Kenneth Fung

Postpartum depression among immigrant women.

Purpose of review Although there has been an increase in research on postpartum depression (PPD), an inadequate focus has been placed on immigrant women. This is a significant limitation given the rapidly changing demographics in North America. Recent findings Immigrants face unique and multiple layers of challenges that may compromise their mental health and prevent them from receiving adequate and equitable care. For immigrant women, many of these stressors are especially compounded in the vulnerable postpartum period, resulting in PPD. Cultural values and practices may be protective in some instances, whereas in other instances they exacerbate PPD. There is a significant gap in existing literature regarding the complex psychosocial, cultural, and spiritual factors that may moderate the effects of the depression. Furthermore, the measurement of PPD is hampered by cross-cultural methodological challenges. Summary Given the complexity of the psychosocial issues facing immigrant women, there is a need to develop a comprehensive response toward addressing the multifaceted challenges, ensuring equitable immigration and related policies; adequate community resources and social services to address social determinants of health; inclusiveness in public health and prevention strategies; equitable access to a culturally competent healthcare system; capacity building of marginalized communities; and culturally competent interventions at the individual level. Additional research using the bidimensional model of acculturation is needed.

Traditional postpartum practices and rituals: a qualitative systematic review

Many cultures around the world observe specific postpartum rituals to avoid ill health in later years. This qualitative systematic review examined the literature describing traditional postpartum practices from 51 studies in over 20 different countries. Commonalities were identified in practices across cultures. Specifically, the themes included organized support for the mother, periods of rest, prescribed food to be eaten or prohibited, hygiene practices and those related to infant care and breastfeeding, among others. These rituals allow the mother to be ‘mothered’ for a period of time after the birth. They may have beneficial health effects as well as facilitate the transition to motherhood. In todays society, with modernization, migration and globalization, individuals may be unable to carry out the rituals or, conversely, feel pressured to carry out activities in which they no longer believe. The understanding of traditional postpartum practices can inform the provision of culturally competent perinatal services.

An Integrative Approach to Cultural Competence in the Psychiatric Curriculum

ObjectiveAs it is increasingly recognized that cultural competence is an essential quality for any practicing psychiatrist, postgraduate psychiatry training programs need to incorporate cultural competence training into their curricula. This article documents the unique approach to resident cultural competence training being developed in the Department of Psychiatry at the University of Toronto, which has the largest residency training program in North America and is situated in an ethnically diverse city and country.MethodsThe authors conducted a systematic review of cultural competence by searching databases including PubMed, Psyc-INFO, PsycArticles, CINAHL, Social Science Abstracts, and Sociological Abstracts; by searching government and professional association publications; and through on-site visits to local cross-cultural training programs. Based on the results of the review, a resident survey, and a staff retreat, the authors developed a deliberate “integrative” approach with a mindful, balanced emphasis on both generic and specific cultural competencies.ResultsLearning objectives were derived from integrating the seven core competencies of a physician as defined by the Canadian Medical Education Directions for Specialists (Can-MEDS) roles framework with the tripartite model of attitudes, knowledge, and skills. The learning objectives and teaching program were further integrated across different psychiatric subspecialties and across the successive years of residency. Another unique strategy used to foster curricular and institutional change was the program’s emphasis on evaluation, making use of insights from modern educational theories such as formative feedback and blueprinting. Course evaluations of the core curriculum from the first group of residents were positive.ConclusionThe authors propose that these changes to the curriculum may lead to enhanced cultural competence and clinical effectiveness in health care.

Traditional postpartum practices and rituals: clinical implications.

