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2.
PLoS One ; 15(6): e0233418, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32574218

RESUMEN

Common mental disorders (CMD) among mothers cause disability, negatively affect child development, and have high long-term economic costs. Little is known about how factors across multiple life dimensions, modeled together, are differentially related to maternal mental health in high poverty contexts. Further, there is limited evidence on determinants of CMD in areas where self-help groups (SHGs) exist to promote women's wellbeing. Filling this evidence gap is important given the high prevalence of CMD and the rapid expansion of SHGs in rural India. Cross-sectional data were collected from 1644 mother-infant pairs living in disadvantaged rural villages across five Indian states-Jharkhand, Madhya Pradesh, West Bengal, Odisha, and Chhattisgarh-surveyed in the Women Improving Nutrition through Group-based Strategies study. CMD were assessed using the 20-item Self Reporting Questionnaire (SRQ). We examined 31 factors across four life dimensions: work (work type, time spent in labor, domestic and caretaking activities), agency (SHG membership, decision-making, gender attitudes), health/nutrition (underweight, fertility, diet diversity, child illness), and household/environment (dependency ratio, wealth, food security, shocks, water, sanitation). Survey-adjusted multivariate logistic and ordinary least squares regression models were fit to examine predictors of CMD or SRQ score. On average, mothers were 26 (range 18-46) years old and their children were 15 (range 6-24) months old. CMD defined as ≥ 8 positive SRQ responses were reported by 262 women (16%). Protective factors included being engaged in agricultural labor as a main occupation relative to being a housewife (AOR 0.18, 95% CI 0.10-0.32), more time working (0.85, 0.77-0.93), higher decision-making (0.33, 0.16-0.69), SHG membership (0.73, 0.56-0.96), and having an improved toilet (0.49, 0.33-0.72). Risk factors included food insecurity (1.13, 1.07-1.20) and shocks to non-farm livelihoods (2.04, 1.10-3.78). Practitioners and policymakers should aim to improve food security, economic wellbeing and social capital, such as that created through SHG membership, to improve maternal mental health. Future research should aim to understand why working outside the home, albeit in agricultural work, appears to protect maternal mental health in this context.


Asunto(s)
Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Madres/psicología , Adulto , Estudios Transversales/métodos , Dieta Saludable/psicología , Femenino , Abastecimiento de Alimentos , Humanos , Trastornos Mentales/metabolismo , Salud Mental/etnología , Persona de Mediana Edad , Estado Nutricional/etnología , Pobreza , Factores de Riesgo , Salud Rural/etnología , Población Rural , Grupos de Autoayuda , Poblaciones Vulnerables/etnología
4.
PLoS One ; 15(6): e0233681, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32579560

RESUMEN

BACKGROUND: There is unreliable, and negligible information on the mental health and trauma-exposure of asylum-seekers and displaced refugees in the Iraqi Kurdistan region. OBJECTIVES: To evaluate how responsible the ethno-religious origins are, for the prevalence of trauma exposure and post-traumatic stress disorder (PTSD) in displaced Iraqi asylum-seekers and refugees residing in the Iraqi Kurdistan region. METHODS: Structured interviews with a cross-sectional sample of 150 individuals, comprised of three self-identified ethno-religious groups (50 participants in each): Christians, Muslims, and Yazidis. RESULTS: 100% prevalence of trauma exposure and 48.7% of current PTSD among refugees, 70% PTSD rate of Yazidi participants, which is significantly higher (p < 0.01) compared to 44% of Muslim participants and 32% of Christian participants. These findings were corroborated using the self-rated PTSD, DSM-5 Checklist, with more severe PTSD symptom scores (p < 0.001) obtained among Yazidis (43.1; 19.7), compared to Muslims (31.3; 20.1) and Christians (29.3; 17.8). Self-rated depressive symptoms (Patient Health Questionnaire-9) were also higher (p < 0.007) among Yazidis (12.3; 8.2) and Muslims (11.7; 5.9), compared to Christians (8.1; 7).


