Community attitudes towards culture‐influenced mental illness: scrupulosity vs. nonreligious OCD among orthodox jews

Culture may particularly influence community attitudes towards mental illness, when the illness itself is shaped by a cultural context. To explore the influence of culture‐specific, religious symptoms on Orthodox Jewish community attitudes, the authors compared the attitudes of 169 Orthodox Jews, who randomly viewed one of two vignettes describing either religious or nonreligious obsessive–compulsive disorder (OCD). Results indicate that though participants were equally likely to perceive both vignettes as mental illness, they were less likely to endorse psychological/medical explanatory models and help‐seeking, and conversely more likely to endorse social–religious explanations, religious help‐seeking, and stigma in relation to religious OCD. Nevertheless, psychological/medical models and help‐seeking were more strongly endorsed for both religious and nonreligious OCD. Beyond implications for Orthodox Jewish community actions, these findings suggest that attitudes towards mental illness may depend on how symptoms relate to community culture. © 2009 Wiley Periodicals, Inc.     

Cultural factors in help‐seeking for child behavior problems: Value orientation,affective responding,and severity appraisals among Chinese‐American parents

This study explored the relationships between cultural values, appraisal of child behavior problems, and associated help‐seeking intentions among Chinese‐American parents. Questionnaires were administered to 120 Chinese‐American parents of elementary‐school‐aged children. Parents were asked how they might respond if their child displayed the behavioral problems depicted in a hypothetical vignette. Influences of Chinese value orientation, severity appraisal, and affective reactions on help‐seeking intentions were examined using regression analyses and structural equation modeling. The study examined three hypotheses regarding the nature of the influence of cultural value orientation on help‐seeking intentions: (a) a direct effect model, (b) an indirect effect through cultural differences in severity appraisal, and (c) an indirect effect through cultural differences in affective responding. Results supported the hypothesis that cultural value orientation exerted an indirect effect on help‐seeking intentions through its influence on affective responding. Those parents who had more traditional Chinese values responded with more feelings of shame to child behavior problems and, in turn, reported lower intentions to seek help. Findings are discussed with reference to the literature on help‐seeking among Asian Americans. © 2001 John Wiley & Sons, Inc.     

Abnormal illness behaviour and locus of control in patients with functional bowel disorders

Objectives: Psychosocial factors have been examined in functional bowel disorders (FBD), including irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC). Abnormal illness behaviour (AIB) has been investigated in IBS patients as evidence of underlying psychological distress and as influencing health‐care‐seeking behaviour. Health locus of control may also contribute to health‐care‐seeking behaviour, as possession of an external locus of control places responsibility for health status onto professionals. Thus, external locus of control may also be more prominent in FBD patients. This study examined whether FBD patients displayed more AIB and an external health locus of control compared with organic disease and non‐patient controls. Design: A cross‐sectional comparison group design was employed. Method: Fifty‐three CIC patients were compared with matched control groups of 50 IBS patients, 51 Crohn's disease patients and 53 non‐patient participants. Questionnaire measures included the Illness Behaviour Questionnaire, the Multi‐dimensional Health Locus of Control, the GHQ, and the SCL‐90R. Results: FBD patients did not differ from Crohn's disease patients on measures of AIB, but all three patient groups differed from non‐patient participants. Crohn's disease patients possessed a higher external locus of control compared with FBD patients and non‐patient controls. There was a general association between AIB and psychopathology. Conclusions: FBD patients did not report more AIB or a higher external locus of control regarding their health status, compared with organic disease controls, but did differ from non‐patients. The presentation of AIB was related to increased psychopathology, suggesting that AIB may be related to psychological distress, irrespective of patient status.     

How internal medicine residents resolve conflicts with attending physicians

Forty-three of 49 residents in an internal medicine residency answered questionnaires in 1988 about resolving conflicts with attending physicians concerning patient care, using ten case scenarios. The residents indicated their likelihoods of using various methods of addressing the conflicts via Likert-type scales. The residents were most likely to negotiate with the attending physician and least likely to ignore the attending physician or withdraw from the case for all scenarios, though the type of procedure affected the decision. The residents planning careers in general medicine or nonmedical specialties were more likely to agree with the attending physician than were the residents planning medicine subspecialty careers (p less than .005); the graduates from osteopathic schools were more likely to withdraw from the case than were the residents from allopathic schools (p = .05). Conflicts between the residents and attending physicians were resolved by negotiation and interaction with the attending physicians, but the nature of the procedure, medical school attended, and future career plans affected the means of resolving the dilemma chosen by the individual resident.     

