Depression and Help Seeking in the Sri Lankan-Australian and Anglo-Australian Community: A Qualitative Exploration-Preliminary Findings

This study compared cultural variances in the understanding of depression, help seeking and management strategies between Anglo-Australians and Sri Lankan immigrants with depression, one of the fastest growing immigrant communities in Australia. From 2012-2104 Sri Lankan (n=18) and Anglo-Australians (n=30) participants living with depression took part in semi-structured interviews. Participant eligibility was verified by significant levels of depression on the DSM IV and K10. Sri Lankans and Anglo-Australians expressed overlap in the experience in symptoms, yet differences in beliefs related to the etiology of depression; in general, Sri Lankan migrants attributed depressive symptoms to ongoing social problems whereas Anglos-Australians generally conceptualized depression as a biomedical disorder. These disparities in illness beliefs influenced help seeking trajectories; Sri Lankans favored self-directed behavioral interventions, and in many cases were hesitant take medication to address mental health issues as this was seen as an admission of “madness.” In contrast early intervention via primary care was common for Anglo-Australians. However, while a significant proportion of Anglo-Australians would use pharmaceutical interventions, many were also prepared to try complementary and alternative therapies. Across both groups stigma still presents a significant barrier to help-seeking, however stigma was particularly noted in the Sri Lankan community. Preliminary analyses suggest important differences in help-seeking strategies that may have implications for improving access to mental health services and the development of culturally salient interventions in the Australian context to cater for the growing Sri Lankan migrant community. The outcomes of this study will provide greater insight into cultural variances of depression and help seeking of Sri Lankan immigrants. These results may further provide valuable information that can be used more broadly in countries receiving Sri Lankan, and possibly other South Asian migrants

Breaking the barriers: overcoming dementia-related stigma in minority communities

Dementia is a global health concern that affects individuals irrespective of their cultural or linguistic backgrounds. However, research has long recognized the pronounced stigma associated with dementia, particularly within Culturally and Linguistically Diverse (CALD) communities. This article seeks to summarize the underlying factors contributing to the heightened levels of dementia stigma within CALD communities, through a review of the literature. Our examination shows that cultural beliefs, language barriers, limited awareness, and the impact of migration on perceptions of aging and cognitive decline are contributing factors. Consequently, our analysis highlights the need for tailored, culturally appropriate interventions aimed at mitigating stigma and enhancing dementia care within CALD populations. Our proposed solutions, built on a social-ecological approach, highlights the critical role of collaborative efforts involving policymakers, healthcare providers, community organizations, and CALD community members in fostering a more dementia-inclusive society. This perspective piece aims to shed light on the distinct challenges faced by CALD communities, while advocating for a holistic approach to redefine perceptions and care strategies tailored to these populations

Using digital media to improve dementia care in India: A pilot randomised control trial

Background: India is undergoing a demographic transition characterised by population ageing and is witnessing a high dementia rate. Although, around 4.4 million people live with dementia in India, dementia awareness is poor and current resources addressing dementia care are basic and often incomplete, duplicated, and/or conflicting. To address this gap, the current study aims to use digital media, which has had a massive technological uptake in India, to improve dementia care in India. / Objective: To describe the design of an intervention study that examines the feasibility and acceptability of a digital media resource (Moving Pictures India) to improve dementia care in India. / Methods: The study employs a mixed methods design and is divided into four phases: (i) video interviews with Indian carers and health professionals; (ii) co-production of resources; (iii) pilot randomised controlled trial (RCT); and (iv) dissemination and analytics. The pilot RCT will follow an experimental parallel group design with two arms aiming to assess impact, feasibility and acceptability of the developed resources. The primary outcome measures for the pilot RCT will be feasibility and acceptability. Secondary outcome measures for the pilot RCT will be carer burden, carer mood and carer quality of life. / Results: This study was funded by the Alzheimer’s Association US in July 2021. In 2023, we will enroll 60 dementia carers (40 carers for the intervention arm and 20 for the control) for the pilot RCT. The study has been approved by the National Institute of Mental Health and Neurosciences (NIMHANS) Ethics Committee (NIMHANS/26th IEC (BEH.SC.DIV.)/2020-21 dated 11.11.2020), Health Ministry's Screening Committee, India (HMSC; proposal ID 2020-10137), the Curtin University Human Research Ethics Committee (HREC; Approval number: HRE2020-0735), and the NARI Research Governance Office (Site specific approval dated 17.03.2021). / Conclusions: This study protocol is designed to deliver unique, co-produced, evidence-based resources to support carers of persons with dementia in India and other countries aiming to utilize digital media for dementia care. Analytics and qualitative feedback post-piloting will be used, if the intervention is found feasible and acceptable, to develop an implementation trial to evaluate the effectiveness of the potential low-risk high-benefit intervention in practice. Clinical Trial: The trial was registered with the Clinical Trials Registry-India (Trial Registration No. CTRI/2021/01/030403). Registered on Jan 12, 2021