Asunto(s)
Depresión/epidemiología , Salud Mental/etnología , Refugiados/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Adolescente , Adulto , Anciano , Cristianismo/psicología , Estudios Transversales , Depresión/psicología , Femenino , Humanos , Pueblos Indígenas/psicología , Pueblos Indígenas/estadística & datos numéricos , Irak/epidemiología , Islamismo/psicología , Masculino , Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Prevalencia , Refugiados/psicología , Autoinforme/estadística & datos numéricos , Trastornos por Estrés Postraumático/psicología , Adulto Joven
5.
Psychiatry Res ; 289: 113094, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32405114

RESUMEN

Background: : In Latin America there are about 45 million indigenous people in 826 communities that represent 8.3% of the population. An estimated 798,365 Aboriginal and Torres Strait Islander were in Australia, 5,2 million indigenous people living in America and 2,13 million in Canada. Racial/ethnic disparities in mental health service use have increased especially in the context of the new coronavirus pandemic. Thus, we aimed to describe the mental health situation of the indigenous population in the context of the COVID-19 pandemic. Method: : The studies were identified in well-known international journals found in three electronic databases: PubMed, Scopus, and MEDLINE. The data were cross-checked with information from the main international newspapers. Results: : According to the literature, due to the COVID-19 pandemic there is a lack of specialized mental health services and professionals, a restricted access to quality information and a lack of access to inputs, causing negative feelings and it can exacerbate pre-existing mental problems (eg: depression, suicidal ideation, smoking and binge drink). The cultural differences are a risk factor to worsen the mental health of this already vulnerable population. Conclusion: : providing psychological first aid is an essential care component for indigenous populations that have been victims COVID-19 pandemic.


Asunto(s)
Infecciones por Coronavirus/psicología , Disparidades en Atención de Salud , Pueblos Indígenas/psicología , Trastornos Mentales/etnología , Salud Mental/etnología , Neumonía Viral/psicología , Grupo de Ascendencia Continental Nativa Americana/psicología , Australia/epidemiología , Betacoronavirus , Infecciones por Coronavirus/etnología , Brotes de Enfermedades , Femenino , Disparidades en el Estado de Salud , Derechos Humanos/psicología , Humanos , Masculino , Trastornos Mentales/epidemiología , América del Norte/epidemiología , Grupo de Ascendencia Oceánica/psicología , Pandemias , Neumonía Viral/etnología , Factores de Riesgo
7.
Recurso de Internet en Inglés, Español, Francés, Portugués, Arabe, Ruso, Chino | LIS - Localizador de Información en Salud | ID: lis-47088

RESUMEN

Organização Mundial da Saúde apresenta dicas para enfrentar consequências psicológicas e mentais do novo coronavírus; doença está gerando estresse na população afetada pelo risco de contaminação, incerteza, isolamento social e desemprego entre outros motivos; guia contempla profissionais de saúde, crianças e idosos, líderes de equipes e pessoas em quarentena.


Asunto(s)
Salud Mental/etnología , Pandemias/prevención & control , Brotes de Enfermedades/prevención & control , Coronavirus , Estrés Psicológico/etiología , Estrés Psicológico/prevención & control , Aislamiento Social/psicología
8.
Prog Cardiovasc Dis ; 63(2): 101-108, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32109483

RESUMEN

Cardiovascular disease (CVD) is an increasingly important cause of morbidity and mortality among people living with HIV (PLWH) now that HIV is a manageable chronic disease. Identification and treatment of comorbid medical conditions for PLWH, including CVD and its risk factors, typically lack a critical component of care: integrated care for histories of trauma. Experiences of trauma are associated with increased HIV infection, CVD risk, inconsistent treatment adherence, and poor CVD outcomes. To address this deficit among those at greatest risk and disproportionately affected by HIV and trauma-i.e., Black and Latinx individuals-a novel culturally-congruent, evidence-informed care model, "Healing our Hearts, Minds and Bodies" (HHMB), has been designed to address patients' trauma histories and barriers to care, and to prepare patients to engage in CVD risk reduction. Further, in recognition of the need to ensure that PLWH receive guideline-concordant cardiovascular care, implementation strategies have been identified that prepare providers and clinics to address CVD risk among their Black and Latinx PLWH. The focus of this paper is to describe the hybrid Type 2 effectiveness/implementation study design, the goal of which is to increase both patient and organizational readiness to address trauma and CVD risk among 260 Black and Latinx PLWH recruited from two HIV service organizations in Southern California. This study is expected to produce important information regarding the value of the HHMB intervention and implementation processes and strategies designed for use in implementing HHMB and other evidence-informed programs in diverse, resource-constrained treatment settings, including those that serve patients living in deep poverty. Clinical trials registry: NCT04025463.


