The Mental Health of Young Return Migrants with Ancestral Roots in Their Destination Country: A Cross-Sectional Study Focusing on the Ethnic Identities of Japanese-Brazilian High School Students Living in Japan.

BACKGROUND: The number of young Japanese Brazilians, who are return migrants with Japanese ancestral roots, is increasing rapidly in Japan. However, the characteristics of their mental health and the relation between mental health and a complex ethnic identity remains unclear. METHODS: This cross-sectional study compared 25 Japanese-Brazilian high school students with 62 Japanese high school students living in the same area. Research using self-report questionnaires on mental health, help-seeking behavior tendencies, and ethnic identity was conducted. The Japanese-Brazilian group was also divided into high and low ethnic identity groups, and their mental health conditions were compared. RESULTS: The Japanese-Brazilian group had significantly poorer mental health conditions and lower ethnic identities than the Japanese group and were less likely to seek help from family members and close relatives. Among the Japanese Brazilians, those with low ethnic identity had significantly poorer mental health than those with high ethnic identity. CONCLUSIONS: Young Japanese Brazilians may face conflicts of ethnic identity that can disturb their mental health. To build an inclusive society, the establishment of community services to support mental health and to help return migrants develop their ethnic identity is essential.

Mental health outcomes in Syrian refugees: A systematic review.

BACKGROUND: Syria is the main country of origin for refugees in the world. The prevalence of mental disorders in this population is high, but there is a lack of more comprehensive data on mental health issues in this population. AIM: This study aims to review the literature for mental health outcomes in Syrian refugees. METHODS: We performed a systematic quantitative literature review of original observational studies indexed on the MEDLINE via PubMed, Embase, Web of Science, PsycINFO, LILACS, and SciELO databases with quantitative data reporting mental health outcomes in Syrian refugees. A descriptive analysis was conducted, and the quality of the included studies was assessed using an adaptation from The National Institutes of Health (NIH) quality assessment tool for observational studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS: A total of 64 studies were included. The majority were published between 2019 and 2020, and focused on the prevalence of post-traumatic stress disorder (PTSD), depression, and anxiety, with a wide range of variations. Other outcomes were difficulties in the post-migration period and promotive factors for mental health, such as resilience, positive coping strategies, and psychosocial well-being. CONCLUSIONS: High prevalence rates of mental disorders were observed, as well as risk factors for their occurrence. Studies showed a very high variability of prevalence rates and heterogeneity in methodologies. There is a need for research focusing on other determinants and specific necessities for mental health, especially in the post-resettlement period.

Ethnoepidemiology and mental health: insights from Latin America.

In this essay, I explore methodological as well as theoretical implications of an ethno-epidemiological approach, aiming to integrate research findings in mental health into new conceptual models. With this objective, I first evaluate the roots and uses of the term "ethnoepidemiology" to designate three research strategies for scientific knowledge production: type I (studies of sociocultural risk factors and ethnically defined risk groups); type II (studies of lay models of distribution and occurrence of illness in populations); type III (ethnographic studies of projects and areas of epidemiologic research). As an illustration, selected methodological features of three studies in which I have participated are presented and discussed. I then elaborate upon methodological developments derived from this experience of doing research, generating new models for transcultural transdisciplinary research of mental health practices. Lastly, I comment on some broad implications of studying mental health problems from an integrated ethnographical and epidemiological point of view, in diverse and deeply unequal societies such as those of contemporary Latin America.

En este ensayo, exploro las implicaciones teóricas y metodológicas de un abordaje etnoepidemiológico, que busca integrar hallazgos de investigaciones en salud mental con nuevos modelos conceptuales. Con este propósito, en primer lugar, evalúo las raíces y los usos del término "etnoepidemiología" para designar tres tipos de estrategias de investigación para la producción de conocimiento científico: tipo I (estudios de factores de riesgo socioculturales y grupos de riesgo definidos étnicamente); tipo II (estudios de modelos populares de distribución y ocurrencia de enfermedades en poblaciones); y tipo III (estudios etnográficos de proyectos y líneas de investigación epidemiológica). Como ejemplo, se presentan y discuten características metodológicas seleccionadas de tres estudios en los que he participado. Posteriormente detallo los desarrollos metodológicos derivados de esta experiencia de hacer investigación, generando nuevos modelos para la investigación transcultural y transdisciplinaria de las prácticas en salud mental y, por último, en las conclusiones, comento algunas implicaciones generales del estudio de los problemas de salud mental desde un punto de vista etnográfico y epidemiológico integrado, en sociedades diversas y profundamente desiguales, como las de la América Latina contemporánea.

