Ólavsøka: The faroese national holiday*

In many cultures with male‐dominated religions, women are subject to illnesses which are attributed to spirit‐possession. Two main alternative therapies are usually available. Treatment is effected either by exorcism, or by domesticating the spirit ‐ a process which de Heusch calls ‘adortism’. In the latter case, women are recruited through illness into female‐centred ‘cults of affliction’, regarded as superstitious and subversive by men, who try to prevent their wives from becoming involved in these cults, preferring exorcism as therapy. Exorcism thus becomes an instrument of male power in the struggle to control women's incipient religiosity. The paper examines the interplay of exorcism and adorcism in relation to gender in Christian, Muslim and Buddhist settings. It concludes by considering the implications of women as well as men practising exorcism, and suggests that the consequences of the formal distinction between exorcism and adorcism may not always be as sharply opposed as appears at first sight.     

Between folk concepts of illness and psychiatric diagnosis: Kitsune-tsuki (fox possession) in a mountain village of Western Japan

Two cases of kitsune-tsuki (fox possession) in a mountain village are examined from psychiatric and ethnographic viewpoints. Kitsune-tsuki, one of the most familiar expressions of madness in Japan, represents, as an interactive performance, religious and mythopoetic contexts metaphorically in time of crises. The atypical symptoms and the complicated clinical process of these cases reflect a multistratified cultural background and its transformation; communal religion, folk tales, kyôgen play, shared concepts of illness, and the post-war rise of one religious cult. The psychiatric diagnosis, trying to arrive at a single correct understanding, partially translates the entangled indigenous illness. Focusing on these issues; the dichotomy between form and content of mental illness, the atypicality of the symptoms and the restructive process of illness experiences, the author reconsiders the possibility of interpretation, diagnosis and treatment which respect the multiple realities.     

Interpreting culture and psychopathology: Primitivist themes in cross-cultural debate

Interpreting the cross-cultural incidence of psychopathology is a focus of continuing debate. This paper explores the lineaments of that debate and its underlying premises concerning difference and distance. Primitivism-a body of ideas, images and vocabularies about cultural others-is characteristically employed to represent non-Western peoples. But it is more fundamentally concerned with the way the West understands itself in contradistinction to these others. It is shown to be a major source of the images used to think about mental illness, and of the intellectual traditions which have constituted cross-cultural psychiatry as a comparative discipline. Psychiatric primitivism employs two opposing perspectives, which we have labelled Barbaric and Arcadian respectively. They are the source of contradictory assertions concerning the relationship between culture and mental illness. They provide the framework which structures contemporary research into the crosscultural incidence and course of schizophrenia, shaping its methodology, its rhetoric, the strategies by which data are interpreted, and the conclusions which it draws. We demonstrate a convergence of themes whereby images of society, person and mental illness come to signify each other. This is epitomized in three of cross-cultural psychiatry's principal subject areas:amok, shamanism, and the therapeutic quality of traditional society.     

Relative Risk of Acute Myocardial Infarction in People with Schizophrenia and Bipolar Disorder: A Population-Based Cohort Study

Objective

Despite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample.

Method

Using nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates.

Results

A total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01~1.32) for schizophrenia and 1.37 (1.08~1.73)for bipolar disorder, and in women, 1.85 (1.58~2.18) and 1.88(1.47~2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder.

Conclusions

In this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.     

Gender Differences in Hemispheric Spatiotemporal EEG Patterns upon Reproduction of Verbal Information

Changes in EEG power and coherence were studied in ten men and ten women during mental reproduction of dichotically presented lists of words. The EEG was recorded with 14 electrodes located over symmetric points of the left and right hemispheres. In all subjects, the mental reproduction was accompanied by an increase in the power of the ₁ rhythm in the frontal regions and a decrease in the power of the ₁ and ₂ rhythms in the caudal regions of the hemispheres. A decrease in the power of the ₂ rhythm in the caudal regions of the hemispheres was greater in women than in men. Gender differences were also observed in the left- and right-hemispheric coherence reactivity. During word reproduction, men showed a higher EEG coherence in the ₂ band in the right hemisphere, while women displayed a greater increase in the coherence of the ₁ and ₂ rhythms in the left hemisphere. Lateral differences in reactivity of the intrahemispheric coherence in these frequency bands were observed only in women and were caused by a decrease in coherent interactions in the right hemisphere and their increase in the left hemisphere. These gender differences can be associated with different strategies of information memorization: men involve predominantly episodic memory, and women use semantic polymodal encoding.     

Caring for mentally ill people.

Despite legislation to harmonise mental health practice throughout Europe and convergence in systems of training there remains an extraordinary diversity in psychiatric practice in Europe. Approaches to tackling substance misuse vary among nations; statistics on psychiatric morbidity are affected by different approaches to diagnosis and treatment of psychiatric disorders; attitudes towards mental illness show definite international differences. Everywhere, though, mental health care for patients with psychotic illnesses is a "cinderella service," and there is a general move towards care falling increasingly on the family and the community.     

Childhood Environment and Mental Wellbeing at Age 60-64 Years: Prospective Evidence from the MRC National Survey of Health and Development

Background

Mental wellbeing, conceptualised as positive affect, life satisfaction and realisation of needs that contribute to psychological growth, captures more than the absence of mental ill health. Several nations now aim to monitor and improve mental wellbeing. Whilst many studies document associations between adverse childhood experiences and mental disorders in adulthood, possible links between childhood experiences and adult mental wellbeing have so far received less attention.

Methods

Using data from 1976 men and women in the MRC National Survey for Health and Development, we investigated prospective associations between childhood socioeconomic and psychosocial environments and the Warwick Edinburgh Mental Wellbeing Scale, designed to capture both hedonic and eudaimonic facets of wellbeing, at age 60-64.

Results

Whilst there was no evidence that childhood socioeconomic circumstances were related to later wellbeing independently of other childhood experiences, elements of childrearing and parenting, parental health and adjustment, and childhood illness were related. More advantaged socioeconomic position was associated with greater wellbeing but this did not explain the links between these childhood exposures and adult wellbeing, suggesting alternative explanatory pathways should be considered.

Conclusions

Childhood illness and family psychosocial environment are associated with mental wellbeing in early older age, with effects sizes that are larger or comparable to socioeconomic circumstances in adulthood. Initiatives to improve the nation’s mental wellbeing that include programmes targeted to supporting families and children may additionally have benefits that continue into older age.     

What inhibits working women with mental disorders from returning to their workplace?-A study of systematic re-employment support in a medical institution

Background

It has been customary for working women in Japan to retire when they marry and to devote themselves to household work as well as having children. However, according to a report published by the Ministry of Internal Affairs and Communications in 2013, the number of working women has increased consistently. As more women are advancing into society, they have more options with respect to lifestyle but may encounter new psychological burdens. Therefore, we reviewed trends among participants in a re-work day care program (hereinafter referred to as “re-work program”) to clarify various problems encountered by working women and the prevalence of mental disorders.

Methods

A total of 454 participants (352 males, mean age 46.5?±?9.4 years; 102 females, mean age 39.8?±?9.4 years) who participated in our re-work program were included in this study. We reviewed their basic characteristics: life background, clinical diagnoses, outcomes after use of the re-work program, and reasons for failing to return to the workplace or start working where applicable.

Results

The number of female participants was small and accounted for less than one fourth of all participants. As many as 67.3 % of the males succeeded in returning to the workplace, but only 48.0 % of the females were successful. The most common reason for failing to return to the workplace in both sexes was the exacerbation of symptoms; among females, other reasons, such as pregnancy, marriage, and family circumstances, were observed occasionally, but these reasons were not reported by the males.

Conclusions

We found that female-specific problems were not the only issue, but rather work-life balance, relationships in the workplace, and gender differences in work roles could also trigger psychiatric disorders. A deeper understanding of the problems encountered by women in the workforce is important for the treatment of their psychiatric disorders. Therefore, it is considered essential for family members, co-workers, medical staff, and others to understand the various problems encountered by working women. Coping with these problems appropriately will aid in treating mental disorders and creating an environment suitable to prevent their development among women.

     

Onchocerca parasites and Wolbachia endosymbionts: evaluation of a spectrum of antibiotic types for activity against Onchocerca gutturosa in vitro

Background

In the Dominican Republic, a Latin American country with filariasis-endemic areas, more than 63,000 people have lymphatic filariasis and more than 400,000 people are at risk of future infection. In this paper, we explore the health beliefs, health-seeking behaviors and self-care practices of women with lymphoedema in filariasis-endemic areas to better understand the needs of women when developing lymphoedema morbidity control programs.

Methods

Qualitative data were collected through semi-structured interviews of 28 women, 3 focus group discussions with 28 women, field notes and photographs.

Results

Women described exhaustive and expensive attempts at seeking a cure for their lymphoedema. Family members were influential in providing women with initial care seeking referrals to indigenous healers credited with influence over physical, mental, spiritual and supernatural properties of illness. When indigenous treatments proved to be ineffectual, the women sought care from trained healthcare providers. Most healthcare providers incorrectly diagnosed the edema, failed to adequately treat and meet the needs of women and were viewed as expensive. Most women resorted to self-prescribing injectable, oral, or topical antibiotics along with oral analgesics as a standard practice of self-care.

Conclusion

Healthcare providers must understand a woman's cultural perspectives of illness, her natural networks of support and referral, her behavioural practices of care-seeking and self-care and the financial burden of seeking care. In the culture of the Dominican Republic family members and traditional healthcare providers are influential advisors on initial health-seeking behaviors and self-care practices. For this reason family-oriented interventions, support groups for women and their families, community education and training on simple, low cost lymphoedema management techniques for indigenous healers are viable ways to influence the early detection, diagnosis and treatment of women with lymphoedema. The extensive use of injectable, oral and topical antibiotics by indigenous healers and women without medical supervision suggests a need for health education messages related to the risks of such practices.     

A Contribution to the Comparative Epidemiology of Schizophrenia in Urban and Rural Places

In psychiatry, epidemiology rests upon statistical studies of mental illness in the population. Much attention was given to this as early as the work of Esquirol, (1) and I. F. Riul' (2) in our country. Zemstvo psychiatrists contributed much in the field of psychiatric morbidity. (3-8) However, as a result of the lack of outpatient psychoneurological institutions in prerevolutionary Russia, these studies, like the majority of those currently being conducted by psychiatrists abroad, resolved fundamentally to isolated unidimensional selective surveys of particular groups in the population. The existence in the Soviet Union of a broad network of outpatient psychiatric institutions permits Soviet psychiatrists to go beyond single-factor selective surveys, to make a systematic study of mental illness in accordance with the data of current dispensary records, and to provide timely therapeutic and social prophylactic assistance to the ill, i.e., to conduct epidemiological research on a higher level of scientific methodology. A number of such studies has been published. (8-23) Therefore the statement by Lin and Standley, (24) who allege — in a monograph, The Role of Epidemiology in Psychiatry, published by the World Health Organization — the absence of epidemiological psychiatric studies in the Soviet Union, must be rejected as unfounded.     

Women and political violence in contemporary Peru

Conclusions It follows from the discussion of the question of women and political violence in the contemporary Peru which I attempted to explore in its historical perspective in this essay, that the peculiarity of the division of labor in the Andean Sierra, based on the gender ideology which recognizes women's work as a complementary to men's work as relatively capable of resisting the extra-economic pressures of underdeveloped capitalism, has facilitated women's incorporation into an armed struggle led by the Sendero Luminoso. For Vicky Peláez, a leading Peruvian journalist, in the conditions of the Andean Sierra the movement could not survive and expand without the participation of women whose historical heritage of struggle has been multiplied by socio-economic and political crisis of the Peruvian state. On the other hand, the organizational framework of the PCP-SL, which recognizes and applies in practice the principle of equality between men and women, has stimulated female political activity. The inclusion of issues important to women in Sendero Luminoso's agenda has given additional impetus to the incorporation of women into class struggle not only as supporters or militants, but also as political and military leaders. Increasing participation of women in political and military actions creates additional conditions for the survival and expansion of collective action started by the PCP-SL years ago, using political violence as the main instrument of a new democratic revolution in Peru.

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Abortion in Canada: religious and ideological dimension's of women's attitudes

This paper examines a number of demographic and sociocultural factors (e.g., age, marital status, family size, religion, religious assiduity, sex-role ideology) as predictors of women's attitudes toward abortion, using data from the Canadian Fertility Survey of 1984. The findings suggest that women's abortion attitudes are to a greater extent based on ideological positions. It appears that anti-abortion stance affects those women who are religious, presumably by increasing the relationship between their general sex-role ideological stances and abortion attitudes. Abortion attitudes also vary according to a woman's education, her size, and province/region of residence.     

Disparities in Oral Cancer Survival among Mentally Ill Patients

Background

Many studies have reported excess cancer mortality in patients with mental illness. However, scant studies evaluated the differences in cancer treatment and its impact on survival rates among mentally ill patients. Oral cancer is one of the ten most common cancers in the world. We investigated differences in treatment type and survival rates between oral cancer patients with mental illness and without mental illness.

Methods

Using the National Health Insurance (NHI) database, we compared the type of treatment and survival rates in 16687 oral cancer patients from 2002 to 2006. The utilization rate of surgery for oral cancer was compared between patients with mental illness and without mental illness using logistic regression. The Cox proportional hazards model was used for survival analysis.

Results

Oral cancer patients with mental disorder conferred a grave prognosis, compared with patients without mental illness (hazard ratios [HR] = 1.58; 95% confidence interval [CI] = 1.30–1.93; P<0.001). After adjusting for patients’ characteristics and hospital characteristics, patients with mental illness were less likely to receive surgery with or without adjuvant therapy (odds ratio [OR] = 0.47; 95% CI = 0.34–0.65; P<0.001). In multivariate analysis, oral cancer patients with mental illness carried a 1.58-times risk of death (95% CI = 1.30–1.93; P<0.001).

Conclusions

Oral cancer patients with mental illness were less likely to undergo surgery with or without adjuvant therapy than those without mental illness. Patients with mental illness have a poor prognosis compared to those without mental illness. To reduce disparities in physical health, public health strategies and welfare policies must continue to focus on this vulnerable group.     

How is Afflictive Possession ‘Learned’? Gender and Motility in South India

This paper examines forms of affliction that are understood as a kind of possession, all the more afflictive because they are experienced as ‘coming out of nowhere’. It is easier to specify the kind of learning associated with valued forms of possession, which occur in the context of ritual performances that entail informal apprenticeships. The sense in which afflictive possession is ‘learned’ is far more diffuse, and occurs much earlier than the point at which diagnosis occurs. This paper traces such learning to early forms of socialisation into gender, focusing on motility and bodily comportment, as central to the way in which the lived body of gender moves between different practical environments. In an environment that includes spirits and deities, female movement acts as guarantor, not only of social stability, but of cosmological order and disorder.     

Antenatal Risk Factors of Postpartum Depression at 20 Weeks Gestation in a Japanese Sample: Psychosocial Perspectives from a Cohort Study in Tokyo

Background

Prevalence of postnatal depression (PND) is high (Western countries, 10–15%; Japan, 17%). PND can cause parenting impairment and affect family health (e.g. child behaviors, cognitive development and physical health). This study aimed to reveal the risk factors of PND during the pregnancy period in a Japanese sample, and to identify the psychosocial risk factors of PND that should be appended to existing obstetric interview sheets. A cohort study with a Japanese sample was conducted.

Methods

All 14 obstetrics hospitals in the Setagaya ward, Tokyo, Japan, participated in this study. Pregnant women who booked their delivery between December 2012 and May 2013 were enrolled. Data used for this study were collected at 20 weeks gestation, a few days and one month postnatal. The questionnaires consisted of psychosocial factors and the Edinburgh Postnatal Depression Scale (EPDS). To identify PND risk factors, multivariate analyses were performed.

Results

A total of 1,775 women participated in this study. Eventually, the data of 1,133 women were used for the multivariate analyses. The demonstrated significant risk factors include EPDS score, primipara, “a perceived lack of family cohesion”, “current physical illness treatment” and “current psychiatric illness treatment”.

Conclusion

This study highlights the importance of mental health screening using psychological measures during the pregnancy period. In addition, family environment, parity, physical and psychiatric illness should be paid attention by professionals in maternal and child health. The results also suggest that mothers’ feelings of developing their families should be supported.     

Common mental health problems in immigrants and refugees: general approach in primary care

Background:

Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care.

Methods:

We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health.

Results:

The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations.

Interpretation:

Systematic inquiry into patients’ migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.Changing patterns of migration to Canada pose new challenges to the delivery of mental health services in primary care. For the first 100 years of Canada’s existence, most immigrants came from Europe; since the 1960s, there has been a marked shift, with greater immigration from Asia, Africa, and Central and South America.¹ The mix differs across the provinces, although nearly all immigrants settle in Canada’s largest cities.² The task of preventing, recognizing and appropriately treating common mental health problems in primary care is complicated for immigrants and refugees because of differences in language, culture, patterns of seeking help and ways of coping.^3–6In consultation with experts in immigrant and refugee mental health, we reviewed the literature to determine associated risks and clinical considerations for primary care practitioners in the approach to common mental health problems among new immigrant or refugee patients.^7–10 In this paper, we review the effect of migration on mental health, use of health care and barriers to care. We outline basic clinical strategies for primary mental health care of migrants including the use of interpreters, family interaction and assessment, and working with community resources.     

