivity need to adopt nuanced strategies for approaching broad polycultural identity questions in clinical practice. Accordingly, this article suggests frameworks and strategies for (1) assessing and confronting one's own cultural preconceptions and prejudices, and (2) developing etic (objective quantitative data) and emic (insiders' experiential worldviews) perspectives pertinent to clinical anthropathology. Both etic and emic perspectives are necessary for polyculturally nuanced, respectful, comprehensive inquiries pertinent to patients' and family's health beliefs, psychiatric difficulties, and health practices. Supplementary material from the DSM-5 section on cultural formulation is adapted and discussed, along with the implications of polycultural psychiatry for education and training in psychiatry.
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Affiliation(s)
- Joel Yager
- From the Department of Psychiatry, University of Colorado School of Medicine
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12
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Castaneda AE, Çilenti K, Rask S, Lilja E, Skogberg N, Kuusio H, Salama E, Lahti J, Elovainio M, Suvisaari J, Koskinen S, Koponen P. Migrants Are Underrepresented in Mental Health and Rehabilitation Services-Survey and Register-Based Findings of Russian, Somali, and Kurdish Origin Adults in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176223. [PMID: 32867157 PMCID: PMC7504052 DOI: 10.3390/ijerph17176223] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/21/2022]
Abstract
Mounting evidence suggests that migration background increases the risk of mental ill health, but that problems exist in accessing healthcare services in people of migrant origin. The present study uses a combination of register- and survey-based data to examine mental health-related health service use in three migrant origin populations as well as the correspondence between the need and use of services. The data are from the Finnish Migrant Health and Wellbeing Study (Maamu), a comprehensive cross-sectional interview and a health examination survey. A random sample consisted of 5909 working-aged adults of Russian, Somali, and Kurdish origin of which 3000 were invited to participate in the survey and the rest were drawn for a register-based approach. Some of the mental health services, based on registers, were more prevalent in the Kurdish origin group in comparison with the general population and less prevalent in the Russian and Somali origin groups. All the migrant origin groups were underrepresented in rehabilitation services. When affective symptoms were taken into account, all the migrant origin groups were underrepresented in all of the services. This calls for actions to promote mental health, diminish the barriers to access services, and improve the service paths for migrants.
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Affiliation(s)
- Anu E. Castaneda
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland;
- Correspondence: ; Tel.: +358-29-524-7848
| | - Katja Çilenti
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland;
| | - Shadia Rask
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Eero Lilja
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Natalia Skogberg
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Hannamaria Kuusio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Essi Salama
- Doctoral Programme in Clinical Research, Faculty of Medicine, University of Turku, FI-20014 Turku, Finland & Child Psychiatry, Turku University Hospital, 20521 Turku, Finland;
| | - Jari Lahti
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland;
| | - Marko Elovainio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland;
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Päivikki Koponen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
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13
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Aggarwal NK, Jarvis GE, Gómez-Carrillo A, Kirmayer LJ, Lewis-Fernández R. The Cultural Formulation Interview since DSM-5: Prospects for training, research, and clinical practice. Transcult Psychiatry 2020; 57:496-514. [PMID: 32838655 DOI: 10.1177/1363461520940481] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
While social science research has demonstrated the importance of culture in shaping psychiatric illness, clinical methods for assessing the cultural dimensions of illness have not been adopted as part of routine care. Reasons for limited integration include the impression that attention to culture requires specialized skills, is only relevant to a subset of patients from unfamiliar backgrounds, and takes too much time to be useful. The DSM-5 Cultural Formulation Interview (CFI), published in 2013, was developed to provide a simplified approach to collecting information needed for cultural assessment. It offers a 16-question interview protocol that has been field tested at sites around the world. However, little is known about how CFI implementation has affected training, health services, and clinical outcomes. This article offers a comprehensive narrative review that synthesizes peer-reviewed, published studies on CFI use. A total of 25 studies were identified, with sample sizes ranging from 1 to 460 participants. In all pilot CFI studies 960 unique subjects were enrolled, and in final CFI studies 739 were enrolled. Studies focused on how the CFI affects clinical practice; explored the CFI through research paradigms in medical communication, implementation science, and family psychiatry; and examined clinician training. In most studies, patients and clinicians reported that using the CFI improved clinical rapport. This evidence base offers an opportunity to consider implications for training, research, and clinical practice and to identify crucial areas for further research.