Older peoples' attitudes to mental illness

Despite the prevalence of mental health problems in later life, older people markedly underutilize mental health services. A greater awareness of factors influencing older peoples' attitudes to mental illness may therefore improve awareness and treatment of mental disorders in this population. A mixed methodology approach was used to explore and compare older peoples' attitudes to mental illness in a sample of clinical and non‐clinical participants. Results indicated that, similar to younger people, older people endorsed a range of positive and negative attitudes to mental illness. However, when attitudes to mental illness were considered within the context of ageing and experience a more complex pattern of results emerged. Although negative attitudes to mental illness were associated with negative attitudes to ageing across the entire sample, clinical participants (and those with prior experience of mental illness) reported more positive attitudes to mental illness and more negative attitudes to ageing than non‐clinical participants, for whom the reverse was true. Attitudes were also differentially related to health behaviour outcomes. Results suggest that attitudes to mental illness and ageing may be linked and mediated by personal experience and capacity for psychological self‐regulation in the face of age‐associated adversity. Copyright © 2009 John Wiley & Sons, Ltd.     

Health care seeking behaviour of patients with sexually transmitted diseases: determinants of delay behaviour

The study aimed to determine the factors associated with a delay in seeking health care for symptoms of sexually transmitted diseases (STDs) among a sample of 1482 patients attending STD clinics. Of the sample 78% were male, 58% sought help from the clinic within the first 6 days of noticing symptoms, 24% waited between 7 and 10 days and 17% waited longer than 10 days before seeking health care. Patients who delayed were those who treated themselves prior to seeking health care, who were female, whose friends waited before seeking treatment, who held misconceptions regarding the cause of STDs, who perceived STDs not to be serious and who valued personal autonomy in sexual behaviours less and had less positive outcome expectations of refusing sex. The data suggest that targeted interventions should be directed specifically at women and the youth. Early health care seeking could be facilitated through improved basic knowledge regarding STDs, control over one's own sexual behaviour and social support for early health care seeking.     

Patient patronage and perspectives of traditional bone setting at an outpatient orthopaedic clinic in Northern Tanzania

BackgroundMuch of Sub-Saharan Africa meets the rising rates of musculoskeletal injury with traditional bone setting, especially given limitations in access to allopathic orthopaedic care. Concern for the safety of bone setter practices as well as recognition of their advantages have spurred research to understand the impact of these healers on public health.ObjectivesOur study investigates the role of bone setting in Tanzania through patient utilization and perspectives.MethodsWe surveyed 212 patients at the outpatient orthopaedic clinic at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Surveys were either self-administered or physician-administered. Summary statistics were calculated using XLSTAT. Open responses were analyzed using a deductive framework method.ResultsOf all surveys, 6.3% (n=13) reported utilizing traditional bone setting for their injury prior to presenting to KCMC. Of the self-administered surveys, 13.6% (n=6) reported utilizing bone setting compared to 4.3% (n=7) of the physician-administered surveys (p=0.050). Negative perceptions of bone setting were more common than positive perceptions and the main reason patients did not utilize bone setting was concern for competency (35.8%, n=67).ConclusionOur study found lower bone setting utilization than expected considering the reliance of Tanzanians on traditional care reported in the literature. This suggests patients utilizing traditional care for musculoskeletal injury are not seeking allopathic care; therefore, collaboration with bone setters could expand allopathic access to these patients. Patients were less likely to report bone setter utilization to a physician revealing the stigma of seeking traditional care, which may present an obstacle for collaboration.     

Religiosity,spirituality, and help‐seeking among Filipino Americans: Religious clergy or mental health professionals?

Data from structured interviews with 2,285 respondents for the Filipino American Community Epidemiological Survey (FACES) were used to examine help‐seeking for emotional distress among Filipino Americans. The influence of religious affiliation, religiosity, and spirituality upon help‐seeking from religious clergy and mental health professionals was assessed after controlling for need (e.g., negative life events, SCL‐90R scores, and somatic symptoms), demographic (e.g., age, gender, marital status, education, county of residence, generational status, and insurance coverage), and cultural variables (e.g., loss of face and language abilities). Rates of help‐seeking from religious clergy versus mental health professionals were comparable (2.5% vs. 2.9%). High religiosity was associated with more help‐seeking from religious clergy but not less help‐seeking from mental health professionals, whereas high spirituality was associated with less mental health help‐seeking. Implications for understanding how religious variables affect help‐seeking were explored. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 675–689, 2004.     