Immigration,Transition into Adult Life and Social Adversity in Relation to Psychological Distress and Suicide Attempts among Young Adults

Background

The increasing incidence of mental health problems among young people is a major concern in many Western countries. The causal mechanisms underlying these trends are not well established, but factors influenced by current societal changes ought to be implicated. Such factors include immigration and social adversity as well as the timing of taking on adult social roles (e.g. gainful employment, parenthood and own housing tenure). We therefore examined relationships between these factors and the risks of psychological distress as well as suicide attempts in young adults, with a focus on gender differences.

Methods

We conducted a population-based study including 10,081 individuals aged 18–29, recruited in 2002 and 2006 in Stockholm, Sweden. Data were collected by record linkage and questionnaires.

Results

Non-European immigrants had an increased risk of distress, and female non-European immigrants had a markedly higher risk of suicide attempts. Both early parenthood (≤24 years) and not being a parent, being a student and the lack of own housing tenure were associated with distress, but only in women. In both sexes, financial strain was associated with the increased risk of distress and suicide attempts, while unemployment was only associated with distress.

Conclusions

Immigration from outside Europe and social adversity are associated with mental health problems in young adults, especially females. Postponed transition into adulthood is associated with poor mental health in young women. These factors are influenced by current societal changes, and may have contributed to the increasing incidence of mental health problems among young people in Western countries.     

Impact of an integrated service system on client outcomes by gender in a national sample of a mentally ill homeless population

Background: Homeless populations with concurrent mental illness have a complex array of service needs that are often addressed in a haphazard or uncoordinated manner. Information is lacking about the effectiveness of programs and public policy in women who are both homeless and mentally ill.Objective: This study assessed the impact of gender on the outcomes of a multisite public policy intervention that implemented components of an integrated service delivery system to address the needs of mentally ill homeless men and women.Methods: A secondary analysis was performed using longitudinal data obtained from homeless men and women in the Access to Community Care and Effective Services and Supports prospective study, which was conducted at 18 sites across the United States. Outcome data from baseline, 3, 12, and 18 months across 5 annual cohorts were analyzed to determine the impact of gender on 6 clinical outcomes, including days of housing, relationships, victimization, social support, alcohol use, and drug use, in homeless men and women with mental illness. The analysis plan included multilevel modeling of longitudinal data.Results: Data were analyzed from a total of 7229 participants, including 4502 men (62%)) (mean age, 38.2 years) and 2727 women (38%) (mean age, 37.2 years). After 18 months of follow-up, women had significantly better outcomes in terms of family relationships (estimated mean score increased 0.100), victimization (score decreased 0.164), and social support (score increased 0.363) than did men (aall, P < 0.001). Being accompanied by children was significantly associated with less change in drug use among women compared with men (P < 0.01). These outcomes were the same across all 18 program sites.Conclusion: Although the addition of services for the homeless in conjunction with clinical and support services offered by case managers had generally positive effects in this study's population, a gender-specific substance abuse treatment intervention should also be included in a comprehensive program for homeless women with mental illness.     

Mental Health Literacy of Depression: Gender Differences and Attitudinal Antecedents in a Representative British Sample

Background

Poor mental health literacy and negative attitudes toward individuals with mental health disorders may impede optimal help-seeking for symptoms of mental ill-health. The present study examined the ability to recognize cases of depression as a function of respondent and target gender, as well as individual psychological differences in attitudes toward persons with depression.

Methods

In a representative British general population survey, the ability to correctly recognize vignettes of depression was assessed among 1,218 adults. Respondents also rated the vignettes along a number of attitudinal dimensions and completed measures of attitudes toward seeking psychological help, psychiatric skepticism, and anti-scientific attitudes.

Results

There were significant differences in the ability to correctly identify cases of depression as a function of respondent and target gender. Respondents were more likely to indicate that a male vignette did not suffer from a mental health disorder compared to a female vignette, and women were more likely than men to indicate that the male vignette suffered from a mental health disorder. Attitudes toward persons with depression were associated with attitudes toward seeking psychological help, psychiatric skepticism, and anti-scientific attitudes.

Conclusion

Initiatives that consider the impact of gender stereotypes as well as individual differences may enhance mental health literacy, which in turn is associated with improved help-seeking behaviors for symptoms of mental ill-health.