Effects of Cognitive Behavioral Group Program for Mental Health Promotion of University Students.

This study aimed to explore the effects of a group cognitive behavioral program on depression, self-esteem, and interpersonal relations among undergraduate students. A non-equivalent control group pretest-posttest design was used. A convenient sample of 37 undergraduates (18 in the experimental group and 19 in the control group) at K university located in Changwon, South Korea was used. Data were collected from February 4, 2019 to June 18, 2019. The experimental group received eight sessions of the program, which were scheduled twice a week, with each session lasting 90 min. Collected data were analyzed using a chi-square test, Fisher's exact test, independent t-test, and repeated measures ANOVA by SPSS/WIN 23.0 (SPSS, Inc., Chicago, IL, USA). The interaction of group and time was significant, indicating that the experimental group showed an improvement in depression, self-esteem, and personal relationship compared to the control group. A significant group by time interaction for depression, self-esteem, and personal relationship was also found between the two groups. The study results revealed that the group cognitive behavioral program was effective in reducing depression and improving self-esteem and interpersonal relation. Therefore, the group cognitive behavioral program can be used for promoting the mental health of students as well as for preventing depression in a university setting.

A biocultural approach to psychiatric illnesses.

RATIONALE: As a species, humans are vulnerable to numerous mental disorders, including depression and schizophrenia. This susceptibility may be due to the evolution of our large, complex brains, or perhaps because these illnesses counterintuitively confer some adaptive advantage. Additionally, cultural and biological factors may contribute to susceptibility and variation in mental illness experience and expression. Taking a holistic perspective could strengthen our understanding of these illnesses in diverse cultural contexts. OBJECTIVES: This paper reviews some of these potential factors and contextualizes mental disorders within a biocultural framework. RESULTS: There is growing evidence that suggests cultural norms may influence inflammation, neurotransmitters, and neurobiology, as well as the illness experience. Specific examples include variation in schizophrenia delusions between countries, differences in links between inflammation and emotion between the United States and Japan, and differences in brain activity between Caucasian and Asian participants indicating that cultural values may moderate cognitive processes related to social cognition and interoception. CONCLUSIONS: Research agendas that are grounded in an appreciation of biocultural diversity as it relates to psychiatric illness represent key areas for truly interdisciplinary research that can result in culturally sensitive treatments and highlight possible biological variation affecting medical treatment.

Morita therapy for depression in adults: A systematic review and meta-analysis.

Morita therapy is a systematic psychological therapy that aims to improve everyday functioning rather than target specific symptoms. However, there has been no systematic review evaluating the evidence of the effectiveness of Morita therapy in the treatment of depression. The aim of this study was to assess the clinical efficacy of Morita therapy in combination with pharmacotherapy in patients 18 and older who were diagnosed with current depressive disorder. A total of 840 patients with depression from 11 randomized controlled trial (RCT) studies were included in this meta-analysis after a literature search of 10 databases was performed from database inception to July 1, 2017. All the eligible studies were determined to have an unclear or high risk of bias. Morita therapy plus pharmacotherapy was significantly superior to pharmacotherapy alone in reducing depression severity. The remission rate of the Morita therapy plus pharmacotherapy group was better than that of the pharmacotherapy alone group. Morita therapy significantly reduced depression severity symptoms and improved the remission rate. Due to the relatively weak quality of the included studies, definitive conclusions cannot be made. Thus, multi-center, well-designed clinical trials with larger cohorts are urgently needed to support the clinical application of Morita therapy.

Mindful attention moderating the effect of experiential avoidance in terms of mental health among Latinos in a federally qualified health center.

The present study examined the moderating role of mindful attention in the relation between experiential avoidance and anxious arousal, social anxiety, depressive symptoms, and the number of mood and anxiety disorders among a sample of Latinos seeking health services at a primary care facility. Participants included 326 adult Latinos (Mage = 39.79 years, SD = 11.27; 88.9% female; 98.2% used Spanish as their first language). Results provided empirical evidence of an interaction between mindful attention and experiential avoidance for anxious arousal, social anxiety, depressive symptoms, and the number of mood and anxiety disorders in the studied sample. Specifically, among Latinos with lower (vs higher) levels of mindfulness, greater experiential avoidance was related to greater anxiety/depressive symptoms and number of mood and anxiety disorders. Together, these data provide novel empirical evidence of the clinically relevant interplay between mindful attention and experiential avoidance regarding a relatively wide array of negative emotional symptoms and disorders among Latino primary care patients. Limitations of the study include a largely female sample and cross-sectional data.

Exploring the association between depression and shenjing shuairuo in a population representative epidemiological study of Chinese adults in Guangzhou, China.

