Intersecting Cultures in Deaf Mental Health: An Ethnographic Study of NHS Professionals Diagnosing Autism in D/deaf Children

Autism assessments for children who are deaf are particularly complex for a number of reasons, including overlapping cultural and clinical factors. We capture this in an ethnographic study of National Health Service child and adolescent mental health services in the United Kingdom, drawing on theoretical perspectives from transcultural psychiatry, which help to understand these services as a cultural system. Our objective was to analyse how mental health services interact with Deaf culture, as a source of cultural-linguistic identity. We ground the study in the practices and perceptions of 16 professionals, who have conducted autism assessments for deaf children aged 0–18. We adopt a framework of intersectionality to capture the multiple, mutually enforcing factors involved in this diagnostic process. We observed that professionals working in specialist Deaf services, or with experience working with the Deaf community, had intersectional understandings of assessments: the ways in which cultural, linguistic, sensory, and social factors work together to produce diagnoses. Working with a diagnostic system that focuses heavily on ‘norms’ based on populations from a hearing culture was a key source of frustration for professionals. We conclude that recognising the intersectionality of mental health and Deaf culture helps professionals provide sensitive diagnoses that acknowledge the multiplicity of D/deaf experiences.     

The Cultural Construction of Mental Illness in Prison: A Perfect Storm of Pathology

Large numbers of individuals in U.S. prisons meet DSM criteria for severe psychiatric disorder. These individuals also have co-occurring personality and substance abuse disorders, medical conditions, and histories of exposure to social pathologies. Based on nine months of ethnographic fieldwork in a U.S. prison, focusing on staff narratives, I utilize interpretivist and constructivist perspectives to analyze how mental health clinicians construct psychiatric disorder among inmates. Discrete categorization of disorders may be confounded by the clinical co-morbidities of inmates and the prison context. Incarcerated individuals’ responses to the institutional context substantially inform mental health staffs’ illness construction and the prison itself is identified as an etiological agent for disordered behaviors. In addition, diagnostic processes are found to be indeterminate, contested, and shaped by interactions with staff. Analysis of illness construction reveals that what is at stake for clinicians is not only provision of appropriate treatment, but also mandates for the safety and security of the institution. Enmeshed in these mandates, prison mental health becomes a particular local form of psychiatric knowledge. This paper contributes to anthropological approaches to mental disorder by demonstrating how local contexts mediate psychiatric knowledge and contribute to the limited ethnographic record of prisons.     

Caring Through Restraint: Violence,Intimacy and Identity in Mental Health Practice

In this article, I discuss the meanings of “restraints,” or physical intervention strategies that are used at a total institution for mentally ill adolescents in the United States. This paper argues that this particularly complex form of mental health treatment is simultaneously a violent and an intimate way in which men relate to one another and also takes on complex meanings about trust and identity in mental health recovery. Using data from 18 months of ethnographic fieldwork at one residential treatment center, this article examines what restraints reveal and embody about intimate interpersonal staff/client relationships, how Black men relate to one another in this setting and how staff members use physical interventions to link institutional mental health treatment with street violence in the outside world. I conclude that understanding these meanings of restraints provides a valuable way of understanding local knowledge in mental health practice, treatment and recovery.     

Utilization of Standardized Mental Health Assessments in Anthropological Research: Possibilities and Pitfalls

In the past decade anthropologists working the boundary of culture, medicine, and psychiatry have drawn from ethnographic and epidemiological methods to interdigitate data and provide more depth in understanding critical health problems. But rarely do these studies incorporate psychiatric inventories with ethnographic analysis. This article shows how triangulation of research methods strengthens scholars’ ability (1) to draw conclusions from smaller data sets and facilitate comparisons of what suffering means across contexts; (2) to unpack the complexities of ethnographic and narrative data by way of interdigitating narratives with standardized evaluations of psychological distress; and (3) to enhance the translatability of narrative data to interventionists and to make anthropological research more accessible to policymakers. The crux of this argument is based on two discrete case studies, one community sample of Nicaraguan grandmothers in urban Nicaragua, and another clinic-based study of Mexican immigrant women in urban United States, which represent different populations, methodologies, and instruments. Yet, both authors critically examine narrative data and then use the Center for Epidemiologic Studies Depression Scale to further unpack meaning of psychological suffering by analyzing symptomatology. Such integrative methodologies illustrate how incorporating results from standardized mental health assessments can corroborate meaning-making in anthropology while advancing anthropological contributions to mental health treatment and policy.     

