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Backround: Many patients from ethnic and minority groups have cultural needs and belief perceptions about health and care that differ from the mainstream population. To be able to cover the needs of the ongoing changing society in healthcare, does the nursing care professionals have awareness of the differences a patient’s cultural background is related to their health and how to help the patient in her new health related cultural environment. Aim: To explore the barriers and obstacles that refugee and asylum seeking women are faced with when looking for healthcare for mental ill-health in Sweden. Method: Qualitative in-depth interview study. Results: The result-analysis generated seven themas which were seen as a barrier or obstacle to seek healthcare to mental ill-health among refugee and asylum seeking women in Sweden. Knowledge about Swedish healthcare, Access to the healthcare and language, Somatic health problems, Education level, Economic situation, Prioritizing things in relation to health, and Taboos, shame, and fear of stigma around mental ill-health. Conclusions: This study shows that there are barriers and obstacles for refugee and asylum seeking women to seek healthcare for mental ill-health in Sweden. The study highlights the care professional’s knowledge cap about how to implement the law about care that cannot be delayed. / Bakgrund: Många patienter från etniska grupper och minoritetsgrupper har kulturella behov och trossystem om vård och omsorg som skiljer sig från den vanliga befolkningen. För att kunna täcka behoven i det ständigt föränderliga samhället inom vården, behöver vårdpersonalen medvetenhet om skillnaderna mellan en patients kulturella bakgrund och deras hälsa och hur man kan hjälpa patienten i sin nya hälsorelaterade kulturmiljö.  Syfte: Att utforska de barriärer och hinder som flykting- och asylsökande kvinnor ställs inför när de söker sjukvård för psykisk ohälsa i Sverige. Metod: Kvalitativ djupintervjustudie.  Resultat: Resultatanalysen genererade sju temas sågs som ett hinder för att söka sjukvård mot psykisk ohälsa bland flykting- och asylsökande kvinnor i Sverige. Kunskap om svensk sjukvård, Tillgång till sjukvården och språk, Somatiska hälsoproblem, Utbildningsnivå, Ekonomisk situation, Prioritering av saker i relation till hälsa samt Taboos, skam och rädsla av stigma kring psykisk ohälsa.  Slutsatser: Denna studie visar att det finns hinder för flykting- och asylsökande kvinnor att söka sjukvård för psykisk ohälsa i Sverige. Studien belyser vårdpersonalens kunskapslucka om hur man ska implementera lagen om vård som inte kan anstå.

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The current study examined levels of acculturation, help-seeking behaviors, and religiosity as predictors of South Asian parents' consonance with play therapy attitudes. Participants consisted of 80 South Asian parents living in the United States, who completed a survey consisting of a demographic questionnaire, the Dimensions of Asian American Acculturation and Enculturation Measure (DAAM), the Inventory of Attitudes towards Seeking Mental Health Services (IASMHS), the Religious Attribution Scale (RAS), and the Play Therapy Parent Attitude Questionnaire (PTPAQ). Findings from the study indicated South Asian parents may agree with play therapy attitudes, specifically that the natural language of children is play and a belief that children have the capability to engage in positive self-direction and self-actualization, but also appear to value guidance, instruction, and structure for children by capable adults. A multiple regression analysis measuring the predictive value of acculturation, help-seeking behavio

Studiens syfte ska ses som ett bidrag till att öka förståelsen för hur socialsekreteraren genom sin professionsroll, upplever och uppfattar möten med hjälpsökande klienter. Studiens frågeställningar omfattar socialsekterarens professionella roll, rollens upplevelse och rollens interaktion som utgör det empiriska fokuset. Studien bottnar i en kvalitativ ansats och datainsamlingsmetoden har genomförts med utgångspunkt genom semistrukturerad intervjumetod. Studien belyser socialsekretarens egna subjektiva upplevelser och deras syn på sin professionella yrkesroll. Studiens fokus riktas mot interaktionen för professionsrollen socialsekreterare i möten med hjälpsökande klienter och då hur socialsekretaren ser på sin roll samt upplevelsen av sin roll. Studiens analysmetod har tagit sin ansats genom en tematisk analys som sammankopplar samband och utifrån det framställs koder och teman.Genom att fokus bär sin riktning mot professionsrollen ”socialsekreteraren” tar studien sin ansats genom det dramaturgiska perspektivet och detta utgör grunden för att de empiriska resultaten från studien analyseras med hjälp av Erving Goffmans dramaturgiska perspektiv. Studiens resultat påvisar att vikten av socialsekreterarens professionsroll är nära sammanlänkat med det relationella perspektivet gentemot den hjälpsökande klienten. Oavsett hur länge eller vad än en hjälpsökande klient ansöker om är det vid denna uppbyggnad som interaktionsprocessen och de sociala handlingarna tar sin början. Interaktionsprocessen och de sociala handlingarna kan exempelvis leda till någonting annat såsom en förändring eller att det inte