Traditional mental illness concepts remain prevalent in China. Shenjing shuairuo (i.e., neurasthenia), a depressive-like syndrome less favored in Western psychiatric nosology, has a long tradition of acceptance among Chinese lay people. The concept may be more easily accepted in China due to the culturally informed view of the importance of harmony between mind and body and is consistent with Traditional Chinese Medicine. The goals of this study were to estimate the prevalence of shenjing shuairuo, the overlap between shenjing shuairuo and depression, and whether these two disorders share correlates. Data was obtained from 751 Chinese adults using stratified random sampling. Spatial epidemiological methods were utilized with face-to-face interviews conducted in Guangzhou, China. The Patient Health Questionnaire (PHQ-9) and the neurasthenia criteria from ICD-10 measured depression and shenjing shuairuo. The prevalence of depression and shenjing shuairuo were 5.3% and 15.4%, respectively. Participants with depression were nearly six times more likely to have shenjing shuairuo. Women were more likely than men to have comorbid depression and shenjing shuairuo. Poorer health was reported across disorders. Those with shenjing shuairuo were more likely to report medical diagnoses. Longer sleep latency was reported for those with shenjing shuairuo and those with depression reported fewer hours of sleep and lower sleep quality. Those with depression alone reported the poorest sleep. Significant diagnostic overlap and few distinct correlates were observed. Nevertheless, the difference in prevalence and acceptance among non-professionals suggests that shenjing shuairuo is a useful category of distress among Chinese adults in Southern China.

Exploring the East-West Divide in Prevalence of Affective Disorder: A Case for Cultural Differences in Coping With Negative Emotion.

Lifetime rates of clinical depression and anxiety in the West tend to be approximately 4 to 10 times greater than rates in Asia. In this review, we explore one possible reason for this cross-cultural difference, that Asian cultures think differently about emotion than do Western cultures and that these different systems of thought help explain why negative affect does not escalate into clinical disorder at the same rate. We review research from multiple disciplines-including cross-cultural psychology, social cognition, clinical psychology, and psychiatry-to make the case that the Eastern holistic principles of contradiction (each experience is associated with its opposite), change (the world exists in a state of constant flux), and context (the interconnectedness of all things) fundamentally shape people's experience of emotions in different cultures. We then review evidence for how these cultural differences influence how successfully people use common emotion regulation strategies such as rumination and suppression.

Compassion-Based Meditation in African Americans: Self-Criticism Mediates Changes in Depression.

This study examines self-criticism as a mechanism through which compassion meditation reduces depressive symptoms in low-income African American men and women (N = 59) who had recently attempted suicide. After completing several measures, including the Levels of Self-Criticism Scale and Beck Depression Inventory-II, participants were randomly assigned to receive either a six-session compassion meditation (CM) group (Grady Compassion and Meditation Program) or a six-session support group. As predicted, path analysis results showed that treatment condition led to changes in self-criticism from pre- to posttreatment, with those receiving CM showing greater reductions in levels of self-criticism than those randomized to the support group. Path analyses also revealed that changes in self-criticism fully mediated the link between condition and changes in depressive symptoms. These findings highlight the importance and value of targeting levels of self-criticism in compassion-based interventions to reduce the depressive symptoms of suicidal African Americans.

Distress disclosure and psychological functioning among Taiwanese nationals and European Americans: The moderating roles of mindfulness and nationality.

Research using Western samples shows that talking about unpleasant emotions-distress disclosure-is associated with fewer psychological symptoms and higher well-being. These benefits of distress disclosure may or may not be observed in East Asia where emotional control is valued. Instead, mindfulness may be more relevant to emotion regulation in East Asia (e.g., Taiwan). In the present study, cultural context (Taiwanese nationals vs. European Americans) and mindfulness were examined as moderators of the relation between distress disclosure and both depression symptoms and life satisfaction. A sample of 256 Taiwanese college students and a sample of 209 European American college students completed self-report measures in their native language. Moderated multiple regression analyses revealed significant interaction effects of mindfulness and distress disclosure on both depression symptoms and life satisfaction for Taiwanese participants but not for European Americans. Specifically, distress disclosure was negatively associated with depression symptoms and positively associated with life satisfaction for Taiwanese low in mindfulness but not for Taiwanese high in mindfulness. For European Americans, distress disclosure was not associated with depression symptoms but was associated with higher life satisfaction, regardless of one's level of mindfulness. These findings suggest that the potential benefits of disclosing distress are a function of one's cultural context as well as, for those from Taiwan, one's mindfulness. (PsycINFO Database Record

Mind-Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review.

Mind-body approaches are commonly used to treat a variety of chronic health conditions, including depression and anxiety. A substantial proportion of individuals with depression and anxiety disorders do not receive conventional treatment; disadvantaged individuals are especially unlikely to receive treatment. Mind-body approaches offer a potentially more accessible and acceptable alternative to conventional mental health treatment for disadvantaged individuals, who may not otherwise receive mental health treatment. This review examines evidence for the efficacy of mind-body interventions for mental health symptoms among disadvantaged populations. While rates of utilization were relatively lower for racial/ethnic minorities, evidence suggests that significant proportions of racial/ethnic minorities are using complementary health approaches as health treatments, especially prayer/healers and natural or herbal remedies. This review of studies on the efficacy of mind-body interventions among disadvantaged populations found evidence for the efficacy of mind-body approaches for several mental and physical health symptoms, functioning, self-care, and overall quality of life.

Anxiety sensitivity and mindful attention in terms of anxiety and depressive symptoms and disorders among Latinos in primary care.

The present investigation examined the interactive effects of anxiety sensitivity and mindful attention in relation to anxiety and depressive symptoms and psychopathology among 145 adult Latinos (85.5% female; Mage=39.9, SD=10.8 and 98.6% used Spanish as their first language) who attended a community-based primary healthcare clinic. As expected, the interaction between anxiety sensitivity and mindful attention was significantly related to number of mood and anxiety disorders, social anxiety, and depressive symptoms. No significant interaction, however, was evident for panic (anxious arousal) symptoms. The form of the significant interaction indicated that Latinos reporting co-occurring higher levels of anxiety sensitivity and lower levels of mindful attention evinced the greatest levels of anxiety/depressive psychopathology, social anxiety, and depressive symptoms. These data provide novel empirical evidence suggesting that there is clinically-relevant interplay between anxiety sensitivity and mindful attention in regard to a relatively wide array of anxiety and depressive variables among Latinos in a primary care medical setting.

[Mental Health Care Utilization of First Generation Vietnamese Migrants in Germany]. / Inanspruchnahme ambulanter psychiatrischer Versorgung bei vietnamesischen Migranten der ersten Generation in Deutschland.

OBJECTIVE: Vietnamese migrants underutilize and are a "hard to reach group" within the existing mental health care system in Germany. METHODS: We analyzed migration related and clinical data for all first-time Vietnamese migrants seeking psychiatric help, within the first 30 months of a newly established outpatient clinic, offering culture-sensitive psychiatric treatment in native Vietnamese language. RESULTS: Most first time patients were female, first generation Vietnamese migrants with poor German language skills. Only 1 /3 of all patients had a psychiatric history, while this number was higher in patients with schizophrenia. Over time, more first time patients with depression were seeking psychiatric care, accompanied with an increase of non-professional referrals within the Vietnamese communities. CONCLUSION: This first study on mental health care utilization in Vietnamese migrants in Germany points towards the fact that "migrants" cannot be considered as a homogeneous group. Mental health care utilization must be evaluated for specific migrant groups, and can be initially improved if offered in native language and when it is referred to by members of migrant communities.

A meta-analysis of the efficacy and safety of traditional Chinese medicine formula Ganmai Dazao decoction for depression.

ETHNOPHARMACOLOGICAL RELEVANCE: Ganmai Dazao (GMDZ) decoction is a traditional Chinese herbal formula commonly used for the treatment of depression. The objective of this study was to assess the efficacy and safety of GMDZ, either alone or as co-therapy, for depression. MATERIALS AND METHODS: We systematically searched key databases (9 Chinese and 7 English) up until May 2013 for randomized controlled trials (RCTs). The primary outcomes were effective rate and self-rated or clinician-rated severity of depression. The secondary outcome was the occurrence of adverse events. Methodological quality of the RCTs was assessed by the Cochrane׳s risk of bias assessment. RESULTS: Ten RCTs were included. All were written in Chinese and the methodological quality was generally low. Pooled analysis of 5 studies which compared GMDZ with antidepressants showed that GMDZ was significantly more efficacious than antidepressants in effective rate (risk ratio: 1.14, 95% CI: 1.02 to 1.27, P=0.02, I(2)=0%), but comparable in Hamilton Depression Rating Scale (HDRS) score (mean difference: -2.10, 95% CI: -4.62 to -0.41, P=0.10, I(2)=92%). With regard to the other 5 studies which compared GMDZ plus antidepressants with antidepressants alone, there was no significant difference in effective rate (risk ratio: 1.24, 95% CI: 0.99 to 1.55, P=0.07, I(2)=93%), but the end-point HDRS score was significantly lower in GMDZ antidepressants combination (mean difference: -4.25, 95% CI: -6.50 to -2.00, P=0.0002, I(2)=96%). Adverse events were more common with antidepressants than GMDZ (rate ratio: 0.52, 95% CI: 0.32 to 0.82, P=0.005, I(2)=37%) and in antidepressants alone compared to GMDZ antidepressants combination (rate ratio: 0.23, 95% CI: 0.08 to 0.68, P=0.08, I(2)=0%). CONCLUSION: The overall results suggest that GMDZ has few side effects and the potential as an antidepressant. Adding GMDZ to antidepressants reduces side effects and enhances efficacy of antidepressants. However, due to the small number of studies and their limitations, further studies with better methodological quality and more comprehensive safety assessment are needed to determine the benefits and risks of GMDZ in the treatment of depression.

The healing process following a suicide attempt: context and intervening conditions.

The purpose of this study was to explore the context and the intervening conditions that impacted on individuals' healing from a suicide attempt. Patients who had survived a suicide attempt (n=14) and their caregivers (n=6) were interviewed in this study. Findings revealed that the suicidal individuals who lived in a sheltered, friendly environment, and had support systems helped their suicidal healing process. Conversely, suicidal individuals who experienced negative aspects of self, family predicaments, environmental difficulties, and the re-emergence of stressors impeded their suicidal healing process. Consequently, health professionals need to promote healthy internal and external environments for suicidal individuals.

"Too blessed to be stressed": a rural faith community's views of African-American males and depression.

Among African-Americans, the faith community has a long history of providing support to its members. Because African-American men tend to delay and decline traditional depression treatment, the faith community may be an effective source of support. The aim of this study was to determine how a rural African-American faith community describes and perceives experiences of depression among African-American males. A convenience sample of 24 men and women participated in focus groups and interview. Four themes were identified: defining depression, etiology of depression, denial of depression, and effect of masculine roles on depression experience.

Psychometric properties of the Connor-Davidson Resilience Scale 10 among low-income, African American men.

The Connor-Davidson Resilience Scale 10 (CD-RISC 10; Campbell-Sills & Stein, 2007) is a self-report measure of resilience that has been found to provide reliable and valid scores among U.S. and international samples, although its psychometric properties have not been validated among African Americans. This study used confirmatory factor analysis (CFA) and structural equation modeling to examine the psychometric properties of the CD-RISC 10 among a community sample of 127 low-income, African American men. Participants completed measures of resilience, spirituality, and psychological distress. CFA results supported the unidimensional factor structure of the CD-RISC 10. The CD-RISC 10 scores also evidenced construct validity by being related to theoretically relevant constructs (i.e., spirituality and psychological distress). Satisfactory internal consistency score reliability was demonstrated. These results support the validity of the CD-RISC 10 scores in a sample of low-income, African American men.

Stories to be told: Korean doctors between hwa-byung (fire-illness) and depression, 1970-2011.

This article analyzes the process of the making of hwa-byung (fire illness) an internationally recognized term for a Korean emotion-related disorder. To index hwa-byung as a valid condition within professional medical circles, Koreans draw on both the traditional idea of "constrained fire" and the DSM's modern identification of "depressive disorders." Examining the research on hwa-byung since the 1970s, conducted by both Korean psychiatrists and doctors of traditional medicine, this article demonstrates how inextricably conceptions of Korean-ness in medicine have been tied to the right positioning of Korea in a global context. The project of defining a uniquely Korean malady reflects the desire of medical professionals to make the indigenous meaningful, thereby guaranteeing a tool for gaining circulation and foreign recognition. Studies of hwa-byung since the 2000s have in many ways been a reflection of the endeavor to interpret patients' narratives as a therapeutic resource. Some hwa-byung specialists have dealt with patients' stories of illness over time and argue for establishing better techniques of clinical communication. Whereas the label of hwa-byung initiated the indigenous turn during the 1980s, now the term succinctly responds to the recent trend of exploring the colloquial dimension of medicine. This also demonstrates the way in which hwa-byung has been (dis)assembled at the junction of global and domestic flows.

Identification of and beliefs about depressive symptoms and preferred treatment approaches among community-living older African Americans.

OBJECTIVE: To examine older African American's recognition of and beliefs about depressive symptoms, preferred symptom management strategies, and factors associated with willingness to use mental health treatments. Differences between the depressed and nondepressed and men and women were examined. DESIGN: Cross-sectional survey. SETTING: Home, senior center. PARTICIPANTS: A total of 153 senior center members (56 male, 97 female) 55 years and older. MEASUREMENTS: Using a depression vignette, participants indicated if the person was depressed and their endorsement of items reflecting beliefs, stigma, symptom management, and willingness to use treatments (yes/no). A 9-item Patient Health Questionnaire assessed current symptomatology. RESULTS: Overall, 24.2% reported depressive symptoms (≥5); 88.2% correctly identified the person in the vignette as depressed. Most (≥75%) endorsed active symptom management strategies, preference for treatment in physician and therapist offices, and willingness to take medications, seek therapy, see doctor, and attend support groups; less than 33% viewed depression as stigmatizing, whereas 48% viewed depression as normal aging. Logistic regressions revealed lower education, higher physical function, and feeling okay if community knew of depression diagnosis were associated with willingness to see physician if feeling depressed; being married and believing antidepressant medications are beneficial were related to willingness to use medications. Different associations emerged for depressed/nondepressed and men and women. CONCLUSIONS: Overall, this older African American sample had positive attitudes and beliefs and endorsed traditional treatment modalities suggesting that beliefs alone are unlikely barriers to underutilization of mental health services. Because different factors were associated with willingness to seek physician help and use medications and factors differed for depressed/nondepressed and by sex, interventions should be tailored.

Training and validation of standardized patients for unannounced assessment of physicians' management of depression.

OBJECTIVE: Standardized patients (SPs) have been developed to measure practitioner performance in actual practice settings, but results have not been fully validated for psychiatric disorders. This study describes the process of creating reliable and valid SPs for unannounced assessment of general-practitioners' management of depression disorders in Iran. METHOD: Ten psychology and nursing students (potential SPs) took part in a five-session course involving training in dialogue and body language. Five scenarios, along with corresponding checklists representing common presentations of mood disorders in primary-care settings, were developed by an expert group. The SPs' role-play performance of their respective scenario was videotaped and scored independently by three psychiatrists according to an observational rating scale to assess validity. The role-play was repeated after 1 week with the same scenario and the same doctor, to assess test-retest reliability. The reliability of each checklist to be used by the SPs was assessed by testing interrater reliability between groups of SPs. RESULTS: The cutoff score for the SPs' portrayal validity was 90% or above for all SPs. Mean interrater reliability for the checklists was acceptable for the SPs watching the same videos and filling in the checklists, while the mean kappa for assessing concurrent validity in filling in the checklists was lower. The test-retest performance for assessing reliability resulted in a mean kappa of 0.72. All SPs except one, who was not recruited, performed acceptably well. CONCLUSION: The authors have demonstrated a thorough validation of the technique of using standardized patients in the portrayal of depressive disorders in primary-care settings in Iran, which creates confidence in employing this technique to evaluate doctors' performance, for example, after an educational intervention. Similar methods of validation can be used for SPs' portrayal of other psychiatric disorders.

The use of Buddhist mindfulness meditation in psychotherapy: a case report from Sri Lanka.

Buddhist practices have been increasingly influencing psychotherapy. For over 20 centuries, Buddhism has been the religion of a majority of Sri Lankans. However, there is little documentation of the use of Buddhist practices in psychotherapy in Sri Lanka. This paper presents a case study in which Theravadan Buddhist mindfulness meditation and cognitive therapy practices were used in the treatment of a client with depressive disorder. The paper also summarizes the influence of Buddhist concepts and mindfulness meditation on psychotherapy and illustrate how Buddhist doctrine and practices can be considered a psychotherapeutic method.

A day in the life of women with a serious mental illness: a qualitative investigation.

PURPOSE: Few studies have taken a holistic perspective to the lives of women with a serious mental illness (SMI). This qualitative study of women with an SMI describes and interprets women's experiences and provides a new understanding about the nature and needs of these women. METHODS: A convenience sample of 30 poor, urban, predominantly African-American women with a diagnosis of an SMI was recruited from an ongoing National Institutes of Mental Health study. Data collection involved face-to-face, in-depth interviews. The interviews were audio-recorded and transcribed verbatim. Data analysis occurred concurrently with data collection using a modified constant comparative method. RESULTS: The majority of the women self-identified as African American, single, having completed high school, and at the time of the interview were either unemployed or on disability. The most common SMI was major depression. A common topic in the women's reflections on their lives was that of social disadvantage both before being diagnosed as well as after to their diagnosis with an SMI. Salient themes of their stories included social isolation, experiencing loss, and having a lack of control over one's own life decisions. CONCLUSION: The findings from this study revealed varied experiences among these women as well as the complexity of their situation. The enhanced understanding of women's situation will allow mental health professionals to improve the quality of life for women with an SMI by taking a contextual approach to the treatment of their mental illness.