儿童幽门螺杆菌感染

幽门螺杆菌感染不仅能引起胃炎、消化性溃疡,诱发胃癌等胃肠道的病变,还与许多胃肠外疾病密切相关,如果不经过特殊治疗将终生带菌,严重的影响小儿的生长发育和身心健康。这些问题引起了儿科医生和儿童保健医生的共同关注。儿童期既是幽门螺杆菌感染的特殊时期,也是控制感染的关键时期。本文将从小儿幽门螺杆菌国内外的感染状况、相关疾病、诊断方法、治疗及预防等几个方面综述如下。     

Shifting Urban Margins: Accessing Unequal Spaces of Ageing and Care in Zanzibar and Muscat

ABSTRACT

Older people constitute a growing proportion of the urban population and are encountered in all kinds of spaces and neighbourhoods across cities. This article argues that urban seniority and elderly care are a fruitful, new lens to study how inhabitants on the social margins create urban space and social cohesion. This article draws on ethnographic research in the cities of Zanzibar, Tanzania, and Muscat, the capital of Oman. Many older inhabitants of cities experience frailty, serious health problems, or even disabilities and are no longer able to work or make a living, which pushes them towards the social margins. The ethnographic examples and reflections in this article illustrate, first, how cities can be investigated from the perspective of social and spatial marginality. Second, they show how urban dwellers’ social positions can shift between the margins and centres of an urban society depending on their health and access to unequal spaces of ageing and care. And third, the paper analyses how some elders respond to marginality by taking up transnational and cosmopolitan agency.     

Generating Revenues: Fiscal Changes in Public Mental Health Care and the Emergence of Moral Conflicts among Care-Givers

Objective: The author examined how thefocus on financial accountability in the publicmental health sector has affected directservice providers' experience of their work. Methods: This was a two-year mixed methodstudy conducted throughout one small, state-runsystem. Data that were collected include fieldnotes taken in the course ofparticipant-observation research, tape-recordedsemi-structured ethnographic interviews, aswell as responses to anethnographically-informed survey instrumentthat was administered to providers throughoutthe system. Results: Interview materialssuggest that care-givers view their jobs as a``calling,' work that they perform in theservice of something greater than themselves. As the public mental health sector increasesits emphasis on fiscal issues, however, theseemployees are experiencing heightened moraltensions around their work. Jobs that wereonce conceptualized as being done ``for love'now are being done ``for money' – a change thatrepresents a moral contamination of theworkplace for many individuals. Conclusions: The goal of enhanced fiscalaccountability in the public mental healthsystem is to increase service effectiveness andcost-efficiency, that is, to do better work andto do it for less money. These study resultssuggest that this strategy could backfire, assome service providers must focus less on thequalities of the services they deliver, andmore on the quantities. The study encouragesmental health services researchers toincorporate ethnographic methods into studydesigns so that participants' experiences canbe taken into account when evaluating theimpact of system changes.     

Healthcare utilization and mortality among veterans of the Gulf War

The authors conducted an extensive search for published works concerning healthcare utilization and mortality among Gulf War veterans of the Coalition forces who served during the 1990-1991 Gulf War. Reports concerning the health experience of US, UK, Canadian, Saudi and Australian veterans were reviewed. This report summarizes 15 years of observations and research in four categories: Gulf War veteran healthcare registry studies, hospitalization studies, outpatient studies and mortality studies. A total of 149728 (19.8%) of 756373 US, UK, Canadian and Australian Gulf War veterans received health registry evaluations revealing a vast number of symptoms and clinical conditions but no suggestion that a new unique illness was associated with service during the Gulf War. Additionally, no Gulf War exposure was uniquely implicated as a cause for post-war morbidity. Numerous large, controlled studies of US Gulf War veterans' hospitalizations, often involving more than a million veterans, have been conducted. They revealed an increased post-war risk for mental health diagnoses, multi-symptom conditions and musculoskeletal disorders. Again, these data failed to demonstrate that Gulf War veterans suffered from a unique Gulf War-related illness. The sparsely available ambulatory care reports documented that respiratory and gastrointestinal complaints were quite common during deployment. Using perhaps the most reliable data, controlled mortality studies have revealed that Gulf War veterans were at increased risk of injuries, especially those due to vehicular accidents. In general, healthcare utilization data are now exhausted. These findings have now been incorporated into preventive measures in support of current military forces. With a few diagnostic exceptions such as amyotrophic lateral sclerosis, mental disorders and cancer, it now seems time to cease examining Gulf War veteran morbidity and to direct future research efforts to preventing illness among current and future military personnel.     