Objectives: In many cultures, postpartum rituals are observed because they are believed to have beneficial mental health effects. Our systematic review examines the research literature investigating the effects of postpartum rituals on postpartum depression (PPD) to determine if the rituals protect against PPD. Methods: MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Library were searched (from 1966 to October 31, 2008). Reference lists of relevant articles and links to related articles were also examined. Both qualitative and quantitative studies that focused on traditional practices and rituals in the postpartum period (that is, within the first year following childbirth) and their relation to PPD or mood were included. Results: Seventy-two studies were considered, with 12 meeting the inclusion criteria. The data were summarized according to the type of ritual including: organized support, diet, and other or multiple postpartum practices, and evidence for or against a protective effect on PPD. Although limited, not all studies suggested that the rituals prevent PPD. Overall, there is some evidence that postpartum rituals dictating appropriate and wanted social support may be of some protective value, depending on numerous contextual factors. Conclusions: This area needs more culturally sensitive and systematic research. Current studies suggest that the key protective element may be the presence of welcome support rather than the specific ritual.

Acceptance and Commitment Therapy: Western adoption of Buddhist tenets?

Acceptance and Commitment Therapy (ACT) is a psychological intervention that has wide clinical applications with emerging empirical support. It is based on Functional Contextualism and is derived as a clinical application of the Relational Frame Theory, a behavioral account of the development of human thought and cognition. The six core ACT therapeutic processes include: Acceptance, Defusion, Present Moment, Self-as-Context, Values, and Committed Action. In addition to its explicit use of the concept of mindfulness, the therapeutic techniques of ACT implicitly incorporate other aspects of Buddhism. This article describes the basic principles and processes of ACT, explores the similarities and differences between ACT processes and some of the common tenets in Buddhism such as the Four Noble Truths and No-Self, and reports on the experience of running a pilot intervention ACT group for the Cambodian community in Toronto in partnership with the community’s Buddhist Holy Monk. Based on this preliminary exploration in theory and the reflections of the group experience, ACT appears to be consistent with some of the core tenets of Buddhism in the approach towards alleviating suffering, with notable differences in scope reflecting their different aims and objectives. Further development of integrative therapies that can incorporate psychological and spiritual as well as diverse cultural perspectives may help the continued advancement and evolution of more effective psychotherapies that can benefit diverse populations.

Improving Access to Mental Health Services for Racialized Immigrants, Refugees, and Non-Status People Living with HIV/AIDS

The demographic characteristics of people living with HIV/AIDS (PHAs) in Canada are increasingly diverse. Despite literature suggesting a potentially heightened mental health burden borne by racialized immigrant, refugee, and non-status PHAs (IRN-PHAs), researchers have hitherto paid insufficient attention to whether existing services adequately address this need and how services might be improved. Employing community-based research methodology involving PHAs from five ethnoracial groups in Toronto, Ontario, this study explored IRN-PHAs’ mental health service-seeking behaviors, service utilization experiences, and suggestions for service improvements. Results showed that while most IRN-PHAs were proactive in improving their mental health, their attempts to obtain support were commonly undermined by service provider mistreatment, unavailability of appropriate services, and multiple access barriers. A three-pronged approach involving IRN-PHA empowerment, anti-stigma and cultural competence promotion, and greater service integration is proposed for improving IRN-PHAs’ mental health service experience.

An exploratory study on the mental health of immigrants, refugees and non-status people living with HIV in Toronto

Purpose – Canadian HIV/AIDS researchers, service providers and policy-makers are faced with new challenges of providing effective and inclusive care that meets the needs of the changing populations infected with and affected by HIV. Since 2005 immigrants and refugees from ethno-racial minority communities have comprised close to 20 percent of all new HIV infections in Canada. Anecdotes shared by PLWHAs and service providers indicated that mental health challenges faced by newcomer PLWHAs was a priority concern for HIV prevention, treatment and care. This paper reports on the results of an exploratory study, which examined the complex factors that influence the mental health of immigrants and refugees living with HIV/AIDS (IR-PLWHAs). Design/methodology/approach – This exploratory study is informed by a critical social science paradigm, which acknowledges that the everyday reality is shaped by interlocking systems of social processes and unequal power relations. The paper used a qualitative interpretative ...

Personality disorders in Asians: Summary, and a call for cultural research

Epidemiological studies show relatively low rates of personality disorder (PD) in Asian-origin samples, but these low rates may result from a lack of understanding about what constitutes PD in Asian cultural contexts. Research on etiology, assessment, and treatment has rarely been extended to incorporate ways in which culture might shape PDs in general, let alone among Asians in particular. PDs did not officially change in DSM-5, but an alternative dimensional system may help link the Asian PD literature to non-clinical personality research. Personality and culture are deeply intertwined, and the research literature on Asian PDs - and on PDs more generally - would benefit greatly from more research unpacking the cultural mechanisms of variation.

Engaging African-Caribbean, Asian, and Latino community leaders to address HIV stigma in Toronto

Purpose Racialized minority and newcomer communities are over-represented in positive HIV cases in Canada. Stigma has been identified as one of the barriers to HIV prevention, testing, and treatment. Faith, media, and social justice sectors have historically served a vital role in promoting health issues in these communities. However, they have been relatively inactive in addressing HIV-related issues. The purpose of this paper is to report on the results of an exploratory study that engaged faith, media, and social justice leaders in the African-Caribbean, Asian, and Latino communities in Toronto. Design/methodology/approach This study used a qualitative interpretive design and focus groups to explore the challenges and opportunities in addressing HIV stigma. A total of 23 people living with HIV and 22 community leaders took part in seven focus groups. Intersectionality was used as an analytical lens to examine the social processes that perpetuate HIV stigma. Findings This paper focuses on the perspectives of community leaders. Five themes were identified: misconception of HIV as a gay disease; moralistic religious discourses perpetuate HIV stigma; invisibility of HIV reinforces community denial; need to promote awareness and compassion for people with HIV; and the power of collective community efforts within and across different sectors. Originality/value Although affected communities are faced with many challenges related to HIV stigma, effective change may be possible through concerted efforts championed by people living with HIV and community leaders. One important strategy identified by the participants is to build strategic alliances among the HIV, media, faith, social justice, and other sectors. Such alliances can develop public education and HIV champion activities to promote public awareness and positive emotional connections with HIV issues, challenge HIV stigma and related systems of oppression, and engage young people in HIV championship.

Prevalence, Incidence, and Persistence of Postpartum Depression, Anxiety, and Comorbidity among Chinese Immigrant and Nonimmigrant Women: A Longitudinal Cohort Study:

Objective: Our objectives were to examine the prevalence and incidence of postpartum depressive, anxiety, and comorbid symptoms over the first postpartum year; the persistence of these symptoms; and the prevalence stratified by immigration status. Method: We conducted a longitudinal cohort study in Ontario, Canada. Participants were 571 Chinese recent immigrant, nonrecent immigrant, and Canadian-born women with live births in 2011 to 2014. Participants were assessed at 4, 12, and 52 weeks postpartum for the presence of possible and high depressive symptomatology (Edinburgh Postnatal Depression Scale [EPDS] >9 and >12, respectively), anxiety symptomatology (State-Trait Anxiety Inventory [STAI] >40), and comorbid symptomatology (EPDS >9 and STAI >40). Prevalence and incidence with 95% confidence intervals were calculated. Results: Prevalence rates were highest at 4 weeks and decreased across time, with possible depressive symptomatology most prevalent at most time points. Incidence rates at 12 and 52 weeks were generally similar. Of those with possible symptomatology at 4 weeks, 42.0% or less continued to have symptomatology at 12 weeks and 17.4% or less at 52 weeks. There were no differences in prevalence of any type of symptomatology between immigrant and Canadian-born Chinese women at 4 weeks, but at 12 and 52 weeks, most types of symptomatology were more common among recent and nonrecent immigrants. Conclusion: Our findings suggest that Chinese immigrant women are a high-risk group for postpartum depressive and anxiety symptomatology. Future research should identify cultural and psychosocial factors associated with immigration that could be addressed in the system of care for postpartum immigrant women.