Global Mental Health and Adolescent Anxiety: Kin, Care and Struggle in New Mexico.

While recent developments within the field of global mental health have illuminated the reality of serious mental health difficulties worldwide, particularly in low-income settings, research that focuses on children and adolescents remains underdeveloped. This is especially the case with respect to ethnographic studies of lived experience of adolescents diagnosed with serious mental health conditions. Drawing from an interdisciplinary study of adolescents in New Mexico who were afflicted with a broad range of disorders according to contemporary research diagnostic criteria, this article focuses on anxiety-related conditions with respect to subjective experience and social-ecological contexts of living with such conditions. We offer preliminary observations regarding the value of linking ethnographic and research diagnostic data to address questions of resilience, endurance, capacity and struggle. These observations are intended as the basis for the formulation of more precise hypotheses about adolescent anxiety, kin, and care under conditions of structural violence marked by psychological, residential, and intergenerational adversity.

Straining Psychic and Social Sinew: Trauma among Adolescent Psychiatric Patients in New Mexico.

Drawing on data from a longitudinal study of 47 adolescents of diverse ethnic backgrounds hospitalized for psychiatric disorder in New Mexico, the article critically examines the relevance of post-traumatic stress disorder (PTSD) to address anthropological questions of how to define the problem. Factors include the utility/limitation of psychiatric diagnostic categories, the lived experience of severe distress, the socioeconomic and political conditions of suffering, and reciprocal relations between immediate and remote social institutions. I discuss the mental health care system for adolescents and present two case studies of young inpatients, emphasizing the need for dual specification of the conditions of trauma and the structure of experience. I argue for understanding patterns of abandonment that shape the raw existence of young people at both the personal and collective levels to apprehend their depth and durability.

Social media & subjectivity: Adolescent lived experiences with social media in a Southern California middle school.

The widespread use of social media (SM) platforms among adolescents has raised concerns over its role in increased adverse physical and mental health conditions. However, current research linking SM use with adolescent health relies on tenuous correlational associations, disproportionately focuses on harmful effects of its use, and seldom examines the perspectives of youth themselves (Odgers and Jensen, 2020; Schønning et al., 2020). This article examines adolescent lived experience in relation to SM platform engagement. Drawing from ethnographic fieldwork conducted in 2018-2019 and 2021-2022 among 75 middle-school adolescents living in an ethnically diverse and low-income Southern California community, we examine adolescent subjective experiences with SM platforms that illuminate adolescent concerns during this developmental stage. By attending to adolescent subjectivity, this article reveals the ways in which engagement with SM platforms is inextricable from cultural, social, political, and socio-emotional milieu.

Depression and anxiety among multiethnic middle school students: Age, gender, and sociocultural environment.

BACKGROUND: Depression and anxiety-related disorders are common among adolescents. Research attention to early adolescence and low-income ethnically diverse populations is limited. AIM: To conduct screening for depression and anxiety at an early age with attention to gender and socioenvironmental context within a low-income setting. METHOD: Mixed methods included the PHQ-9A and GAD-10 screening instruments and ethnographic interviews. RESULTS: 75 ethnically diverse middle school students were included. Mean years age was 11.2 (0.74). Females had higher PHQ-9A sum scores than males (p = .002, Mann-Whitney test) and higher GAD-10 sum scores than males (p = .016, Mann-Whitney test). After controlling for multiple comparisons, girls had higher mean responses on three PHQ-9A items (p < .006, two-sided t-test) and only one GAD-10 item (p < .005, two-sided t-test). Ethnographic interviews revealed contexts associated with girls' experiences of depression and anxiety, including gender-based violence in both school and home environments. Salient for girls and boys alike were worries about consequences of COVID-19 for family with respect to illness, death, job loss, economic hardship. Fears over student perceptions of intensified discrimination and racism in school and community were prominent. These problems were experienced by students as barriers to educational engagement. CONCLUSION: Specific attention to early adolescence is needed to identify emergence of subsyndromal conditions which may benefit from therapeutic attention to reduce symptom severity, identify sociocultural, structural, and gender-specific stressors, and to enhance educational engagement.

Illness experience and reasons for nonadherence among individuals with bipolar disorder who are poorly adherent with medication.