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14
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Brunnet AE, Dos Santos Lobo N, Silveira T, Kristensen CH, Derivois D. Migrations, trauma and mental health: A literature update on psychological assessment. Encephale 2020; 46:364-371. [PMID: 32576365 DOI: 10.1016/j.encep.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Migrants and refugees often face potentially traumatic events and post-migratory stressors. Upon arrival in the host country, they can be referred to mental health services to assess the impact of their previous experiences. These cross-cultural clinical encounters may raise questions, particularly regarding the assessment of mental health using models based on Western conceptions of psychopathology. OBJECTIVES AND METHOD The objective of the present non-systematic review of the literature is to discuss the psychological evaluation of post-traumatic reactions in migrants and refugees. More specifically, we present current research on psychopathology, resilience and post-traumatic development (PTG) among the migrant and refugee population. We also examine the cross-cultural validity of concepts such as Post-Traumatic Stress Disorder, resilience and PTG. Finally, we describe the most frequently used tools in cross-cultural psychological assessment and briefly reflect on the question of cultural sensitivity of mental health professionals. A bibliographic search was carried out using the databases: PILOTS, Pubmed, APA PsycNET, and Google Scholar using the following keywords: "migrants", "refugees", "posttraumatic stress disorder", "mental health", "Psychopathology", "risk factors", "protection factors", "posttraumatic growth" and "resilience". We have also reviewed the reference lists of articles encountered from database searches. RESULTS Responses to a potentially traumatic situation are multiple. Regarding the migrant and refugee population, the reviewed articles studied different post-traumatic reactions such as resilience, post-traumatic development, and psychopathologies. The most studied psychopathological responses were depression, anxiety and Post-traumatic Stress Disorder. After reviewing these studies, we asked the following question: considering the complexity of the migration process, what are the factors associated with the development of these different post-traumatic responses? Indeed, several individual and social factors before, during and after migration influence the mental health of individuals in a migration situation. Among the most cited risk factors identified were: to be a victim of or witness to violence in the country of origin and, after migration, to face post-migration difficulties such as asylum denial, to be in a precarious situation with regard to housing and work, as well as the difficulties linked to adaptation to the new culture. We have also described protective factors for the mental health of this population, such as: social support, psychological support, and a good quality of life in the host country. The reviewed articles also describe an important influence of cultural aspects on mental health, such as the perception of an event as traumatic. Although the authors of the reviewed articles accept this influence of culture on post-traumatic responses, most of the tools used to assess the mental health of migrants and refugees were created in a Western context. Studies show a growing concern with these cultural aspects, and certain tools that allow a more culturally sensitive evaluation, such as the "Cultural Formulation Interview", are being developed. DISCUSSION AND CONCLUSION Even if the concern with the sensitivity of the tools used in cross-cultural assessment seems to be more present in the international literature, researchers seem to encounter difficulties in better understanding the effects of culture on the mental health of individuals. With increasingly diverse societies, new research should not be based on participants' geographic or ethnic origins, but rather try to "unpack" culture with, for example, the exploration of the relationships between certain values or orientations and the different expressions of psychological distress. Finally, given the still lacking development in the field of cross-cultural research, certain practices, such as the participation of interpreters, the supervision of cultural mediators or the use of culturally sensitive tools, can help the clinician to maintain good practices with patients from different cultures in the diagnostic and psychotherapeutical processes.
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Affiliation(s)
- A E Brunnet
- Pontifical Catholic University of Rio Grande do Sul, Graduate Program in Psychology, School of Health Sciences, Porto Alegre, Rio Grande do Sul, Brazil; University of Burgundy - Franche-Comté, Laboratory Psy-DREPI EA 7458, Dijon, France.
