Qualitative cross-sectional study of the perceived causes of depression in South Asian origin women in Toronto

Objective: To explore how South Asian origin women in Toronto, Canada, understand and explain the causes of their depression. Design: Cross-sectional in-depth qualitative interviews. Setting: Outpatient service in Toronto, Ontario. Participants: Ten women with symptoms of depression aged between 22 and 65 years of age. Seven were from India, two from Sri Lanka and one from Pakistan. Four were Muslim, three Hindu and three Catholic. Two participants had university degrees, one a high school diploma and seven had completed less than a high school education. Eight were married, one was unmarried and one a widow. Results: Three main factors emerged from the participant narratives as the causes of depression: family and relationships, culture and migration and socioeconomic. The majority of the participants identified domestic abuse, marital problems and interpersonal problems in the family as the cause of their depression. Culture and migration and socioeconomic factors were considered contributory. None of our study participants reported spiritual, supernatural or religious factors as causes of depression. Conclusion: A personal-social-cultural model emerged as the aetiological paradigm for depression. Given the perceived causation, psycho-social treatment methods may be more acceptable for South Asian origin women.This research was supported by a strategic training grant (grant number TUF 96115) from the Canadian Institutes of Health Research provided for the Social Aetiology of Mental Illness Training Program

Racism psychosis and common mental disorder among ethnic minority groups in England

Background. The aim of this study was to explore the relationship between risk of psychosis, common mental disorder (CMD) and indicators of racism among ethnic minority groups in England and how this relationship may vary by particular ethnic groups. Method. A multivariate analysis was carried out of quantitative, cross-sectional data from a nationally representative community sample of people aged between 16 and 74 years from the largest ethnic minority groups in England: those of Caribbean, Indian, Pakistani, Bangladeshi and Irish origin. Results. Experience of interpersonal racism and perceiving racism in the wider society each have independent effects on the risk of CMD and psychosis, after controlling for the effects of gender, age and socio-economic status. There was some variation in the findings when they were conducted for separate ethnic and gender groups. Conclusions. An understanding of the relationship between racism and mental health may go some way towards explaining the ethnic variations found in both CMD and, particularly, psychosis

Suicide by burning in the South Asian origin population in England and Wales a secondary analysis of a national data set

Objectives A descriptive analysis of suicide by burning in England and Wales in the general population and in people of South Asian origin. Design A cross-sectional secondary analysis of a national data set. Setting A population study of all those who died by suicide in England and Wales between 1993 and 2003 inclusive. Participants All cases of suicide and undetermined intent identified by the Office for National Statistics for England and Wales. A computer algorithm was used to identify people of the South Asian origin from their names. There were 55 140 suicides in the UK between 1993 and 2003. The ratio of male to female suicides was 3:1. There were 1455 South Asian suicides identified by South Asian Name and Group Recognition Algorithm. Primary and secondary outcome measures Death by suicide and undetermined intent, as determined by Coroner's Inquest. ICD9 codes E958.1 and E988.1 and ICD10 codes X76 and Y26. Results 1.77% of suicides in the general population and 8.45% of suicides in the South Asian origin population were by burning. The suicide rate by burning was 0.8/100 000 person-years for England and Wales and 2.9/100 000 person-years for the South Asian origin population. The odds of suicide by burning were increased in the South Asian group as a whole (OR 3.06, 95% CI 2.30 to 4.08). Those born in Asia and Africa were at higher risk than those born in the UK (OR 2.69, 95% CI 2.01 to 3.60 and OR 2.10, 95% CI 1.46 to 3.01, respectively). The increased risk was for those aged 25-64 years. Conclusion Suicide by burning remains a significant issue in the South Asian origin working-age population in England and Wales. A prevention strategy could target working-age people of South Asian origin born abroad as they are at the highest risk. More in depth research on the reasons for using this method may help to identify possible prevention strategies

The Incidence of Psychotic Disorders and Area-level Marginalization in Ontario, Canada: A Population-based Retrospective Cohort Study

Background: There is limited Canadian evidence on the impact of socio-environmental factors on psychosis risk. We sought to examine the relationship between area-level indicators of marginalization and the incidence of psychotic disorders in Ontario. Methods: We conducted a retrospective cohort study of all people aged 14 to 40 years living in Ontario in 1999 using health administrative data and identified incident cases of psychotic disorders over a 10-year follow-up period. Age-standardized incidence rates were estimated for census metropolitan areas (CMAs). Poisson regression models adjusting for age and sex were used to calculate incidence rate ratios (IRRs) based on CMA and area-level marginalization indices. Results: There is variation in the incidence of psychotic disorders across the CMAs. Our findings suggest a higher rate of psychotic disorders in areas with the highest levels of residential instability (IRR = 1.26, 95% confidence interval [CI], 1.18 to 1.35), material deprivation (IRR = 1.30, 95% CI, 1.16 to 1.45), ethnic concentration (IRR = 1.61, 95% CI, 1.38 to 1.89), and dependency (IRR = 1.35, 95% CI, 1.18 to 1.54) when compared to areas with the lowest levels of marginalization. Marginalization attenuates the risk in some CMAs. Conclusions: There is geographic variation in the incidence of psychotic disorders across the province of Ontario. Areas with greater levels of marginalization have a higher incidence of psychotic disorders, and marginalization attenuates the differences in risk across geographic location. With further study, replication, and the use of the most up-to-date data, a case may be made to consider social policy interventions as preventative measures and to direct services to areas with the highest risk. Future research should examine how marginalization may interact with other social factors including ethnicity and immigration

