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Dinesh Bhugra

Publications and source records attributed to Dinesh Bhugra.

At least 19 recordsLinked to original sources
PubMed2025

Policy paper of the Committee on Ethics and Task Force on Migration and Mental Health: Migration and mental health of migrants, refugees, asylum seekers - Ethical dilemmas and concerns.

BACKGROUND: International migration is a complex phenomenon of global and historical relevance. It includes voluntary, forced, and workforce migration, shaped by diverse determinants. Push factors comprise war, persecution, and political instability, while pull factors include stability, economic opportunities, education, and favorable living conditions. Forced migration is frequently associated with displacement and a disproportionate burden of mental health disorders, which are urgent yet difficult to address due to structural, cultural, and legal barriers. METHODS: Evidence demonstrates that restricted health care access exacerbates psychiatric disorders, while treatment delays contribute to poorer outcomes. Barriers include administrative limitations, linguistic and cultural differences, stigma, and resource shortages. This policy paper was developed by the Committee on Ethics and the Task Force on Migration and Mental Health of the European Psychiatric Association (EPA). Relevant literature was reviewed and combined with the professional expertise of committee members. The draft was subsequently evaluated by the Publication Committee and the EPA Board, and revised accordingly. RESULTS: Ethical principles in refugee care are insufficiently implemented in many European countries. Core principles of medical ethics - beneficence, respect for autonomy, non-maleficence, and justice - as well as the obligation to advance psychiatric standards and apply psychiatric expertise for societal benefit, are inconsistently upheld. CONCLUSIONS: The primary duty of physicians is to promote health and well-being through competent, timely, and compassionate care. The EPA therefore advocates coordinated strategies to mitigate the mental health consequences of war, displacement, and trauma, and to secure equitable access to psychiatric services for migrants and refugees.

Humans↗
PubMed2007

The concept of neurosis in a cross-cultural perspective.

PURPOSE OF REVIEW: The aim of this review is to discuss the current state of research on the concept of neurosis across cultures and to document the advances made in this field over the previous year. RECENT FINDINGS: There has been a significant alteration in the concept of neurosis in most cultures, with the relative abandonment of the term 'neurosis' and replacing the concept with that of common mental disorders. The state of research on the aetiopathogenesis of neurosis has moved towards neurobiological, neurophysiological and genetic factors. Neuroticism as a personality trait has retained its role in the development of neurotic disorders. The epidemiological studies on neurotic disorders are equivocal across cultures. Besides, studies on clinical presentation of common mental disorders, somatization and abnormal illness behaviour show some cultural variations. Though there are no significant advances in the management of neurosis equivalents, it seems that the specific serotonin receptor inhibitors may have a role in management of these conditions. SUMMARY: The recent literature shows acceptance of common mental disorders across cultures replacing neurotic disorders. Other conceptual equivalents of neurosis are seen in somatoform disorders, somatization and abnormal illness behaviour. Some traditional culture-bound neurotic syndromes and idioms of distress persist.

Comorbidity↗
PubMed2006

Obsessive-compulsive disorder and personality disorder: evidence from the British National Survey of Psychiatric Morbidity 2000.

BACKGROUND: Previous studies indicate that most individuals with obsessive-compulsive disorder (OCD) have comorbid personality disorders (PDs), particularly from the anxious cluster. However, the nature and strength of this association remains unclear, as the majority of previous studies have relied heavily on clinical populations. We analysed the prevalence of screen positive personality disorder in a representative sample of adults with OCD living in private households in the UK. METHODS: A secondary analysis of data from the 2000 British National Survey of Psychiatric Morbidity. The prevalence of PD, as determined by the SCID-II questionnaire, was compared in participants with OCD, with other neuroses and non-neurotic controls. Within the OCD group we also analysed possible differences relating to sex and subtypes of the disorder. RESULTS: The prevalence of any screen positive PD in the OCD group (N=108) was 74%, significantly greater than in both control groups. The most common screen positive categories were paranoid, obsessive-compulsive, avoidant, schizoid and schizotypal. Compared to participants with other neuroses, OCD cases were more likely to screen positively for paranoid, avoidant, schizotypal, dependent and narcissistic PDs. Men with OCD were more likely to screen positively for PDs in general, cluster A PDs, antisocial, obsessive-compulsive and narcissistic categories. The presence of comorbid neuroses in people with OCD had no significant effect on the prevalence of PD. CONCLUSIONS: Personality pathology is highly prevalent among people with OCD who are living in the community and should be routinely assessed, as it may affect help-seeking behaviour and response to treatment.

