Culturally sensitive grief interventions: a scoping review protocol

Objective: The objective of this scoping review is to understand the extent and type of evidence in relation to culturally sensitive interventions for bereaved individuals. A particular aim is to inform future research on the development of grief interventions. Introduction: Prolonged grief disorder is associated with a range of negative psychosocial consequences, making treatment crucial for affected individuals. Culture plays a large role in the expression of grief, mourning rituals and practices or the meaning of and beliefs about death. Although there is growing interest in culturally sensitive interventions for grief, the current literature lacks a comprehensive synthesis of evidence. A scoping review is considered appropriate to fill this gap. Inclusion criteria: This review will include sources with participants having experienced bereavement following the loss of a loved one and having taken part in a culturally sensitive psychosocial grief intervention. Studies conducted in non-WEIRD (Western, Educated, Industrialized, Rich, Democratic) contexts or studies targeting a cultural or subcultural group outside the majority group (regarding age, religion, sexual orientation, etc.) will be included. Methods: This review will be conducted following the JBI methodology for scoping reviews. Searches will be conducted in 11 databases (Scopus, Embase, Cochrane, Sociological Abstracts, IBSS, PTSDpubs, PsycINFO, MEDLINE, CINAHL, SocINDEX and Web of Science). Limits include language (English and German) and publication date (from 2000). The two-step screening process (titles and abstracts, full text) will be piloted, data extracted and collated. Results from the data extraction will be presented in a narrative summary and tabular form

Culturally sensitive grief treatment and support: A scoping review

Objective The goal of this scoping review was to assess the scope and nature of evidence concerning culturally sensitive grief treatment and support interventions, aiming to provide valuable insights for future research on grief intervention development. Introduction Prolonged grief disorder (PGD), associated with adverse psychosocial outcomes, requires treatment. The norms of a person’s culture influence grief expression, mourning rituals, and perspectives on death. Despite increasing interest in culturally sensitive grief interventions, a comprehensive synthesis of evidence is lacking. A scoping review was deemed fitting to address this gap. Inclusion criteria This review included studies featuring participants experiencing clinically relevant grief and engaged in culturally sensitive psychosocial grief interventions. It included studies conducted in non-WEIRD contexts or those focusing on sociocultural (sub)groups distinct from the majority (in terms of age, religion, sexual orientation, etc). Methods Following JBI methodology for scoping reviews, 13 databases were searched (Scopus, Embase, Cochrane, Sociological Abstracts, IBSS, PTSDpubs, PsycINFO, PsycArticles, PSYNDEX, MEDLINE, CINAHL, SocINDEX, and Web of Science). Limits included language (English and German), peer-reviewed articles and publication date (from 2000). The two-step screening process (titles and abstracts, full text) was piloted, and data were extracted and collated. Results Eighteen studies were included, displaying diversity in geographical location, methodology, and target populations. Interventions targeted various forms of clinically relevant grief, lost relationships, and sociocultural groups. Cultural adaptation processes varied, with seven studies using a top-down approach. Sources of information for formative research involved theoretical models and empirical data, while local experts and qualitative research (e.g., key informant interviews) informed cultural adaptation. Outcome measures were diverse, with 15 studies showing significant pre-post intervention changes, while two did not. Conclusions The review highlighted the emerging significance of culturally sensitive interventions for PGD, emphasizing the need for standardized approaches and further research. By shedding light on gaps and providing recommendations, it offers insights for future researchers in this field

Mental health stigma at primary health care centres in Lebanon: qualitative study

