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Biomedical subjects

Dinesh Bhugra

Publications and source records attributed to Dinesh Bhugra.

At least 37 records · Page 2Linked to original sources
PubMed2005

Ethnic density, cultural congruity and mental illness in migrants.

Migration is now well understood to be associated with mental illness in many parts of the world. However, the cause and effects of migration that are associated with mental illness continue to be a point of debate. The Ethnic Density concepts give a plausible explanation. On further elaboration, we conclude that a move from a sociocentric society to an egocentric one leads to more distress and more mental illness. Cultural incongruity faced by a migrant in an alien culture has a similar impact. Several theories on migratory distress have tried to explain psychiatric morbidity: high morbidity at source, individual predisposition, stress, misdiagnosis and racial discrimination. We hypothesise that the impact of ethnic density and cultural congruity occurs in a social context.

Culture↗
PubMed2005

Editorial.

Explore the source record for details and available documents.

Humans↗
PubMed2005

Pathways to care for patients with bipolar disorder.

Bipolar disorder is a chronic, debilitating psychiatric illness with serious ramifications for patients, their families, and society. Despite the availability of effective treatments, this disease often goes untreated due to medical, financial, legal/governmental, and cultural barriers. In this review we explore possible reasons for this problem. Misdiagnosis of bipolar disorders is a common medical barrier. One pathway to care for individuals with bipolar disorder is through referral from primary care, but primary care physicians generally have not received special training in the recognition and management of bipolar disorder. This often leads to diagnostic delays or errors, which prevents timely 'filtering' of patients into specialized care. Using data bases we explored these pathways. Legislation in the USA, such as the Emergency Medical Treatment and Active Labor Act (EMTALA), designed to ensure access to inpatient mental health care, has instead given hospitals financial incentives to limit inpatient mental health care capacities. Reimbursement of mental health care expenses is a significant issue impacting a patient's ability to gain access to care, as bipolar disorder is a costly disease to treat. Improving access to care among the bipolar community will require multilateral strategies to influence the actions and attitudes of patients, communities, providers, health care systems, and state/national governments. In other cultures, barriers to care differ according to a number of factors such as type of services, explanatory models of illness, misdiagnosis and perceptions of care givers. It is essential that clinicians are aware of pathways and barriers so that appropriate and accessible care can be provided.

Bipolar Disorder↗
PubMed2005

Migration, cultural bereavement and cultural identity.

Migration has contributed to the richness in diversity of cultures, ethnicities and races in developed countries. Individuals who migrate experience multiple stresses that can impact their mental well being, including the loss of cultural norms, religious customs, and social support systems, adjustment to a new culture and changes in identity and concept of self. Indeed, the rates of mental illness are increased in some migrant groups. Mental health practitioners need to be attuned to the unique stresses and cultural aspects that affect immigrants and refugees in order to best address the needs of this increasing and vulnerable population. This paper will review the concepts of migration, cultural bereavement and cultural identity, and explore the interrelationship between these three aspects of the migrant's experience and cultural congruity. The complex interplay of the migration process, cultural bereavement, cultural identity, and cultural congruity, along with biological, psychological and social factors, is hypothesized as playing a major role in the increased rates of mental illness in affected migrant groups.

Journal Article↗
PubMed2004

Migration, distress and cultural identity.

When people migrate from one nation or culture to another they carry their knowledge and expressions of distress with them. On settling down in the new culture, their cultural identity is likely to change and that encourages a degree of belonging; they also attempt to settle down by either assimilation or biculturalism. In this paper, various hypotheses explaining the act of migration and its relationship with mental distress are described. A new hypothesis is proposed suggesting that when sociocentric individuals from sociocentric cultures migrate to egocentric societies they may feel more alienated. In order to assess and manage migrants, the clinicians need to be aware of the pathways into migration.

Acculturation↗
PubMed2004

Effect of an educational pamphlet on help-seeking attitudes for depression among British South Asian women.

South Asian women suffer disproportionately high rates of suicide and attempted suicide. Yet few intervention studies on this group have been done. A total of 180 British South Asian women were sampled to pilot test an educational pamphlet about depression and suicidality. After reading the pamphlet, significantly more women assessed themselves as willing to confide in their clinicians, friends, and spouses if they felt depressed or suicidal, rather than not telling anyone. Also, more women reported that they felt that antidepressants were helpful for depression after they read the pamphlet. These changes remained four to six weeks later. The pamphlet was feasible for use in primary care and community settings and highly acceptable among British South Asian women and professionals.

Adult↗
PubMed2004

Ethnicity, goal striving and schizophrenia: a case-control study of three ethnic groups in the United Kingdom.

