Still Standing Inside: A Local Idiom Related to Trauma among Namibian Speakers of Khoekhoegowab.

Euro-centric psychiatric conceptualizations often ignore the interplay of local with universal factors in psychological suffering. Emic, locally focused perspectives can enrich etic knowledge to provide culturally sensitive care and to better elucidate the role of culture in mental illness. This study explored the idiom Tsûsa ǃNaeǃkhais xa hâǃnâ/mâǃnâ/ǂgâǃnâhe hâ (a terrible event has entered a person and remains standing inside), which was understood to relate to experiences of trauma and post-traumatic stress, among speakers of Khoekhoegowab, a southern-African click language. Semi-structured interviews were conducted with 16 participants from six urban and rural communities in Namibia. Questions probed perceptions of the idiom in terms of etiology, course, and risk and resilience factors from a socio-ecological framework. Five key themes were identified using thematic analysis: origin in a shocking event; intrusive recurrence of memories, "it keeps on coming back"; the close interplay between mental and physical suffering; the importance of active engagement in healing through prayer and acceptance; and the role of the community in both alleviating and amplifying distress. Our findings highlight local norms and strategies for adaptive coping, and the benefits of exploring local idioms to elucidate the braiding together of universal and cultural elements in psychological distress

Discrimination, Trauma, and Psychological Distress among Central American Immigrants: The Role of Social Connectedness and Belonging

Thesis advisor: Pratyusha Tummala-NarraThe present-day sociopolitical climate, with its noxious anti-immigrant sentiment and policies, has increased the emotional stress experienced by immigrant-origin populations. This dissertation presents findings from research that explored the relationship between race-and ethnicity-based discrimination, exposure to trauma, and psychological distress among a sample of Central American–origin immigrants and refugees in the United States. Informed by socio-ecological and contemporary acculturation theory, this research extended the traumatic stress and migration literature by examining how a global sense of social connectedness, as well as a sense of belonging to one’s ethnic community or the mainstream community, may mitigate or exacerbate the influence of discrimination and trauma on mental health. In addition, this research explored the potential moderating role of immigrant generation and documentation status. Participants (N=89) between 18 and 70 years of age completed surveys both online (N=28) and in person (N=61). Survey instruments included a demographic questionnaire, the Perceived Racism Scale for Latinos (PRSL), the Trauma History Questionnaire (THQ), the Social Connectedness Scale – Revised (SCS-R), the Social Connectedness in Mainstream (SCMN) and the Social Connectedness in the Ethnic Community (SCETH) scales, as well as measures to assess for symptoms of depression (PHQ-9), anxiety (GAD-7), posttraumatic stress (PCL-C), and somatization (SSS-8). Ordinary least-squares regression analyses revealed that discrimination and exposure to trauma significantly predicted psychological distress. Higher levels of social connectedness predicted lower levels of depression, anxiety, and PTSD. Mainstream social connectedness was found to moderate the association between exposure to trauma and PTSD such that for individuals with low levels of SCMN, posttraumatic stress was consistently relatively high regardless of the degree of trauma exposure. For those individuals with high SCMN, posttraumatic stress symptoms were low when trauma exposure was low. However, all individuals regardless of their sense of mainstream belonging experienced high PTSD when trauma exposure was high. In addition, a lower sense of mainstream belonging augmented the strength of the association between discrimination on depression, whereas a stronger sense of mainstream belonging reduced the strength of this relation. Specifically, individuals with low SCMN reported higher depressive symptoms with increasing perceived discrimination, while individuals with high SCMN reported similar levels of depression even at increasing levels of discrimination. Analyses did not support moderation effects for ethnic social connectedness, immigrant generation and documentation status. The study’s strengths and limitations as well as its significance for future research and practice are discussed. Implications highlight the multifaceted and dynamic nature of belongingness in the context of discrimination and trauma, and speak to the importance of culturally responsive and multi-systemic interventions.Thesis (PhD) — Boston College, 2018.Submitted to: Boston College. Lynch School of Education.Discipline: Counseling, Developmental and Educational Psychology

Still Standing Inside: A Local Idiom Related to Trauma among Namibian Speakers of Khoekhoegowab

Euro-centric psychiatric conceptualizations often ignore the interplay of local with universal factors in psychological suffering. Emic, locally focused perspectives can enrich etic knowledge to provide culturally sensitive care and to better elucidate the role of culture in mental illness. This study explored the idiom Tsûsa ǃNaeǃkhais xa hâǃnâ/mâǃnâ/ǂgâǃnâhe hâ (a terrible event has entered a person and remains standing inside), which was understood to relate to experiences of trauma and post-traumatic stress, among speakers of Khoekhoegowab, a southern-African click language. Semi-structured interviews were conducted with 16 participants from six urban and rural communities in Namibia. Questions probed perceptions of the idiom in terms of etiology, course, and risk and resilience factors from a socio-ecological framework. Five key themes were identified using thematic analysis: origin in a shocking event; intrusive recurrence of memories, “it keeps on coming back”; the close interplay between mental and physical suffering; the importance of active engagement in healing through prayer and acceptance; and the role of the community in both alleviating and amplifying distress. Our findings highlight local norms and strategies for adaptive coping, and the benefits of exploring local idioms to elucidate the braiding together of universal and cultural elements in psychological distress

The management of acute venous thromboembolism in clinical practice - study rationale and protocol of the European PREFER in VTE Registry

Background: Venous thromboembolism (VTE) is a major health problem, with over one million events every year in Europe. However, there is a paucity of data on the current management in real life, including factors influencing treatment pathways, patient satisfaction, quality of life (QoL), and utilization of health care resources and the corresponding costs. The PREFER in VTE registry has been designed to address this and to understand medical care and needs as well as potential gaps for improvement. Methods/design: The PREFER in VTE registry was a prospective, observational, multicenter study conducted in seven European countries including Austria, France Germany, Italy, Spain, Switzerland, and the UK to assess the characteristics and the management of patients with VTE, the use of health care resources, and to provide data to estimate the costs for 12 months treatment following a first-time and/or recurrent VTE diagnosed in hospitals or specialized or primary care centers. In addition, existing anticoagulant treatment patterns, patient pathways, clinical outcomes, treatment satisfaction, and health related QoL were documented. The centers were chosen to reflect the care environment in which patients with VTE are managed in each of the participating countries. Patients were eligible to be enrolled into the registry if they were at least 18 years old, had a symptomatic, objectively confirmed first time or recurrent acute VTE defined as either distal or proximal deep vein thrombosis, pulmonary embolism or both. After the baseline visit at the time of the acute VTE event, further follow-up documentations occurred at 1, 3, 6 and 12 months. Follow-up data was collected by either routinely scheduled visits or by telephone calls. Results: Overall, 381 centers participated, which enrolled 3,545 patients during an observational period of 1 year. Conclusion: The PREFER in VTE registry will provide valuable insights into the characteristics of patients with VTE and their acute and mid-term management, as well as into drug utilization and the use of health care resources in acute first-time and/or recurrent VTE across Europe in clinical practice. Trial registration: Registered in DRKS register, ID number: DRKS0000479