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Biomedical subjects

K Bhui

Publications and source records attributed to K Bhui.

At least 19 recordsLinked to original sources
PubMed2003

User involvement in the planning and delivery of mental health services: a cross-sectional survey of service users and providers.

OBJECTIVE: To identify methods for involving service users in the planning and delivery of psychiatric services and factors which may assist and impede this process. METHOD: A cross-sectional postal survey of user groups and providers of psychiatric services throughout Greater London (UK). RESULTS: Seventeen (94%) service providers and 29 (48%) user groups responded to the survey. Service providers employed a wide variety of different methods for involving users but none met national standards for user involvement (UI). Service providers stated that the main obstacle to UI was that users who took part were not representative of local patients. User groups highlighted staff resistance as a major obstacle and 80% stated that they were not satisfied with current arrangements for UI. CONCLUSION: While users and providers of mental health services were able to identify changes resulting from UI the responsiveness of staff and the representativeness of service users may be impeding this process.

Cross-Sectional Studies↗
PubMed2001

Cultural influences on the prevalence of common mental disorder, general practitioners' assessments and help-seeking among Punjabi and English people visiting their general practitioner.

BACKGROUND: Culture influences symptom presentation and help-seeking and may influence the general practitioner's assessment. METHODS: We recruited Punjabi and English GP attenders to a two-phase survey in London (UK) using the Amritsar Depression Inventory and the General Health Questionnaire as screening instruments. The Clinical Interview Schedule was the criterion measure. General practitioners completed Likert assessments. RESULTS: The second phase was completed by 209 Punjabi and 180 English subjects. The prevalence of common mental disorders was not influenced by culture. Punjabi cases more often had 'poor concentration and memory' and 'depressive ideas' but were not more likely to have somatic symptoms. General practitioners were more likely to assess Punjabis with common mental disorder as having 'physical and somatic' symptoms or 'sub-clinical disorders'. Punjabi cases with depressive ideas were less likely to be detected compared with English ones. In comparison to English men, English women were under-detected by Asian general practitioners. Help-seeking English subjects were more likely to be correctly identified as cases. CONCLUSIONS: The prevalence of common mental disorders and somatic symptoms does not differ across cultures. Among English subjects, general practitioners were more likely to identify correctly pure psychiatric illness and mixed pathology; but Punjabi subjects with common mental disorders were more often assessed as having 'sub-clinical disorders' and 'physical and somatic' disorders. English women were less well detected than English men. English help-seeking cases were more likely to be detected.

Adolescent↗
PubMed2001

Transcultural psychiatry: some social and epidemiological research issues.

BACKGROUND: Mental Health Research across cultural groups is often criticised for using imprecise measures of cultural group and for using outcome measures as if they have universal validity. AIMS: 1. To Investigate the effect of using different cultural group variables on the findings of a survey of prevalence of Common Mental Disorders. 2. To demonstrate that assumptions of validity for outcomes measures can affect the interpretation of data from prevalence surveys. METHODS: We recruited Punjabi and English subjects to a phase prevalence survey that included the Amritsar Depression Inventory and the General Health Questionnaire as screening instruments. The Clinical Interview Schedule was the outcome measure. This paper reports on a secondary analysis of the data. We used ethnic group, place of birth, religion, first language and language spoken at interview as possible cultural group variables and compared the prevalence estimates. We then considered the limitations of conventional methods to assess prevalence, by looking at mean scores on each of the three instruments in both cultural groups. RESULTS: Cultural group variables did not influence the prevalence estimates for Common Mental Disorder. Although conventional scoring methods showed no difference in prevalence across cultures, the mean scores on each instrument, when compared across cultural groups, differed for the Amritsar Depression Inventory. This instrument showed a higher mean score for the Punjabis suggesting a higher prevalence. The findings are discussed in the context of value laden 'assumptions' about validity. CONCLUSIONS: The findings of prevalence surveys depend on assumptions of validity. The 'culture' of psychiatry is a closed system in which validation studies support its basic assumptions.