Etnoepidemiología y salud mental: perspectivas desde América Latina / Ethnoepidemiology and mental health: insights from Latin America

RESUMEN En este ensayo, exploro las implicaciones teóricas y metodológicas de un abordaje etnoepidemiológico, que busca integrar hallazgos de investigaciones en salud mental con nuevos modelos conceptuales. Con este propósito, en primer lugar, evalúo las raíces y los usos del término "etnoepidemiología" para designar tres tipos de estrategias de investigación para la producción de conocimiento científico: tipo I (estudios de factores de riesgo socioculturales y grupos de riesgo definidos étnicamente); tipo II (estudios de modelos populares de distribución y ocurrencia de enfermedades en poblaciones); y tipo III (estudios etnográficos de proyectos y líneas de investigación epidemiológica). Como ejemplo, se presentan y discuten características metodológicas seleccionadas de tres estudios en los que he participado. Posteriormente detallo los desarrollos metodológicos derivados de esta experiencia de hacer investigación, generando nuevos modelos para la investigación transcultural y transdisciplinaria de las prácticas en salud mental y, por último, en las conclusiones, comento algunas implicaciones generales del estudio de los problemas de salud mental desde un punto de vista etnográfico y epidemiológico integrado, en sociedades diversas y profundamente desiguales, como las de la América Latina contemporánea.

ABSTRACT In this essay, I explore methodological as well as theoretical implications of an ethno-epidemiological approach, aiming to integrate research findings in mental health into new conceptual models. With this objective, I first evaluate the roots and uses of the term "ethnoepidemiology" to designate three research strategies for scientific knowledge production: type I (studies of sociocultural risk factors and ethnically defined risk groups); type II (studies of lay models of distribution and occurrence of illness in populations); type III (ethnographic studies of projects and areas of epidemiologic research). As an illustration, selected methodological features of three studies in which I have participated are presented and discussed. I then elaborate upon methodological developments derived from this experience of doing research, generating new models for transcultural transdisciplinary research of mental health practices. Lastly, I comment on some broad implications of studying mental health problems from an integrated ethnographical and epidemiological point of view, in diverse and deeply unequal societies such as those of contemporary Latin America.

A etnopsicanálise de Devereux no filme Jimmy P: uma introdução à clínica transcultural / El etnopsicoanálisis de Devereux en la película Jimmy P: una introducción a la clínica transcultural / The ethnopsychoanalysis of Devereux in the movie Jimmy P: an introduction to the transcultural clinic

RESUMO Georges Devereux (1908-1985) é conhecido como, juntamente com Géza Rohéim (1891-1953), um dos criadores da etnopsicanálise, disciplina que articula os saberes da Psicanálise e da Antropologia. Sua primeira grande obra foi Psychoterapie d'un indien des plaines, livro publicado em 1951 e que narra a análise de um indígena Blackfoot, ex-combatente da Segunda Guerra. O livro foi a base para a elaboração do filme Jimmy P., traduzido no Brasil como Terapia intensiva. O objetivo deste artigo é apresentar uma discussão introdutória a algumas das ideias de Devereux a partir de recortes do filme Jimmy P., dirigido por Arnaud Desplechin em 2013. Além disso, também buscamos as aproximações e inovações do autor em relação a Freud. Concluímos que, no que diz respeito às aproximações enquanto técnica e prática entre Devereux e Freud, observamos no filme que Devereux incorpora à sua técnica a prática da interpretação dos sonhos, a associação livre e faz referências à teoria freudiana durante o tratamento, como o complexo de Édipo e a transferência. A partir das intuições freudianas sobre a relação entre cultura e psiquismo, Devereux avança para a formulação de uma etnopsicanálise, resultado do reconhecimento do entrelaçamento inseparável de esquemas individuais e culturais. Se as proposições de Devereux fomentaram na França o desenvolvimento de uma prática clínica que considera as diferenças culturais de populações de imigrantes oriundas de diferentes países, mais promissoras ainda parecem ser as chances de florescimento de uma psicanálise transcultural num terreno fértil em diversidade étnica como o Brasil.