Treatment engagement of individuals experiencing mental illness: review and update

Individuals living with serious mental illness are often difficult to engage in ongoing treatment, with high dropout rates. Poor engagement may lead to worse clinical outcomes, with symptom relapse and rehospitalization. Numerous variables may affect level of treatment engagement, including therapeutic alliance, accessibility of care, and a client's trust that the treatment will address his/her own unique goals. As such, we have found that the concept of recovery‐oriented care, which prioritizes autonomy, empowerment and respect for the person receiving services, is a helpful framework in which to view tools and techniques to enhance treatment engagement. Specifically, person‐centered care, including shared decision making, is a treatment approach that focuses on an individual's unique goals and life circumstances. Use of person‐centered care in mental health treatment models has promising outcomes for engagement. Particular populations of people have historically been difficult to engage, such as young adults experiencing a first episode of psychosis, individuals with coexisting psychotic and substance use disorders, and those who are homeless. We review these populations and outline how various evidence‐based, recovery‐oriented treatment techniques have been shown to enhance engagement. Our review then turns to emerging treatment strategies that may improve engagement. We focus on use of electronics and Internet, involvement of peer providers in mental health treatment, and incorporation of the Cultural Formulation Interview to provide culturally competent, person‐centered care. Treatment engagement is complex and multifaceted, but optimizing recovery‐oriented skills and attitudes is essential in delivery of services to those with serious mental illness.     

Adolescent Medicine: Attitudes,Training, and Experience Of Pediatric,Family Medicine,and Obstetric-Gynecology Residents

Purpose: Several studies have documented a deficiency in the delivery of preventive services to adolescents during physician visits in the United States. This study sought to assess and compare pediatric, family medicine (FM), and obstetrics and gynecology (OB/GYN) resident perceptions of their responsibility, training, and experience with providing comprehensive health care services to adolescents.Methods: A 57-item, close-ended survey was designed and administered to assess resident perceptions of the scope of their practice, training, and experience with providing adolescent health care across a series of health care categories.Results: Of the 87 respondents (31 OB/GYN, 29 FM, and 27 pediatric), most residents from all three fields felt that the full range of adolescent preventive and clinical services represented in the survey fell under their scope of practice. Residents from all three fields need more training and experience with mental health issues, referring teenagers to substance abuse treatment programs, and addressing physical and sexual abuse. In addition, OB-GYN residents reported deficiencies in training and experience regarding several preventive counseling and general health services, while pediatric residents reported deficiencies in training and experience regarding sexual health services.Conclusions: Our results indicate that at this time, residents from these three specialties are not optimally prepared to provide the full range of recommended preventive and clinical services to adolescents.     

Associations between Parent-Adolescent Attachment Relationship Quality,Negative Life Events and Mental Health

Purpose

The aim of this study was to examine the association of negative life events and parent-adolescent attachment relationship quality with mental health problems and to explore an interaction between the parent-adolescent attachment relationship and one or multiple negative life events on the mental health of adolescents.

Methods

A two-year longitudinal study was conducted among first-year secondary school students (N = 3181). The occurrence of life events and the quality of parent-adolescent attachment were assessed at baseline and mental health status at two-year follow-up by means of self-report questionnaires. Binary logistic regression analyses were conducted to assess associations between life events, parent-adolescent attachment and mental health problems. Relative Excess Risk due to Interaction techniques were used to determine the interaction effects on the additive scale.

Results

Life events were related to mental health status, as was parent-adolescent attachment. The combined effect of an unfavourable parent-adolescent attachment with life events on mental health was larger than the sum of the two individual effects. Among adolescents with one life event or multiple life events, an unfavourable parent-adolescent attachment increased the risk of mental health problems at follow-up compared to the group without life events.

