Women's Experiences and Perceptions of Depression in India: A Metaethnography.

In India, social determinants of health, including poverty, domestic violence, and inadequate social support disproportionately affect women, leaving them more vulnerable to depression than men. We conducted a metaethnography to synthesize qualitative data from 13 studies (1987-2017) that explored women's experiences and perceptions of depression in India. We used a feminist standpoint to critically examine how gender shapes these experiences and perceptions. Indian women's experiences of depression were embedded in their social worlds. Women perceived interpersonal conflict, caregiving burden, domestic violence, financial insecurity, adverse reproductive events and widowhood as causes of depression. Women used cultural expressions to describe physical, emotional, and cognitive distress. The detrimental impact of discriminatory social conditions, gender inequalities, and traditional gender roles on Indian women's mental health highlights the need for gender-sensitive mental health research and practice that can attend to women's sociocultural context and promote values of gender equality and social justice.

Employment of trauma informed principles in the Palabras Fuertes project: Implications for narrative research with older Latinx communities.

In the US, there is a growing number of older Latinx communities. Qualitative approaches such as narrative inquiry may be fruitful endeavors to elucidate their lived experiences. However, older Latinx communities, including sexual minorities, are disproportionately exposed to social, health, and historical challenges that may result in exposure to potentially traumatic events (e.g. discrimination, illness, grief, etc.). The recognition of high rates of exposure to potentially traumatic events among participants has led to the recommended adoption of Trauma Informed (TI) principles for use in non-trauma specific research. At present, there are limited examples and discussions about the implementation of TI principles in qualitative research and our literature review yielded no discussion of the use of TI principles in narrative inquiry or with older Latinx communities. In this manuscript, we advocate for the adoption of TI principles when engaging in narrative inquiry with older Latinx adults. Second, we discuss examples of TI guided practices we employed while conducting the Palabras Fuertes study of life history narratives with older Latino immigrant gay men living in New York City. Finally, based on these experiences, we provide recommendations for incorporating TI into future narrative research with older Latinx communities.

Older immigrant Latino gay men and childhood sexual abuse: Findings from the Palabras Fuertes project.

Childhood Sexual Abuse (CSA) and maltreatment have long-term negative impacts on survivors, including older adults. Yet, limited qualitative examinations of how these experiences impact the lives of older adults exists and even fewer among older Latino gay men. We drew data from life-history narratives the first author conducted with five Spanish speaking older Latino gay men in New York City. Our analyses were guided by an Ecological Model, a Suffering lens, and our clinical social work experience with older adults, sexual minorities and people of color. All participants reported sexual experiences prior to the age of 15 and possible emotional and physical maltreatment. Yet, not all participants perceived these experiences as abuse. Our findings indicate how cultural, linguistic and contextual factors may affect disclosure and coping. Despite the fact that CSA and maltreatment occurred decades ago, these early experiences affected long-term psychosocial functioning. Our findings support a need for future research and clinical practice that considers the subjective perceptions of childhood sexual experiences and maltreatment and how these relate to psychosocial functioning in Latino gay men during older adulthood.

Life Course Challenges Faced by Siblings of Individuals with Schizophrenia May Increase Risk for Depressive Symptoms.

BACKGROUND: Research suggests siblings of individuals with schizophrenia are at a heightened risk for depressive symptomatology. Research has not yet examined whether the strains of growing up with a brother or sister with schizophrenia contribute to this risk. This study examined whether early life course burdens associated with an emerging mental illness, and current objective and subjective caregiver burden predicted depressive symptoms in siblings of individuals with schizophrenia. METHOD: Forty-one siblings of individuals with schizophrenia were recruited from a large study of schizophrenia neurobiology to complete a self-administered questionnaire and a neuropsychological test battery. RESULTS: Early life course burdens and current objective and subjective burdens explained incremental variance in depressive symptoms of siblings of individuals with schizophrenia after accounting for gender and global neurocognitive function. Higher levels of depressive symptoms among siblings were associated with perceptions of being stigmatized by the community (ß=.37, p<.01), and perceiving that the brother or sister's emerging illness negatively impacted the sibling's social life during childhood and adolescence (ß=.39, p<.01). Taking on adult responsibilities while the sibling was growing up was found to be protective against depressive symptoms in adulthood (ß= -.36, p<.01). CONCLUSIONS: Early life course burdens associated with having a sibling with schizophrenia and current subjective burden provide insight into psychosocial factors that may contribute to the risk for depression in this sibling group. Mental health service providers and psychoeducation programs would benefit by considering these factors when developing family-based interventions.

Suicidal ideation and suicide attempts among adults with psychotic experiences: data from the Collaborative Psychiatric Epidemiology Surveys.

IMPORTANCE: Suicide is a leading cause of preventable death, especially among individuals with psychotic disorders, and may also be common among nonclinical populations of adults with subthreshold psychotic experiences. Understanding this association has the potential to critically bolster suicide prevention efforts. OBJECTIVES: To examine the association between 12-month suicidality and 12-month psychotic experiences and to test the hypotheses that psychotic experiences are associated with increased prevalence of suicidal ideation and suicide attempts during the concurrent period and with greater severity of suicidal behavior. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey data were drawn from a large general population-based sample of households in the United States identified through the Collaborative Psychiatric Epidemiology Surveys (2001-2003). Adult household residents (n = 11,716) were selected using a clustered multistage sampling design with oversampling of racial/ethnic minority groups. Logistic regression models were adjusted for potential demographic confounders and co-occurring DSM-IV mental health conditions. EXPOSURES: Twelve-month psychotic experiences assessed with the Composite International Diagnostic Interview, version 3.0 psychosis screen. MAIN OUTCOMES AND MEASURES: Twelve-month suicidal ideation and suicide attempts. RESULTS: Respondents reporting psychotic experiences were more likely to report concurrent suicidal ideation (odds ratio [OR], 5.24; 95% CI, 2.85-9.62) and suicide attempts (OR, 9.48; 95% CI, 3.98-22.62). Most respondents with psychotic experiences (mean [SE], 65.2% [4.2%]) met criteria for a DSM-IV depressive, anxiety, or substance use disorder. Among respondents with suicidal ideation, those with psychotic experiences were likely to make an attempt during the concurrent 12-month period (OR, 3.49; 95% CI, 1.05-11.58) when adjusting for co-occurring psychiatric disorders. In contrast, depressive (OR, 1.67; 95% CI, 0.62-4.52), anxiety (OR, 1.57; 95% CI, 0.40-6.09), and substance use disorders (OR, 1.64; 95% CI, 0.24-11.17) did not reliably identify those at risk for attempts among respondents with suicidal ideation. The mean (SE) 12-month prevalence of suicide attempts among individuals reporting ideation and psychotic experiences and meeting criteria for any psychiatric disorder was 47.4% (10.9%) compared with 18.9% (4.8%) among those with just ideation and a disorder. Psychotic experiences were especially prevalent among individuals reporting severe attempts and may account for nearly one-third of attempts with intent to die (population attributable risk, 29.01%) in the United States annually. CONCLUSIONS AND RELEVANCE: Assessment of psychotic experiences among individuals with suicidal ideation has potential clinical and public health utility in reducing the prevalence of suicide attempts, particularly attempts with intent to die.

Effects of psychoeducation for Korean Americans with chronic mental illness.

OBJECTIVE: Korean Americans' access to mental health services may be limited because of differences in their views of mental illness compared with Westerners, unfamiliarity with treatment methods, and cultural associations of social stigma with mental problems. This study used data from an urban outpatient clinic to assess the effects of a ten-week psychoeducational intervention for Korean Americans with chronic mental illness. METHODS: Forty-eight Korean-American adults with a diagnosis of schizophrenia were randomly assigned to either an experimental group that provided a culturally sensitive psychoeducational group program in addition to individual supportive therapy or a control group that offered only individual supportive therapy. The two groups were compared on pre- and posttreatment measures of psychiatric symptoms, attitudes about and understanding of mental illness, and coping skills. The experimental psychoeducational treatment group was expected to show lower symptom severity, greater understanding of mental illness leading to a decreased perception of stigma, and greater coping skills after the intervention than the control group. Comparisons were made with repeated-measures analysis of covariance with the effects of gender and education controlled for. RESULTS: Compared with the control group, the psychoeducational group showed significantly reduced symptom severity and perception of stigma and greater coping skills immediately after treatment. CONCLUSIONS: These findings suggest that a culturally sensitive psychoeducational intervention is a useful short-term treatment modality for Korean Americans with a diagnosis of schizophrenia.

How siblings of those with severe mental illness perceive services and support.

This study examines the complex and varied effects associated with having a brother or sister with a severe and persistent mental illness (SPMI) on the lives of adult siblings without chronic disability. Through five focus group interviews, 19 participants were asked to describe the impact that having a brother or sister with mental illness had on their lives. Codes and categories derived from the text of the transcribed interviews were grouped into broad themes. The respondents described the manifestations and challenges of contending with the SPMI of an adult sibling. They focused on gaps in services and communication with mental health providers, particularly with regard to timing of interventions and identifying readiness for treatment, as well as their own mental health needs. The article concludes with a discussion of the increased need for exchange of information and clarity of communication among family members and providers, following best practice guidelines that are well documented but not well implemented.