BACKGROUND: The need to achieve is common to all societies, and failure to do so may have a highly detrimental psychological impact. For those on the margins of mainstream society, especially migrants or descendants of migrants, the impact of failed or poor achievements may increase their vulnerability to mental illness. AIMS: In a prospective study of schizophrenia in three ethnic groups (White, Indian and African-Caribbean) we studied the impact of goal striving and investigated whether the gap between the poor achievement and the high aspirations of members of some minority ethnic groups was potentially a factor contributing to the development of the illness. METHODS: The patients and age- and sex-matched controls from their respective communities were asked to rate their perceived current levels of achievement and their past and future expectations in five domains--social standing, housing, education, employment and financial status on a 10-point scale. RESULTS: The control subjects from the three ethnic groups scored similarly in most areas, supporting the validity of inter-ethnic comparisons. The gap between achievement and expectations did not appear to cause high disappointment levels in any group, and in fact only in the domain of housing did the African-Caribbean patients assess their current achievement as being significantly lower than that of their matched controls. CONCLUSIONS: Poor housing conditions may be one of the risk factors contributing to the high incidence of schizophrenia in African-Caribbeans.

Achievement↗
PubMed2004

Assessing the prevalence of depression in Punjabi and English primary care attenders: the role of culture, physical illness and somatic symptoms.

Previous studies exploring the prevalence of depression among South Asians reported inconsistent findings. Research artefacts due to sampling bias, measurements errors and a failure to include ethnographic methods may all explain this. We estimated the prevalence of depression, and variations of prevalence with culture, cultural adaptation, somatic symptoms and physical disability in a cross-sectional primary care survey of Punjabi and English attendees. We included a culture specific screening instrument, culturally adapted the instruments and offered bilingual interviews. We found that, compared with their English counterparts, depressive diagnoses were more common among Punjabis, Punjabi women, Punjabis with physical complaints and, contrary to expectation, even Punjabis with low scores for somatic symptoms.

Acculturation↗
PubMed2004

Globalisation and mental disorders. Overview with relation to depression.

BACKGROUND: Globalisation is the process by which traditional boundaries of cultures are changing. Industrialisation, urbanisation and influence of the media are influencing idioms of distress across cultures. AIMS: To discuss the role of globalisation, using the epidemiology, diagnosis, clinical presentation and treatment of depression across various cultures as an example. METHOD: Recent studies focusing on transcultural aspects of depression were reviewed and summarised. RESULTS: Cultural, social and religious mores account for variations in the presentation of depression across cultures. Somatic symptoms are common presenting features throughout the world and may serve as cultural idioms of distress, but psychological symptoms can usually be found when probed. Feelings of guilt and suicide rates vary across cultures and depression may be underdiagnosed. CONCLUSIONS: Training packages could enhance clinicians'cultural competency in multicultural settings. However, globalisation is likely to influence idioms of distress and pathways to care in ways that are difficult to predict.

Acculturation↗
PubMed2004

Culture-bound syndromes: the story of dhat syndrome.

BACKGROUND: Culture-bound syndrome is a term used to describe the uniqueness of some syndromes in specific cultures. Dhat (semen-loss anxiety) has been considered to be an exotic 'neurosis of the Orient'. AIMS: To ascertain the presence of similar symptoms and syndromes in different cultures and historical settings. METHOD: Electronic and manual literature searches were used to gather information on the existence and description of semen-loss anxiety in different cultures and settings. RESULTS: Most of the empirical studies on dhat syndrome have emerged from Asia, whereas its concepts have been described historically in other cultures, including Britain, the USA and Australia. The different sources indicate the universality of symptoms and global prevalence of this condition, despite its image as a 'neurosis of the Orient'. CONCLUSIONS: It appears that dhat (semen-loss anxiety) is not as culture-bound as previously thought. We propose that the concept of culture-bound syndromes should be modified in line with DSM-IV recommendations.

Anxiety Disorders↗
PubMed2004

Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity.

BACKGROUND: Adverse early circumstances may be more common in people who later develop psychotic disorders. AIMS: To use data from the second British National Survey of Psychiatric Morbidity to examine associations between psychotic disorders and a number of early victimisation experiences. METHOD: Psychiatric disorders were identified through structured assessment of adults resident in private households in Britain (n=8580). Respondents were asked whether they had experienced selected events displayed on cards. RESULTS: Compared with respondents with other psychiatric disorders or with none, the prevalence of every experience bar one was significantly elevated in those with definite or probable psychosis. The largest odds ratio was for sexual abuse. Controlling for depressed mood somewhat reduced the odds ratios for the individual experiences. CONCLUSIONS: In people with psychosis, there is a marked excess of victimising experiences, many of which will have occurred during childhood. This is suggestive of a social contribution to aetiology.

Accidents↗
PubMed2004

Trends in service use and treatment for mental disorders in adults throughout Great Britain.