Conclusion

Results supported an interaction effect between parent-adolescent attachment and negative life events on mental health. Especially adolescents with one or multiple life events and an unfavourable parent-adolescent attachment seems to be a vulnerable group for mental health problems. Implications for further research are discussed.     

Animal-assisted therapies for youth with or at risk for mental health problems: A systematic review

To systematically review experimental evidence regarding animal-assisted therapies (AAT) for children or adolescents with or at risk for mental health conditions, we reviewed all experimental AAT studies published between 2000–2015, and compared studies by animal type, intervention, and outcomes. Studies were included if used therapeutically for children and adolescents (≤21 years) with or at risk for a mental health problem; used random assignment or a waitlist comparison/control group; and included child-specific outcome data. Of 1,535 studies, 24 met inclusion criteria. Of 24 studies identified, almost half were randomized controlled trials, with 9 of 11 published in the past two years. The largest group addresses equine therapies for autism. Findings are generally promising for positive effects associated with equine therapies for autism and canine therapies for childhood trauma. The AAT research base is slim; a more focused research agenda is outlined.     

A European project on health problems, mental disorders and cross-cultural aspects of developing effective rehabilitation procedures for refugee and immigrant youth

The project is an international comparative study on risk and protective factors of adolescent health and well-being, with particular focus on youth with immigrant (or refugee) experience. This is a comprehensive study on the quality of life and health outcomes of adolescent youth that looks at group-specific differences within different socio-cultural contexts across six European countries, including those of post-conflict communities. The research project combines both quantitative and qualitative methods, using a common set up across all countries involved with the goal of collecting data on 3500 adolescents that are strictly comparable to allow cross-country analyses. It is particularly aimed at increasing the understanding of acculturation processes of a particularly sensitive population of adolescent refugees and immigrants and of the influence that the interaction of contextual and developmental factors has on their mental health and psychological well-being. in COll. Antropol. 27 (2003) 2: 431–438     

Stressful life events and co-occurring depression,substance abuse and suicidality among American Indian and Alaska Native adolescents

Depression, suicidality and substance abuse disorders are examined with special emphasis on the role of stressful life events in predicting severity and patterns of comorbidity among American Indian and Alaska Native adolescents in boarding school environments. Both amount and severity of comorbidity increase with age and specific patterns of comorbidity are associated with gender. Different types and amounts of stressful life events predict specific combinations of comorbidity. These outcomes are interpretable with respect to associated cultural dynamics and the ecology of mental health services delivery for Indian and Native adolescents. Theoretical and methodological issues are discussed in relation to the use of stressful life events in examining cultural factors related to comorbidity among culturally different populations.     

Social Capital, Narratives of Fragmentation, and Schizophrenia: An Ethnographic Exploration of Factors Shaping African-Caribbeans’ Social Capital and Mental Health in a North London Community

Recent research studies have proposed the concept of social capital—broadly defined as social networks, community cohesion, and participation—as a social risk factor for health disparities and the high rates of schizophrenia among individuals of Caribbean heritage in England. However, many of the existing studies lack sociohistorical contexts and do not capture the experiential dimensions of individuals’ social capital. This paper adds to the debate by examining the mechanisms and sociocultural processes that shape the understandings and experiences of social capital in a sample of British African-Caribbeans. Drawing on ethnographic and survey data collected over 2 years in a North London community, the paper focuses on participants’ every day experiences and the stories they tell about their community and social fragmentation. These stories suggest that social changes and historical forces interact to affect the social capital and emotional well-being of local African-Caribbean residents. I argue that my participants’ collective narratives about their social environment contribute to the emotional tone of the community, and create added stressors that may impact their mental health.     

Overweight in adolescents: Implications for health expenditures

We consider a compelling research question raised by the growing prevalence of overweight among adolescents: do overweight adolescents incur greater health care expenditures than adolescents of normal weight? To address this question, we use data from the Medical Expenditure Panel Survey (MEPS) and estimate a two-part, generalized linear model (GLM) of health spending. Considering separate models by gender, we find that overweight females incur $790 more in annual expenditures than those of normal weight but we find no expenditure differences by bodyweight for males. We find that mental health spending is associated with part of the disparity in expenditures for adolescent females but establishing causality between mental health problems and weight-related health expenditure differences is challenging.     