RESUMEN Georges Devereux (1908-1985) es conocido, juntamente con Géza Rohéim (1891-1953), como uno de los creadores del etnopsicoanálisis, asignatura que articula los saberes del Psicoanálisis y de la Antropología. Su primera gran obra fue Psychoterapie d'un indien des plaines, libro publicado en 1951 y que narra el análisis de un indígena Blackfoot, ex-combatiente de la Segunda Guerra. El libro fue la base para la elaboración de la película Jimmy P. y fue traducido en Brasil como Terapia intensiva. El objetivo de este artículo es presentar una discusión introductoria a algunas de las ideas de Devereux a partir de trechos de la película Jimmy P., dirigida por Arnaud Desplechin en 2013. Además, buscamos las aproximaciones e innovaciones del autor con relación a Freud. Concluimos que, en lo que dice respecto a la aproximación en cuanto a la técnica y práctica entre Devereux y Freud, observamos en la película que Devereux incorpora a su técnica la práctica de la interpretación de los sueños, la asociación libre y hace referencias a la teoría freudiana durante el tratamiento, como el complejo de Edipo y la transferencia. A partir de las intuiciones freudianas sobre la relación entre cultura y psique, Devereux avanza para la formulación de un etnopsicoanálisis, resultado del reconocimiento del entrelazamiento inseparable de esquemas individuales y culturales. Si las proposiciones de Devereux fomentaron en Francia el desarrollo de una práctica clínica que considera las diferencias culturales de poblaciones de inmigrantes oriundas de diferentes países, más promisoras aún parecen ser las probabilidades de florecimiento de un psicoanálisis transcultural en un terreno fértil en diversidad étnica como Brasil.

ABSTRACT Georges Devereux (1908-1985) is known for being, together with GézaRohéim (1891-1953), one of the creators of ethnopsychoanalysis, a subject that articulates the knowledge of Psychoanalysis and Anthropology. His first great work was Psychoterapie d'un indien des plaines, a book published in 1951 and that narrates the analysis of a Blackfoot American Indian, ex-combatant of the Second War. The book was the basis for the elaboration of the movie Jimmy P., translated in Brazil as Terapiaintensiva. The aim of this study was to present an introductory discussion to some of Devereux's ideas from clippings of the film Jimmy P., directed by Arnaud Desplechin in 2013. In addition, we also looked for the author's approaches and innovations in relation to Freud. We concluded that, in the matter of approaching as a technique and practice between Devereux and Freud, we observe in the movie that Devereux incorporates to his technique the practice of dream interpretation, free association, and makes references to Freud's theory during the treatment, as the Oedipus complex and transference. Starting from Freudian intuitions about the relation between culture and psyche, Devereux advances for the formulation of an ethnopsychoanalysis, a result of the recognition of the inseparable interweaving of individual and cultural schemes. If the propositions of Devereux promoted in France the development of a clinical practice that considers the cultural differences of populations of immigrants from different countries, more promising still appear to be the chances of a transcultural psychoanalysis flourishing in a fertile terrain in ethnic diversity such as Brazil.

A transcultural study of hoarding disorder: Insights from the United Kingdom, Spain, Japan, and Brazil.