Background: Mental health-related stigma is a global public health concern and a major barrier to seeking care. In this study, we explored the role of stigma as a barrier to scaling up mental health services in primary health care (PHC) centres in Lebanon. We focused on the experiences of Healthcare Providers (HCPs) providing services to patients with mental health conditions (MHCs), the views of policy makers, and the perceptions of stigma or discrimination among individuals with MHCs. This study was conducted as part of INDIGO-PRIMARY, a larger multinational stigma reduction programme. Methods: Semi-structured qualitative interviews (n = 45) were carried out with policy makers (n = 3), PHC management (n = 4), PHC staff (n = 24), and service users (SUs) (n = 14) between August 2018 and September 2019. These interviews explored mental health knowledge, attitudes and behaviour of staff, challenges of providing treatment, and patient outcomes. All interviews were coded using NVivo and a thematic coding framework. Results: The results of this study are presented under three themes: (1) stigma at PHC level, (2) stigma outside PHC centres, and (3) structural stigma. SUs did not testify to discrimination from HCPs but did describe stigmatising behaviour from their families. Interestingly, at the PHC level, stigma reporting differed among staff according to a power gradient. Nurses and social workers did not explicitly report incidents of stigma but described patients with MHCs as uncooperative, underscoring their internalized negative views on mental health. General practitioners and directors were more outspoken than nurses regarding the challenges faced with mental health patients. Mental health professionals revealed that HCPs still hold implicitly negative views towards patients with MHCs however their attitude has improved recently. Our analysis highlights five layers of stigma affecting SUs. Conclusion: This qualitative study reveals that stigma was still a key concern that affects patients with MHC. SUs reported experiencing overt stigmatising behaviour in the community but less explicit discrimination in a PHC setting. Our findings emphasise the importance of (1) combatting structural stigma through legal reform, (2) addressing interpersonal stigma, (3) committing PHC management to deliver high quality mental health integrated services, and (4) reducing intrapersonal stigma by building public empathy. Keywords: Mental health Stigma; Primary health care (PHC); Qualitative researc

Perspectives of healthcare providers, service users, and family members about mental illness stigma in primary care settings: A multi-site qualitative study of seven countries in Africa, Asia, and Europe

Background: Stigma among healthcare providers is a barrier to the effective delivery of mental health services in primary care. Few studies have been conducted in primary care settings comparing the attitudes of healthcare providers and experiences of people with mental illness who are service users in those facilities. Such research is necessary across diverse global settings to characterize stigma and inform effective stigma reduction. Methods: Qualitative research was conducted on mental illness stigma in primary care settings in one low-income country (Nepal), two lower-middle income countries (India, Tunisia), one upper-middle-income country (Lebanon), and three high-income countries (Czech Republic, Hungary, Italy). Qualitative interviews were conducted with 248 participants: 64 primary care providers, 11 primary care facility managers, 111 people with mental illness, and 60 family members of people with mental illness. Data were analyzed using framework analysis. Results: Primary care providers endorsed some willingness to help persons with mental illness but reported not having appropriate training and supervision to deliver mental healthcare. They expressed that people with mental illness are aggressive and unpredictable. Some reported that mental illness is incurable, and mental healthcare is burdensome and leads to burnout. They preferred mental healthcare to be delivered by specialists. Service users did not report high levels of discrimination from primary care providers; however, they had limited expectations of support from primary care providers. Service users reported internalized stigma and discrimination from family and community members. Providers and service users reported unreliable psychiatric medication supply and lack of facilities for confidential consultations. Limitations of the study include conducting qualitative interviews in clinical settings and reliance on clinician-researchers in some sites to conduct interviews, which potentially biases respondents to present attitudes and experiences about primary care services in a positive manner. Conclusions: Primary care providers' willingness to interact with people with mental illness and receive more training presents an opportunity to address stigmatizing beliefs and stereotypes. This study also raises important methodological questions about the most appropriate strategies to accurately understand attitudes and experiences of people with mental illness. Recommendations are provided for future qualitative research about stigma, such as qualitative interviewing by non-clinical personnel, involving non-clinical staff for recruitment of participants, conducting interviews in non-clinical settings, and partnering with people with mental illness to facilitate qualitative data collection and analysis

Culturally sensitive grief interventions: a scoping review protocol

This document serves as the preregistration of the protocol of "Culturally sensitive grief interventions: a scoping review protocol"

University Students' Life Stressors and Mental Health in Georgia and German-Speaking Switzerland

Background: The university years are associated with a variety of stressors, and recently, COVID-19 has presented an additional burden on students’ mental well-being. As mental health manifestations of stressors may differ between countries, this study compared students from Switzerland and the Republic of Georgia regarding the burden of stressors and the role of potentially culture-dependent risk and protective factors of mental health (i.e., help-seeking, cross-cultural coping, fatalism, sense of coherence). Method: We assessed two samples of university students in Georgia ( N = 425) and German-speaking Switzerland ( N = 298), using a cross-sectional design. Quantitative data were collected with online questionnaires during the third wave of the pandemic. Mental health screenings included measures of depression, anxiety, and adjustment disorder. Results: General life- and COVID-19-related stress levels were higher in Georgia than in Switzerland. Georgian students experienced more adjustment disorder symptoms but lower levels of depression and anxiety. While Swiss students reported more protective factors (formal and informal help-seeking, sense of coherence), Georgian students experienced more risk factors (fatalism and avoidance coping). Despite significant correlations between potentially culture-dependent risk and protective factors and mental health, few associations remained significant above and beyond the impact of general life stress. Conclusions: The high prevalence of stressors and adjustment disorder symptoms and risk factors for mental health among Georgian students illustrates a potential need for psychosocial support with stress management. The cross-cultural applicability of Western models of student mental health services should be evaluated