blir en försämring för den hjälpsökande klienten. Det handlar om att skapa en medvetenhet kring sin professionsroll som socialsekreterare i förhållande till de sociala processer som sker utifrån ett klientperspektiv och i ett organisatoriskt perspektiv. Kärnan är att mötas genom sociala handlingsprocesser där det uppstår interaktion. / The purpose of the study should be seen as a contribution to increasing the understanding of how the social worker, through his professional role, experiences and perceives encounters with help-seeking clients. The study's questions include the socialworker's professional role, the role's experience, and the role's interaction and this constitutes the empirical focus. The study is based on a qualitative approach and the data collection method has been carried out based on semi-structured interviews. The study is based on a qualitative approach interview conducted by the semi-structured interview method. The study highlights the social worker's own subjective experiences and their view of their professional role. The focus of the study is directed towards the interaction for the professional role of social worker in meetings with help-seeking clients and then how the social worker views his role and the experience of his role. The study's analysis method has taken its approach through a thematic analysis, connects connections and based on this, codes and themes are presented. By focusing on the professional role of the "social worker", the study takes its approach through the dramaturgical perspective, and this forms the basis for the empirical results from the study to be analyzed using Erving Goffman's dramaturgical perspective. The results of the study show that the importance of the social worker's professional role is closely linked to the relational perspective towards the help-seeking client. No matter how long or whatever a help-seeking client applies for, it is at this settlement that the interaction process and social actions begin. It can be for something else, such as a change or as if there is no deterioration. It is about creating an awareness of one's professional role as a social worker –in relation to the social processes that take place from a client perspective and in an organizational perspective. The core is to meet through social action processes where interaction occurs.

by Chung Yee-ha, Ida. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 313-326). / Abstract and questionnaire also in Chinese. / Acknowledgments --- p.i / Abstract (English version) --- p.ii-iii / Abstract (Chinese version) --- p.iv / Chapter Chapter 1: --- Introduction --- p.1-9 / Chapter Chapter 2: --- The Addiction Profile in Hong Kong --- p.10-28 / Chapter Chapter 3: --- Literature Review --- p.29-94 / Chapter Chapter 4: --- Research Questions and Hypotheses --- p.95-104 / Chapter Chapter 5: --- Methodology --- p.105-119 / Chapter Chapter 6: --- Results --- p.120-185 / Chapter Chapter 7: --- Discussion --- p.186-238 / Chapter Chapter 8: --- Summary and Conclusions --- p.239-250 / Appendix A: A Summary of the Local Studies on Adolescent Drug Abuse 251 - --- p.268 / Appendix B: Questionnaire (Chinese version) --- p.269-289 / Appendix C: Revised Reasons Scale (Chinese version) --- p.290-292 / Appendix D: Questionnaire (English version) --- p.293-310 / Appendix E: Revised Reasons Scale (English version) --- p.311-312 / References --- p.313-326

The ongoing war in the Democratic Republic of Congo (DRC) has caused sustained trauma on a number of levels and stressors that could easily have debilitating consequences on the mental health of Congolese citizens. The literature further reveals that immigration brings with it a host of additional stressors. The stress related to immigration, an appreciation of diverse cultural understandings of mental health, the burdens and costs of adequate mental health policy and provisioning within developing countries, are concepts that are not well understood nor fully documented. The present study explored the cultural understanding and help-seeking behaviours of Congolese immigrants in South Africa. The purpose of the study was to understand the ways in which Congolese cope with stressors related to immigration. Using SocialIdentity Theory as a partial conceptual framework, the role of acculturation processes in their understanding and help-seeking behaviours regarding mental health challenges, were examined. A platform for participants to suggest suitable ways of responding to improving the management of mental challenges in their community was provided. A qualitative approach, based on Participatory Action Research (PAR) and content analysis to explore the emerging narratives, was used with a Gauteng-based sample to gather the accounts of the lived experiences of Congolese immigrants. A snowball sampling technique enabled twenty-seven respondents to participate in one paired conversation and five focus groups. The emerging findings are critically discussed aligned to the six categories of inquiry structured by the interview schedule, namely, coping strategies since immigration, the understanding of mental health challenges, the possible impact of being immersed in the South African culture, perceptions of mental challenges and persons affected within the Congolese community, the preferred help-seeking behaviours