Evaluating awareness of New York's Assisted Outpatient Treatment Law among adult siblings of persons with mental illness.

This study examined knowledge of New York's Assisted Outpatient Treatment law, enacted November 1999, among adult siblings of persons with mental illness. Mailed survey responses collected between April, 2000 and September, 2001 from 100 siblings residing in New York State were reviewed. Only 48% acknowledged familiarity with the law. Possessing higher education, reading about mental illness more often, planning to occupy future caregiving roles, maintaining membership in a support group, and reporting that their siblings experienced more difficulties with treatment compliance were associated with a familiarity with the law. Among those aware of the law, two thirds incorrectly believed eligibility for a court order was contingent on a history of violent behavior. Low rates of general awareness and knowledge of the law highlight the need for further community education.

Sibling perspectives on severe mental illness: reflections on self and family.

Through focus group interviews, participants were asked to describe the impact over time of having a sibling with severe mental illness. Transcript content was then organized into categories and overarching themes using grounded-theory analysis. Respondents' personal and interpersonal experiences are presented, along with suggestions for professional outreach and further research.

Mediation analysis of critical time intervention for persons living with serious mental illnesses: assessing the role of family relations in reducing psychiatric rehospitalization.

OBJECTIVE: Critical Time Intervention (CTI) is a time-limited care coordination intervention designed to reduce homelessness and other adverse outcomes for persons living with serious mental illness during the transition period between institutions and community living. This study assesses whether CTI improves the quality of family relationships between family members and individuals living with serious mental illness, and examines whether changes in quality of family relationship mediated the association between the intervention and psychiatric rehospitalization outcomes. METHOD: This study utilizes data from a randomized controlled trial that assessed the effect of CTI in preventing homelessness. Following discharge from inpatient psychiatric treatment in New York City, 150 previously homeless persons living with serious mental illness were randomly assigned to receive usual services only or 9 months of CTI in addition to usual services. RESULTS: Findings from mixed-effects regression models indicated that those assigned to the CTI group reported greater frequency of family contact and greater improvement in satisfaction with family relations than the comparison group during the 18-month follow-up period. Mediation analysis revealed that greater improvement in satisfaction with family relations mediated the effect of CTI on psychiatric rehospitalization outcome, but only at a modest level. CONCLUSION AND IMPLICATIONS FOR PRACTICE: These findings suggest that a relatively brief but targeted intervention delivered at the point of hospital discharge may contribute to strengthening family relations and that improvement in perceived family relationship quality can contribute to a reduction in psychiatric rehospitalization.

Treatment seeking and unmet need for care among persons reporting psychosis-like experiences.

OBJECTIVE: Psychosis-like experiences may be clinically significant given their demonstrated associations with concurrent psychological distress and the later development of diagnosable psychotic disorders. Prior studies of treatment for psychosis-like experiences have yielded conflicting results. The aims of this study were to investigate help seeking and need for care among individuals with psychosis-like experiences in a large general population sample. METHODS: Data from the Collaborative Psychiatric Epidemiology Surveys (N=10,541) were used to examine help-seeking behaviors among survey respondents who reported psychosis-like symptoms over a 12-month period. Adjusted odds ratios were calculated for a variety of help-seeking variables, with control for demographic factors and co-occurring psychiatric conditions. RESULTS: Among the 10,541 respondents, 3.4% reported a psychosis-like experience in the past 12 months. Respondents who reported psychosis-like experiences were more than twice as likely as those who did not to seek treatment. Those who reported such experiences but who did not seek treatment were more likely to have felt the need for or to have been encouraged by others to seek treatment and less likely to have felt that they had no psychiatric problem. Associations with unmet need for care were largely attributable to co-occurring psychiatric disorders. CONCLUSIONS: Respondents with psychosis-like experiences had elevated rates of help seeking, as well as significant unmet clinical need among those not in treatment.

The subjective experience of youths at clinically high risk of psychosis: a qualitative study.