Asunto(s)
Afroamericanos/psicología , Fármacos Anti-VIH/uso terapéutico , Enfermedades Cardiovasculares/prevención & control , Asistencia Sanitaria Culturalmente Competente/organización & administración , Infecciones por VIH/tratamiento farmacológico , Sobrevivientes de VIH a Largo Plazo/psicología , Conocimientos, Actitudes y Práctica en Salud/etnología , Hispanoamericanos/psicología , Salud Mental/etnología , Aceptación de la Atención de Salud/etnología , Servicios Preventivos de Salud/organización & administración , Adolescente , Adulto , Anciano , Fármacos Anti-VIH/efectos adversos , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/etnología , Enfermedades Cardiovasculares/psicología , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/etnología , Infecciones por VIH/psicología , Estado de Salud , Humanos , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Modelos Organizacionales , Factores Protectores , Factores Raciales , Proyectos de Investigación , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Carga Viral , Adulto Joven
9.
J Relig Health ; 59(1): 431-451, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31828596

RESUMEN

Religion, a prominent factor among Black diasporic communities, influences their health outcomes. Given the increase in Black Caribbeans living in the United States, it is important to understand how religion's function among different ethnic groups of Black Americans. We systematically reviewed four databases and included articles of any study design if they (a) focused on the religious experiences of emerging adults (18-29 years) identifying as Black Caribbean in the United States, in light of medical, public health, or mental health outcomes, and (b) were published before November 30, 2018. Study results contribute to future studies' conceptualization and measurement of religion among Black Caribbean emerging adults.


Asunto(s)
Grupo de Ascendencia Continental Africana , Estado de Salud , Religión , Espiritualidad , Adulto , Afroamericanos , Región del Caribe/etnología , Emigración e Inmigración , Femenino , Humanos , Masculino , Salud Mental/etnología , Estados Unidos
10.
Anthropol Med ; 27(1): 32-48, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30714836

RESUMEN

The individual and social construction of psychological distress is fundamental to help-seeking and the extent to which interventions are seen as credible. Where pluralistic attributions for mental health problems predominate, the development of global mental health (GMH) interventions in the form of task-shifting approaches create increased access to new ways of understanding and responding to distress. However, little is known about how participants in these initiatives manage these encounters. This qualitative study in Malawi explored village-based health workers' (HSAs) and patients' and carers' views of the causes of distress and how these beliefs influenced help-seeking and the health workers' response.Eight HSAs and nine paired patients/carers were interviewed separately to enable each of nine experiences of distress to be explored. Findings revealed a complex set of personal, social and cultural influences that informed causative attributions and help-seeking decisions. Patients/carers viewed psychosocial stresses as compelling explanations and readily reported others attributing their distress to supernatural causes (bewitchment). Yet attributional beliefs alone were not the only influence over help-seeking, which evolved pragmatically in response to the impact of treatments and social pressure for conformity. In turn HSAs navigated the interactions with patients/carers by emphasising the biomedical approach and discrediting bewitchment attributions. This caused tensions when biomedical interventions were unhelpful or the traditional healers' approach proved beneficial.Conclusions add to the call for such task-shifting approaches to work with communities to discern authentic and practical responses to mental distress that mirror the 'pluralism and pragmatism' found in the communities they serve.


