Comparing the clinical presentation of first-episode psychosis across different migrant and ethnic minority groups in Montreal, Quebec.

Can J Psychiatry. 2012 May;57(5):300-8

Authors: van der Ven E, Bourque F, Joober R, Selten JP, Malla AK

Abstract
OBJECTIVE: To explore differences in severity and nature of symptoms of first-episode psychosis (FEP) according to ethnic group and migrant status.
METHOD: We administered rating scales to assess positive and negative symptoms, as well as general psychopathology, to 301 consecutive patients presenting with an FEP within a defined catchment area in Montreal, Quebec, classified according to ethnicity and migrant status. Symptom scores of Euro-Canadian patients without a recent history of migration, that is, the reference group (n = 145), were compared with those of African and Afro-Caribbean (n = 39), Asian (n = 27), Central and South American (n = 15), Middle Eastern and North African (n = 24), and European and North American (n = 39) patients.
RESULTS: Except for referral source, there were no significant differences between ethnic groups on any demographic variables. The African and Afro-Caribbean group had a higher level of negative symptoms (especially alogia) and general psychopathology scores on the Positive and Negative Syndrome Scale (especially, uncooperativeness, preoccupation, and poor attention), compared with the reference group. Ethnic groups did not differ on the Scale for the Assessment of Positive Symptoms scores.
CONCLUSIONS: A comparison of FEP patients from different ethnic groups and native-born Euro-Canadians revealed no significant differences in the nature of positive symptoms at first presentation or in age at onset, suggesting that there was no evidence for the hypothesis that ethnic minorities are misdiagnosed as psychotic. Increased severity of negative symptoms and general psychopathology, specifically among the black ethnic minority group, may have implications for the role of ethnicity for the treatment and outcome of the initial episode of psychotic disorders.

PMID: 22546062 [PubMed - indexed for MEDLINE]

Achieving balance: healing in native art.

J Physician Assist Educ. 2012;23(4):47-9

Authors: Walker LK

Abstract
It has been my great fortune to have spent this past summer traveling across North America with my husband. We left our home state of New Hampshire in June and, in late July, arrived in the 49th state, Alaska, where we have settled in for the winter. From Manitoulin Island and the shores of Lake Huron to the Black Hills of South Dakota and on through the Canadian Rockies, we traveled through a number of North American Native communities. It is this experience and my recent introduction to Alaskan Native culture and peoples that are the impetus for this feature, where I will explore the historical and re-emerging use of art to promote health and healing in Native communities.

PMID: 23437624 [PubMed - indexed for MEDLINE]

Depression in China: integrating developmental psychopathology and cultural-clinical psychology.

J Clin Child Adolesc Psychol. 2012 Sep;41(5):682-94

Authors: Ryder AG, Sun J, Zhu X, Yao S, Chentsova-Dutton YE

Abstract
With a starting point in John Abela's groundbreaking developmental psychopathology research on adolescent depression in China, we aimed to review the state of the literature on Chinese depression across the lifespan. We began with Dr. Abela's published studies relevant to depression in China and our own research with adults before turning to the reference lists of these articles to find additional sources. Then we conducted literature searches using PsycINFO and PubMed to find other relevant studies published between April 2001 and April 2011 . There are two distinct literatures on depression in China. Developmental psychopathology research has emphasized adolescent samples and cognitive models of causation; cultural-clinical psychology and cultural psychiatry research have emphasized adult samples and the meanings associated with emotions, symptoms, and syndromes. Both approaches to the study of depression in China have yielded important findings but have also highlighted issues that could be better addressed by incorporating the other approach. Beyond depression in China, the psychological study of culture and mental health more generally would benefit from greater exchange between developmental psychopathology and cultural-clinical psychology.

PMID: 22900498 [PubMed - indexed for MEDLINE]

Sun protection and exposure behaviors among Hispanic adults in the United States: differences according to acculturation and among Hispanic subgroups.