regarding mental health challenges and, finally, their recommendations for improving the management of mental health challenges. The layered meta-analysis of the data consisted of interrogating the thematic categories, then conducting an analytical review aligned to both the pertinent research aim and objectives, as well as related theoretical positions and research findings. v | P a g e The key research question underpinning this study was formulated as follows: “Will immigrating from the DRC to South Africa change the understanding and help-seeking behaviours of Congolese?” The study drew on the processes of acculturation from Social Identity Theory to examine these processes. Participants reported experiencing the effects of acculturation but in different ways. Patterns of assimilation, separation and integration were found. The study therefore served to contribute to our understanding of the effects of acculturation with regard to the cultural understanding and help-seeking behaviours of Congolese immigrants in South Africa regarding mental health. Most significantly, the assumption of high levels of trauma and stress within this vulnerable community were unfounded. Rich and complex survival strategies have emerged requiring refinement of our knowledge about migrant communities. The strengths and relative weaknesses of the study are shared as well as a set of recommendations for future research in this domain. / Psychology / M. Sc.(Psychology)

With the advent of Highly Active Antiretroviral Therapy (HAART), people with the human immune deficiency virus (HIV) infection are increasingly enjoying longer and relatively healthy lives, particularly in developed countries. However, black Africans and African-Caribbean people in the United Kingdom and other developed countries are not yet enjoying the full benefits of HAART, essentially as a result of delayed diagnosis. Delayed diagnosis, in addition to affecting the health of infected individuals, also creates a community reservoir for the spread of the infection; thereby hampering prevention and control strategies by international and NHS guidelines. The delayed diagnosis may be grounded in individual, societal and health service factors that guide help-seeking behaviours of black African and African-Caribbean populations. This study set out to investigate the help-seeking behaviours to diagnose HIV and AIDS among UK based black African and African-Caribbean people, and to investigate the dynamics in those behaviours by place of origin (Africa vs. Caribbean) and by gender. A qualitative methodological approach involving semi-structured interviews was used to explore help-seeking behaviours to diagnose HIV and AIDS among black Africans and African-Caribbean populations in the UK and compared by gender. Thirty (30) purposively selected individuals from patients attending two sexual health clinics in the city of London were interviewed. These included 16 black Africans and 14 African-Caribbean people, and 16 men and 14 women. The symbolic interactionist perspective, and the concepts of broken narratives/silences, biographical disruption and biographical abruption guided the study and interpretation of findings. One main theme ‘Africanness’ and two sub-themes (“African way” and “African thing”) emerged from the findings. The “African way” embodies the risk factors involved in contracting or transmitting HIV and the “African thing” represents the HIV status itself. This is a cultural construction of HIV and AIDS within the acceptable context of participants which helped them to talk about HIV and AIDS without addressing it by the biomedical idiom. The notion of ‘Africanness’ provided a ‘marker’ for African identity. The “African thing” represented a new landscape for naming HIV without necessarily calling it by name and provided a comfortable platform for participants to seek help. The “African way” described the risk behaviours by participants that resulted in the “African thing”. Three sociological concepts; ‘broken narratives or silences, biographical disruption and biographical abruption were key issues in HIV and AIDS diagnosis at a late stage and have formed the basis for the development of a model of help-seeking for diagnosis by participants. Apparently, the main determinants of help-seeking for diagnosis of HIV and AIDS are dependent on cultural factors. Stigma is reinforced by the national health care system practices as well as health professionals themselves. This potentially increases the reluctance among black African and African-Caribbean populations to voluntarily test for HIV. An HIV diagnosis is seemingly a challenging experience because of the impending uncertainties associated with it. Seeking help for diagnosis may even be more difficult because of the anticipated and unpleasant experiences along the path to diagnosis. This may guide the individual to consider other alternatives outside the biomedical pathway, potentially; the biomedical path becomes the least likely choice, especially with black African and African-Caribbean populations. An insufficient cultural understanding is likely to result in inadequate recognition of alternative medical practices, insufficient attention to alternatives to biomedical health systems and potential distortion of the meaning of health messages linking them to practice.