Asunto(s)
Agentes Comunitarios de Salud/psicología , Conocimientos, Actitudes y Práctica en Salud/etnología , Trastornos Mentales/etnología , Aceptación de la Atención de Salud/etnología , Adolescente , Adulto , Antropología Médica , Femenino , Humanos , Malaui , Masculino , Medicina Tradicional Africana , Salud Mental/etnología , Adulto Joven
11.
Am J Public Health ; 110(1): 112-118, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31725330

RESUMEN

Objectives. To examine if exposure to victimization (e.g., homicide, violence, sexual assault, arson, kidnapping) is related to health problems, health care access and barriers, and health needs-beyond the effects of female genital mutilation or cutting (FGM/C)-among Somali women and adolescent girls.Methods. We collected original survey data in 2017 from 879 female Somalis in Arizona.Results. Compared with nonvictims, victims experienced significantly more health problems, were significantly less likely to have a designated place to receive health care, and identified significantly more health care needs and barriers to health care. Victims were 4 times more likely to experience depression or trauma and more than twice as likely to experience sexual intercourse problems, pregnancy problems, and gynecological problems. Among Somalis with FGM/C, victims had a 15% higher predicted probability of pregnancy-related health problems and a 19% higher predicted probability of gynecological health problems compared with nonvictimized Somalis with FGM/C.Conclusions. Somalis exposed to victimization have more health problems, needs, and health care barriers.Public Health Implications. Although more than 98% of Somali women and adolescent girls have undergone FGM/C, crime victimization affects health more than FGM/C alone.


Asunto(s)
Circuncisión Femenina/etnología , Víctimas de Crimen/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Estado de Salud , Violencia/etnología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Salud Mental/etnología , Persona de Mediana Edad , Aceptación de la Atención de Salud/etnología , Somalia/etnología , Estados Unidos/epidemiología , Heridas y Traumatismos/etnología , Adulto Joven
12.
Artículo en Inglés | MEDLINE | ID: mdl-31817874

RESUMEN

The Social Emotional Health Survey-Secondary (SEHS-S), which is a measure of core psychological assets based on a higher-order model of Covitality, is comprised of 36 items and four latent traits (with three measured subscales): belief in self (self-efficacy, self-awareness, and persistence), belief in others (school support, family coherence, and peer support), emotional competence (emotional regulation, behavioral self-control, and empathy), and engaged living (gratitude, zest, and optimism). Previous international studies have supported the psychometric properties of the SEHS-S. The present study extended this research by examining the psychometric properties of a Spanish-language adaptation with a sample of 1042 Spanish adolescents (Mage = 14.49, SD = 1.65.). Confirmatory factor analyses replicated the original factorial structure, with hierarchical omega between 0.66-0.93, with 0.94 for the total score. Factorial invariance across genders revealed small latent mean differences. A path model evaluated concurrent validity, which revealed a significant association between Covitality and bidimensional mental health (psychological distress and well-being). Specifically, correlational analyses showed a negative association with internalizing/externalizing symptoms, and positive associations with subjective well-being, health-related quality of life, and prosocial behaviors. This study provides an example of a culturally relevant adaptation of an international tool to measure student strengths, which is critical to planning school programming and policy.


Asunto(s)
Hispanoamericanos/psicología , Lenguaje , Salud Mental/etnología , Encuestas y Cuestionarios/normas , Adolescente , Emociones , Empatía , Análisis Factorial , Relaciones Familiares , Femenino , Humanos , Masculino , Optimismo , Grupo Paritario , Psicometría , Calidad de Vida , Reproducibilidad de los Resultados , Autoeficacia , Factores Socioeconómicos
13.
Artículo en Inglés | MEDLINE | ID: mdl-31846237

RESUMEN

Objective: Religion is said to play a strong role in the attitude toward health and disease in Arab and Muslim countries. To what extent this is also true of Arabs and Muslims living in the United States is unknown. The objective of this pilot study was to determine the influence of religious beliefs on the attitudes of Arab-American Muslims toward mental illness, especially depression. Methods: The Depression Awareness Questionnaire (DAQ) was administered to a group of Arab-American Muslims, aged > 18 years, attending a psychoeducational seminar in Dearborn, Michigan, from October 2017 to October 2018. Results: Seventy-five respondents (27 men and 48 women) completed the DAQ. Although 64 (85.3%) respondents believed that depression is a medical illness and 59 (78.7%) believed that depressed patients will get better with treatment, 24 (32.0%) believed that antidepressant medications will lead to addiction. Also, 26 (34.7%) respondents reported that black magic or the evil eye could cause depression and 28 (37.3%) believed that being close to God prevented depression. Conclusions: Although this group of Arab-American Muslims understood the gravity of depression and the importance of treatment, their religious beliefs played a strong role in their approach to mental health.


Asunto(s)
Árabes/psicología , Actitud Frente a la Salud/etnología , Depresión/etnología , Islamismo/psicología , Aculturación , Depresión/psicología , Trastorno Depresivo/etnología , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Salud Mental/etnología , Proyectos Piloto , Encuestas y Cuestionarios , Estados Unidos/etnología
14.
BMC Public Health ; 19(1): 1521, 2019 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-31727039

RESUMEN

BACKGROUND: Improving the rates of, and instruments used in, screening for perinatal depression and anxiety among Aboriginal and Torres Strait Islander women are important public health priorities. The Kimberley Mum's Mood Scale (KMMS) was developed and later validated as an effective and acceptable perinatal depression and anxiety screening tool for the Kimberley region under research conditions. Other regions have expressed interest in using the KMMS with perinatal Aboriginal and Torres Strait Islander women. It is, however, important to re-evaluate the KMMS in a larger Kimberley sample via a real world implementation study, and to test for applicability in other remote and regional environments before recommendations for wider use can be made. This paper outlines the protocol for evaluating the process of implementation and establishing the 'real world' validity and acceptability of the KMMS in the Kimberley, Pilbara and Far North Queensland in northern Australia. METHODS: The study will use a range of quantitative and qualitative methods across all sites. KMMS validation/revalidation internal consistency of Part 1 will be determined using Cronbach's alpha. Equivalence for identifying risk of depression and anxiety compared to a standard reference assessment will be determined from receiver operating characteristic curves. Sensitivity and specificity will be determined based on these cut-points. Qualitative methods of phenomenology will be used to explore concepts of KMMS user acceptability (women and health professionals). Additional process evaluation methods will collate, assess and report on KMMS quality review data, consultations with health service administrators and management, field notes, and other documentation from the research team. This information will be reported on using the Dynamic Sustainability Framework. DISCUSSION: This project is contributing to the important public health priority of screening Aboriginal and Torres Strait Islander women for perinatal depression and anxiety with tools that are meaningful and responsive to cultural and clinical needs. Identifying and addressing barriers to implementation contributes to our understanding of the complexity of improving routine clinical practie. TRIAL REGISTRATION: The study was registered retrospectively on 15/05/2019 with the Australian and New Zealand Clinical Trial registry (ACTRN12619000580178).


Asunto(s)
Afecto , Ansiedad/diagnóstico , Depresión/diagnóstico , Tamizaje Masivo/métodos , Salud Mental/etnología , Grupo de Ascendencia Oceánica/psicología , Atención Perinatal/métodos , Adolescente , Adulto , Ansiedad/etnología , Depresión/etnología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/etnología , Femenino , Humanos , Lactante , Recién Nacido , Islas , Tamizaje Masivo/normas , Madres/psicología , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/etnología , Mujeres Embarazadas/etnología , Mujeres Embarazadas/psicología , Psicometría , Queensland , Proyectos de Investigación , Estudios Retrospectivos , Adulto Joven
15.
Med Care ; 57(12): 960-967, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31730568

RESUMEN

OBJECTIVES: Our objectives were to assess rates of perceived stigma in health care (clinical) settings reported by racially diverse New York City residents and to examine if this perceived stigma is associated with poorer physical and mental health outcomes. METHODS: We analyzed data from the 2016 New York City Community Health Survey. We applied bivariable and multivariable methods to assess rates of perceived stigma, and perceived stigma's statistical relationship with health care access, physical health status, and mental health status controlling for sociodemographics and health insurance status. RESULTS: Perceived stigma was associated with poorer health care access [odds ratio (OR)=7.07, confidence interval (CI)=5.32-9.41), depression (OR=3.80, CI=2.66-5.43), diabetes (OR=1.86, CI=1.36-2.54), and poor overall general health (OR=0.43, CI=0.33-0.57). Hispanic respondents reported the highest rate of perceived stigma among racial and ethnic minority groups (mean=0.07, CI=0.05-0.08). CONCLUSIONS: We found that perceived stigma in health care settings was a potential barrier to good health. Prior studies have illustrated that negative health outcomes are common for patients who avoid or delay care; thus, the unfortunate conclusion is that even in a diverse, heterogeneous community, stigma persists and may negatively affect well-being. Therefore, eliminating stigma in clinical settings should be a top priority for health care providers and public health professionals seeking to improve health equity.