Adolescent↗
PubMed2006

Coping with depression in later life: a qualitative study of help-seeking in three ethnic groups.

BACKGROUND: Research suggests high levels of depression and low levels of service use among older adults from UK minority ethnic groups. This study aimed to explore older adults' attitudes and beliefs regarding what would help someone with depression, and to consider how these may facilitate or deter older people from accessing treatment. METHOD: In-depth individual qualitative interviews were conducted with older adults with depression (treated and untreated) and the non-depressed older population. A multi-cultural approach was used that incorporated the perspectives of 32 black Caribbean, 33 South Asian and 45 white British older adults. RESULTS: Participants felt that the responsibility for combating depression was an internal and individual task with support considered secondary. However, the majority expressed a willingness and desire to discuss psychosocial problems. Within the black Caribbean group, conversing with God through prayer was seen as an effective means of overcoming depression, while a large proportion of South Asian and white British participants identified families as an important source of help. There was wide variation in how older adults construed the role of the general practitioner (GP) and many expressed acute awareness of the demands on GPs' time. CONCLUSIONS: Efforts to socialize and remain active may provide a useful and acceptable adjunct to clinical interventions. However, there is a need to communicate that depression often necessitates formal help, and that it is acceptable to voice concerns regarding emotional states in a GP consultation. The findings suggest that older adults would welcome the opportunity to discuss their feelings with health-care professionals.

Adaptation, Psychological↗
PubMed2006

Primary care professionals' perceptions of depression in older people: a qualitative study.

An understanding of patients' perspectives is crucial to improving engagement with health care services. For older people who may not wish to bother medical professionals with problems of living such as depression, such exploration becomes critical. General practitioners (GPs), nurses and counsellors working in 18 South London primary care teams were interviewed about their perceptions of depression in older people. All three professional groups shared a predominantly psychosocial model of the causes of depression. While presentation of somatic symptoms was seen as common in all age groups, identification of depression in older patients was complicated by co-existent physical illnesses. GPs reported that older patients rarely mentioned psychological difficulties, but practice nurses felt that older people were less inhibited in talking to them about "non-medical" problems. Many older people were perceived to regard symptoms of depression as a normal consequence of ageing and not to think it appropriate to mention non-physical problems in a medical consultation. Men were thought to be particularly reluctant to disclose emotional distress and were more vulnerable to severe depression and suicide. Some GPs had mixed feelings about offering medication to address what they believed to be the consequences of loneliness and social isolation. Participants thought that many older people regard depression as a "sign of weakness" and the perceived stigma of mental illness was widely recognised as a barrier to seeking help. Cultural variations in illness beliefs, especially the attribution of symptoms, were thought to profoundly influence the help-seeking behaviour of elders from minority ethnic groups. Families were identified as the main source of both support and distress; and as such their influence could be crucial to the identification and treatment of depression in older people.

Adult↗
PubMed2006

The Asian tsunami.

Explore the source record for details and available documents.

Adaptation, Psychological↗
PubMed2006

Mental health and psychosocial support after the tsunami: observations across affected nations.

The countries affected by the tsunami responded to the natural disaster promptly but with different results and outcomes. The reasons for this varied response were many. The outcome depended upon a number of factors, including the extent of the damage to property and lives, accessibility of the areas and existing disaster plans. In this paper we present the overall observations and suggest the way forward.

Asia↗
PubMed2006

Mental health, psychosocial support and the tsunami.

Disasters can have major impact on social and psychological functioning when individuals are exposed to these either indirectly or directly. The responses and coping strategies used by individuals are strongly influenced by cultural factors as well as social support and other factors. In this paper the challenges in planning and delivery of mental health services are described and suggestions put forward for preparedness of future disasters. In cultures which are kinship-based, the help may be available within kinship, and statutory services may rely on such systems.

Adaptation, Psychological↗
PubMed2006

Tsunami and mental health in Thailand.