Do Web-based Mental Health Literacy Interventions Improve the Mental Health Literacy of Adult Consumers? Results From a Systematic Review

Background: Low levels of mental health literacy (MHL) have been identified as an important contributor to the mental health treatment gap. Interventions to improve MHL have used traditional media (eg, community talks, print media) and new platforms (eg, the Internet). Evaluations of interventions using conventional media show improvements in MHL improve community recognition of mental illness as well as knowledge, attitude, and intended behaviors toward people having mental illness. However, the potential of new media, such as the Internet, to enhance MHL has yet to be systematically evaluated. Objective: Study aims were twofold: (1) To systematically appraise the efficacy of Web-based interventions in improving MHL. (2) To establish if increases in MHL translated into improvement in individual health seeking and health outcomes as well as reductions in stigma toward people with mental illness. Methods: We conducted a systematic search and appraisal of all original research published between 2000 and 2015 that evaluated Web-based interventions to improve MHL. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to report findings. Results: Fourteen studies were included: 10 randomized controlled trials and 4 quasi-experimental studies. Seven studies were conducted in Australia. A variety of Web-based interventions were identified ranging from linear, static websites to highly interactive interventions such as social media games. Some Web-based interventions were specifically designed for people living with mental illness whereas others were applicable to the general population. Interventions were more likely to be successful if they included “active ingredients” such as a structured program, were tailored to specific populations, delivered evidenced-based content, and promoted interactivity and experiential learning.Conclusions: Web-based interventions targeting MHL are more likely to be successful if they include active ingredients. Improvements in MHL see concomitant improvements in health outcomes, especially for individuals with mild to moderate depression. The most promising interventions suited to this cohort appear to be MoodGYM and BluePages, 2 interventions from Australia. However, the relationship between MHL and formal and informal help seeking is less clear; self-stigma appears to be an important mediator with results showing that despite improvements in MHL and community attitudes to mental illness, individuals with mental illness still seek help at relatively low rates. Overall, the Internet is a viable method to improve MHL. Future studies could explore how new technology interfaces (eg, mobile phones vs computers) can help improve MHL, mental health outcomes, and reduce stigma

"I'm running my depression:" Self-management of depression in neoliberal Australia

The current study examines how the neoliberal imperative to self-manage has been taken up by patients, focusing specifically on Indian-Australians and Anglo-Australians living with depression in Australia. We use Nikolas Rose's work on governmentality and neoliberalism to theorise our study and begin by explicating the links between self-management, neoliberalism and the Australian mental health system. Using qualitative methods, comprising 58 in-depth interviews, conducted between May 2012 and May 2013, we argue that participants practices of self-management included reduced use of healthcare services, self-medication and self-labour. Such practices occurred over time, informed by unsatisfactory interactions with the health system, participants confidence in their own agency, and capacity to craft therapeutic strategies. We argue that as patients absorbed and enacted neoliberal norms, a disconnect was created between the policy rhetoric of self-management, its operationalisation in the health system and patient understandings and practices of self-management. Such a disconnect, in turn, fosters conditions for risky health practices and poor health outcomes

Depression and help seeking in the Sri Lankan-Australian and Anglo-Australian community: A qualitative exploration

The current qualitative study examined the role of culture in the conceptualization of depression and illness behaviours in Sri Lankan migrants residing in Australia and Anglo-Australians. The specific study objectives were to investigate: Patient’s perceptions of their depression; how culture shapes illness behaviours; the influence of social networks on health care trajectories; how stigma operates across cultural groups; and to identify evidence-based interventions specifically designed to treat depression in migrant communities. Findings highlighted the necessity to shift away from a ‘one-size-fits-all’ approach towards the development of programs and interventions tailored to be salient to target migrant communities

Breaking the barriers : overcoming dementia-related stigma in minority communities

Dementia is a global health concern that affects individuals irrespective of their cultural or linguistic backgrounds. However, research has long recognized the pronounced stigma associated with dementia, particularly within Culturally and Linguistically Diverse (CALD) communities. This article seeks to summarize the underlying factors contributing to the heightened levels of dementia stigma within CALD communities, through a review of the literature. Our examination shows that cultural beliefs, language barriers, limited awareness, and the impact of migration on perceptions of aging and cognitive decline are contributing factors. Consequently, our analysis highlights the need for tailored, culturally appropriate interventions aimed at mitigating stigma and enhancing dementia care within CALD populations. Our proposed solutions, built on a social-ecological approach, highlights the critical role of collaborative efforts involving policymakers, healthcare providers, community organizations, and CALD community members in fostering a more dementia-inclusive society. This perspective piece aims to shed light on the distinct challenges faced by CALD communities, while advocating for a holistic approach to redefine perceptions and care strategies tailored to these populations