Ethical Issues in Adolescents' Sexual and Reproductive Health Research in Nigeria

There is increasing interest in the need to address the ethical dilemmas related to the engagement of adolescents in sexual and reproductive health (SRH) research. Research projects, including those that address issues related to STIs and HIV, adverse pregnancy outcomes, violence, and mental health, must be designed and implemented to address the needs of adolescents. Decisions on when an individual has adequate capacity to give consent for research most commonly use age as a surrogate rather than directly assessing capacity to understand the issues and make an informed decision on whether to participate in research or not. There is a perception that adolescents participating in research are more likely to be coerced and may therefore not fully comprehend the risk they may be taking when engaging in research. This paper examines the various ethical issues that may impact stakeholders' decision making when considering engaging adolescents in SRH research in Nigeria. It makes a case for lowering the age of consent for adolescents. While some experts believe it is possible to extrapolate relevant information from adult research, studies on ethical aspects of adolescents' participation in research are still needed, especially in the field of sexual and reproductive health where there are often differences in knowledge, attitudes and practices compared to adults. The particular challenges of applying the fundamental principles of research ethics to adolescent research, especially research about sex and sexuality, will only become clear if more studies are conducted.     

Glucose-6-Phosphate Dehydrogenase Deficiency and Physical and Mental Health until Adolescence

BackgroundTo examine the association of glucose-6-phosphate dehydrogenase (G6PD) deficiency with adolescent physical and mental health, as effects of G6PD deficiency on health are rarely reported.MethodsIn a population-representative Chinese birth cohort: “Children of 1997” (n = 8,327), we estimated the adjusted associations of G6PD deficiency with growth using generalized estimating equations, with pubertal onset using interval censored regression, with hospitalization using Cox proportional hazards regression and with size, blood pressure, pubertal maturation and mental health using linear regression with multiple imputation and inverse probability weighting.ResultsAmong 5,520 screened adolescents (66% follow-up), 4.8% boys and 0.5% girls had G6PD deficiency. G6PD-deficiency was not associated with birth weight-for-gestational age or length/height gain into adolescence, but was associated with lower childhood body mass index (BMI) gain (-0.38 z-score, 95% confidence interval (CI) -0.57, -0.20), adjusted for sex and parental education, and later onset of pubic hair development (time ratio = 1.029, 95% CI 1.007, 1.050). G6PD deficiency was not associated with blood pressure, height, BMI or mental health in adolescence, nor with serious infectious morbidity until adolescence.ConclusionsG6PD deficient adolescents had broadly similar physical and mental health indicators, but transiently lower BMI gain and later pubic hair development, whose long-term implications warrant investigation.     

Identity,Subjectivity, and Disorders of Self in Psychosis

Alterations in self-experience are increasingly attended to as relevant and important aspects of schizophrenia, and psychosis more broadly, through a burgeoning self-disorders (SD) literature. At the same time, issues of self, subject, and subjectivity within schizophrenia-spectrum illnesses have also gained attention from researchers across the social sciences and humanities, and from ethnographic research especially. This paper examines the subjective experience of disruptions in self-identity within a cohort of first episode psychosis (FEP) service users, critically engaging with the SD literature and bringing it into conversation with social sciences and humanities scholarship on self and schizophrenia. Drawing findings from an ongoing ethnographic study of young peoples’ experiences with psychosis, we explore meanings of mental distress relating to psychotic episodes and attend to issues of self, identity, and subjectivity. We critique the division between “normal” and “pathological” self-experience that is endorsed within the SD literature, arguing against the notion that fragmentation of self-experience in schizophrenia-spectrum illnesses is indicative of psychopathology. We highlight how experiences categorized as psychosis are also important and complete aspects of one’s social world and inner life and explore the ways in which at least some aspects of disruptions of self-identity stem from clinical situations themselves—in particular, from asymmetries of power within the mental health system. Relating our findings to feminist, postcolonial, and disability studies’ approaches to the “self,” we emphasize the complex interplay between interpersonal, cultural, and structural aspects of self-experience within FEP.