BMC Public Health. 2012;12:985

Authors: Coups EJ, Stapleton JL, Hudson SV, Medina-Forrester A, Natale-Pereira A, Goydos JS

Abstract
BACKGROUND: Skin cancer prevention interventions that target the growing number of U.S. Hispanics are lacking. The current study examined the prevalence and correlates of sun protection and exposure behaviors (i.e., sunscreen use, shade seeking, use of sun protective clothing, and sunburns) among U.S. Hispanics with sun sensitive skin, with a focus on potential differences according to acculturation and Hispanic origin.
METHODS: The sample consisted of 1676 Hispanic adults who reported having sun sensitive skin (i.e., they would experience a sunburn if they went out in the sun for one hour without protection after several months of not being in the sun). Participants completed survey questions as part of the nationally representative 2010 National Health Interview Survey. Analyses were conducted in August 2012.
RESULTS: Greater acculturation was linked with both risky (i.e., not wearing sun protective clothing) and protective (i.e., using sunscreen) sun-related practices and with an increased risk of sunburns. Sun protection and exposure behaviors also varied according to individuals' Hispanic origin, with for example individuals of Mexican heritage having a higher rate of using sun protective clothing and experiencing sunburns than several other subgroups.
CONCLUSIONS: Several Hispanic subpopulations (e.g., those who are more acculturated or from certain origins) represent important groups to target in skin cancer prevention interventions. Future research is needed to test culturally relevant, tailored interventions to promote sun protection behaviors among U.S. Hispanics. Such initiatives should focus on public health education and increasing healthcare provider awareness of the importance of skin cancer prevention among Hispanics.

PMID: 23153104 [PubMed - indexed for MEDLINE]

"The trauma experienced by generations past having an effect in their descendants": Narrative and historical trauma among Inuit in Nunavut, Canada.

Transcult Psychiatry. 2013 Mar 7;

Authors: Crawford A

Abstract
"Sivulirijat aksururnaqtukkuurnikugijangat aktuiniqaqsimaninga kinguvaanginnut" translates as "the trauma experienced by generations past having an effect in their descendants." The legacy of the history of colonialism is starting to take narrative shape as Inuit give voice to the past and its manifestations in the present through public commissions such as the federal Truth and Reconciliation Commission and the Inuit-led Qikiqtani Truth Commission. However, an examination of other discursive contexts reveals a collective narrative of the colonial past that is at times silent, incomplete or seemingly inconsistent. Reading the political narrative through the Nunavut Land Claims Agreement, and the proceedings of the Legislative Assembly of Nunavut since its formation on April 1, 1999, exposes an almost complete silence about this history. Oral histories, an important form for the preservation and transmission of traditional cultural knowledge, do narrate aspects of this experience of contact, but in accounts that can appear highly individual, fragmented, even contradictory. In contrast, one domain that does seem to register and engage with the impacts of this history of colonialism is Inuit art, specifically visual art and film. In some cases these artistic narratives pre-date the historical trauma narratives of the commissions, which began with the Royal Commission on Aboriginal Peoples (RCAP) in the mid-1990s. This paper examines these narrative alternatives for recounting historic trauma in Nunavut, while also considering the implications of understanding historical trauma as narrative.

PMID: 23475452 [PubMed - as supplied by publisher]

The physical and mental health of Inuit children of teenage mothers.

Health Rep. 2012 Dec;23(4):15-22

Authors: Guèvremont A, Kohen D

Abstract
BACKGROUND: The physical and mental health of children of teenage mothers differs from that of children of older mothers. Compared with the overall population of Canada, Inuit experience first-time pregnancy earlier. However, little population-based research has examined health outcomes for Inuit children of women who began childbearing in their teens.
DATA AND METHODS: This study uses data from the 2006 Aboriginal Children's Survey to compare physical and mental health outcomes of 2- to 5-year-old Inuit children of teenage and older mothers.
RESULTS: The physical and mental health outcomes of Inuit children differed depending on whether their mother had been a teenager or aged 25 or older when she began childbearing. Although some differences were explained by socio-economic factors, others, namely, ear infections, dental problems and hyperactivity/inattention, were not.
INTERPRETATION: Further research is needed to determine what underlies differences in the mental and physical health of Inuit children of teenage and older mothers.

