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Introduction: In South Asia, particularly in regions with strong patriarchal norms, widowhood is stigmatized, compounding the negative impact of grief and partner loss. This study measured the prevalence of mental health symptoms among widows in Nepal and its relationship to demographic variables. Methods: This cross-sectional study surveyed 588 Nepalese widows from six districts in Nepal (mean age = 52.62, SD = 13.99) who had lost their spouses within the past two years. Participants completed the Anxiety, Depression and Stress Scale (ADSS). Analyses examined prevalence of anxiety, depression, and stress symptoms, using standard ADSS cut-points. Level of anxiety, depression, and stress symptoms measured by the ADSS in the sample were also compared with female psychiatric and nonpsychiatric normative ADSS data, and were compared with one available comparison sample (a sample of older Nepalese women). Measures of association between ADSS scores and demographic variables were computed. Results: Results showed that a high percentage of the Nepalese widows reported moderate to severe symptoms of anxiety, depression, and stress. They also endorsed significantly higher levels of anxiety, depression, and stress symptoms relative to normative data and the comparison sample. Stress scores were significantly negatively correlated with age, Anxiety and Depression scores were associated with income under the poverty line, and Depression scores were associated with homemaker status. Discussion: These findings confirm the high emotional distress among widowed women in Nepal, and establish the relationship between emotional distress and poverty, homemaker status, and age. These findings can inform public health efforts and mental health care providers regarding the mental health needs of widows in Nepal.
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BACKGROUND: Asians and Asian Americans have the lowest rate of mental health service utilization (25%) in the US compared to other racial/ethnic groups (39 - 52%), despite high rates of depression, anxiety, and suicidal ideation. The lack of culturally-responsive mental health trainings hinders access to mental health services for these populations. We assessed the mental health priorities of Asian communities in Greater Boston and evaluated cultural responsiveness of the Mental Health First Aid (MHFA), a first-responder training teaching participants skills to recognize signs of mental health and substance use challenges, and how to appropriately respond. METHODS: This is community-based participatory research with the Boston Chinatown Neighborhood Center (BCNC), Asian Women For Health (AWFH), and the Addressing Disparities in Asian Populations through Translational Research (ADAPT) Coalition. We conducted focus groups with community-based organization staff and community members to assess mental health priorities of Asian populations in Boston, MA. We then evaluated the utility and cultural-responsiveness of the English-language MHFA for Asian populations through pre- and post-training questionnaires and focus groups with community participants. Paired t-tests were used to evaluate questionnaire responses. Thematic analysis was used to analyze interviews. RESULTS: In total, ten staff and eight community members participated in focus groups, and 24 community members completed the MHFA and pre- and post-training questionnaires. Common mental health challenges in the Asian communities reported by participants were loneliness, high stigma around mental illnesses, academic pressure, and acculturation stress. Compared to pre-training, MHFA participants demonstrated lower personal mental health stigma (p < 0.001) and higher mental health literacy (p = 0.04) post-training. Participants also noted the lack of data statistics and case studies relevant to Asian populations in the training, and desired the training be offered in languages spoken by Asian ethnic subgroups (e.g., Chinese, Vietnamese). CONCLUSION: Cultural-responsiveness of the MHFA for Asian populations could be improved with the inclusion of data and case studies that capture common mental health challenges in the Asian communities and with translation of the MHFA to non-English languages predominant in Asian communities. Increasing the cultural relevance and language accessibility of the MHFA could facilitate wider adoption of these trainings across communities and help to reduce mental health stigma and gaps in literacy and service utilization.