Background. Previous research suggests that individuals experiencing DSM-IV panic attacks (PA) are at increased risk for various forms of psychopathology, including anxiety, depressive and substance use disorders. However, little is known regarding whether the sole occurrence of fearful spells (FS-only; distressing spells of anxiety with less than four panic symptoms and/or lacking crescendo in symptom onset) similarly elevates the risk for subsequent psychopathology and could therefore be promising to identify high-risk groups for targeted preventive interventions. Thus, the current dissertation thesis aims to examine (a) whether FS-only predict incident mental disorders in addition to full-blown PA and whether their associations with subsequent psychopathology differ from those obtained for PA, (b) whether FS-only, PA, and panic disorder (PD) share similar etiologies, (c) which characteristics of initial FS/PA and other risk factors predict a progression to more severe panic pathology and other mental disorders, and (d) whether help-seeking/potential treatment in individuals with panic alters the risk for subsequent psychopathology. Methods. A representative community sample of adolescents and young adults (N=3021, aged 14-24 at baseline) was prospectively followed up in up to three assessment waves over a time period of up to 10 years. FS-only, PA, PD, and other mental disorders were assessed at each assessment wave using the DSM-IV-M-CIDI. Additional modules/questionnaires were used to assess characteristics of initial FS/PA (T1/T2), potential risk factors, and help-seeking/potential treatment. Logistic regressions were applied to test associations (Odds Ratios, OR) of FS-only and PA at baseline with incident mental disorders at follow-up as well as respective interactive effects with help-seeking at baseline. Associations (Hazard Ratios, HR) of putative risk factors with the onset of panic pathology (FS-only, PA, and PD) or the onset of subsequent anxiety/depressive vs. substance use disorders in those with panic pathology (aggregated data across assessment waves) were estimated with Cox regressions. Multinomial logistic regressions were used to test associations of initial FS/PA characteristics (aggregated from T1 and T2) with PA and PD (lifetime incidences aggregated across assessment waves). Results. FS-only at baseline predicted incident anxiety and depressive disorders at follow-up (OR 1.59-4.36), while PA at baseline predicted incident anxiety, depressive, and substance use disorders at follow-up (OR 2.08-8.75; reference group: No FS/PA). Merely any anxiety disorder (OR=3.26) and alcohol abuse/dependence (OR=2.26) were significantly more strongly associated with PA than with FS-only. Female sex, parental anxiety disorders, parental depressive disorders, behavioral inhibition, harm avoidance, lower coping efficacy, and parental rejection predicted FS-only, PA, and PD (HR 1.2-3.0), whereas the associations with other risk factors partially differed for FS-only, PA, and PD and tended to be more pronounced for PA and PD than for FS-only. Alcohol consumption, use of drugs/medication, and physical illness as perceived reasons for the initial FS/PA were associated with the occurrence of full-blown PA (without PD, OR 2.46-5.44), while feelings of anxiety/depression and having always been anxious/nervous as perceived reasons for the initial FS/PA, appraising the initial FS/PA as terrible and long-term irritating/burdensome, subsequent feelings of depression, avoidance of situations/places, and consumption of medication, alcohol, or drugs were associated with the development of PD (OR 2.64-4.15). A longer duration until “feeling okay again” was associated with both PA and PD (OR 1.29-1.63 per category). Moreover, partially different risk constellations in subjects with panic pathology (FS/PA/PD) predicted the onset of subsequent anxiety/depressive vs. substance use disorders. Panic pathology (FS/PA) and help-seeking/potential treatment at baseline interacted on predicting incident PD (OR=0.09) and