PMID: 23356041 [PubMed - indexed for MEDLINE]

Tuberculosis and common mental disorders: international lessons for Canadian immigrant health.

Can J Nurs Res. 2012 Dec;44(4):56-75

Authors: Bender A, Guruge S, Hyman I, Janjua M

Abstract
Tuberculosis is a pressing global health issue. Its association with other infections, illnesses, and social factors, including immigration, is well known, yet comparatively little research has examined the connections between tuberculosis and mental disorder, particularly among immigrants in Canada. The authors report on a scoping review conducted to better understand the synergies of tuberculosis, mental disorders, and underlying social conditions as they affect immigrants' health. They highlight the articles that focused on the co-occurrence of tuberculosis and depression/anxiety. After describing their approach and strategy, the authors present key thematic categories: prevalence, clinical presentation, and effects of stigma and poverty. Examining the research within the global context, they argue that migration contributes to these synergistic conditions. The review shows that Canadians stand to gain much by learning from low- and middle-income countries about what constitutes best evidence in approaching complex global health issues.

PMID: 23448075 [PubMed - in process]

Strange but common bedfellows: the relationship between humanitarians and the military in developing psychosocial interventions for civilian populations affected by armed conflict.

Transcult Psychiatry. 2012 Jul;49(3-4):492-518

Authors: Kienzler H, Pedersen D

Abstract
This essay analyses how the relationships between Cold War and post-Cold War politics, military psychiatry, humanitarian aid and mental health interventions in war and post-war contexts have transformed over time. It focuses on the restrictions imposed on humanitarian interventions and aid during the Cold War; the politics leading to the transfer of the PTSD diagnosis and its treatment from the military to civilian populations; humanitarian intervention campaigns in the post-Cold War era; and the development of psychosocial intervention programs and standards of care for civilian populations affected by armed conflict. Viewing these developments in their broader historical, political and social contexts reveals the politics behind mental health interventions conducted in countries and populations affected by warfare. In such militarized contexts, the work of NGOs providing assistance to people suffering from trauma-related health problems is far from neutral as it depends on the support of the military and plays an important role in the shaping of international politics and humanitarian aid programs.

PMID: 22722981 [PubMed - indexed for MEDLINE]

Pathways to forensic mental health care in Toronto: a comparison of European, African-Caribbean, and other ethnoracial groups in Toronto.

Can J Psychiatry. 2012 Jul;57(7):414-21

Authors: Flora N, Barbaree H, Simpson AI, Noh S, McKenzie K

Abstract
OBJECTIVE: To describe pathways taken to care by a sample of patients in a secure forensic unit who have been found not criminally responsible or unfit to stand trial, and to investigate the pathways taken by patients within 3 ethnoracial subgroups of origin: European, African or Caribbean, and Other.
METHOD: Fifty patients from secure forensic units were interviewed using the Encounter Form developed for pathways mapping undertaken in the World Health Organization field trials. Differences in the types of caregivers seen, the total number of caregivers seen, and the time taken to reach forensic psychiatric services were compared across the 3 ethnoracial groupings.
RESULTS: Most people committed their index offence after they had already had contact with general mental health services. Few significant differences were observed in the pathways to secure forensic units across the European, African-Caribbean, and Other ethnoracial groups.
CONCLUSIONS: These findings suggest that improvements in general mental health services may be a key to decreasing the use of forensic psychiatric services. Further research is required to explore factors that may predict and prevent offending. Larger studies are needed to examine ethnoracial differences in pathways to care.

PMID: 22762296 [PubMed - indexed for MEDLINE]

Differences in sexual guilt and desire in east Asian and Euro-Canadian men.

J Sex Res. 2012;49(6):594-602

Authors: Brotto LA, Woo JS, Gorzalka BB

Abstract
Differences in sexual desire between individuals of East Asian and European descent are well-documented, with East Asian individuals reporting lower sexual desire. The mechanisms that underlie this disparity have received little empirical attention. Recent research has found that sex guilt, "a generalized expectancy for self-mediated punishment for violating or for anticipating violating standards of proper sexual conduct" (Mosher & Cross, 1971 , p. 27), mediates the relationship between culture and sexual desire in East Asian and Euro-Canadian women. The goal of this study was to explore this role of sex guilt in men. Male Euro-Canadian (n = 38) and East Asian (n = 45) university students completed online questionnaires. The East Asian men reported significantly lower sexual desire and significantly higher sex guilt. Sex guilt was a significant mediator of the relationship between ethnicity and sexual desire, as well as a significant mediator between mainstream acculturation and sexual desire. Among the East Asian men, mainstream acculturation was significantly and negatively correlated with sex guilt such that increasing mainstream acculturation was associated with less sex guilt. The diagnostic and clinical implications of the findings are discussed.

PMID: 22004159 [PubMed - indexed for MEDLINE]

Racial differences in pain treatment and empathy in a Canadian sample.

Pain Res Manag. 2012 Nov-Dec;17(6):381-4

Authors: Kaseweter KA, Drwecki BB, Prkachin KM

Abstract
BACKGROUND: Evidence of inadequate pain treatment as a result of patient race has been extensively documented, yet remains poorly understood. Previous research has indicated that nonwhite patients are significantly more likely to be undertreated for pain.
OBJECTIVE: To determine whether previous findings of racial biases in pain treatment recommendations and empathy are generalizable to a sample of Canadian observers and, if so, to determine whether empathy biases mediate the pain treatment disparity.
METHODS: Fifty Canadian undergraduate students (24 men and 26 women) watched videos of black and white patients exhibiting facial expressions of pain. Participants provided pain treatment decisions and reported their feelings of empathy for each patient.
RESULTS: Participants demonstrated both a prowhite treatment bias and a prowhite empathy bias, reporting more empathy for white patients than black patients and prescribing more pain treatment for white patients than black patients. Empathy was found to mediate the effect of race on pain treatment.
CONCLUSIONS: The results of the present study closely replicate those from a previous study of American observers, providing evidence that a prowhite bias is not a peculiar feature of the American population. These results also add support to the claim that empathy plays a crucial role in racial pain treatment disparity.

PMID: 23248809 [PubMed - indexed for MEDLINE]

Factors associated with intimate partner violence by a former partner by immigration status and length of residence in Canada.

Ann Epidemiol. 2012 Nov;22(11):772-7

Authors: Du Mont J, Hyman I, O'Brien K, White ME, Odette F, Tyyskä V

Abstract
PURPOSE: We examined intimate partner violence (IPV) by a former partner among Canadian-born and immigrant women by length of residence in Canada.
METHODS: Data from a 2009 national, population-based, telephone survey were used to determine the prevalence of and factors associated with any type of IPV (emotional, financial, physical, and/or sexual) by a former partner with whom there had been contact in the previous 5 years among immigrant women 0 to 19 years in Canada, 20 or more years or longer in Canada, and Canadian-born women (n = 1681).
RESULTS: Of immigrant women in Canada for 0 to 19 years, 41.6% had experienced IPV by a former partner; for immigrant women in Canada for 20 or more years or longer, 60.6%, and Canadian-born women, 61.5% (P = .0423). In a logistic regression model adjusted for age and other sociodemographic characteristics, immigrant women in Canada for 0 to 19 years were less likely than Canadian-born women to experience any IPV (odds ratio, 0.266; 95% confidence interval, 0.130-0.544). There was no difference in the occurrence of any IPV between immigrant women in Canada 20 or more years or longer and Canadian-born women.
CONCLUSIONS: High rates of any IPV by a former partner were found for both Canadian-born and immigrant women. Within immigrant communities, specific prevention campaigns should address the high risk of experiencing IPV at later stages of resettlement.

PMID: 23041655 [PubMed - indexed for MEDLINE]

The impact of hepatitis B knowledge and stigma on screening in Canadian Chinese persons.

Can J Gastroenterol. 2012 Sep;26(9):597-602

Authors: Li D, Tang T, Patterson M, Ho M, Heathcote J, Shah H

Abstract
BACKGROUND: Chronic hepatitis B (CHB) infection is endemic in East Asia, and those who emigrate to North America have higher rates of CHB infection when compared with the general population. To date, Chinese persons residing in Canada have not been mandated to be screened for CHB infection.
OBJECTIVE: To understand factors that influence hepatitis B screening behaviour among the Chinese community in Toronto, Ontario, and to determine whether stigma acts as a barrier to screening.
METHODS: Self-identified Chinese individuals at a family physician's office and at English as a second language (ESL) classes in Toronto completed a questionnaire with demographic questions, a hepatitis B virus (HBV) stigma scale and an HBV knowledge scale. Pearson product moment correlation and multiple regression techniques were used to analyze the data.
RESULTS: The study group included 343 individuals. Their mean (± SD) age was 48.76 ± 17.49 years and the majority were born in China (n=229 [68%]). The mean score on the HBV knowledge scale was 10.13 ± 1.76 (range 0 to 15), with higher scores indicating greater HBV knowledge. The mean score on the stigma scale was 54.60 ± 14.18 (range 20 to 100), with higher scores indicating more stigma. Being an immigrant, having a family physician and having greater knowledge of HBV were associated with increased rates of screening for this infection. In contrast, greater levels of HBV stigma were associated with decreased likelihood of screening for HBV infection.
CONCLUSIONS: HBV stigma is associated with reduced rates of screening for this infection.

PMID: 22993729 [PubMed - indexed for MEDLINE]

The development of young children of immigrants in Australia, Canada, the United kingdom, and the United States.

Child Dev. 2012 Sep-Oct;83(5):1591-607

Authors: Washbrook E, Waldfogel J, Bradbury B, Corak M, Ghanghro AA

Abstract
In spite of important differences in some of the resources immigrant parents have to invest in their children, and in immigrant selection rules and settlement policies, there are significant similarities in the relative positions of 4- and 5-year-old children of immigrants in Australia, Canada, the United Kingdom, and the United States. Children of immigrants underperform their counterparts with native-born parents in vocabulary tests, particularly if a language other than the official language is spoken at home, but are not generally disadvantaged in nonverbal cognitive domains, nor are there notable behavioral differences. These findings suggest that the cross-country differences in cognitive outcomes during the teen years documented in the existing literature are much less evident during the early years.

PMID: 22966925 [PubMed - indexed for MEDLINE]

Changing psychiatric perception of African-Americans with affective disorders.

J Nerv Ment Dis. 2012 Dec;200(12):1031-40

Authors: Jarvis GE

Abstract
This article explored the origins and implications of the underdiagnosis of affective disorders in African-Americans. MEDLINE and old collections were searched using relevant key words. Reference lists from the articles that were gathered from this procedure were reviewed. The historical record indicated that the psychiatric perception of African-Americans with affective disorders changed significantly during the last 200 years. In the antebellum period, the mental disorders of slaves mostly went unnoticed. By the early 20th century, African-Americans were reported to have high rates of manic-depressive disorder compared with whites. By the mid-century, rates of manic-depressive disorder in African-Americans plummeted, whereas depression remained virtually nonexistent. In recent decades, diagnosed depression and bipolar disorder, whether in clinical or research settings, were inexplicably low in African-Americans compared with whites. Given these findings, American psychiatry needs to appraise the deep-seated effects of historical stereotypes on the diagnosis and treatment of African-Americans.

PMID: 23197118 [PubMed - indexed for MEDLINE]

Racial discrimination experienced by aboriginal university students in Canada.

Can J Psychiatry. 2012 Oct;57(10):617-25

Authors: Currie CL, Wild TC, Schopflocher DP, Laing L, Veugelers P

Abstract
OBJECTIVES: Racial discrimination is an established life course social determinant of health associated with adverse psychological outcomes among minority populations. However, little is known about the extent to which Aboriginal people in Canada may experience racial discrimination and consequent adverse psychological effects. This study sought to measure the extent to which Aboriginal university students living in an urban area of Canada experienced racism, to triangulate this evidence with US data and qualitative findings, and to examine the impact of these experiences on mental health.
METHODS: Data for this mixed method study were collected via in-person surveys with a volunteer sample of Aboriginal university students (n = 60) living in a mid-sized city in central Canada in 2008-2009.
RESULTS: Results indicate Aboriginal university students experienced more frequent racism across a greater number of life situations than African- and Latino-American adults in the United States. Student reactions to these experiences were symptomatic of what has been termed racial battle fatigue in the United States. Students who considered themselves traditional or cultural Aboriginal persons were significantly more likely to experience discrimination.
CONCLUSIONS: Results underline the need for policies aimed at reducing racism directed at Aboriginal people in urban areas and the growth of services to help Aboriginal people cope with these experiences. Results highlight the need for further research to determine the potential pathogenic consequences of racial discrimination for Aboriginal people in Canada.

PMID: 23072953 [PubMed - indexed for MEDLINE]

Paniya Voices: a Participatory Poverty and Health Assessment among a marginalized South Indian tribal population.

BMC Public Health. 2010;10:149

Authors: Mohindra K, Narayana D, Harikrishnadas C, Anushreedha S, Haddad S

Abstract
BACKGROUND: In India, indigenous populations, known as Adivasi or Scheduled Tribes (STs), are among the poorest and most marginalized groups. 'Deprived' ST groups tend to display high levels of resignation and to lack the capacity to aspire; consequently their health perceptions often do not adequately correspond to their real health needs. Moreover, similar to indigenous populations elsewhere, STs often have little opportunity to voice perspectives framed within their own cultural worldviews. We undertook a study to gather policy-relevant data on the views, experiences, and priorities of a marginalized and previously enslaved tribal group in South India, the Paniyas, who have little 'voice' or power over their own situation.
METHODS/DESIGN: We implemented a Participatory Poverty and Health Assessment (PPHA). We adopted guiding principles and an ethical code that promote respect for Paniya culture and values. The PPHA, informed by a vulnerability framework, addressed five key themes (health and illness, well-being, institutions, education, gender) using participatory approaches and qualitative methods. We implemented the PPHA in five Paniya colonies (clusters of houses in a small geographical area) in a gram panchayat (lowest level decentralized territorial unit) to generate data that can be quickly disseminated to decision-makers through interactive workshops and public forums. PRELIMINARY FINDINGS: Findings indicated that the Paniyas are caught in multiple 'vulnerability traps', that is, they view their situation as vicious cycles from which it is difficult to break free.
CONCLUSION: The PPHA is a potentially useful approach for global health researchers working with marginalized communities to implement research initiatives that will address those communities' health needs in an ethical and culturally appropriate manner.

PMID: 20307290 [PubMed - indexed for MEDLINE]

Influence of the DSM-IV Outline for Cultural Formulation on multidisciplinary case conferences in mental health.

Anthropol Med. 2012;19(3):261-76

Authors: Dinh NM, Groleau D, Kirmayer LJ, Rodriguez C, Bibeau G

Abstract
The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IV-TR) includes an Outline for Cultural Formulation (CF) that identifies cultural information that can be used to modify diagnosis, clinical assessment and treatment plan. This study examined the use of the CF by a Cultural Consultation Service in the psychiatric assessment of patients referred by primary care providers. The study uses conversation analysis of 12 clinical case conferences to explore the ways in which the CF influenced the interaction of a multidisciplinary group of mental health professionals in conceptualizing the implications of patients' cultural background and current context for diagnosis and treatment planning. The results suggest that the CF can be a useful tool for interdisciplinary collaboration and knowledge transfer by providing a framework to systematically introduce different disciplinary perspectives and levels of description that transcend the narrow frame of disorder-centred psychiatric diagnosis, assessment and care.

PMID: 22309357 [PubMed - indexed for MEDLINE]