ABSTRACT This article discusses the foundations of a new direction in psychiatry: gerontopsychiatry. It outlines the challenges, research methods, scientific and clinical approaches, and the most common mental disorders in old age.
Burden of care is a complex construct. A gender approach could help to a further understanding of the process. However, previous publications give us inconclusive data. The aim of this study is to evaluate the impact of gender and other factors in the burden experienced by relatives of people diagnosed with schizophrenia spectrum disorders. A sample of 93 Mediterranean Caucasian caregivers (70% women) of 61 patients (87% men) responded to a structured interview and to the Spanish version of Zarit Burden Interview (ZBI). The ZBI showed a 0.872 Cronbach α-coefficient. The best factorial solution included five main components explaining 62% of the variance. Of caregivers, 89% showed high levels of burden. Burden ZBI scores (from highest to lowest) accounted for: worries about patient's future, strain, interference with privacy, lack of resources and feelings of rejection towards the patient. Global burden was not associated with carer's gender but it was significant with patients' gender (p = 0.025). There were significant differences in caregiver's gender in items 'Health' (p = 0.020) and 'Loss of life control' (p = 0.027). Burden suffered by female patients' caregivers was 13 points higher (95%CI: 2–24%). In conclusion, in our sample, few relatives escaped from emotional distress and patient's gender influenced the results.
The Perceived Ethnic Discrimination Questionnaire-Community Version Brief (PEDQ-CVB) is a widely used brief multidimensional measure of general racial discrimination for both students and community populations. We evaluated the factor structure and measurement equivalency of the PEDQ-CVB across diverse racial/ethnic and gender groups. The groups in the current study were Black (N = 306), Asian (N = 310), Latinx (N = 163), multiracial (N = 108), women (N = 555), and men (N = 372). Confirmatory factor analysis (CFA) and test of competing models suggested that the four-factor and bifactor (with four specific factors and one general factor) models were best fitting and most conceptually meaningful. Based on the bifactor model, the PEDQ-CVB could be represented unidimensionally (total scale score) for applied measurement. Multi-group CFAs found evidence of measurement invariance for configural, metric, and scalar models across racial/ethnic and gender groups, suggesting that men and women, and individuals self-identifying as Black, Asian, Latinx and multiracial, interpreted PEDQ-CVB items in a similar fashion. Our findings substantiate the utility of the PEDQ-CVB as a brief general measure of racial/ethnic discrimination and the validity of results from prior studies that used the PEDQ-CVB. Study limitations and future directions for research are discussed.
This study examined the double jeopardy effect of perceived discrimination and lack of parental support on depression among adolescents of immigrant parents in the United States. Two complementary hypotheses were tested. The first hypothesis postulates the independent effects of perceived discrimination and lack of parental support, and the second hypothesis postulates that perceived discrimination and lack of parental support jointly affect perceived depression in such a way that children of immigrants who felt discriminated and did not have parental support experienced a significantly higher level of perceived depression than those who felt discriminated but had parental support. The data of this study came from the Children of Immigrants Longitudinal Study (CIL), 1991–2005. The study’s sample consisted of 4110 adolescents who completed the interviews in 1992 and 1995. Ordinary least square regression was used to test the hypotheses. The results supported the study’s hypotheses, suggesting that adolescents of immigrant parents who experienced discrimination and lacked parental support suffered from a significantly higher level of perceived depression. Implications for formal and informal social services are discussed.
In Canada, high rates of anxiety, depression and suicides have resulted in mental health crises in First Nation (FN) communities. To date, Indigenous worldviews and approaches have not been fully heeded in mainstream strategies to address the complexity of living in colonial oppression, despite ongoing crises for decades. We describe perspectives of eight FN communities explaining cultural facilitators of mental wellbeing. The objective is to promote understanding of wellbeing in the context of sociocultural realities of FN communities and elaborate community-based practices. Qualitative methods involved FN partners in study design, implementation and data interpretation processes. Local research assistants collected data in all participating communities. Respondents were purposefully selected, Elders were recommended based on their knowledge of FN cultures and traditional wellness practices and awareness of health and social issues in respective communities. Results challenge specific histories of dispossession and assaults on community, language, identity, Elders, family; traditional healing practices emerged as important in enhancing mental wellbeing among FN. Culturally informed approaches aim to restore balance and harmony as pre-requisite to health. A framework based on the voices of FN in Manitoba is proposed for achieving mental wellbeing by and for FN people as an integral part of primary healthcare.
