Cover -- Title -- Copyright -- Contents -- List of Figures -- Preface -- Acknowledgments -- Introduction -- 1 Cultural Bearings: Identity and Ethos in Fiji -- 2 Body Imagery, Ideals, and Cultivation: Discourses on Alienation and Integration -- 3 Nurturing and Food Exchange: An Ethos of Care -- 4 Disclosure and Exposure: The Body and Its Secrets Revealed -- 5 The Body as a Community Forum: Spirit Possession and Social Repossession -- 6 Cultural Metaphors: Body and Self -- Epilogue: On Being Gwalili in the West -- Appendix A: Glossary and Language Notes -- Appendix B: Research Methods -- Appendix C: Graphic Representations of the Data -- Notes -- Bibliography -- Index -- A -- B -- C -- D -- E -- F -- G -- H -- I -- J -- K -- L -- M -- N -- O -- P -- Q -- R -- S -- T -- V -- W -- Y.
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The colonial and postcolonial roots of global mental health efforts / Jonathan Sadowsky and Jeremy Greene -- Resocializing global mental health : what anthropological perspectives offer to learners, educators, and practitioners / Anne E. Becker and Arthur Kleinman -- Promoting global mental health equity in training programs : establishing ethical and reciprocal partnerships / James Griffith, Michael Morse, Samah Jabr, Sherein Abdeen, and Sauharda Rai -- Developing a global mental health training curriculum / Bibhav Acharya, Colin Buzza, Jennifer Guo, Madhur Basnet, Erick Hung, and Craig Van Dyke -- Mentorship in global mental health / Brandon A. Kohrt, David Citrin, Bikash Gauchan, Dristy Gurung, Manaswi Sangraula, Byamah B. Mutamba, Bonnie N. Kaiser, Abdelrhman Elnasseh, Markos Tesfaye, Eshetu Girma, Nilanga Abeysinghe, Pragya Rimal, and Joop T.V.M. de Jong -- Implementation of integrated care models : lessons for training and practice in low-resource settings / Christopher Kemp, Lydia Chwastiak, Inge Petersen, Arvin Bhana, Bradley H. Wagenaar, Jürgen Unützer, and Deepa Rao -- Educational partnerships : addressing challenges in meeting trainee goals with established or new global mental health educational programs / Carla Marienfeld, Xinran Hu, Yang Yang, Zhening Liu, Eve Lasswell, and Robert M. Rohrbaugh -- Mobilizing a range of resources to advance research and service in global mental health training / Pamela Scorza, Brian Neff, Tahilia J. Rebello, LeShawndra Price, Matias Irarrazaval, Lidia Goveia, David Ndetei, Victoria Mutiso, Andre Fiks-Salem, Liza Magill, Victoria Leonard, Milton Wainberg, and Kathleen M. Pike -- Student engagement in global mental health : perspectives on curricular, extra-curricular, and advocacy opportunities / Brendan Eappen, Nick Seymour, Matthew Basilico, Georgina Miguel Esponda, Concilia Tarisai Bere, and Helen Jack -- Training for humanitarian crisis response and mental health system reform / Giuseppe Raviola, Rabih El Chammay, Amruta Houde, Sarah Singer, and Stephanie L. Smith -- Neurology in global mental health delivery and training / J. Reginald Fils-Aimé and Aaron L. Berkowitz -- Substance use disorders in global mental health delivery and training / Hilary S. Connery, R. Kathryn McHugh, Meghan Reilly, Sonya Shin, and Shelly F. Greenfield.
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Although gastrointestinal and other somatic symptoms are common in patients with anorexia nervosa (AN), and a growing cross-national literature indicates that not all anorexic patients exhibit the core diagnostic symptom of fat phobia, the relationship between somatic symptoms and anorexic illness remains unclear. Our objective was to evaluate gastrointestinal dysfunction (GD) in Chinese patients with fat phobic (FP) and nonfat phobic (NFP) anorexia nervosa. A total of 113 FP- and 28 NFP-AN outpatients underwent standardized clinical assessment and completed a new 8-item GD scale and other psychopathological measures. A majority (79.4%) of AN patients reported at least some gastrointestinal complaints on the GD scale (Cronbach's alpha = 0.78). FP-AN patients scored significantly higher than NFP-AN patients. The FP-AN with high GD group reported a higher level of specific and general psychopathology than the FP- and NFP-AN with low GD groups. Contrary to expectations, gastrointestinal symptoms were more common in FP-AN than NFP-AN patients. FP-AN with high GD was more severe than FP- and NFP-AN with low GD. The current fat phobic conceptualization of the anorexic illness may overlook its phenomenologic heterogeneity and reify a dichotomy that is inconsistent with patients' varied experience of food restriction.