Asunto(s)
Grupos de Población Continentales/psicología , Accesibilidad a los Servicios de Salud , Estado de Salud , Salud Mental/etnología , Estigma Social , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Depresión/etnología , Diabetes Mellitus/etnología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Aceptación de la Atención de Salud/etnología , Factores Socioeconómicos , Adulto Joven
16.
Am J Public Health ; 109(12): 1786-1788, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31622153

RESUMEN

Objectives. To examine the relationship between aggressive enforcement of anti-immigration policies and mental health among Hispanics/Latinos in the United States before and after major national immigration policy changes.Methods. Data were drawn from Behavioral Risk Factor Surveillance System surveys administered from 2014 to 2018. The exposure was the rate of immigration arrests in the 2 months before the survey date within the respondent's state of residence. Outcomes included past-month reporting of (1) number of days of poor mental health, (2) at least 1 day of poor mental health, and (3) frequent mental distress.Results. There was no relationship between arrest rates and mental health among Hispanic/Latino respondents across the overall period. After consideration of policy changes, however, a 1-percentage-point increase in a state's immigration arrest rate in the postpolicy period was significantly associated with each mental health morbidity outcome.Conclusions. We found evidence supporting an association between worsening mental health among Hispanics/Latinos and increased arrest rates following the announcement of several restrictive immigration policies. The potential public health effects of aggressive immigration enforcement must be better acknowledged and addressed in immigration debates.


Asunto(s)
Emigrantes e Inmigrantes/psicología , Emigración e Inmigración/legislación & jurisprudencia , Hispanoamericanos/psicología , Salud Mental/etnología , Sistema de Vigilancia de Factor de Riesgo Conductual , Femenino , Humanos , Masculino , Estrés Psicológico/etnología , Estados Unidos
17.
PLoS Med ; 16(9): e1002908, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31539373

RESUMEN

BACKGROUND: Mental illness stigma is a fundamental barrier to improving mental health worldwide, but little is known about how to durably reduce it. Understanding of mental illness as a treatable medical condition may influence stigmatizing beliefs, but available evidence to inform this hypothesis has been derived solely from high-income countries. We embedded a randomized survey experiment within a whole-population cohort study in rural southwestern Uganda to assess the extent to which portrayals of mental illness treatment effectiveness influence personal beliefs and perceived norms about mental illness and about persons with mental illness. METHODS AND FINDINGS: Study participants were randomly assigned to receive a vignette describing a typical woman (control condition) or one of nine variants describing a different symptom presentation (suggestive of schizophrenia, bipolar, or major depression) and treatment course (no treatment, treatment with remission, or treatment with remission followed by subsequent relapse). Participants then answered questions about personal beliefs and perceived norms in three domains of stigma: willingness to have the woman marry into their family, belief that she is receiving divine punishment, and belief that she brings shame on her family. We used multivariable Poisson and ordered logit regression models to estimate the causal effect of vignette treatment assignment on each stigma-related outcome. Of the participants randomized, 1,355 were successfully interviewed (76%) from November 2016 to June 2018. Roughly half of respondents were women (56%), half had completed primary school (57%), and two-thirds were married or cohabiting (64%). The mean age was 42 years. Across all types of mental illness and treatment scenarios, relative to the control vignette (22%-30%), substantially more study participants believed the woman in the vignette was receiving divine punishment (31%-54%) or believed she brought shame on her family (51%-73%), and most were unwilling to have her marry into their families (80%-88%). In multivariable Poisson regression models, vignette portrayals of untreated mental illness, relative to the control condition, increased the risk that study participants endorsed stigmatizing personal beliefs about mental illness and about persons with mental illness, irrespective of mental illness type (adjusted risk ratios [ARRs] varied from 1.7-3.1, all p < 0.001). Portrayals of effectively treated mental illness or treatment followed by subsequent relapse also increased the risk of responses indicating stigmatizing personal beliefs relative to control (ARRs varied from 1.5-3.0, all p < 0.001). The magnitudes of the estimates suggested that portrayals of initially effective treatment (whether followed by relapse or not) had little moderating influence on stigmatizing responses relative to vignettes portraying untreated mental illness. Responses to questions about perceived norms followed similar patterns. The primary limitations of this study are that the vignettes may have omitted context that could have influenced stigma and that generalizability beyond rural Uganda may be limited. CONCLUSIONS: In a population-based, randomized survey experiment conducted in rural southwestern Uganda, portrayals of effectively treated mental illness did not appear to reduce endorsement of stigmatizing beliefs about mental illness or about persons with mental illness. These findings run counter to evidence from the United States. Further research is necessary to understand the relationship between mental illness treatment and stigmatizing attitudes in Uganda and other countries worldwide. TRIAL REGISTRATION: The experimental procedures for this study were registered with ClinicalTrials.gov as "Measuring Beliefs and Norms About Persons With Mental Illness" (NCT03656770).


Asunto(s)
Grupo de Ascendencia Continental Africana/psicología , Conocimientos, Actitudes y Práctica en Salud/etnología , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Prejuicio/etnología , Opinión Pública , Población Rural , Estereotipo , Adolescente , Adulto , Femenino , Humanos , Masculino , Trastornos Mentales/etnología , Salud Mental/etnología , Persona de Mediana Edad , Recurrencia , Religión y Medicina , Vergüenza , Resultado del Tratamiento , Uganda , Adulto Joven
18.
Med Care ; 57(10): 773-780, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31415338

RESUMEN

INTRODUCTION: Colorectal cancer (CRC) is a common but largely preventable malignancy. Screening is recommended for all adults aged 50-75 years; however, screening rates are low nationally and vary by patient factors and across health care systems. It is currently unknown whether there are inequities in CRC screening rates by patient sociodemographic and/or clinical factors in the Veterans Health Administration (VA) where the majority of patients are CRC screening-eligible age and CRC is the third most commonly diagnosed cancer. METHODS: We performed a retrospective cohort study using VA national clinical performance and quality data to determine the overall CRC screening rate, rates by patient sociodemographic and clinical factors, and predictors of screening adjusting for patient and system factors. We also determined whether disparities in screening exist in VA. RESULTS: The overall CRC screening rate in VA was 81.5%. Screening rates were lowest among American Indians/Alaska Natives [75.3%; adjusted odds ratio (aOR)=0.77, 95% confidence interval (CI)=0.65-0.90], those with serious mental illness (75.8%; aOR=0.65, 95% CI=0.61-0.69), those with substance abuse (76.9%; aOR=0.76, 95% CI=0.72-0.80), and those in the lowest socioeconomic status quintile (79.5%; aOR=1.10-1.31 for quintiles 2-5 vs. lowest quintile 1). Increasing age, Hispanic ethnicity, black race, Asian race, and high comorbidity were significant predictors of screening uptake. CONCLUSIONS: Many racial/ethnic disparities in CRC screening documented in non-VA settings do not exist in VA. Nonetheless, overall high VA CRC screening rates have not reached American Indians/Alaska Natives, low socioeconomic status groups, and those with mental illness and substance abuse. These groups might benefit from additional targeted efforts to increase screening uptake.


Asunto(s)
Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Salud de los Veteranos/estadística & datos numéricos , Anciano , Neoplasias Colorrectales/etnología , Neoplasias Colorrectales/psicología , Grupos Étnicos/estadística & datos numéricos , Femenino , Disparidades en Atención de Salud , Hispanoamericanos/estadística & datos numéricos , Humanos , Indios Norteamericanos/estadística & datos numéricos , Masculino , Salud Mental/etnología , Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Oportunidad Relativa , Aceptación de la Atención de Salud/etnología , Pobreza/etnología , Pobreza/estadística & datos numéricos , Estudios Retrospectivos , Factores Socioeconómicos , Estados Unidos , United States Department of Veterans Affairs , Salud de los Veteranos/etnología
19.
Infant Ment Health J ; 40(5): 742-756, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31291015