Depression and help-seeking in a western sample of 'highly acculturated' Chinese and controls

BACKGROUND: It is commonly reported that "the Chinese" have low rates of depression, partially reflecting a greater tendency to somatize and to be less likely to seek help. OBJECTIVE: To examine the impact of acculturation on depression reporting and help-seeking patterns. METHOD: We compared 50 highly acculturated Chinese with age and gender-matched non-Chinese control subjects in a western region on measures of state and lifetime depression, attributional interpretation of somatic cues and help-seeking. RESULTS: The highly acculturated Chinese did not differ in state depression rates or tendency to 'somatize'. There were trends for the Chinese to be less likely to view any depressive episode as a 'disorder' and to seek help for a psychological problem. CONCLUSION: Differences held to exist in the Chinese in acknowledging, reporting and seeking help for depression appear strongly culturally determined.     

Help‐seeking intentions for breast‐cancer symptoms: A comparison of the self‐regulation model and the theory of planned behaviour

Purpose: Delays in seeking help for symptoms have been found to be associated with poorer outcome in breast‐cancer patients. This study explores symptom perceptions and health beliefs as predictors of intentions to seek medical help in a general female population. The utility of the self‐regulation model of illness cognition and the theory of planned behaviour were examined in predicting help‐seeking intentions for potential symptoms of breast cancer in a general population sample. Methods: A general population sample of 546 women completed a postal questionnaire comprising items examining components of the self‐regulation model and the theory of planned behaviour. Help‐seeking intention was determined by asking participants to rate the likelihood of visiting their GP for a range of breast symptoms. Results: Hierarchical multiple regression analysis revealed that the cognitive component of the self‐regulation model accounted for approximately 22% of the variance in help‐seeking intention. Identity (β = 0.45, p < .001) emerged as a significant predictor of intention to seek help. Inclusion of the components of the theory of planned behaviour accounted for an additional 7% of the variance; the significant predictors were attitude to help‐seeking (β = 0.19, p <.001) and perceived behavioural control (β = 0.12, p <.01). Conclusions: Intention to seek medical help for a potential breast‐cancer symptom may be mediated, partly, by cognitive representations of the identity and consequences of breast cancer and by attitudes towards help‐seeking and perceived behavioural control. Although less than one‐third of the variance was accounted for, these results have important implications for future research (in terms of identifying which variables should be examined) and for the development of a model of help‐seeking behaviour in women with breast‐cancer symptoms.     

Women's mental health in the Muslim world: cultural, religious, and social issues

In Arab communities, several cultural factors, derived mainly from the subordinate position of women, have been shown to affect the prevalence, clinical picture, health seeking behaviour, course and management of psychopathology in women. Women are definitely at a greater risk of developing mental disorders such as depressive, somatoform, anxious or eating disorders, as well as suicidal behaviors. Furthermore, mentally ill women are more stigmatized, have less access to care and suffer from a worse social outcome. This paper describes a series of culture-related risk factors such as education, work, sexuality, marriage, and infertility, which significantly contribute to triggering mental disorders in females, or to worsen their course and outcome. The authors recommend that mental health providers should play a critical role by addressing the cultural as well as psychological conditions that create and maintain threats to women's mental health.     

The role of knowledge and beliefs in help seeking behaviour for cancer: a quantitative and qualitative approach

The study involved quantitative methods to assess the relationship between knowledge about cancer related symptoms and help seeking behaviour and qualitative methods to explore the role of patient's beliefs about cancer in explaining the gap between knowledge and behaviour. Patients (288) (response rate 72%) from one urban general practice completed a questionnaire consisting of 25 symptoms which they rated for whether they were cancer symptoms (knowledge) and whether the symptoms would prompt them to visit the doctor (hypothetical help seeking behaviour). Twenty patients were then selected who represented a range of knowledge levels and help seeking behaviour and interviewed about their beliefs about cancer. The results showed that the majority of patients had fair knowledge and appropriate help seeking behaviour and indicated a significant association between these variables. However, this relationship was not absolute and although significant the correlation was low. Accordingly, although the subjects knew which symptoms were indicative of cancer, this knowledge was not entirely predictive of their help seeking behaviour. The interviews provided insights into the beliefs which may explain the knowledge/behaviour gap. In particular, analysis of the interviews indicated that the interviewees represented cancer in terms of feelings of fear and death, that they described the process of symptom recognition as involving a fear of finding out the truth, they regarded screening programmes as something to be avoided and understood the causes of cancer either in terms of personal behaviour and internal causes which may result in recriminations or external causes which were beyond their control. The results are discussed in terms of the role of beliefs in mediating the association between knowledge and behaviour and the possible implications for developing educational programmes.     

MENTAL HEALTH SERVICE SEEKING AMONG KOREAN INTERNATIONAL STUDENTS IN THE UNITED STATES: A PATH ANALYSIS

South Koreans represent the third largest group of international students in the United States, yet little is known about their help‐seeking behaviors, nor how these behaviors might be influenced by Asian cultural values. The purpose of this study is to (a) explore the effects of public stigma, self‐stigma, and attitudes associated with seeking counseling services on the relationship between cultural values and willingness to seek counseling services and (b) develop a more culturally sensitive help‐seeking model based on modified labeling theory. Participants included 177 Korean international students in the United States. Results indicated that the effect of cultural values on mental health service‐seeking behaviors is mediated by one's perception of public stigma toward counseling services, self‐stigma, and attitudes toward counseling services among Korean international students. Implications for developing outreach programs to promote help‐seeking behaviors among Asian international students are discussed.     

Help‐seeking behavior of west African Migrants

In this article, the authors present essential aspects of the help‐seeking behavior with regard to mental health problems of Ghanaian migrants in the Netherlands. Samples of citizens in the general population (n=97) and outpatients treated in mental health care facilities (n=36) were included. Data were acquired by administering a semi‐structured interview. Quantified data were analysed using hierarchical multiple regression analyses and direct (standard) logistic analyses. Help‐seeking pathways are multi‐determined. Being involved in Dutch society may determine an individual's attitude toward health care and the time before taking action. Particularly, socio‐demographic variables (e.g., age, unemployment, urbanicity) and acculturative demands (integrative skills, normative orientation) shape the help‐seeking orientation and service utilization in multiethnic settings. A liaison between mental health services, traditional healers, religious leaders and self‐help groups might therefore benefit patients. By identifying and emphasizing the specific social and acculturation components that facilitate or deter health behaviours, we are better able to implement health care interventions among different ethnic and cultural communities. © 2008 Wiley Periodicals, Inc.     

Mediation by illness perceptions of the effect of personality and health threat communication on coping with the diagnosis of diabetes

Objectives. (1) To examine the relationship of personality traits and diabetes health threat communication (DHTC) to the coping strategies of newly diagnosed diabetes patients; (2) to determine to what extent these postulated effects are mediated by illness representations (IRs). Design. A longitudinal prospective study based on the common sense model. Methods. Patients were assessed shortly after diagnosis and 2 years after the diagnosis of diabetes. Personality traits (Mini‐markers) were assessed at baseline. The DHTC Questionnaire was completed at baseline and 2 years. The Revised Illness Perception Questionnaire and the coping orientation to problems experienced were completed at 2 years. Mediation by IRs of the potential influence of personality and DHTC on coping behaviour was assessed by the method of Baron and Kenny. Results. Multiple regression analyses showed that educational level, agreeableness, openness/intellect, conscientiousness, and perceptions of a more reassuring health message since diagnosis were related to more adaptive coping (e.g., active coping, planning). The association of openness and perceived reassuring health message with active coping showed complete mediation by illness coherence and personal control. Openness led to seeking emotional support mediated by perceived personal control. Coherence associated with (partial mediation) the relation of openness to planning. Similarly, personal control and coherence mediated the relation of openness to positive reinterpretation and growth (PRG). Agreeableness had a direct relationship with active coping and PRG but led to planning and seeking instrumental support mediated by perceived treatment effectiveness. Perceptions of a threatening health message were associated with seeking instrumental and emotional support and this was mediated by symptom perception but threat had a direct relationship with planning. Conclusions. Both personality traits and health threat communication predict the way individuals cope with diabetes. The relationships of these factors are largely mediated through measurable IRs. The results suggest targets for intervention to achieve greater problem‐focused coping.     

SEEKING HELP FOR PSYCHOLOGICAL DISTRESS IN URBAN CHINA

Based on data gathered through a household survey of 1,474 urban residents in Beijing, this study examines Chinese help‐seeking behaviors in times of psychological distress and perceived barriers to seeking professional help. The results demonstrate that most respondents rely on informal means of seeking help whereas mental health and medical services are underused. The Internet has become a preferred alternative help‐seeking approach, particularly among the young educated migrant population. Respondents with higher socioeconomic status are more likely to utilize professional services. The tendency to seek help informally is associated with refusal to recognize the need of professional help, whereas embarrassment and stigma are significant factors in the use of alternative services, particularly the Internet. In addition to showing a general lack of trust in professional mental health services, the more psychologically distressed subgroup also expressed concerns about the affordability of professional treatment.     