depression (OR=0.22) at follow-up in a way that panic pathology only predicted these disorders in individuals not seeking help at baseline. Conclusions. Findings suggest that individuals with FS-only are at similar risk of developing subsequent psychopathology compared to individuals with full-blown PA. Specific initial FS/PA characteristics and additional risk factors may be used to identify sub-groups of individuals with panic pathology, which are at particular risk of progressing to more severe panic pathology or other mental disorders and might therefore profit from supplemental outcome-related preventive interventions in addition to panic-specific treatment. Future research may replicate the current findings and test the efficacy of targeted preventive interventions in panickers at elevated risk for PD and other forms of psychopathology. / Theoretischer Hintergrund. Auf Grundlage früherer Forschungsbefunde ist anzunehmen, dass Personen mit DSM-IV-Panikattacken (PA) ein erhöhtes Risiko für zahlreiche psychische Störungen, einschließlich Angst-, depressiver und Substanzstörungen, aufweisen. Unklar ist jedoch, ob das alleinige Auftreten von Fearful Spells (FS-only, Angstanfälle mit weniger als vier Paniksymptomen und/oder fehlendem Crescendo in der Symptomentwicklung) das Risiko für Psychopathologie in ähnlicher Weise erhöht und hilfreich sein könnte, um Hochrisikogruppen für Präventivinterventionen zu identifizieren. Innerhalb der vorliegenden Dissertation wird daher untersucht, (a) ob FS-only zusätzlich zu PA inzidente psychische Störungen vorhersagen und ob sich Unterschiede in den Assoziationen von FS-only vs. PA mit nachfolgender Psychopathologie ergeben, (b) ob FS-only, PA und Panikstörung (PS) ähnliche Ätiologien teilen, (c) welche Merkmale initialer FS/PA und welche anderen Risikofaktoren die Entwicklung schwerer Panikpathologie und weiterer psychischer Störungen vorhersagen und (d) ob Hilfesuchverhalten/potenzielle Behandlung bei Personen mit Panik das Risiko für nachfolgende Psychopathologie verändert. Methodik. Eine repräsentative Bevölkerungsstichprobe Jugendlicher und junger Erwachsener (N=3021, 14-24 Jahre zur Baseline-Erhebung) wurde in bis zu drei Erhebungswellen über einen Zeitraum von bis zu 10 Jahren untersucht. FS-only, PA, PS und andere psychische Störungen wurden zu jeder Erhebungswelle mithilfe des DSM-IV-M-CIDI erfasst. Merkmale initialer FS/PA (T1/T2), mögliche Risikofaktoren sowie Hilfesuchverhalten/potenzielle Behandlung wurden mit weiteren Modulen und Fragebögen erhoben. Mithilfe logistischer Regressionen wurden Assoziationen (Odds Ratios, OR) von FS-only und PA zu Baseline mit inzidenten psychischen Störungen zum Follow-Up sowie diesbezügliche Interaktionen mit Hilfesuchverhalten zu Baseline getestet. Zusammenhänge zwischen möglichen Risikofaktoren und dem Auftreten von Panikpathologie (FS-only, PA und PS) bzw. nachfolgender Angst-/depressiver und Substanzstörungen bei Personen mit Panikpathologie (Verwendung von über die Erhebungswellen hinweg aggregierter Daten) wurden mithilfe von Cox-Regressionen geschätzt. Multinomiale logistische Regressionen wurden genutzt, um Assoziationen von Merkmalen initialer FS/PA (aggregiert über T1 und T2) mit PA und PS (über die Erhebungswellen hinweg aggregierte Lebenszeitinzidenzen) zu erfassen. Ergebnisse. FS-only zu Baseline sagten inzidente Angst- und depressive Störungen zum Follow-Up vorher (OR 1.59-4.36), wohingegen PA zu Baseline inzidente Angst-, depressive und Substanzstörungen zum Follow-Up vorhersagten (OR 2.08-8.75; Referenzkategorie: Keine FS/PA). Lediglich irgendeine Angststörung (OR=3.26) und Alkoholmissbrauch/-abhängigkeit (OR=2.26) waren signifikant stärker mit PA als mit FS-only assoziiert. Weibliches Geschlecht, elterliche Angst- und depressive Störungen, Verhaltenshemmung, Schadensvermeidung, geringere Coping-Erwartung und elterliche Zurückweisung sagten FS-only, PA und PS vorher (HR 1.2-3.0), während sich teils unterschiedliche Assoziationen anderer Risikofaktoren mit FS-only, PA und PS ergaben, die tendenziell stärker für PA und PS als für FS-only waren. Alkoholkonsum, Drogen-/Medikamentengebrauch und körperliche Erkrankungen als wahrgenommene Gründe für die initiale FS/PA waren mit dem Auftreten vollständiger PA assoziiert (ohne PS; OR 2.46-5.44), während Gefühle von Angst/Depression und die Einschätzung schon immer ängstlich/nervös gewesen zu sein als wahrgenommene Gründe für die initiale FS/PA, die Bewertung der initialen FS/PA als schrecklich und langfristig verunsichernd/belastend, nachfolgende Gefühle von Niedergeschlagenheit, Vermeidung von Situationen/Orten und Konsum von Medikamenten, Alkohol oder Drogen mit der Entwicklung von PS assoziiert waren (OR 2.64-4.15). Eine längere Dauer bis sich die betroffene Person wieder vollständig in Ordnung fühlte war sowohl mit PA als auch mit PS assoziiert (OR 1.29-1.63 pro Kategorie). Weiterhin sagten teils unterschiedliche Risikokonstellationen bei Personen mit Panikpathologie (FS/PA/PS) die nachfolgende Entstehung von Angst-/depressiven und Substanzstörungen vorher. Panikpathologie (FS/PA) und Hilfesuchverhalten/potenzielle Behandlung zu Baseline interagierten bei der Vorhersage von inzidenter PS (OR=0.09) und Depression (OR=0.22) zum Follow-Up; d.h. das Vorhandensein von Panikpathologie sagte diese Störungen nur bei Personen ohne, nicht aber bei Personen mit Hilfesuchverhalten zu Baseline vorher. Schlussfolgerungen. Die vorliegenden Ergebnisse implizieren, dass Personen mit FS-only im Vergleich zu Personen mit vollständigen PA ein ähnliches Risiko für die Entwicklung nachfolgender Psychopathologie aufweisen. Spezifische Merkmale initialer FS/PA und zusätzliche Risikofaktoren könnten zur Identifikation von Sub-Gruppen von Personen mit Panik genutzt werden, die sich durch ein besonderes Risiko für schwergradige Panikpathologie und andere psychische Störungen auszeichnen und demzufolge von Outcome-bezogenen Präventionen (ergänzend zu Panik-spezifischer Intervention) profitieren könnten. Zukünftige Studien sollten die vorliegenden Befunde replizieren und die Effektivität gezielter Präventivinterventionen bei Personen mit erhöhtem Risiko für PS und andere psychische Störungen testen.

Syftet med studien var att undersöka unga vuxna somaliers uppfattningar om psykisk ohälsa och hur de ser på att söka stöd och hjälp från omgivningen. Metoden som har använts är kvalitativ metod och data har samlats in genom semistrukturerade intervjuer. Studiens intervjupersoner var unga vuxna med somalisk bakgrund vilka var mellan 19 till 29 år varav tre var kvinnor och tre var män. Studiens analys gjordes med hjälp av en kvalitativ manifest innehållsanalys. Resultatet av studien visar att unga vuxna somaliers uppfattning om psykisk ohälsa ser olika ut och att det är ett svårdefinierat begrepp. Unga vuxna somalier upplever även att det inte går att prata öppet om psykisk ohälsa med omgivningen, särskilt bland familjen. Uppfattning om stöd och hjälp är att det undviks, religionen har även stor betydelse och samtidigt finns det kunskapsbrist gällande var de kan söka hjälp och stöd för psykiska besvär. / The purpose of the study was to explore Somali young adults’ perception of mental illness and how they look on seeking support and help from people in the surrounding environment. The method that has been used is a qualitative method using semi-structured interviews. The participants in the interviews were young adults with a Somali ethnic background. There were three men and women and their ages vary between 19 to 29 years old. The analysis was done using a qualitative manifest content analysis. The result of the study shows that young adults Somalis’ perception of mental illness looked different and difficult to define. Young adult Somalis also feel that it is not possible to talk openly about mental illness with people in their surroundings, especially with members of the family. Their perception of support and help is that it is avoided, religion plays a major role among it and there is a lack of knowledge regarding where they can seek help and support for mental illness.