| | - N Dos Santos Lobo
- Pontifical Catholic University of Rio Grande do Sul, Graduate Program in Psychology, School of Health Sciences, Porto Alegre, Rio Grande do Sul, Brazil
| | - T Silveira
- Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - C H Kristensen
- Pontifical Catholic University of Rio Grande do Sul, Graduate Program in Psychology, School of Health Sciences, Porto Alegre, Rio Grande do Sul, Brazil
| | - D Derivois
- University of Burgundy - Franche-Comté, Laboratory Psy-DREPI EA 7458, Dijon, France
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Jarvis GE, Kirmayer LJ, Gómez-Carrillo A, Aggarwal NK, Lewis-Fernández R. Update on the Cultural Formulation Interview. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:40-46. [PMID: 32047396 PMCID: PMC7011218 DOI: 10.1176/appi.focus.20190037] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This article reviews the clinical and research literature on the Cultural Formulation Interview (CFI) since its publication in DSM-5. The CFI is an interview protocol designed to be used by clinicians in any setting to gather essential data to produce a cultural formulation. The CFI aims to improve culturally sensitive diagnosis and treatment by focusing clinical attention on the patient's perspective and social context. Preliminary evidence indicates that the CFI can improve clinical communication by enhancing clinician-patient rapport, allowing the clinician to obtain new, cultural data in a relatively short period, eliciting patients' perspectives on what caused their symptoms, and helping patients to become aware of their problems in more insightful ways. With practice, the CFI takes approximately 20 minutes to complete. The CFI has been evaluated internationally in the United States, Canada, Kenya, Peru, the Netherlands, India, and Mexico and generally has been found to be clinically acceptable and useful in these varied settings. Clinicians receiving as little as one hour of training on the CFI improved their ability to work with culturally diverse patients. The CFI may be more difficult to conduct with patients who have severe symptoms, including acute psychosis, suicidal behavior, aggression, and cognitive impairment. The CFI provides a simple way to begin the process of cultural assessment, and its systematic use can foster a reflective stance and promote systemic thinking in routine clinical practice about the patient's life and experience.
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Affiliation(s)
- G Eric Jarvis
- Division of Social and Transcultural Psychiatry, McGill University, and Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec (Jarvis, Kirmayer, Gómez-Carrillo); Department of Psychiatry, Columbia University, New York (Aggarwal, Lewis-Fernández); New York State Center of Excellence for Cultural Competence (Aggarwal, Lewis-Fernández), Anxiety Disorders Clinic (Lewis-Fernández), and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, and Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec (Jarvis, Kirmayer, Gómez-Carrillo); Department of Psychiatry, Columbia University, New York (Aggarwal, Lewis-Fernández); New York State Center of Excellence for Cultural Competence (Aggarwal, Lewis-Fernández), Anxiety Disorders Clinic (Lewis-Fernández), and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York
| | - Ana Gómez-Carrillo
- Division of Social and Transcultural Psychiatry, McGill University, and Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec (Jarvis, Kirmayer, Gómez-Carrillo); Department of Psychiatry, Columbia University, New York (Aggarwal, Lewis-Fernández); New York State Center of Excellence for Cultural Competence (Aggarwal, Lewis-Fernández), Anxiety Disorders Clinic (Lewis-Fernández), and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York
| | - Neil Krishan Aggarwal
- Division of Social and Transcultural Psychiatry, McGill University, and Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec (Jarvis, Kirmayer, Gómez-Carrillo); Department of Psychiatry, Columbia University, New York (Aggarwal, Lewis-Fernández); New York State Center of Excellence for Cultural Competence (Aggarwal, Lewis-Fernández), Anxiety Disorders Clinic (Lewis-Fernández), and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York
| | - Roberto Lewis-Fernández
- Division of Social and Transcultural Psychiatry, McGill University, and Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec (Jarvis, Kirmayer, Gómez-Carrillo); Department of Psychiatry, Columbia University, New York (Aggarwal, Lewis-Fernández); New York State Center of Excellence for Cultural Competence (Aggarwal, Lewis-Fernández), Anxiety Disorders Clinic (Lewis-Fernández), and Hispanic Treatment Program (Lewis-Fernández), New York State Psychiatric Institute, New York
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Faregh N, Lencucha R, Ventevogel P, Dubale BW, Kirmayer LJ. Considering culture, context and community in mhGAP implementation and training: challenges and recommendations from the field. Int J Ment Health Syst 2019; 13:58. [PMID: 31462908 PMCID: PMC6708207 DOI: 10.1186/s13033-019-0312-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 08/05/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Major efforts are underway to improve access to mental health care in low- and middle-income countries (LMIC) including systematic training of non-specialized health professionals and other care providers to identify and help individuals with mental disorders. In many LMIC, this effort is guided by the mental health Gap Action Programme (mhGAP) established by the World Health Organization, and commonly centres around one tool in this program: the mhGAP-Intervention Guide. OBJECTIVE To identify cultural and contextual challenges in mhGAP training and implementation and potential strategies for mitigation. METHOD An informal consultative approach was used to analyze the authors' combined field experience in the practice of mhGAP implementation and training. We employed iterative thematic analysis to consolidate and refine lessons, challenges and recommendations through multiple drafts. Findings were organized into categories according to specific challenges, lessons learned and recommendations for future practice. We aimed to identify cross-cutting and recurrent issues. RESULTS Based on intensive fieldwork experience with a focus on capacity building, we identify six major sets of challenges: (i) cultural differences in explanations of and attitudes toward mental disorder; (ii) the structure of the local health-care system; (iii) the level of supervision and support available post-training; (iv) the level of previous education, knowledge and skills of trainees; (v) the process of recruitment of trainees; and (vi) the larger socio-political context. Approaches to addressing these problems include: (1) cultural and contextual adaptation of training activities, (2) meaningful stakeholder and community engagement, and (3) processes that provide support to trainees, such as ongoing supervision and Communities of Practice. CONCLUSION Contextual and cultural factors present major barriers to mhGAP implementation and sustainability of improved services. To enable trainees to effectively apply their local cultural knowledge, mhGAP training needs to: (1) address assumptions, biases and stigma associated with mental health symptoms and problems; (2) provide an explicit framework to guide the integration of cultural knowledge into assessment, treatment negotiation, and delivery; and (3) address the specific kinds of problems, modes of clinical presentations and social predicaments seen in the local population. Continued research is needed to assess the effectiveness these strategies.