Over 5000 people lost their lives when the Asian tsunami hit the Andaman coast of southern Thailand. The delivery of services was complicated because a large number of tourists were in the area. The setting up of the Mental Health Centre for the Thai Tsunami disaster within the Department of Mental Health produced prompt mental health response. Regular contact using a variety of means provided supervision and mentoring. The Thai response built on the existing volunteer network. A Mobile Mental Health Team provided on the spot needs assessment and help. Thai experience provides a culturally acceptable way of delivering mental health services and normalization was the most appropriate response.

Adolescent↗
PubMed2006

Concepts and causation of depression: a cross-cultural study of the beliefs of older adults.

PURPOSE: This U.K. study explored how older adults with depression (treated and untreated) and the general older population conceptualize depression. A multicultural approach was used that incorporated the perspectives of Black Caribbean, South Asian, and White British older adults. The study sought to explore and compare beliefs about the nature and causes of depression, and to suggest ways in which these beliefs act to facilitate or deter older people from accessing treatment. DESIGN AND METHODS: One hundred and ten in-depth separate interviews were conducted for 45 White British, 33 South Asian, and 32 Black Caribbean individuals. The interviews explored what the word depression meant to participants, and their beliefs regarding depression's causes. RESULTS: Depression was often viewed as an illness arising from adverse personal and social circumstances that accrue in old age. White British and Black Caribbean participants defined depression in terms of low mood and hopelessness; South Asian and Black Caribbean participants frequently defined depression in terms of worry. Those receiving antidepressants were more likely to acknowledge psychological symptoms of depression. Differences in attribution were found between the ethnic groups. IMPLICATIONS: A social model of depression is closer to the beliefs of older people than the traditional medical model. Culturally appropriate inquiries about recent life events could be used to facilitate discussion about depression. Our data suggest that many older adults would respond to probing by primary care physicians about their mood. Health and social care professionals need to be sensitive to the language of depression used by different ethnic groups.

Aged↗
PubMed2006

Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000.

OBJECTIVE: There is little information about obsessive-compulsive disorder in large representative community samples. The authors aimed to establish obsessive-compulsive disorder prevalence and its clinical typology among adults in private households in Great Britain and to obtain generalizable estimates of impairment and help-seeking. METHOD: Data from the British National Psychiatric Morbidity Survey of 2000, comprising 8,580 individuals, were analyzed using appropriate measurements. The study compared individuals with obsessive-compulsive disorder, individuals with other neurotic disorders, and a non-neurotic comparison group. ICD-10 diagnoses were derived from the Clinical Interview Schedule-Revised. RESULTS: The authors identified 114 individuals (74 women, 40 men) with obsessive-compulsive disorder, with a weighted 1-month prevalence of 1.1%. Most individuals (55%) in the obsessive-compulsive group had obsessions only. Comorbidity occurred in 62% of these individuals, which was significantly greater than the group with other neuroses (10%). Co-occurring neuroses were depressive episode (37%), generalized anxiety disorder (31%), agoraphobia or panic disorder (22%), social phobia (17%), and specific phobia (15%). Alcohol dependence was present in 20% of participants, mainly men, and drug dependence was present in 13%. Obsessive-compulsive disorder, compared with other neurotic disorders, was associated with more marked social and occupational impairment. One-quarter of obsessive-compulsive disorder participants had previously attempted suicide. Individuals with pure and comorbid obsessive-compulsive disorder did not differ according to most indices of impairment, including suicidal behavior, but pure individuals were significantly less likely to have sought help (14% versus 56%). CONCLUSIONS: A rare yet severe mental disorder, obsessive-compulsive disorder is an atypical neurosis, of which the public health significance has been underestimated. Unmet need among individuals with pure obsessive-compulsive disorder is a cause for concern, requiring further investigation of barriers to care and interventions to encourage help-seeking.

Comorbidity↗
PubMed2006

Representation of asylum seekers and refugees among psychiatric inpatients in London.