Cross-Cultural Comparison↗
PubMed2000

Common mood and anxiety states: gender differences in the protective effect of physical activity.

BACKGROUND: We wished to examine the impact of the duration and intensity of physical activity on common anxiety and depressive states. METHOD: A nested case-control design was applied to data from the Health and Lifestyle Survey. Anxiety and depressive states were measured by caseness on the General Health Questionnaire. Physical activity variables were defined from a detailed activity schedule. RESULTS: After adjustment for potential confounders, the findings suggest that compared to men who reported 0-44 min of daily physical activity, there is benefit to men who exercise for at least 92 min a day (92-161 min a day: OR = 0.57, 95% CI = 0.37-0.87, P<0.01; 162-554 min a day: OR = 0.65, 95% CI = 0.43-0.97, P<0.05), but not to women. The protective effect does not appear to vary according to the intensity of activity in men or women. CONCLUSIONS: Physical activity of long duration amongst men confers protection against common mood and anxiety states. This study found no such protection for women.

Adolescent↗
PubMed2000

Bulimic disorders and sociocentric values in north India.

BACKGROUND: Previous studies have shown low rates of eating disorders in some developing countries. We set out to investigate the prevalence of bulimia in an all-female college population in north India and relate it to sociocentrism of the culture. METHODS: A total of 504 students in an all-girls private college in an industrial town in north India completed the Hindi translation of the Bulimia Investigatory Test, Edinburgh (BITE). A random sample of 50 students, irrespective of their scores, were interviewed using the DSM-III-R interview for eating disorders; they were also asked about qualitative aspects of their relationship with the family and their own views of their identity. RESULTS: There was no effect of age, social class, religion or height on the distribution of BITE scores. Three key factors emerged; these were related to the constructs of compulsive activity, impulsivity/sociocentric avoidance and associated attitudinal responses and depressive thinking with features of helplessness and feelings of failure. Acculturation was not related to BITE scores. Virtually all interviewees had sociocentric views of theirselves. CONCLUSIONS: Sociocentrism and impulsivity account for a significant amount of the variance. The role of sociocentrism in influencing patterns of eating deserves to be studied further.

Acculturation↗
PubMed2000

Cross-cultural validity of the Amritsar Depression Inventory and the General Health Questionnaire amongst English and Punjabi primary care attenders.

BACKGROUND: In order to estimate the health needs of cultural groups, the cross-cultural validity of instruments requires investigation in distinct cultural rather than ethnic or racial groups. METHOD: We screened 'Punjabi' and 'English' primary care attenders in South London (UK), using the General Health Questionnaire (GHQ-12), an English origin instrument, and the Amritsar Depression Inventory (ADI), which was developed in the Punjab in India. The criterion measure was the Clinical Interview Schedule (CIS-R). We calculated the validity coefficients, optimal thresholds and the area under the 'Receive Operating Characteristic' curve to compare cross-cultural performance. We identified items on each questionnaire that contribute to performance of the instruments. RESULTS: The GHQ-12 has high validity coefficients in both cultural groups. The ADI performs as well amongst English subjects, but among Punjabis it is poorer than the GHQ-12. Among Punjabis who have been resident in the UK for over 30 years, the ADI performs no better than chance. Few items on the ADI or the GHQ are strongly predictive of case status. CONCLUSIONS: The GHQ-12 shows good validity in both cultures. Expressions of distress may change due to acculturation. 'Culturally sensitive' screening instruments need to reflect this. Further work might attend to the changing expressions of distress following migration.

Adult↗
PubMed1999

Racism in psychiatry: paradigm lost--paradigm regained.