Measuring perceived racism and psychosis in African-Caribbean patients in the United Kingdom: the modified perceived racism scale

AIM: The increased rate of psychosis and poorer service-related outcomes in UK African-Caribbeans may in part be related to racism; racism as an aetiological factor remains comparatively under-investigated. We wanted to develop a measure of perceived racism in UK African-Caribbean patients with psychosis METHODS: We modified the Perceived Racism Scale (PRS) by substituting a mental-health-services' racism domain for the employment-racism domain and administered it to a sample of 150 individuals. RESULTS: 110 people completed the PRS with a total mean perceived racism score of 54.2 for the previous year and 71.3 for the lifetime. The modified instrument had good internal consistency, and both a similar factor-analytic structure and sampling adequacy to the original instrument. CLINICAL IMPLICATIONS: The modified PRS was acceptable to the sample, withstands statistical scrutiny and produced similar totals to those in previously-tested populations. Subjective measurement of perceived racism may improve understanding of psychosis in African-Caribbeans, improve engagement and, hopefully, outcome

Patient Characteristics, Length of Stay, and Functional Improvement for Schizophrenia Spectrum Disorders: A Population Study of Inpatient Care in Ontario 2005 to 2015

Objectives: Schizophrenia and associated illnesses account for a large proportion of mental illness burden and health care expenditures, with the majority of expense involving inpatient care. To date, the literature exploring factors associated with length of stay (LOS) and functional improvement during inpatient care is underdeveloped. In response, this study examined the association between patient characteristics, LOS, and functional improvement using Ontario Mental Health Reporting System (OMHRS) data from 2005 to 2015. Methods: The associations of patient characteristics (including key demographics, psychosocial variables, reasons for admission, and service use history) and 2 outcome measures (LOS and Global Assessment of Functioning [GAF]) were analysed with generalised linear mixed modelling (GLMM). From 2005 to 2015, a total of 48,498 episodes for distinct patients from 18 psychiatric hospitals and 57 general hospitals in Ontario were included. Results: For psychiatric and general hospitals, mean LOS was 96.6 and 20.5 days, and mean GAF improvement was 14.8 and 16.1, respectively. The majority of associations probed demonstrated a high degree of significance with similar patterns across general and tertiary facility contexts. Older age and more recent readmission following a psychiatric discharge were associated with longer LOS and less GAF improvement. Recent experience of adverse life events and substance misuse were associated with shorter LOS. Conclusions: While the findings of this exploratory cross-sectional analysis will require further inquiry with respect to validity and reliability, they suggest that a different service pathway is likely required for individuals with greater psychosocial challenge and extensive service use histories

Refugees, Higher Education, and Informational Barriers

The purpose of the qualitative study was to explore the experiences, needs, barriers, and expectations of survivors of torture and/or war interested in entering post-secondary education in Canada. We conducted 38 interviews with participants from the Canadian Centre for Victims of Torture (CCVT), 10 interviews with CCVT staff, and 1 focus group with 3 participants, which followed a semi-structured interview guide, and were analyzed using a constant comparative method. Survivors of torture and/or war report experiencing informational barriers to navigating educational pathways, accessing professional supports, evaluating credentials, financing education, navigating immigration systems, using online resources, delaying their educational progress, and contributing to mental health distress.L’objectif de cette étude qualitative était d’étudier les expé-riences, les besoins, les obstacles et les attentes de survivants à la torture et/ou à la guerre souhaitant faire des études postsecondaires au Canada. Nous avons réalisé 38 entretiens avec des participants provenant du Centre Canadien pour Victimes de la Torture (CCVT) et 10 entretiens avec des membres du personnel de ce centre; nous avons également travaillé avec un groupe cible de trois participants qui ont suivi les consignes d’un guide d’entretien semi-structuré et ont été évalués à l’aide d’une méthode comparative constante. Les survivants à la torture et/ou à la guerre ont fait état d’obstacles à type de manque d’information sur l’orientation dans les filières d’études, l’accès à des soutiens professionnels, l’évaluation des diplômes, le financement des études, l’orientation dans les systèmes d’immigration et l’utilisation des ressources en ligne, l’ensemble de ces insuffisances retardant leur progression sur le plan des études et contribuant à des difficultés de santé mentale

The role of untreated psychosis in neurodegeneration: A review of hypothesized mechanisms of neurotoxicity in first-episode psychosis

For over 20 years, studies have tried to measure the association between the duration of untreated psychosis (DUP) and changes in brain morphology. A hypothesis that untreated psychosis is neurotoxic has been postulated, but the mechanisms of that toxicity have not been described. We re-analyzed papers collected for a systematic review to extract data on the hypotheses that have been generated on the potential mechanisms by which DUP could impact brain morphology in first-episode psychosis. Dopaminergic hyperactivity, prolonged hypothalamic-pituitary-adrenal activation, and persistent activity of catecholamines have been hypothesized as mechanisms to explain these associations. However, the question remains as to whether the observed structural changes are permanent or may be reversed via antipsychotic treatment

Cognitive Remediation for Individuals with Psychosis in a Supported Education Setting: A Pilot Study

Cognitive remediation (CR) is a treatment approach that is being increasingly examined as a means through which the cognitive impacts of schizophrenia might be ameliorated. While CR has demonstrated good outcomes when paired with supported employment, little is known regarding how it might be integrated within supported education contexts. In this study CR was examined in a supported education context with 16 individuals with psychosis. The findings indicated that CR aligned well with the academic curriculum with very low attrition, was found useful by students, and showed similar pre-post differences on cognitive measures as those found in previous work