Assoziation von Tagesschlaf mit dem Risiko chronischer Erkrankungen

Research question

What is the role of daytime naps for our long-term health?

Methods

Data from 23,620 participants of the EPIC-Potsdam Study were investigated by Cox regression to analyse the relationship between daytime sleep and risk of major chronic diseases (type 2 diabetes, cardiovascular diseases, and cancer). Daytime sleeping habits were assessed by self-reports at the baseline interview. Incident chronic diseases were determined by follow-up questionnaires and verified with information from the treating physician, cancer registries, or death certificates.

Results

Self-reported daytime sleep at baseline was not associated with chronic diseases in the overall study sample. However, there had been a significant effect modification by hypertension showing that daytime naps were inversely related to risk of chronic diseases among non-hypertensive participants, but directly related to chronic diseases among hypertensives.

Conclusion

A worse health condition or poorer sleep quality at night, e.g., sleep-related breathing disorders, among persons with hypertension reporting daytime sleep might explain the observation of a direct association between daytime naps and risk of chronic diseases. In contrast, short daytime naps among healthy persons might be a part of good lifestyle with stress-relieving effects. Thus, daytime sleeping habits can reflect different concepts of lifestyle and health.     

Health seeking behaviour and challenges in utilising health facilities in Wakiso district,Uganda

Background

The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs.

Objectives

To assess the health seeking practices and challenges in utilising health facilities in a rural community in Wakiso district, Uganda.

Methods

The study was a cross sectional survey that used a structured questionnaire to collect quantitative data among 234 participants. The sample size was obtained using the formula by Leslie Kish.

Results

While 89% of the participants were aware that mobile clinics existed in their community, only 28% had received such services in the past month. The majority of participants (84%) did not know whether community health workers existed in their community. The participants'' health seeking behaviour the last time they were sick was associated with age (p = 0.028) and occupation (p = 0.009). The most significant challenges in utilising health services were regular stock-out of drugs, high cost of services and long distance to health facilities.

Conclusions

There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy.     

Depression in the Chinese: the impact of acculturation

BACKGROUND: Studies of depression in the Chinese have long identified low rates and a greater likelihood of somatization, findings which could reflect cultural influences or real differences. We report a study from a western region examining the impact of acculturation on depression to clarify the role of cultural factors. METHOD: In a Sydney-based study, Chinese subjects (n = 385) and a matched control group of 143 non-Chinese subjects completed either a Chinese or English questionnaire assessing state and lifetime depression, attributional style, depression recognition and help-seeking. The impact of acculturation was examined by several strategies. RESULTS: Any tendency by the Chinese to somatize depression appeared to be attenuated by acculturation. State depression levels countered the view that Chinese necessarily deny depression. Lifetime depression rate differences were also attenuated by acculturation, with Chinese subjects being less likely than controls to judge episodes as a distinct disorder and to seek professional help. CONCLUSIONS: Results suggest that Australian Chinese do not differ intrinsically in recognizing and ascribing depressive symptoms, and that the greater the degree of acculturation, the greater the tendency for reporting persistent and impairing depressive episodes.     

Thinking outside the black box: The importance of context in understanding the impact of a preoperative education nursing intervention among Chinese cardiac patients

Objective

In a randomized controlled trial of a preoperative education intervention conducted for Chinese cardiac patients, we observed a greater effect on symptoms of anxiety and depression than that reported with regard to similar interventions in western care settings. The objective of this qualitative study was to help explain the findings of the trial by exploring Chinese patients’ experience of seeking and receiving information before cardiac surgery.

Methods

Semi-structured interviews were conducted with a purposive sample of 20 trial participants before discharge (ten from the preoperative education group; ten from the usual care control group). Data were analyzed using a thematic analysis approach.

Results

A total of five themes were generated: the role of reputation and hierarchy; gaining strength from knowledge; information as a low priority; being kept in the dark; and learning through peer support.

Conclusion

In health care systems where service users are given relatively little information, interventions designed to inform patients about their treatment are likely to have a much greater impact on their psychological health.

Practice implications

Providers of services for patients undergoing cardiac surgery in China should be encouraged to incorporate information giving into routine practice, tailored according to individual need.