Racism and psychiatry have been 'linked' in the public imagination, largely because psychiatry is seen as an instrument of social control, and racism as a different form of oppression which permeates society at large. Racism in psychiatry is often believed to be the mediating factor in cases of 'psychiatric misdiagnosis' and 'mismanagement.' Misdiagnosis includes underdiagnosis and overdiagnosis; this can account for the non-delivery of appropriate treatments because of an erroneous diagnostic label. In some instances this leads to a deferred intervention, or in some ethnic groups, help-seeking is delayed for unnecessarily long periods. Racism is not a recent phenomenon. The blunt application of the word 'racism' perpetuates conceptual confusion about what is meant by the term, what processes are taking place, how much of the processes are institutionalized or individual and to what degree individuals are aware of the impact of their actions. We propose a way of understanding racism in psychiatric practice, and suggest that within such a framework, the therapist/professional and the patient can work together towards improving patient care.

Attitude of Health Personnel↗
PubMed1998

Unmet needs of remand prisoners.

A needs assessment protocol which examines 11 problem areas was devised. This was administered to 277 prisoners on remand at Brixton Prison. We found high levels of unmet need for housing, treatment of substance abuse and neurotic symptoms. Twenty-nine per cent were transferred to hospital under the provisions of the Mental Health Act and about a third of those at liberty to do so complied with a discharge plan. Diversion and discharge planning can potentially meet the unmet needs of remand prisoners.

Adult↗
PubMed1998

African-Caribbean men remanded to Brixton Prison. Psychiatric and forensic characteristics and outcome of final court appearance.

BACKGROUND: African-Caribbean men are over-represented in psychiatric and forensic services and in the prison population. A failure of community services to engage mentally ill African-Caribbean men and their presentation through the criminal justice system culminates in a repeated pattern of forensic service and criminal justice system contact. METHOD: We carried out a cross-sectional survey during a one-year period of a sample of potentially mentally ill men remanded to HMP Brixton in south London. Men were interviewed to establish their place of birth, first language, socio-demographic profile, ethnicity, psychiatric diagnosis, levels of alcohol and substance misuse, criminality, violence involved in their index offence, past psychiatric and forensic contacts and outcome of court appearance. RESULTS: Two hundred and seventy-seven men were interviewed. In comparison with White men, African-Caribbean men were more often diagnosed as having schizophrenia and were more often sent to hospital under a mental health act order. African-Caribbean men were remanded in custody despite more stable housing conditions and more favourable indices of lifetime criminality, substance misuse and violence. CONCLUSIONS: Community services, including diversion schemes, should be especially sensitive to African-Caribbean men with schizophrenia who 'fall out of care', who are not diverted back into care and are therefore unnecessarily remanded.

Adult↗
PubMed1998

Training and supervision in effective cross-cultural mental health services.

For mental health professionals working in areas with large black and minority ethnic populations, adequate training and continuing supervision are essential in providing culturally acceptable services. Local multidisciplinary training is the most suitable method of integrating training and supervision and developing culturally appropriate services.

Cultural Diversity↗
PubMed1998

Transcultural psychiatry: do problems persist in the second generation?

The sociodemographic patterns among minority ethnic groups in the UK are changing. The younger, and in some instances British born, minority ethnic population appears to suffer from higher rates of some and lower rates of other psychiatric disorders. The exact patterns vary according to the ethnicity. Some of the data and explanations for these variations are discussed in this article.

Acculturation↗
PubMed1997

Sexual and relationship problems amongst patients with severe chronic psychoses.

Recent studies have begun to examine the complexity and frequency of sexual and relationship problems amongst samples of community resident people with severe psychoses. For the purposes of this study, subjects with severe persistent psychoses and under the care of a single community team were interviewed using a semi-structured clinical interview and structured diagnostic interview of marital and sexual satisfaction. Functional disability was assessed by the Multnomah Community Ability Scale. Amongst those interviewed (n = 53) the prevalence of sexual difficulties was 47.5% and 30.8% for men (n = 40) and women (n = 13), respectively. The majority of men (82.5%) and some of the women (38.5%) were not in intimate relationships; 42.5% of men and 38.5% of women had never had a sexual relationship. Amongst community resident patients with severe psychoses, the level of unmet need for specific interventions (including assessment procedures, psychotherapeutic, pharmaco-therapeutic) for sexual and relationship dysfunction is high. This warrants evaluation of service structures and treatment packages tailored for this group.

Adult↗