Legitimising depression: community perspectives and the help-seeking continuum

This article deploys a legitimacy framework to explore how Anglo-Australian and Indian-Australian community members living in Melbourne, Australia, interpret the diagnosis and treatment of depression. Examining community beliefs about depression illuminates the lay-discourses that people living with depression encounter when they disclose their experiences to others. Based on 10 focus groups with 77 community members from Indian-Australian and Anglo-Australian backgrounds, we deploy three frames of legitimacy through which depression is described: biomedical, situational, and moral. Indian-Australian participants were less likely to see depression as a legitimate biomedical condition, describing it primarily in situational terms often connected to migration experiences. Additionally, Indian-Australians often described succumbing to depression as a sign of individual weakness, suggesting that disclosing depression within their community risks loss of moral legitimacy. Anglo-Australians more readily recognised the biomedical legitimacy of depression but offered lay-critiques of medical diagnoses and treatment with antidepressants. In cases of long-term depression, there was a potential loss of moral legitimacy within both communities. The findings illustrate variation in the ways and degrees to which depression and its treatment are socially legitimised across two communities, which manifests in a continuum of diverse approaches to help-seeking.This research was funded by a fellowship from the Australian National Health and Medical Research Council (NHMRC) Grant ID 1036154 awarded to Dr Bianca Brijnath. An Australian Postgraduate Award supported Dr Josefine Antoniades

An examination of australian general practitioners' knowledge, attitudes and practices in relation to sleep disorders

Background: Sleep disorders represent an under-recognised public health problem and are reported to be underdiagnosed in general practices.Aims: To examine general practitioners’ (GPs) attitude, knowledge and practice behaviour and identify barriers to detection,diagnosis and treatment of sleep disorders encountered in the Australian primary care setting.Method: Using mixed methods, quantitative data from the Dartmouth Sleep Knowledge Questionnaire (DSKQ) were analysedusing MS Excel 2007. Qualitative data were obtained from one focus group and eight interviews. Data were thematicallyanalysed.Results: 15 GPs participated; seven in a focus group and eight in interviews. Scores from DSKQ suggest gaps in GPs’knowledge. Qualitative analysis revealed that patients frequently presented with sleep disorders underpinned by mentalhealth disorders. GPs agreed that prescribing pharmacological interventions was undesirable and behavioural interventionswere preferred. Barriers included limited training for GPs, lack of resources, patient expectations and willingness to engagein lifestyle changes, and consultation time constraints.Discussion: Greater flexibility to investigate sleep related problems within the standard consultation and improved accessto educational activities could assist GPs. Patient factors, such as adherence to management strategies, are paramount tosuccessful management of sleep disorders; however, these obstacles to clinical practice may be difficult to overcome.Conclusion: Providing education for GPs about sleep disorders, greater flexibility within consultations may improve patientcare and patient engagement in management strategies may assist, yet a critical success factor in disease managementincludes patient engagement in management strategies

Boundary crossers : how providers facilitate ethnic minority families' access to dementia services

Objectives: Providers who work closely with ethnic minority people with dementia and their families are pivotal in helping them access services. However, few studies have examined how these providers actually do this work. Using the concept of "boundary crossers,"this article investigates the strategies applied by these providers to facilitate access to dementia services for ethnic minority people with dementia and their families. Methods: Between 2017 and 2020, in-depth video-recorded interviews were conducted with 27 health, aged care, and community service providers working with ethnic minority people living with dementia across Australia. Interviews were conducted in one of seven languages and/or in English, then translated and transcribed verbatim into English. The data were analyzed thematically. Results: Family and community stigma associated with dementia and extra-familial care were significant barriers to families engaging with services. To overcome these barriers, participants worked at the boundaries of culture and dementia, community and systems, strategically using English and other vernaculars, clinical and cultural terminology, building trust and rapport, and assisting with service navigation to improve access. Concurrently, they were cognizant of familial boundaries and were careful to provide services that were culturally appropriate without supplanting the families' role. Discussion: In negotiating cultural, social, and professional boundaries, providers undertake multidimensional and complex work that involves education, advocacy, negotiation, navigation, creativity, and emotional engagement. This work is largely undervalued but offers a model of care that facilitates social and community development as well as service integration across health, aged care, and social services. © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved