Diabetes is a psychologically demanding disease with a major impact on a patient’s quality and quantity of life. The outcome of diabetes is highly dependent on the self-care activities of the person with diabetes. Depression is common among people with diabetes, complicating this self-management and thereby increasing the risk of developing diabetes-related complications. Despite depression’s specific relevance to diabetes and the serious impact it has on the disease, it is estimated that only one third of people with both diabetes and major depression are recognized and appropriately treated for both disorders. The aim of this thesis therefore was to investigate the interrelationship between depression and diabetes and evaluate methods of improving recognition rates and access treatment within a health care setting. Routine screening for depression using standardised depression screening instruments has been recommended for all adults in primary care to improve the low recognition rates of depression in this population. The aim of Study 1 was therefore to compare the effectiveness of four commonly used depression screening instruments (CES-D, HADS, DMI, SCAD) in identifying depression in a diabetes sample. This research was important as little previous research had investigated the efficacy of these depression screening measures within this specialist group and an evaluation of their comparative performance had not yet been conducted. 150 patients with diabetes receiving care at the endocrinology outpatient clinics of two major public hospitals in Brisbane, Australia completed a battery of questionnaires and were also involved in a structured clinical interview (CIDI-SF) to establish a criterion standard. Results indicated that three of the screening measures (CES-D, HADS, DMI-10) could be considered reliable predictors of depression in this sample. There was however evidence that the CES-D could be considered the preferred measure as it had the best ability to discriminate between depression and non-depression, it showed reasonable sensitivity, high specificity, and it was able to stand alone as a predictor of major depression with its predictive ability not improved with the inclusion of diabetes symptoms. Study two of this thesis investigated the demographic, medical, and psychosocial correlates of depression in patients with diabetes. This research was important as information about risk profiles can help improve rates of diagnosis and treatment and may provide a method by which screening can be more focused and cost effective. 1069 hospital outpatient patients with diabetes were asked to complete a battery of questionnaires to accomplish this aim. The results found that co-morbid depression in patients with diabetes was associated with type-1 diabetes, younger age, poor glycaemic control, insulin treatment, co-morbid medical illness, increased diabetes symptoms, lack of a partner, lower income, stressful life events, low social support, and poor quality of life. Of particular interest was the finding that the inclusion of psychosocial predictors reduced the predictive ability of many demographic and medical factors. Study three of this thesis investigated the impact of a depression screening and feedback procedure on a patient’s level of depression, glucose control, and quality of life. While routine screening for depression has recently been recommended for all patients with diabetes, no previous research had been conducted to evaluate the efficacy of this approach on treatment and patients outcomes. 164 patients with diabetes who were found to be depressed in study 2 were involved in a randomised controlled trial which compared patients who received feedback regarding their depression status with those patients who did not receive any feedback. The results found high rates of depression in this sample and suggested that screening for depression and providing feedback to patients regarding the outcomes of screening had beneficial effects on depression at six months but not on glycaemic control or quality of life. The final study in this thesis attempted to investigate the help seeking behaviours of patients following feedback and to identify barriers to seeking care. 82 participants who received feedback regarding their depression status in study 3 were contacted for a structured telephone interview. Results indicated that only 52.44% of depressed diabetes patients followed the recommended advice and sought help for their depression. Of the patients that did not seek help, several barriers to seeking care were reported. Overall, the results indicated that attitudes relating to the severity of the disorder and the need for treatment were more salient barriers for participants in this study than logistical issues, stigma, or current levels of depression.

Research has shown that a high number of South Asian people suffer with mental health problems and that South Asian women specifically, are at high risk of attempting self -harm or suicide. However, there seems to be a low uptake of the mainstream services offered by the South Asian community as a whole, compared to their white counterparts. Furthermore, the existing literature in this area is scarce and focuses on identifying barriers that South Asian women face in accessing help. This mixed methods study explored the mental health help seeking experiences of British born South Asian women. For the first part of the study, six (N=six) women who had successfully accessed therapy were interviewed and the qualitative data was analysed using Braun and Clarke’s (2006) framework for thematic analysis. The main superordinate themes identified included: therapy as a positive experience, perseverance and persistence, need to know basis, fears about being judged, the need for more publicising and awareness, recovery as an ongoing process, medical professionals needing to be more proactive, developing autonomy and putting your own needs first, developing understanding and the importance of the first step. Various subordinate themes were identified for some of these main superordinate themes. The second part of this study involved delivering a psycho educational workshop (which was partly based on the qualitative data generated in the first part of the study) to a group of South Asian women (N=25). Their attitude towards help seeking was measured before, immediately after and four weeks after the workshop using Fischer and Farina’s (1995) Attitudes toward Seeking Professional Psychological Help Scale. An ANOVA Test indicated a statistically significant difference in attitudes to help seeking before, immediately after and four weeks after the workshop. This study helped to get a better understanding of the experiences of a marginalised group and demonstrated how such information can be used to develop new and innovative interventions that can be used with a client group that appear to have low levels of engagement with and referral to mental health services.

To provide empirical basis for mental health interventions in the deprived sub-Saharan African region, this study explored the perspectives of the Igbo people of south-eastern Nigeria on four dimensions of mental illness: causal beliefs, attitudes towards sufferers, preferred treatment pathways and perceived barriers to accessing formal psychiatric care. Mixed sampling methods were used to select participants who completed quantitative questionnaires. The number of participants varied between 200 and 706 in the exploratory studies but remained constant (n = 1127) in the confirmatory studies. The study found mixed endorsements of the supernatural, biological and psychosocial causal explanations with supernatural causations being significantly more endorsed. The study also found mixed treatment preferences with formal psychiatric care being significantly more preferred to the spiritual pathway which was in turn significantly more preferred to the traditional pathway. Significant negative attitudes and desire for social distance from persons with mental illness were observed across groups. Barriers to accessing mental healthcare were also significantly perceived with ideological barriers being significantly more perceived than instrumental barriers. Systematic associations were found between causal beliefs and treatment preferences: supernatural causal belief predicted preference for the spiritual and traditional treatment pathways while psychosocial causal belief predicted preference for both formal psychiatric care and the traditional treatment pathway. Mixed causal attributions and treatment preferences reflect holistic view of health and healing and calls for the evolution of complementary model of care that would incorporate people's spiritual and cultural needs. The prospect is supported in psychosocial causal beliefs being associated with preference for the traditional treatment pathway. Significant negative attitude is a contradiction in the traditionally communitarian and predominantly Christian culture, and is deserving of intervention in the context where the solidarity of the social network should compensate for the inadequate mental healthcare. Significantly more ideological than instrumental barriers have crucial policy implication; improved conceptualizations of mental illness should precede improvement of facilities and services or else these could be underused. Demographic correlates of causal beliefs, negative attitudes, pathway preferences and barriers to accessing formal mental healthcare care were determined for targeted interventions.

The study is a qualitative systematic literature study that maps existing research on help-seeking barriers for abused women. The purpose of the study was to identify which help-seeking barriers exist. Violence in a close relationship is a worldwide problem. It affects every third woman at some point in her life. Despite several measures to counteract and prevent violence, the statistics rather show an increase. Social agencies work hard with various information campaigns, and research has come a long way in mapping and understanding how violence in close relationships works. Various action programs have been launched to counteract harmful gender norms, and unhealthy masculinity norms. Men's violence against women, even if we call it violence in close relationships, stems from patriarchal societies and values, where control and the need for power constitute a strong driving force for men. The violence is usually of an escalating nature, and lasts for a long time. Violence can take the form of physical, psychological, sexual and material violence, and through systematic combinations of these, the man restricts his female victim's freedom of action and controls her behavior. There are various explanatory models for acts of violence, the most common of which are the need to control the woman and maintain the position of power as a man. Despite preventive work, efforts and information campaigns, knowledge-seeking and outreach from social services, women's shelters and the police, the problem remains. Why do women not seek help? The result of our study were several barriers, which have been divided into different themes, including barriers based on stigma, and various structural barriers, among others. The thematization has then been analyzed on the basis of selected psychological and sociological theories. We present suggestions for future research, and provide an overall picture of the research which is reviewed.

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.

No description available.