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Affiliation(s)
- Neda Faregh
- Department of Psychology, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6 Canada
- Global Mental Health Program, McGill University, Montreal, Canada
| | - Raphael Lencucha
- School of Physical & Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC H3G 1Y5 Canada
- Global Mental Health Program, McGill University, Montreal, Canada
| | - Peter Ventevogel
- Public Health Section, Division of Programme Support and Management, United Nations High Commissioner for Refugees, 94 Rue de Montbrillant, 1202 Geneva, Switzerland
| | - Benyam Worku Dubale
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Laurence J. Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Ave, Montreal, QC H3A 1A1 Canada
- Global Mental Health Program, McGill University, Montreal, Canada
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Abstract
Research indicates that homeless women are reported to experience more mental health issues than women who are not homeless and are an increasing proportion of the overall homeless population. In addition, homeless women are more likely to have alcohol and/or other drug use disorders. We provide a comprehensive review of the contemporary literature that revealed homeless women experience a range of mental health problems including depression, anxiety, post-traumatic stress disorder and alcohol and other drug use disorders. Studies in this literature review indicate that some women have pre-existing mental health issues which precipitate homelessness while others develop mental illness because of their homelessness; domestic violence was also recognised as an antecedent to homelessness, although further research is needed in this area. The results of this study indicate that the homeless cohort is a complex one with distinct needs. We provide information that can help refine assessment processes and plan appropriate services to address the mental health needs of homeless women. Finally, recommendations for mental health nursing practice in regard to caring for homeless women are made.
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Affiliation(s)
- Alison Duke
- a Bolton Clarke Homeless Persons Program, McAuley Community Services for Women , Melbourne , Australia
| | - Adam Searby
- b School of Health and Biomedical Sciences - Nursing , RMIT University , Melbourne , Australia
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Aggarwal NK, Lam P, Jiménez-Solomon O, Desilva R, Margolies PJ, Cleary K, Cain B, Dixon L, Lewis-Fernández R. An Online Training Module on the Cultural Formulation Interview: The Case of New York State. Psychiatr Serv 2018; 69:1135-1137. [PMID: 30041589 PMCID: PMC6347550 DOI: 10.1176/appi.ps.201800119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Professional organizations and government guidelines recommend cultural competence training for providers, but the lack of a standardized cultural assessment has hindered research. Studies with the DSM-5 Cultural Formulation Interview (CFI) suggest that active learning during training improves perceptions of the CFI's usefulness as a cultural competence tool. This column reports demographic characteristics and evaluation scores among 423 providers who completed an online CFI training module developed through the New York State Office of Mental Health. Both the module, which uses the principle of active learning, and the CFI were associated with strong favorability ratings.
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Affiliation(s)
- Neil Krishan Aggarwal
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Peter Lam
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Oscar Jiménez-Solomon
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Ravi Desilva
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Paul J Margolies
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Katherine Cleary
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Bernadette Cain
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Lisa Dixon
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
| | - Roberto Lewis-Fernández
- Dr. Aggarwal, Mr. Lam, Mr. Jiménez-Solomon, Dr. Desilva, Dr. Margolies, Ms. Cleary, and Ms. Cain are with the New York State Psychiatric Institute, New York. Dr. Aggarwal, Dr. Desilva, and Dr. Margolies are also with Columbia University College of Physicians and Surgeons, New York. Dr. Dixon and Dr. Lewis-Fernández are with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Lewis-Fernández is editor of this column
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