Though problematic hoarding is believed to be a universal human behavior, investigations of clinically-defined hoarding disorder (HD) have been confined almost exclusively to Western countries. The current investigation sought to describe and directly compare the features of individuals meeting diagnostic criteria for HD across four distinct cultural settings. Participants were 82 individuals meeting DSM-5 diagnostic criteria for HD, recruited and assessed by trained clinicians at one of four project sites: London, Barcelona, Fukuoka, and Rio de Janeiro. A series of semi-structured interviews and self-report scales were administered, including assessments of socio-demographic characteristics, psychiatric comorbidity, and severity of hoarding and related features. Results indicate that the severity and core features of HD, as well as the cognitions and behaviors commonly associated with this condition, are largely stable across cultures. However, some differences in patient demographics-in particular age, marital status, and clinical expression-as well as comorbid psychiatric features also emerged. These findings confirm that HD, as defined in DSM-5, exists and presents with similar phenomenology across the studied cultures. Future, more fine-grained, research will be needed to study the features of the disorder in additional cultures (e.g., non-industrialized nations) and to evaluate the impact of these cultural aspects on the design of interventions for the disorder.

A cross-cultural clinical comparison between subjects with obsessive-compulsive disorder from the United States and Brazil.

Although OCD is a global problem, the literature comparing, in a direct and standardized way, the manifestations across countries is scarce. Therefore, questions remain as to whether some important clinical findings are replicable worldwide, especially in the developing world. The objective of this study was to perform a clinical comparison of OCD patients recruited in the United States (U.S.) and Brazil. Our sample consisted of 1187 adult, treatment-seeking OCD outpatients from the U.S. (n=236) and Brazil (n=951). With regards to the demographics, U.S. participants with OCD were older, more likely to identify as Caucasian, had achieved a higher educational level, and were less likely to be partnered when compared to Brazilians. Concerning the clinical variables, after controlling for demographics the two samples presented largely similar profiles. Brazilian participants with OCD, however, endorsed significantly greater rates of generalized anxiety disorder and post-traumatic stress disorder, whereas U.S. subjects were significantly more likely to endorse a lifetime history of addiction (alcohol-use and substance-use disorders). This is the largest direct cross-cultural comparison to date in the OCD field. Our results provide much needed insight regarding the development of culture-sensitive treatments.

Sleep Paralysis in Brazilian Folklore and Other Cultures: A Brief Review.

Sleep paralysis (SP) is a dissociative state that occurs mainly during awakening. SP is characterized by altered motor, perceptual, emotional and cognitive functions, such as inability to perform voluntary movements, visual hallucinations, feelings of chest pressure, delusions about a frightening presence and, in some cases, fear of impending death. Most people experience SP rarely, but typically when sleeping in supine position; however, SP is considered a disease (parasomnia) when recurrent and/or associated to emotional burden. Interestingly, throughout human history, different peoples interpreted SP under a supernatural view. For example, Canadian Eskimos attribute SP to spells of shamans, who hinder the ability to move, and provoke hallucinations of a shapeless presence. In the Japanese tradition, SP is due to a vengeful spirit who suffocates his enemies while sleeping. In Nigerian culture, a female demon attacks during dreaming and provokes paralysis. A modern manifestation of SP is the report of "alien abductions", experienced as inability to move during awakening associated with visual hallucinations of aliens. In all, SP is a significant example of how a specific biological phenomenon can be interpreted and shaped by different cultural contexts. In order to further explore the ethnopsychology of SP, in this review we present the "Pisadeira", a character of Brazilian folklore originated in the country's Southeast, but also found in other regions with variant names. Pisadeira is described as a crone with long fingernails who lurks on roofs at night and tramples on the chest of those who sleep on a full stomach with the belly up. This legend is mentioned in many anthropological accounts; however, we found no comprehensive reference on the Pisadeira from the perspective of sleep science. Here, we aim to fill this gap. We first review the neuropsychological aspects of SP, and then present the folk tale of the Pisadeira. Finally, we summarize the many historical and artistic manifestations of SP in different cultures, emphasizing the similarities and differences with the Pisadeira.

Traditional healing practices originating in Aruba, Bonaire, and Curaçao: A review of the literature on psychiatry and Brua.