RESUMEN

Effecting a paradigm shift from "reproductive health" to "reproductive justice" within the perinatal field requires changes simultaneously at the levels of the individual healthcare provider and the system of care. The Infant-Parent Program at the University of California, San Francisco (UCSF) has extended its pioneering infant and early childhood mental health consultation to perinatal service systems applying an infant mental health approach to programs caring for expecting and new parents. In partnership with two nursing programs, UCSF consultants direct their efforts at supporting reflective practice capacities and use-of-self in patient-provider relationships. Both nursing programs serve vulnerable groups of expectant and new parents who grapple with challenges to health and well-being stemming from structural racism. As reflective capacities are supported within the consultation case conferences, providers spontaneously identify the need for tools to effectively address issues of race, class, and culture and to combat structural racism throughout the healthcare system. Policies and procedures that uphold structural racism cease to be tolerable to providers who bring their full selves to the work that they are trained to do. Using these nurse consultation partnerships as organizational case studies, this article describes a range of challenges that arise for providers and delineates steps to effective engagement toward reproductive justice.


Asunto(s)
Asistencia Sanitaria Culturalmente Competente , Personal de Salud , Relaciones Profesional-Paciente/ética , Racismo/prevención & control , Derivación y Consulta , Diversidad Cultural , Asistencia Sanitaria Culturalmente Competente/métodos , Asistencia Sanitaria Culturalmente Competente/organización & administración , Femenino , Personal de Salud/psicología , Personal de Salud/normas , Humanos , Lactante , Salud del Lactante/etnología , Salud Mental/etnología , Investigación en Evaluación de Enfermería , Embarazo , Derivación y Consulta/ética , Derivación y Consulta/normas , Estados Unidos , Poblaciones Vulnerables/etnología
20.
Int J Soc Psychiatry ; 65(6): 496-506, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31288604

RESUMEN

BACKGROUND: Resilience, or an individual's positive response in managing life's adversities, is of increasing interest in addressing the mental health disparities in refugees. Although the link between stressful life events and poor mental health is established, research on the role of resilience on the mental health of refugees is limited. AIMS: This study assessed the association between resilience and anxiety or depression in resettled Bhutanese adults in Western Massachusetts. METHODS: A cross-sectional survey was conducted among 225 Bhutanese (men: 113, women: 112) refugees aged 20-65 residing in Massachusetts. Resilience was measured with the 25-item Wagnild and Young's Resilience Scale including two constructs as follows: a 17-item 'personal competence' that measures self-reliance, independence, determination, resourcefulness, mastery and perseverance and an 8-item 'acceptance of self and life' that measures adaptability, flexibility and a balanced perspective of life. Higher total scores indicate greater resilience. The Hopkins Symptom Checklist-25 was used to measure anxiety (10-item) and depression (15-item) with a cutoff mean score of ⩾1.75 for moderate to severe symptoms. Associations of resilience with anxiety or depression scores were assessed using multiple-linear and logistic regression analyses. RESULTS: The proportion of participants with above threshold anxiety and depression were 34.2% and 24%, respectively. Resilience was inversely associated with both anxiety (beta for 1 unit change in resilience scores: ß = -0.026; p = .037) and depression (ß = -0.036, p = .041). 'Personal competence' resilience was inversely associated with both anxiety (ß = -0.041 p = .017) and depression (ß = -0.058, p = .019), but 'acceptance of self and life' resilience was not. Participants with the highest tertile of resilience scores had a significantly decreased risk of anxiety (ORs (95% CI): 0.13 (0.04-0.40)) and depression (0.16 (0.04-0.60)). CONCLUSION: Higher resilience was associated with reduced anxiety and depression among Bhutanese with personal competence resilience accounting for most of the effects. These findings suggest the potential targets for mental-health intervention to improve resilience in refugees.


Asunto(s)
Ansiedad/etnología , Depresión/etnología , Salud Mental/etnología , Refugiados/psicología , Resiliencia Psicológica , Adulto , Bután/etnología , Estudios Transversales , Femenino , Humanos , Modelos Lineales , Modelos Logísticos , Masculino , Massachusetts/epidemiología , Persona de Mediana Edad , Análisis Multivariante , Escalas de Valoración Psiquiátrica , Apoyo Social , Trastornos por Estrés Postraumático/etnología , Adulto Joven
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