AIM: Nonadherent individuals are the most likely to avoid participating in research studies, thus limiting potential opportunities to develop evidence-based approaches for adherence enhancement. This mixed-method analysis evaluated factors related to adherence among 20 poorly adherent community mental health clinic patients with bipolar disorder (BD). METHODS: Illness experience was evaluated with qualitative interview. Quantitative assessments measured symptoms (Hamilton Depression Rating Scale, Young Mania Rating Scale, Brief Psychiatric Rating Scale), adherence behavior, and treatment attitudes. Poor adherence was defined as missing 30% or more of medication. RESULTS: Minorities (80%), unmarried individuals (95%), and those with substance abuse (65%) predominated in this nonadherent group of patients with BD. Individuals were substantially depressed (mean Hamilton Depression Rating Scale, 19.2), had at least some manic symptoms (mean Young Mania Rating Scale, 13.6), and had moderate psychopathology (mean Brief Psychiatric Rating Scale, 41.2). Rates of missed medications were 41% to 43%. Forgetting to take medications was the top reason for nonadherence (55%), followed by side effects (20%). Disorganized home environments (30%), concern regarding having to take long-term medications (25%) or fear of side effects (25%), and insufficient information regarding BD (35%) were relatively common. Almost one third of patients had individuals in their core social network who specifically advised against medication. Access problems included difficulty paying for medications among more than half of patients. Interestingly, patients reported good relationships with their providers. CONCLUSIONS: Forgetting to take medication and problems with side effects are primary drivers of nonadherence. Lack of medication routines, unsupportive social networks, insufficient illness knowledge, and treatment access problems may likewise affect overall adherence. Complementary quantitative and qualitative data collection can identify reasons for nonadherence and may inform specific clinical approaches to enhance adherence.

Advancing Health Equity in Digital Mental Health: Lessons From Medical Anthropology for Global Mental Health.

Digital health engenders the opportunity to create new effective mental health care models-from substance use recovery to suicide prevention. Anthropological methodologies offer a unique opportunity for the field of global mental health to examine and incorporate contextual mental health needs through attention to the lived experience of illness; engagement with communities; and knowledge of context, structures, and systems. Attending to these diverse mental health needs and conditions as well as the limitations of digital health will allow global mental health researchers, practitioners, and patients to collaboratively create new models for care in the service of equitable, accessible recovery.

Gender differences in subjective experience and treatment of bipolar disorder.

Treatment nonadherence is a leading cause of poor outcomes among populations with bipolar disorder (BD) and is related to subjective experience of illness and treatment. This study examined gender differences in the experience of illness and treatment for those with BD, specifically in regards to treatment adherence. This cross-sectional analysis pooled data from 3 BD studies. A semistructured qualitative instrument, the Subjective Experience of Medication Interview, elicited information on subjective differences in treatment adherence between men and women. Men and women experience comparable levels of stigma and they comparably value lessened irritability and/or impulsivity because of medications. However, men and women differed in fear of weight gain because of medications, value of social support, and self-medication behaviors. Selected differences in subjective illness experience between men and women might be used to inform gender-sensitive approaches to enhance treatment adherence among populations with BD.

Loneliness, adolescence, and global mental health: Soledad and structural violence in Mexico.

In this article, we call into question recent public health claims that loneliness is a problem of epidemic proportions. Current research on this topic is hindered by an overreliance on limited survey data and by paradigmatic imbalance that delineates the study of loneliness to psychological, cognitive, neuroendocrinological and immunological effects, social functioning, physical health, mortality, and gene effects. The article emphasizes that scientific approaches to the phenomena of loneliness are more appropriately conceived and investigated as inherently matters for social, relational, cultural, and contextual analysis of subjective experience. Studies of loneliness and possible relationships to mental health status require investigations of social, environmental, and institutional structures as well as families, peers, friends, counselors, and health providers. This article takes a step in this direction through examining the lived experience of 35 high school students and their families living under conditions of social adversity in Tijuana, B.C., Mexico, with attention to anxiety and depression. Utilizing ethnographic interviews, observations, and psychological screening tools, we provide an overview for the group and illustrate the interrelations of subjective experience and social environment through a case study. These data reveal the vital role of understandings of loneliness, depression, and anxiety from the perspectives of adolescents themselves. We conclude that future studies of loneliness are best informed by in-depth data on subjective experience in relation to social features to advance understandings within the field of global mental health and allied fields.

"Somebody Is Gonna Be Hurt": Involuntary Drug Treatment in Mexico.

Involuntary drug treatment (IDT) is ineffective in decreasing drug use, yet it is a common practice. In Mexico, there are not enough professional residential drug treatment programs, and both voluntary and involuntary drug treatment is often provided by non-evidence based, non-professional programs. We studied the experiences of people who inject drugs (PWID) in Tijuana who were taken involuntarily to drug centers under the auspices of a federally funded police operation. We provide insight into how the health, wellbeing, human rights, dignity, and security of PWID ought to be at the center of international drug policies included in universal health care systems.

Awareness of stigma among persons with schizophrenia: marking the contexts of lived experience.