A number of concepts exist which reveal an interaction between endogenous and psychogenic factors in stress-induced disorders in patients with schizophrenia. These concepts relate to psychological, pathophysiological, and sociological aspects of the problem. In this study we look at the respective states described within the clinical concept of reactive schizophrenia.Materials: Fifty clinical cases were included: 32 females and 18 males, mean age 38.6 ± 12.5. Thirty-three patients (66%) had a diagnosis of ‘schizophrenia’, 17 patients (34%) were diagnosed with ‘schizotypal personality disorder’ according to DSM-5 criteria. The performed examination included a clinical interview, analysis of the current clinical state, analysis of the medical history.Results: From the perspective of concept of ‘reactive schizophrenia’, the subjects of our study can be split into two groups based on their mechanism of development and psychogenic vs. endogenous contributions. These two groups may be characterized as ‘psychogenic provocation of a schizophreniform disorder’ and ‘endogenous provocation of a psychogenic disorder’ respectively.Conclusions: The results observed made it possible to re-establish the hypothesis of ‘reactive schizophrenia’. The principal feature is the specific interaction between endogenous and psychogenic factors, i.e. the psychogenic provocation of endogenous disorders.
Traditional and alternative medicine is an integral part of the mental healthcare system of many African countries. The treatments and practices of these traditional and alternative healers will be influenced by their ideas about the causes and effects of mental disorders. With the concept of explanatory models of illness as a framework, we examined the notions of different categories of traditional and faith healers about mental disorders. Using case vignettes, we conducted interviews with 36 participants to explore their beliefs about the causes, course and effects of a serious mental disorder, a common mental disorder and a disorder driven by social circumstances. From our data, there was consensus about what constituted a serious mental disorder. However, the other disorders were not seen as mental disorders. Although there was an acknowledgement of biological and social causes of serious mental illness, the dominant view was that of supernatural causes. The most significant effect of mental illness reported was a loss of social connectedness and productivity. These models are discussed with reference to their implications for collaboration, mental health literacy efforts, as well as biomedical practice.
Bachelor level social work students in Greece were surveyed to assess their attitudes towards the mentally ill in relation to their level of familiarity with mental illness, their demographics and study-related characteristics. The research sample included 370 students who completed a self-report questionnaire including sociodemographic data, the 40-item Community Attitudes towards the Mentally Ill scale (CAMI) and the 11-item Level of Familiarity Questionnaire. Results from analyses showed that the mean Familiarity index was significantly greater in third- and fourth-year students than in those attending the first and second years. Also, scores on Authoritarianism and Social restrictiveness decreased as the year of study increased. Familiarity index was significantly negatively correlated with both the Authoritarianism and Social restrictiveness dimensions. Increased age and year of studies were found to be positively correlated with Benevolence and Community mental health ideology scores. Furthermore, the Familiarity index was positively correlated with both Benevolence and Community mental health ideology dimensions. The results indicate that the year of studies and level of familiarity play a crucial role in students’ attitudes towards people with mental illness. Implications for additional research and education of bachelor level social work students are discussed.