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Asiático , Pesquisa Participativa Baseada na Comunidade , Emigrantes e Imigrantes , Grupos Focais , Humanos , Boston , Feminino , Asiático/psicologia , Adulto , Masculino , Emigrantes e Imigrantes/psicologia , Pessoa de Meia-Idade , Primeiros Socorros/métodos , Transtornos Mentais/etnologia , Transtornos Mentais/terapia , Serviços de Saúde Mental , Competência Cultural , Saúde Mental/etnologia , Assistência à Saúde Culturalmente CompetenteRESUMO
Background: The COVID-19 pandemic and rise in anti-Asian racism have had adverse mental health impacts in Asian communities. The lack of culturally-responsive and linguistically-accessible mental health trainings hinders access to mental health services for Asian populations. In this study, we assessed the mental health needs of Asian communities in Greater Boston and evaluated cultural responsiveness of the Mental Health First Aid (MHFA), a first-responder training teaching participants skills to recognize signs of mental health and substance use challenges, and how to appropriately respond. Methods: This community-based participatory research with the Boston Chinatown Neighborhood Center (BCNC), Asian Women For Health (AWFH), and the Addressing Disparities in Asian Populations through Translational Research (ADAPT) Coalition employed two phases. In phase 1, we conducted focus groups with BCNC and AWFH staff and peer educators to assess mental health priorities of Asian populations in Boston. Findings informed phase 2, which evaluated cultural responsiveness of the MHFA through pre- and post-training questionnaires and focus groups with community participants. The pre-training questionnaire asked about mental health needs and barriers, help-seeking behaviors, and literacy; and personal and Asian community stigma. The post-training questionnaire and focus group with community participants asked about cultural competence of MHFA training for Asian populations. Paired t-tests were used to evaluate questionnaire responses. Thematic analysis was used to analyze interviews. Results: In total, 10 staff/educators and 8 community members participated in focus groups. They identified common mental health needs and workforce and culturally-responsive community strategies to support persons with mental health issues. Twenty-four community participants completed pre- and post-training questionnaires. They reported the MHFA training reduced mental health care stigma and increased mental health literacy. Recommendations to increase cultural-responsiveness of the MHFA were to include mental health case studies common in Asian populations and provide the training in other languages (e.g., Chinese, Vietnamese). Conclusion: Cultural responsiveness of the MHFA for Asian populations could be improved with the inclusion of case studies specific to the Asian communities and accessibility of the training in other languages. Increasing the cultural relevance and language accessibility of these trainings could help reduce mental health stigma and gaps in mental health awareness and service utilization among Asian populations.
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The COVID-19 crisis has resulted in disruption of everyday life worldwide but the impact and response to the pandemic have not been uniform. Many countries rapidly deployed physical-distancing mandates to curb the spread of the virus; others did not. Social distancing strategies are necessary to reduce the transmission of the virus but there may be unintended consequences. We examined psychological distress in four societies with distinct public health strategies (South Korea, Hong Kong, France and the United States) to identify common and region-specific factors that may contribute to mental health outcome during the pandemic. From March to July of 2020, a survey of demographics, general health, mental health, loneliness and social networks was conducted. Overall, younger age, greater concern for COVID, and more severe loneliness predicted worse psychological outcome but the magnitudes of these effects varied across the four regions. Objective measures of social isolation did not affect mental health. There were also notable differences in psychological outcome; Hong Kong, with very strict social distancing protocols plus ongoing political unrest, suffered the most drastic deterioration of mental health. To prepare for an impending mental health crisis, concerted efforts to reduce loneliness should be integrated into a comprehensive public health strategy.
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COVID-19/prevenção & controle , Comparação Transcultural , Solidão , Saúde Mental/estatística & dados numéricos , Distanciamento Físico , Rede Social , Estresse Psicológico/epidemiologia , Adulto , Feminino , França/epidemiologia , Hong Kong/epidemiologia , Humanos , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estados Unidos/epidemiologiaRESUMO
This is a pilot study of demographic and acculturation factors in relation to attitudes toward seeking psychological help among Lao and Cambodian refugees and immigrants in the United States of America. Cambodian and Laotian American adults in the United States of America were approached to complete help-seeking attitudes and acculturation scales. T test and hierarchical multiple regression analyses were used to analyze the relationships between the demographic and acculturation variables, and attitudes toward seeking psychological help. Out of 270 target subjects approached there were 108 respondents. Of the demographic variables, gender was associated with favorable attitudes towards psychological help-seeking. As expected, women were significantly more likely than men to recognize the need for help, to seek psychological help, to be more open to discussing mental health problems, and have more confidence in professional services. Acculturation was more powerfully associated with help- seeking attitudes than any of the demographic variables. In hierarchical multiple regression, acculturation contributed significant unique variance over and beyond the entire set of demographic variables to openness to discussing problems and having confidence in professional help. The findings of this pilot study suggest that there are significant barriers to seeking psychological help among Lao and Cambodian Americans. Attention to the issues of gender and levels of acculturation may improve access.