This article investigates the subjective experience of stigma attached to schizophrenia-related disorders. We examine data from anthropological interviews from a community sample of 90 out-patients residing in a metropolitan area of the United States. Patients were under treatment with atypical antipsychotic medication, and their symptoms were for the most part relatively well controlled. Overall, 96% of participants reported an awareness of stigma that permeated their daily life. Based on an understanding of stigma as a product of interpersonal, reciprocal social processes, we identify 6 types of social relations and 5 identity domains in which social stigma is routinely encountered by participants. We describe the experience of stigma in each of these 11 subcategories, and suggest that taken together they constitute a framework of social and personal factors involved in the struggle to recover from psychotic illness. Among types of social relations, anonymous social interactions most commonly generated an awareness of stigma. Among identity domains, being a person who regularly takes medication was most commonly associated with an awareness of stigma. The finding that multiple forms of stigma are encountered irrespective of substantial symptomatic, functional, and subjectively perceived improvement creates a complex situation of stigma despite recovery.

The range of symptoms in refugees of war: the New Mexico Refugee Symptom Checklist-121.

The range of symptoms experienced by refugees of war has not been empirically assessed. The New Mexico Refugee Symptom Checklist-121 (NMRSCL-121) was developed utilizing established guidelines and evaluated for its psychometric properties. Community-dwelling Kurdish and Vietnamese refugees reported 48 (SD = 31) persistent and bothersome somatic and psychological symptoms on the NMRSCL-121. Internal consistency and test-retest reliability for the total scale and for most subscales were acceptable, and construct and concurrent validity for the NMRSCL-121 data was shown. There were modest ethnic group differences on symptom severity and psychometric properties of NMRSCL-121 subscales. The NMRSCL-121 produces reliable and valid assessments of a wide range of symptoms in 2 broad community samples of displaced adult refugees.

Adolescent experience of psychotropic treatment.

Despite growing concern over the treatment of adolescents with psychiatric medications, little research has examined youth understandings and interpretations of mental illness and psychotropic treatment. This article reports the exploratory findings of semi-structured and open-ended interviews carried out with 20 adolescents diagnosed with one or more psychiatric disorders, and who were currently prescribed psychiatric medications. Grounded theory coding procedures were used to identify themes related to adolescent subjective experience with psychiatric medications. The categories identified are interpreted as different points of view through which adolescents understand and take action upon their illness concerns; their need for medication treatment; their perceptions of how medications work; their responses to parental and other influences upon medication treatment; and, their everyday management activities.

Personal and societal construction of illness among individuals with rapid-cycling bipolar disorder: a life-trajectory perspective.

OBJECTIVE: Bipolar disorder is a chronic mental illness associated with substantial impairment in quality of life and function. Although there has been tremendous growth in understanding bipolar disorder with respect to treatments, very little study has focused on the viewpoint of affected individuals. The purpose of this study was to examine the subjective experience of illness among 19 men and women with rapid cycling bipolar disorder receiving treatment at an academic psychiatry clinic. METHODS: Personal constructs of illness with respect to life-trajectory and societal reaction to the individual, specifically the issue of stigma, were evaluated using a semistructured, open-ended anthropological interview. RESULTS: Participants perceived bipolar disorder as a disease with biologic underpinnings. Stigma was a major issue for all individuals. In common with individuals without serious mental illness, individuals with bipolar disorder work at mastering developmental tasks appropriate for their life stage. At times, younger individuals appeared to have difficulty separating their own identity from the effects of illness. For older individuals with bipolar disorder, life was perceived to be disrupted by bipolar disorder, with early plans and dreams often "derailed." CONCLUSION: Although bipolar disorder may severely alter an individual's planned life trajectory, accomplishment of life goals can at least partially offset the sense of loss that is often seen in bipolar illness.

Stigma despite recovery: strategies for living in the aftermath of psychosis.

In this article, we identify an array of creative strategies used by persons diagnosed with schizophrenia-related illness to deflect and resist social stigma, and address the lived experience of deploying these strategies in the intersubjective context of everyday life. The data are derived from anthropological interviews and ethnographic observations of ninety persons who received treatment at community mental health facilities in an urban North American locale. Nearly all were keenly aware of stigma that permeated their lives. Their predicament is contradictory: on the one hand, they have recovered relative to previous states of psychosis; on the other hand, their subjectivity is saturated by intense awareness of social stigma that seems intractable in relation to temporal or functional criteria. Ironically, these lives can be characterized as fraught with stigma despite recovery. The strategies generated to resist the impact of stigma highlight the fact that persons with these illnesses are often not only exceedingly socially aware but also strategically skilled in response to social assaults on their personhood and survival. We examine these strategies in terms of (1) the social characteristics of each afflicted person, (2) the situational characteristics of managing stigma, (3) the cultural context of recovery, and (4) the illness-specific characteristics of schizophrenia.

Toward specifying the nature of the relationship between expressed emotion and schizophrenic relapse: the utility of curvilinear models.

Although expressed emotion (EE) has been demonstrated to be associated with the course of schizophrenia, the nature of this relationship is unclear. This study proposes that testing for curvilinear relationships can identify the specific nature of the relationships between EE indices and relapse. The utility of curvilinear models was explored through a reanalysis of data from a prior study of EE among Mexican-Americans (Karno et al., 1987). The results suggest that the relationship between the EE index of emotional overinvolvement (EOI) and relapse is curvilinear and that high levels of EOI may exert a toxic effect on course of illness whereas medium levels of EOI may be protective. The relationship between the EE index of warmth and relapse is also curvilinear and high levels of warmth appear to exert a protective effect on the course of illness. The role of culture is explored in explaining the specific manner in which EE relates to relapse among Mexican-Americans.

Research issues for improving treatment of U.S. Hispanics with persistent mental disorders.

This article reports on the outcome of an expert consensus meeting in August 2005 sponsored by the National Institute of Mental Health, which assembled 15 senior researchers with a background in treatment and services research with the Hispanic population. The purpose of the workshop was to identify research issues most pertinent for improving quality and effectiveness of treatment for Hispanics experiencing persistent mental disorders, defined as psychiatric syndromes that are of sufficient severity and duration to cause long-term impairment in social and occupational functioning and significant disability. The spectrum of ideas and recommendations advanced at the one-day meeting was wide and overlapping; therefore, the rich body of material was subsequently organized into five topics: diagnosis, quality of care and culturally appropriate services, psychosocial intervention development, psychopharmacologic interventions, and access to care. Although the authors recognize that the review was broad and the agenda presented is ambitious and in many instances generalizes to priority areas in overall mental health services and treatment research, the recommendations are intended to stimulate research for addressing the unique problems and research deficits that affect Hispanics with persistent mental disorders.

Gender identity and implications for recovery among men and women with schizophrenia.

The concept of gender considers masculinity and femininity as a cultural construct that varies along a continuum. Subjectively perceived, gender may affect the experience of illness among persons with schizophrenia and may have an impact on treatment and recovery. This study evaluated gender identity, according to the Bem Sex Role Inventory, among 90 men and women with schizophrenia and schizoaffective disorders. The findings indicate that persons with schizophrenia experience their gender identity in ways that vary from culturally normative standards. Both men and women scored lower on traditional masculine descriptive measures compared with persons without schizophrenia. This finding has important implications for recovery.

Subjective experience of recovery from schizophrenia-related disorders and atypical antipsychotics.

AIMS: This article investigates the subjective experience of the process of improvement and recovery from the point of view of persons diagnosed (according to research diagnostic criteria) with schizophrenia and schizo-affective disorders. METHODS: A community study of persons using psychiatric services was conducted for a sample of ninety subjects taking atypical antipsychotic medications. Sociodemographic data and clinical ratings were collected to complement the qualitatively developed Subjective Experience of Medication Interview (SEMI), which elicits narrative data on everyday activities, medication and treatment, management of symptoms, expectations concerning recovery, stigma, and quality of life. RESULTS: Recovery was observed through: (1) relatively low ratings of psychiatrically observed symptomatology through BPRS scores; (2) the subjective sense among the majority (77.4%) of participants that taking medication plays a critical role in managing symptoms and avoiding hospitalization; and (3) the subjective sense articulated by the vast majority (80%) that they would recover from their illness and that the quality of their lives would improve (70.6%). CONCLUSION: The overall quality of improvement and recovery is best characterized as an incremental, yet definitively discernable, subjective process.

The experience of schizophrenia: what's gender got to do with it? A critical review of the current status of research on schizophrenia.

The role of gender in schizophrenia is explored, and literature on gender and schizophrenia is critically reviewed. The importance of investigating gender differences in schizophrenia is underscored by the lack of sufficient research in this area to date and the comparative neglect of sociocultural issues during the "decade of the brain." The importance of incorporating gender factors into research analysis is demonstrated via an interdisciplinary discussion that involves psychiatric, anthropological, and sociological theory. Methodological and measurement issues in gender-based research are considered. Selected directions for future research initiatives that expand beyond a dichotomous comparison of "male" and "female" sex differences to examine the role of gender along a continuum as a sociocultural influence on schizophrenia onset, illness presentation, and treatment are presented.