OBJECTIVE: Refugees are at high risk of mental disorders but often complain about a lack of access to appropriate care. The purpose of this study was to assess the representation of refugees among psychiatric inpatients, given that it has been suggested that they use a disproportionate level of care compared with nonrefugees. METHODS: A census of all psychiatric inpatient units in London was used to determine the numbers of inpatients, the numbers of refugees, and measures of need, such as compulsory detention, duration of admission, need for interpreters, and whether inpatient status was appropriate. RESULTS: Of 2,955 psychiatric inpatients, 134 (4.5 percent) were refugees. Refugees' admission rates were similar to or lower than those of nonrefugees. Refugees were more likely to be inappropriately placed, to require interpreters, and to have more complex needs. CONCLUSION: The results of this study suggest that refugees are not overusing London's psychiatric inpatient units but have complex needs that challenge existing service providers.

Adolescent↗
PubMed2005

First incidence depression in the Lundby Study: a comparison of the two time periods 1947-1972 and 1972-1997.

BACKGROUND: The Lundby Study is a prospective, longitudinal study on a total population consisting of 3563 subjects during 50 years. This study compares first incidence rates of depression and cumulative probabilities for developing a depression over the two time periods 1947-1972 and 1972-1997. METHOD: The Lundby Study started in 1947. Follow-ups were carried out in 1957 and in 1972. In 1997 the surviving subjects (N=1797) were interviewed by psychiatrists with a semi-structured interview. Best-estimate consensus diagnoses were used and ICD-10 and DSM-IV diagnoses were added. Further, 1030 subjects who had died during the last follow-up period 1972-1997 were investigated. RESULTS: Women had higher incidence rates than men in both periods. The average annual incidence rate was lower for women and tended to be lower for men 1972-1997 as compared with 1947-1972. The cumulative probability for developing a depression was 22.5% for men and 30.7% for women 1972-1997. In 1947-1972 the corresponding figures were 22.8% in men and 35.7% in women. LIMITATIONS: The recall period is of considerable length, probably introducing recall bias. The inter-rater reliability over 50 years is fairly acceptable concerning depression. CONCLUSION: Lower annual standardised incidence rates were seen in 1972-1997 compared with 1947-1972. These findings suggest that the trend of increasing rates of depression in the Lundby cohort has terminated. Incidence rates and cumulative probabilities to develop a depression were higher for women than for men, indicating that gender differences continue to play a role.

Adult↗
PubMed2005

Psychiatric and social aspects of suicidal behaviour in prisons.

BACKGROUND: Suicidal behaviour and completed suicide are serious problems within British prisons, leading to significant morbidity and mortality, and are the focus of major efforts towards their prevention. AIM: To explore the demographic, social and psychiatric correlates of suicidal behaviour in prisons in England and Wales and their relationship with health service use; and to develop a combined psychosocial model of risk. METHOD: This report analyses the prevalence of suicidal ideation and suicide attempts in the ONS National Prison Survey, and their association with the presence of psychiatric disorders, personality disorder, substance abuse and social risk factors. These data were compared with data from the second national survey of psychiatric morbidity in adults living at home. In both surveys, a two-phase interviewing procedure was used, covering general health, health service use, assessment of psychiatric disorders, life events, social supports, suicidal behaviour, activities of daily living, sociodemographic data, substance abuse and intelligence. RESULTS: Suicidal thoughts and suicide attempts were commoner in prisons than in the general population and these were significantly associated with higher rates of psychosis, neurosis and personality disorder in prisons. In addition, demographic and factors such as being young, single, white, leaving school early and experiencing poor social support and significant social adversity were important risk factors for suicidal thoughts. Crucially, there was no separate category of people at suicidal risk who did not have psychiatric disorders. CONCLUSIONS: The high rates of suicidal behaviour in prisons cannot be addressed without adequate attention to the high rates of psychiatric disorder and vulnerability factors in prisoners.

Adolescent↗
PubMed2005

Sati: a type of nonpsychiatric suicide.

Sati as an act of ritual suicide has been reported from the Indian subcontinent, especially among the Hindus, for several centuries. Although legally proscribed, these acts occur even now in modern India. The principle behind such acts has been put forward as the principle of good wife. There is little evidence to suggest that women who commit this act suffer from a formal mental illness. Cultural factors and gender role expectations play a significant role in the act and its consequences. Using recent examples, this paper illustrates the cultural factors, which may be seen as contributing to the act of suicide. Other factors embedded in the act also emphasize that not all suicides have underlying psychiatric disorders and clinicians must take social causation into account while preparing any prevention strategies.

Cause of Death↗