Brua is an Afro-Caribbean religion and healing tradition from the southern part of the former Netherlands Antilles. Like other Caribbean healing traditions, it plays a significant role in shaping how individuals experience and express disorders which Western health professionals consider to require psychiatric care. Because little has been published on Brua, and because patients from Aruba, Bonaire, and Curaçao are often reluctant to discuss their commitment to this tradition, they are often misdiagnosed and either over- or undertreated by biomedically trained health professionals. The present paper provides a review of the literature on Brua and its relation to psychiatry. A systematic search was carried out in PubMed, the Ovid database, Google Scholar, and the historical literature. Our search yielded 35 texts on Brua, including three peer-reviewed scientific papers and eight academic theses. From those texts Brua emerges as a holistic patchwork of creolized beliefs and practices which are considered to be both cause and remedy for a wide variety of ailments. Despite the fact that tension between the Brua discourse and Western-oriented psychiatric practice is significant, adherence to Brua does not seem to cause much patient delay in help-seeking. However, belief in Brua as a possible source of mental and physical complaints, as well as patients' frequent recourse to Brua practices, including the use of hallucinogens, may affect the diagnosis and treatment of mental disorders.

Understanding psychopathology in migrants: a mixed categorical-dimensional approach.

BACKGROUND: Literature on mental disorders in migrants is constantly increasing. Only a few studies describe psychopathological dimensions in migrants over their nosographic diagnoses; however, there is a growing literature about the greater utility of a categorical-dimensional approach, rather than a solely categorical approach, in the understanding of mental disorders. The aim of this paper is to describe the phenomenology of mental disorders in migrants referred to the Transcultural Psychiatric Team of Bologna (BoTPT), by analysing the psychopathological dimensions that underlie their clinical diagnoses. METHODS: We recruited all migrants who attended the BoTPT between May 1999 and July 2009. The psychopathological assessment was conducted with the Association for Methodology and Documentation in Psychiatry (AMDP) and clinical diagnoses were formulated according to ICD-10. We proceeded through a two-step analysis: (1) comparing the prevalence rates of psychopathological symptoms across diagnoses; then (2) conducting a factor analysis to assess how those symptoms configure psychopathological dimensions and how these dimensions underlie clinical diagnoses. RESULTS: As expected, we found significant associations between diagnoses and the prevalence of their core psychopathological symptoms. Factor analysis revealed a strong polymorphism of the psychopathological presentation of mental disorders and unexpectedly showed that in each diagnostic cluster, the first extracted factor was not composed of core symptoms. CONCLUSIONS: A mixed categorical-dimensional approach seems to improve the description of the psychopathology among migrants, as it adds relevant information regarding psychopathological dimensions useful to the understanding of the peculiar clinical expressivity of our patients.

El ritual y la locura: psiquiatría y cultura en Colombia / The Ritual and the madness: psychiatry and culture in Colombia

Este artículo explora, desde la antropología médica, el papel del ritual en la enfermedad mental. En él se plantea un debate entre el paradigma biomédico de la enfermedad mental, en donde se privilegia la palabra médica, y un paradigma aquí denominado "híbrido", en donde se privilegia la palabra del enfermo. Este último es híbrido en cuanto permite la combinación de elementos de la racionalidad científica, con una expresión conceptual y una vivencia emocional de la "locura" que apela a la magia y al ritual según lógicas culturales peculiares de la población colombiana. Esta es una polémica de insoslayable importancia en la práctica cotidiana de la clínica psiquiátrica e Colombia. Para una mejor comprensión de sus dimensiones, se revisan teorías relativas al surgimiento de la racionalidad científica y a la consolidación de la modernidad occidental. El punto de vista defendido es que la ciencia no es un buen árbitro entre la creencia y el conocimiento. Además, que una visión épica de la modernidad como un proceso inflexible de corrección y sustitución de las superticiones y los errores premodernos, bien puede ser infundada y ella misma errónea. De tal manera, no se propone que se deseche el conocimiento científico en el tratamiento de la "locura" sino a que lo ritual ocupe la dimensión que le corresponde para una comprensión holística de la enfermedad...

This article explores, from a medical anthropological perspective, the role of ritual in mental illness. Thus, a debate is stated between the biomedical paradigm of mental diseases, in which medical discourse is emphasized, and a paradigm which is here called "hybrid", and where the patient´s discourse is privileged. The latter is a hybrid paradigm in so far as it combines some elements of scientific rationality, with an emotional and conceptual illness narrative which makes use of magical and ritual elements peculiar to a particular cultural logic characteristic of this country´s population...