Since 2014, children from El Salvador, Guatemala, and Honduras unaccompanied by their parents have fled in large numbers to the United States to escape violent crime and social disadvantage. Current mental health policies in the U.S. government's response can be improved based on guidelines from professional psychiatric and psychological organizations. These guidelines emphasize the importance of immigration and culture, raising questions into how the field of cultural psychiatry can offer conceptual frameworks and methods to research unaccompanied minor migration as a humanitarian problem. This paper conducts a policy analysis by reviewing shortcomings in the U.S. response and explores the potential contributions of cultural psychiatrists in optimizing services to address the needs of these children in the U.S. and their countries of origin.
Acculturation has been examined as a risk factor for eating disorders, but interpretation of findings has been limited by inconsistent operationalization of this construct across studies. The study aim was to develop and evaluate a population-specific measure of acculturation for ethnic Fijian adolescent schoolgirls, to use in future analyses related to eating disorders. Our findings suggest that acculturation is a multidimensional construct characterized by distinct, though related, dimensions of orientation to ethnic Fijian and/or western/global culture with respect to a range of behaviors and attitudes. In contrast to theoretical models positing uni-dimensional, orthogonal, or oblique relations between cultural identities in individuals undergoing acculturation, our study findings support a heterogeneous pattern among correlations of dimensions across contrasting cultural identities. We suggest multidimensional measures of acculturation are optimal — and socio-demographic proxies inadequate — for characterization of this complex process for health research.
Orphans in post-conflict settings have unique needs that have not been well-characterized. In post-conflict Liberia, maternal orphans are more likely to be without care than paternal orphans. This study examined the experiences of maternal orphans in Liberia, as they attempted to care for themselves and seek care from others, and the barriers they faced. In-depth interviews were conducted with 75 post-conflict Liberian orphans. We performed a secondary narrative analysis of interview transcripts from all maternal or double orphans (n = 17). We identified similar elements across narratives: traumatic loss, disconnection from family and community, and the desire for a savior. Female high-risk orphans were more likely to have formal substitute caregiving arrangements in which they were living with someone who was a relative or had been selected by a relative. Male orphans more commonly lacked arranged substitute care, but this allowed them to form relationships with substitute caregivers of their choosing. Sex also played a role in the provision of caregiving; substitute care was provided by women. Findings highlighted the syndemic relationship between poverty, violence, transactional sex, trauma, and substance use that traps high-risk Liberian orphans. Interventions are needed to improve access to mental health care, sober communities, housing, and education support. The need to integrate these services into indigenous institutions and address barriers related to stigma is explored.
AbstractObjectiveThe purpose of this study was to characterize the impact of adolescent pregnancy on families and describe the needs of adolescent mothers and their infants in order to assess the need for intervention and identify potential intervention targets.BackgroundAdolescent mothers and their offspring face an increased risk of mental health problems. Adolescent mothers and their families also face significant resource constraints; 95% live in low‐ and middle‐income countries (LMICs). Cost‐effective interventions are needed to improve outcomes for this vulnerable group.MethodThis qualitative study conducted in Lima, Peru, consisted of four clinician focus groups and 18 in‐depth interviews with adolescent mothers and their family members. Data were coded thematically, and direct content analysis was employed.ResultsThe study identified the following issues facing adolescent parents: the transition to parenthood, the need for family support, difficulty accessing support, the difficulty for family members of providing support, and ideas about responsibility and adolescent autonomy.ConclusionOverall, these findings demonstrate the need for interventions that engage families and address barriers to accessing support, including relationship conflict and differing beliefs about responsibility and autonomy.ImplicationsInterventions are needed for adolescent mothers in LMICs that mobilize family support. Clinicians who care for these patients need to be aware of the family context and the resources available where they practice.
Background: The mental health treatment gap for youth in low- and middle-income countries (LMICs) is substantial; strategies for redress are urgently needed to mitigate the serious health and social consequences of untreated mental illness in youth. Aims: To estimate the burden of major depressive episode (MDE) and posttraumatic stress disorder (PTSD) as well as utilization of care among Haitian youth in order to describe the mental health treatment gap in a LMIC setting. Methods: We estimated the point prevalence of MDE, PTSD, and subthreshold variants in a school-based sample of youth ( n = 120, ages 18–22 years) using a modified Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID)-based interview and examined treatment utilization among those receiving one of these diagnoses. We assessed additional psychopathology with self-report measures to examine validity of study diagnostic assignments. Results: The combined prevalence of full-syndrome or subthreshold MDE or PTSD was high (36.7%). A large majority of affected individuals (88.6%) had accessed no mental health services in the health sector, and 36.4% had accessed no care of any kind in either the health or folk sectors in the past year. Conclusion: Findings demonstrate a high mental health burden among Haiti's youth and that many youth with MDE and PTSD are not accessing mental health care.
Background: Task-sharing with teachers to promote youth mental health is a promising but underdeveloped strategy in improving care access in low-income countries. Aims: To assess feasibility, acceptability and utility of the teacher accompaniment phase of a school-based Teacher- Accompagnateur Pilot Study (TAPS) in Haiti. Methods: We assigned student participants, aged 18–22 years ( n = 120), to teacher participants ( n = 22) within four Haitian schools; we instructed participants to arrange meetings with their assigned counterparts to discuss mental health treatment, academic skills, and/or well-being. We measured student and teacher perceived feasibility, acceptability and utility of meetings with self-report Likert-style questions. We examined overall program feasibility by the percentage of students with a documented meeting, acceptability by a composite measure of student satisfaction and utility by the percentage with identified mental health need who discussed treatment with a teacher. Results: Favorable ratings support feasibility, acceptability and utility of teacher- accompagnateur meetings with students. The majority of students (54%) met with a teacher. Among students with an identified mental disorder, 43.2% discussed treatment during a meeting. Conclusion: This accompaniment approach to mental health task-sharing with teachers provided a school-based opportunity for students with mental health need to discuss treatment and has potential relevance to other low-income settings.
Abstract Background The Zanmi Lasante Depression Symptom Inventory (ZLDSI) is a screening tool for major depression used in 12 primary care clinics in Haiti's Central Plateau. Although previously validated in a clinic-based sample, the present study is the first to evaluate the validity and clinical utility of the ZLDSI for depression screening in a school-based population in central Haiti.
Methods We assessed depressive symptoms in a school-based sample of transitional age youth (18–22 years; n = 120) with the ZLDSI. Other mental health-related assessments included a modified Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) for current Major Depressive Episode, the Center for Epidemiologic Studies Depression Scale, and selected items adapted from the Global School-Based Health Survey mental health module. Diagnostic assignments of major depressive episode (MDE) were based on modified SCID interviews.
Results The ZLDSI demonstrated good overall accuracy in identifying current MDE (Area under the Curve = .92, 95% CI = .86, .98, p < .001). We ascertained ≥12 as the optimal cut-off point to screen for depression with a sensitivity of 100% and a specificity of 73.9%. In addition, the ZLDSI was associated with other measures of depressive symptoms, suggesting that it demonstrates construct validity.
Conclusions Study findings support that the ZLDSI has clinical utility for screening for depression among school-going transitional age youth.
For the poorest of our world, non-communicable diseases and injuries (NCDIs) account for more than a third of their burden of disease; this burden includes almost 800000 deaths annually among those aged younger than 40 years, more than HIV, tuberculosis, and maternal deaths combined. • Despite already living in abject poverty, between 19 million and 50 million of the poorest billion spend a catastrophic amount of money each year in direct out-of-pocket costs on health care as a result of NCDIs. • Progressive implementation of affordable, cost-effective, and equitable NCDI interventions between 2020 and 2030 could save the lives of more than 4·6 million of the world's poorest, including 1·3 million who would otherwise die before the age of 40 years. • To avoid needless death and suffering, and to reduce the risk of catastrophic health spending, essential NCDI services must be financed through pooled, public resources, either from increased domestic funding or external funds. • National governments should set and adjust priorities based on the best available local data on NCDIs and the specific needs of the worst off. • International development assistance for health should be augmented and targeted to ensure that the poorest families affected by NCDIs are included in progress towards universal health care.