OBJECTIVE: Understanding the experience of individuals across stages of schizophrenia is important for development of services to promote recovery. As yet, little is known about the experience of individuals who exhibit prodromal symptoms of schizophrenia. METHODS: Audiotaped interviews were conducted with 27 participants of diverse racial-ethnic backgrounds who were at clinically high risk of psychosis (15 males and 12 females; mean age 21). Phenomenological qualitative research techniques of coding, consensus, and comparison were used. RESULTS: Emergent themes differed by gender. Themes for males were feeling abnormal or "broken," focus on going "crazy," fantasy and escapism, and alienation and despair, with a desire for relationships. Themes for females were psychotic illness among family members, personal trauma, struggle with intimate relationships, and career and personal development. CONCLUSIONS: The finding of relative social engagement and future orientation of females identified as at risk for psychosis is novel and has implications for outreach and treatment.

Family history of schizophrenia as a risk factor for axis I psychiatric conditions.

People with first-degree relatives with schizophrenia are at an elevated risk of developing the disorder themselves. High rates of psychotic symptoms in non-psychotic disorders, high rates of comorbidity in psychotic disorders, and diversity of outcomes following psychosis-risk states together suggest that this vulnerability may be for psychiatric conditions in general, not limited to schizophrenia. In this study, data from the National Survey of American Life (NSAL) were used to examine the association between having a first-degree relative with schizophrenia and the lifetime development of a range of non-psychotic axis I psychiatric disorders using adjusted odds ratios. Having a relative with schizophrenia was associated with increased risk for most non-psychotic psychiatric conditions examined, including those expected to be associated with schizophrenia (affective, anxiety, and substance use disorders) and those not expected (bulimia, disorders of childhood onset), excluding respondents with lifetime psychotic symptoms and controlling for demographic factors. Family history of schizophrenia among this predominantly African-American and Afro-Caribbean sample appears to be a risk factor for a range of axis I diagnoses, supporting a continuous rather than categorical nature of psychiatric vulnerability. Future studies should examine whether these associations are due to genetic or environmental factors, or both.

Child loss and psychosis onset: evidence for traumatic experience as an etiological factor in psychosis.

Previous research suggests that trauma may contribute to psychosis onset. In this study, we examine the effect of parental loss of a child on the onset of psychotic experience using data from the National Comorbidity Survey Replication, hypothesizing that child loss will precede the onset of psychosis and will be associated with a later age of onset. We likewise tested this association for six other psychiatric conditions to demonstrate specificity for psychosis. Individuals with a psychotic disorder who had lost a child had a significantly later age of onset, particularly in males, even when controlling for demographic variables and co-occurring substance abuse and psychiatric disorders. Psychosis onset frequently occurred within a year of child loss. No associations were found between child loss and onset of other psychiatric conditions, supporting specificity of the effect on psychosis. The presented findings implicate child loss as an etiological factor in the onset of psychosis, providing converging evidence with previous studies demonstrating associations between more widely studied trauma exposures (abuse, neglect, and assault) and psychosis.

Acculturative stress and psychotic-like experiences among Asian and Latino immigrants to the United States.

Previous studies have shown variation in the prevalence and incidence of psychosis across immigrant groups, but the underlying mechanisms are not fully understood. Stress related to acculturation may increase risk for psychosis among immigrant groups. In this study we examine the association between acculturative stress and psychotic-like experiences in a sample of Latino- and Asian-American immigrants to the United States in the National Latino and Asian American Study (n=2434). Acculturative stress was associated with visual and auditory hallucinations among Asians, but only with hearing voices among Latinos. Increased risk for psychotic-like experiences among Latinos was primarily associated with younger age of immigration. Acculturative stress appears to be a promising candidate mechanism explaining the relationship between immigration and psychosis, particularly among Asian Americans. Ethnic differences may reflect variability between groups that integrate more readily into the host culture and those that are subject to greater discrimination and environmental adversity.

Economic expenditures associated with instrumental caregiving roles of adult siblings of persons with severe mental illness.

Siblings of persons with mental illness who assume primary caregiving roles experience substantial and tangible economic impacts associated with this responsibility. This study investigated mailed survey responses collected from 156 adult siblings of persons with mental illness from New York State to examine instrumental costs associated with providing support to siblings with illness. Genders of both siblings, severity of the relatives' mental illness, and number of surviving parents in the family distinguished those occupying primary caregiving responsibility from those not in primary roles. Current caregivers incurred greater instrumental costs in the form of financial expenses, time spent in care activities, and crisis involvement than did those who were not primary care providers. Additional demographic and behavioral factors related to siblings with and without illness were associated with specific dimensions of instrumental expenditure. As siblings become increasingly engaged in caregiving, social service professionals must assume leadership in promoting programs and policies that meaningfully support family involvement for relatives with mental illness.