BACKGROUND: Trends in health treatments and outcomes in the general population may be used to monitor achievement of health targets. AIMS: To investigate changes in mental health services and treatment in Britain over a 7-year period. METHOD: National surveys of psychiatric morbidity were completed in 1993 and 2000 in households throughout Great Britain. Standardised interviews were used to establish psychiatric case status and service and treatment utilisation in adults aged 16-64 years. RESULTS: Use of psychotropic medication doubled in those designated as psychiatric cases. In the non-case-status population antidepressant use rose from 0.16% in 1993 (95% CI 0.07-0.25) to 2.02% in 2000 (95% CI 1.69-2.35). However, the overall prevalence of neurotic and psychotic disorder hardly changed from 1993 to 2000. Use of specialised 'talking treatments'did not increase significantly, except in the non-case group. CONCLUSIONS: Treatment with psychotropic medication alone is unlikely to improve the overall mental health of the nation. A policy based almost exclusively on treatment of identified cases should be augmented by preventive approaches.

Adolescent↗
PubMed2003

Perceived causes of suicide attempts by U.K. South Asian women.

Perceived causes of suicide attempts were examined in 180 ethnic South Asian women living in the London area. The 3 factors endorsed most frequently and strongly as causes of suicide attempts in South Asian women were violence by the husband, being trapped in an unhappy family situation, and depression.

Adult↗
PubMed2003

Inception rates of deliberate self-harm among adolescents in West London.

BACKGROUND: Studies have suggested that inception rates of deliberate self-harm among different ethnic group adolescents are broadly similar. AIMS: We set out to study the rates of adolescent self-harm over a calendar year in Ealing--part of West London. METHODS: All cases of deliberate self-harm presenting to the A&E department and paediatrics were identified and socio-cultural factors studied. Ethnicity was obtained using self-ascription. RESULTS: A total of 76 cases were identified over one year. Using the at risk population as denominator, no differences in inception rates were noted according to ethnicity. Overdoses were the commonest method used for deliberate self-harm. CONCLUSIONS: The similarities between the Asian and white adolescents suggest that some common aetiological factors may be at play. The risk factors may be related to gender rather than ethnicity in this age group.

Adolescent↗
PubMed2003

Prevalence of bulimic behaviours and eating attitudes in schoolgirls from Trinidad and Barbados.

We investigated eating attitudes and the prevalence of bulimic disorders in a group of 362 schoolgirls from the islands of Trinidad and Barbados using key questions from the Bulimia Investigatory Test, Edinburgh (BITE) and additional questions for the exploration of eating attitudes and dieting practices. A random sample of 92 girls were interviewed using the DSM-III-R Bulimia Diagnostic Interview. Only three subjects (0.8%) scored over the cut-off point on the BITE. None of the interviewees was diagnosed as having bulimia nervosa. Two hundred and forty-five girls (67.7%) reported being terrified of becoming fat and fat-fear was associated with higher Body Mass Index, dieting and exercising for losing weight. Girls of African origin were found to have a more unusual eating pattern and more concerns about their eating habits. The prevalence of bulimic disorders in Caribbean schoolgirls is still very low, but they are a population at increasing risk since they share the western ideals of slimness and engage in dieting behaviours.

Adolescent↗
PubMed2002

Social environment, ethnicity and schizophrenia. A case-control study.

BACKGROUND: There is accumulating evidence that genetic and neurodevelopmental factors cannot solely account for the pathogenesis of schizophrenia. In view of the reportedly increased incidence of schizophrenia among the African-Caribbean population in Britain, we sought to establish the socio-environmental influences which distinguished African-Caribbean patients from white British and Asian patients with schizophrenia, as well as from normal population controls of the same community. METHOD: A matched case-control study was conducted in London between 1991 and 1993. Inclusion criteria for patients was a first onset psychosis between the ages of 18 and 64. Symptoms were recorded using the Present State Examination (PSE), and a research diagnosis of schizophrenia was made using the CATEGO program. Comparisons were made on a range of demographic and socio-environmental measures between patients (n = 100: 38 African-Caribbean, 38 white and 24 Asian) and the same number of normal controls. RESULTS: Three socio-environmental variables differentiated the African-Caribbean cases from their peers and their normal controls: unemployment, living alone and a long period of separation from either or both parents as a minor. Though all patients were much more likely than controls to be unemployed at first contact with the services (odds ratio 5.5, 95 % CI 2.59, 11.68), the odds ratio was highest among African-Caribbeans, and further conditional logistic regression analysis demonstrated that unemployment was significantly associated with the high rate of caseness among African-Caribbeans. However, the direction of cause and effect cannot be determined from this type of study. Despite the fact that African-Caribbean cases were more likely than their peers and same group controls to live alone (p < 0.05), this did not achieve significance using Fisher's Exact Test. Separation from both parents in childhood distinguished African-Caribbean cases from their controls and from cases and controls of the other ethnic groups (odds ratio 5.0, 95 % CI 1.09, 22.82). This event cannot be attributed to the premorbid manifestations of schizophrenia, nor to psychoses in the parents, and hence is a possible explanatory factor for the high incidence of schizophrenia among African-Caribbeans in Britain. CONCLUSIONS: These findings indicate that unemployment and early separation from both parents distinguish African-Caribbeans diagnosed with schizophrenia from their counterparts of other ethnic groups as well as their normal peers, and imply that more attention needs to be focussed on socio-environmental variables in schizophrenia research.

Adult↗