Dhat syndrome is a culture-bound syndrome commonly reported in the Indian subcontinent, where sexual competence in man is the trademark of masculinity. Socio-demographic profile, phenomenology and clinical profile of Dhat syndrome, and its related misconceptions were ascertained in the study. Fifty random cases were studied with the tools such as Mini International Neuropsychiatric Interview (MINI-plus) scale, the General Health Questionnaire–28 (GHQ – 28), the Hamilton Depression Rating Scale (HAM-D) and the Hamilton Anxiety Rating Scale (HAM-A). The mean age, with standard deviation (SD), of the sample was 16.67 (± 6.65) years. 38% of patients were diagnosed to have a psychiatric illness among which a majority of cases were diagnosed with a depressive illness (18%). The GHQ Score (Mean ± SD), HAM-D (Mean ± SD) and HAM-A (Mean ± SD) of patients were 11.2 ± 8.2, 16.4 ± 6.1 and 16.1 ± 5.8, respectively. Our study suggests the presence of psychiatric co-morbidity in Dhat syndrome, such cases should be referred to consultation-liaison psychiatrists for proper management, and relevant education should be provided to young adults to remove the myths and misconceptions.
The exposure of first responders to emergencies and disaster puts them at high risk of experiencing vicarious trauma. First responders are typically male and literature suggests that a negative connotation of masculinity creates a stigma that leads to low help-seeking behaviour and poorer psychological outcomes. This study examines Filipino dimensions of masculinity namely perceived cognitive ability, sense of community, and assertive dominance and how these dimensions predict adaptive coping and its outcomes. Surveys of 135 male first responders reveal that perceived cognitive ability and sense of community positively predict adaptive coping. Results also support the hypothesis that adaptive coping mediates the relationship of perceived cognitive ability, and sense of community positively with psychological well-being. However, there was no relationship between assertive dominance and adaptive coping. Rather, assertive dominance predicted vicarious trauma. The results contribute to the literature by showing that masculinity ideologies have both positive and negative relationships with mental health. This has implications on how emergency organizations can help support first responders.
ABSTRACT This study was conducted to investigate the depression, anxiety and stress status in the various trimesters of pregnancy. This cross-sectional study was conducted on 605 pregnant women referring to Tabriz health centres and health bases by using a two-stage cluster sampling method. Data were collected using the socio-demographic characteristics questionnaire and the Depression, Anxiety and Stress Scale (DASS-21). The Kruskal Wallis statistical test was used to analyze the data. Some 22.8% of the women were depressed in the first trimester, 30.3% in the second trimester and 36.6% in the third trimester. The corresponding percentages were 17.3%, 12.2% and 27.3% for the anxiety variable and 19.8%, 24.7% and 31.7% for the stress variable. According to the results of this study, in addition to the routine care provided during pregnancy, programmes must be developed to evaluate, diagnose and treat possible mental disorders during this period so that the health of pregnant women and their newborns can be guaranteed.
This study examined the cross-cultural comparability of the Personality Assessment Inventory (PAI: Morey, 1991) in Vietnam, employing a sample of 128 nonclinical Vietnamese native speakers and 53 bilingual Vietnamese/English speakers. The Vietnamese version demonstrated comparable internal consistency to that obtained in the original PAI US standardization sample, with Cronbach's αs ranging from .41 to .94 and similar trends in reliability across scales. Exploratory factor analysis yielded factors replicating components commonly obtained in prior studies of the PAI. Vietnamese-English bilingual subjects who completed both the Vietnamese adaption and the original PAI showed few differences in their responses across versions. The Vietnamese sample generally scored higher than the US standardization sample on the majority of PAI scales; however, none of these mean scores were elevated to levels of clinical significance. Covariance analyses suggested that a negative response style drove many of these differences, potentially indicating cultural differences in approaches to self-reporting emotional distress. Methodological limitations, potential mediating factors, and future research directions are discussed.
The purpose of this study was to investigate common mental disorders among Tajik migrant and non-migrant wives in a primary care center. Using a cross sectional design, quantitative surveys using standard questionnaires were administered to 300 married Tajik women aged 18-45 in Dushanbe. Descriptive and multivariate analyses described the demographic and mental health patterns, and comparison of key sub-groups, using Chi-square, T-test and regression. 26% of women in primary care had moderate or severe depression, 17% had moderate or severe anxiety and 20% had moderate or severe PTSD. Lifetime physical or emotional abuse was reported in 22% and women with lifetime physical or emotional abuse had higher depression, anxiety and PTSD scores. Significant multivariate associations predicted the following risk factors: for depression (R2=.40): higher number of people you live with, older age of woman, and migrant husband; for anxiety (R2=.41):more direct trauma and older age of woman; for PTSD (R2 =.48):lower number of people you live with, more direct trauma, older age of woman, highernumber of children, non-migrant husband, and lifetime emotional or physical abuse. Mental health interventions are needed in primary care settings for women with common mental disorders, including those exposed to trauma and migration.
Like in much of Sub-Saharan Africa, descriptive data about psychiatric inpatients and inpatient psychiatric care in Malawi is limited. This study describes the inpatient population at the Bwaila Hospital Psychiatric Unit in Lilongwe, Malawi, as well as treatments received and treatment outcomes. Records of 419 psychiatric inpatients hospitalized from January 1, 2011 to December 31, 2011 were reviewed. Patients were primarily male (73.0%) and were most commonly referred from district hospitals (46.4%). Nearly all patients were involuntarily hospitalized under Malawi's Mental Treatment Act (94.2%). Schizophrenia (30.1%), cannabis use disorder (27.9%) and alcohol use disorder (25.1%) were the most common diagnoses. Suicidal ideation was reported by 4.8% of patients and 2.4% had attempted suicide prior to admission. Homicidal ideation was reported by 7.3% of patients and 5.1% of patients assaulted another patient during their hospitalization. Mean length of stay was 22.1 ± 27.7 days (range: 1.0-243.0). Chlorpromazine (81.3%), diazepam (75.8%), carbamazepine (59.8%) and fluphenazine (56.0%) were the most commonly used medications on the ward. Stabilization and discharge to home was the most common outcome (68.0%), followed by transfer to another hospital (19.5%), discharge against medical advice (8.2%), abscondment (3.4%) and death (1.0%).
This study investigated the moderating effects of culture-driven individual differences in the relationship between work conditions and work-related health outcomes in Switzerland and South Africa: Swiss natives (n = 397) and Swiss foreigners (n = 224), White South Africans (n = 432) and non-White South Africans (n = 434). We used the horizontal and vertical individualism and collectivism scale to measure culture-driven individual differences, the Job Content Questionnaire to measure psychological job demands, and the General Health Questionnaire and the General Work Stress Scale to measure work-related health outcomes. Results suggest that high vertical individualism had a general buffering effect in the stress–strain relationship among the South African White group. Low vertical collectivism played a similar role among the South African non-White group and the Swiss foreigners group, while high horizontal collectivism had a detrimental effect in stressful work conditions in both South African groups. Finally, horizontal individualism had no moderating effect. Generally, our study suggests that to investigate the moderating role of culture-driven individual differences according to the ethnic group of belonging is promising, given that the same individual characteristic does not necessarily interact in the same way in the stress–strain relationship.
Although some similarities are evident in manifestations, etiology and coping, research suggests that cultural variations may explain different reactions to workplace violence. This study explores similarities and differences between Italian and Irish workers' well-being in relation to robberies and theft exposure. A sample of Italian (N = 319) and Irish (N = 251) employees working in small businesses completed a self-report questionnaire examining post-traumatic symptoms and trauma-related coping self-efficacy. Results indicated that Italian victims reported higher post-traumatic symptoms than their Irish counterparts. When compared to those who experienced thefts only, Italian victims who had experienced both thefts and robberies experienced more post-traumatic symptoms and lower coping self-efficacy, whereas Irish employees differed significantly only in hyper-arousal symptomatology. Regression analyses revealed that coping self-efficacy had a protective role against the risk of developing post-traumatic symptomatology. In both countries, interventions fostering employees' coping self-efficacy perceptions might stimulate psychological recovery, especially among victims of both thefts and robberies.
The current study examined a mediation model of help-seeking stigma towards group therapy in a community sample of clinical and non-clinical Arabs adults in Israel (n = 196). Path analyses indicated that public stigma demonstrated an indirect effect with intentions to seek group therapy through self-stigma, and self-stigma demonstrated a direct relationship with intentions. The strengths of these paths did not differ based on gender or clinical/non-clinical presentation. Examination of differences in public stigma, self-stigma and intentions based on gender and mental health group (clinical/non-clinical) revealed a significant interaction between mental health group and gender. Clinical males demonstrated greater public stigma, self-stigma and intentions compared with non-clinical males. Clinical women demonstrated reported self-stigma, but there were no differences in public stigma or intentions based on mental health group. Among non-clinical participants, women reported lower public stigma and intentions than men, but there were no gender differences observed among clinical participants. These findings build upon group therapy research that has examined help-seeking stigma in samples of non-Israeli Arabs, samples of predominantly Jewish Israeli participants and/or undergraduate students. Implications for future research are discussed.
Internalized stigma is a barrier to mental health care in China, and stigma reduction is expected to promote treatment utilization, especially for mood disorders and schizophrenia. We aimed to identify the most common domains of internalized stigma of mental illness and to test the hypothesis that people with more severe mood disorders evidence more internalized stigma than those with less severe disorders. The Internalized Stigma of Mental Illness (ISMI) was administered to 366 outpatients with various mood disorders in Shanghai. Reliability statistics were calculated and frequently-endorsed items were identified. The magnitude of internalized stigma was compared among diagnostic categories and among sociodemographic groups. Except for stigma resistance, the ISMI and its subscales had good internal consistency. Across subgroups, stereotype endorsement was most commonly reported. Bipolar (versus depressive) disorders, male gender, and less education were associated with more internalized stigma, especially social withdrawal. Contrasting findings in Western countries, those with family history of mental illness trended toward more internalized stigma. We conclude that anti-stigma interventions should focus on reducing social withdrawal and stereotype endorsement, especially for those with more severe mood disorders, males, less educated individuals, and those with family history of mental illness.
Our purpose was to study the prevalence of mental disorders with an emphasis on somatic symptoms and their association with social support in a Chilean semi-rural area. We studied a sample of 796 adults born between 1974 and 1978 in Limache, Chile. The Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-15 and the Medical Outcomes Study Social Support Scale test were used to assess depression, anxiety, somatic symptoms and social support, respectively. We found that the prevalence of psychosomatic symptoms was 63.8% in women (most of them in the severe range) and 34.1% in men. The rates of depression and anxiety were 17.7 and 21.7%, respectively. Psychosomatic symptoms were strongly associated with depression (male OR:10.33, CI 95%:2.91–34.54; female OR:6.19, CI 95%:2.64–14.52) and anxiety (male OR:2.63, CI 95%:1.04–6.63; female OR:3.97, CI 95%:2.02–7.78). The association between psychosomatic symptoms and functional impairment was mainly due to symptoms of depression and anxiety. Mental disorders were inversely associated with social support. We conclude that psychosomatic symptoms were the norm, especially in women. Social support is marginally lower in those with a mental disorder, but still perceived as high. Physical complains in these communities are frequently the expression of depression and anxiety.
A sense of hopelessness is common but under-identified among poor children in sub-Saharan Africa (SSA). Given the concomitant inadequate screening, assessment, and a lack of culturally and developmentally appropriate measures in much of SSA, identifying reliable and valid measures of hopelessness is needed. One promising candidate, the Beck Hopelessness Scale (BHS), has undergone limited evaluation in the region and none with non-adult populations. The present study assesses the psychometric properties of the BHS using data from a diverse sample of 3965 school-going youth (M = 12.2, SD = 1.1) in Kenya. Given inconclusive results from model comparisons of previously established factor structures, we used parallel analysis, exploratory factor analysis, and confirmatory factor analysis to ascertain the factor structure of the BHS in this sample. We also evaluated measurement invariance of the scale across two key developmental ages (9–12 and 13–18), given distinct cognitive and emotional differences. Models supported a one-factor 20-item structure with partial invariance across child and adolescent samples. Concurrent criterion validity correlations were in the small to medium range. Findings provide evidence of the utility of the BHS as a psychometrically sound measure that possesses cultural relevance to Kenyan youth.