Mental health stigma at primary health care centres in Lebanon:qualitative study

BACKGROUND: Mental health-related stigma is a global public health concern and a major barrier to seeking care. In this study, we explored the role of stigma as a barrier to scaling up mental health services in primary health care (PHC) centres in Lebanon. We focused on the experiences of Healthcare Providers (HCPs) providing services to patients with mental health conditions (MHCs), the views of policy makers, and the perceptions of stigma or discrimination among individuals with MHCs. This study was conducted as part of INDIGO-PRIMARY, a larger multinational stigma reduction programme. METHODS: Semi-structured qualitative interviews (n = 45) were carried out with policy makers (n = 3), PHC management (n = 4), PHC staff (n = 24), and service users (SUs) (n = 14) between August 2018 and September 2019. These interviews explored mental health knowledge, attitudes and behaviour of staff, challenges of providing treatment, and patient outcomes. All interviews were coded using NVivo and a thematic coding framework. RESULTS: The results of this study are presented under three themes: (1) stigma at PHC level, (2) stigma outside PHC centres, and (3) structural stigma. SUs did not testify to discrimination from HCPs but did describe stigmatising behaviour from their families. Interestingly, at the PHC level, stigma reporting differed among staff according to a power gradient. Nurses and social workers did not explicitly report incidents of stigma but described patients with MHCs as uncooperative, underscoring their internalized negative views on mental health. General practitioners and directors were more outspoken than nurses regarding the challenges faced with mental health patients. Mental health professionals revealed that HCPs still hold implicitly negative views towards patients with MHCs however their attitude has improved recently. Our analysis highlights five layers of stigma affecting SUs. CONCLUSION: This qualitative study reveals that stigma was still a key concern that affects patients with MHC. SUs reported experiencing overt stigmatising behaviour in the community but less explicit discrimination in a PHC setting. Our findings emphasise the importance of (1) combatting structural stigma through legal reform, (2) addressing interpersonal stigma, (3) committing PHC management to deliver high quality mental health integrated services, and (4) reducing intrapersonal stigma by building public empathy

COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study

International audienceBackground: Various observations have suggested that the course of COVID-19 might be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases receiving rituximab compared with those not receiving rituximab. We aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases.Methods: In this cohort study, we analysed data from the French RMD COVID-19 cohort, which included patients aged 18 years or older with inflammatory rheumatic and musculoskeletal diseases and highly suspected or confirmed COVID-19. The primary endpoint was the severity of COVID-19 in patients treated with rituximab (rituximab group) compared with patients who did not receive rituximab (no rituximab group). Severe disease was defined as that requiring admission to an intensive care unit or leading to death. Secondary objectives were to analyse deaths and duration of hospital stay. The inverse probability of treatment weighting propensity score method was used to adjust for potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body-mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure, and the underlying disease [rheumatoid arthritis vs others]). Odds ratios and hazard ratios and their 95% CIs were calculated as effect size, by dividing the two population mean differences by their SD. This study is registered with ClinicalTrials.gov, NCT04353609.Findings: Between April 15, 2020, and Nov 20, 2020, data were collected for 1090 patients (mean age 55·2 years [SD 16·4]); 734 (67%) were female and 356 (33%) were male. Of the 1090 patients, 137 (13%) developed severe COVID-19 and 89 (8%) died. After adjusting for potential confounding factors, severe disease was observed more frequently (effect size 3·26, 95% CI 1·66-6·40, p=0·0006) and the duration of hospital stay was markedly longer (0·62, 0·46-0·85, p=0·0024) in the 63 patients in the rituximab group than in the 1027 patients in the no rituximab group. 13 (21%) of 63 patients in the rituximab group died compared with 76 (7%) of 1027 patients in the no rituximab group, but the adjusted risk of death was not significantly increased in the rituximab group (effect size 1·32, 95% CI 0·55-3·19, p=0·53).Interpretation: Rituximab therapy is associated with more severe COVID-19. Rituximab will have to be prescribed with particular caution in patients with inflammatory rheumatic and musculoskeletal diseases