Linda K. Sussman

Treatment-seeking for depression by black and white Americans

This paper examines data from a psychiatric epidemiologic survey of 3004 households in St Louis to determine whether there are distinctions between black and white Americans in their propensities to seek treatment for episodes of depression and to discover those groups least likely to seek care. The process initiated by the experiencing of unusual or distressing signs or symptoms and completed by seeking treatment for those complaints is a complex one, involving several steps. Numerous factors may affect decisions regarding treatment-seeking including characteristics of the individuals themselves, characteristics of the symptoms, and attitudes and beliefs about the causes and proper treatment of psychiatric problems or mood. We, therefore, also examine the available epidemiologic data for some clues concerning those factors which may have contributed to the observed patterns of treatment-seeking. Significantly fewer blacks meeting psychiatric criteria for a diagnosis of depression had sought professional care. Moreover, severity of the problem was significantly related to treatment-seeking among blacks and it was among those with the least severe problems that the greatest differences were found. Whites did not significantly exceed blacks in seeking care when depressive episodes were long lasting, severe or frequent. Although there was some indication that blacks may be more tolerant of depressive symptoms, a considerable proportion of blacks who felt they had a troublesome problem had never sought professional care. There was little evidence to suggest that a fear of being stigmatized prevented blacks from seeking care. However, blacks were more likely to report that fear of treatment and of being hospitalized had prevented them from seeking care. A number of hypotheses generated by the epidemiologic data are presented. Once large-scale surveys such as this have delineated the patterns of health care utilization and identified those groups at high risk of not receiving care, anthropological concepts and problem-oriented field research may be extremely useful in testing hypotheses concerning those factors underlying the observed behavioral patterns.

Satellite Imagery, Human Ecology, Anthropology, and Deforestation in Madagascar

Satellite images were used to determine rates of deforestation over the past 35 years and to identify current deforestation “hotspots” in the eastern rainforests and in the dry endemic forests of southern Madagascar. The analysis of population trends, topography, and coincident ethnographic research points to a number of different factors influencing deforestation in these regions. Each of these factors generates different problems for conservation and development, most of which are not being dealt with adequately.

Racial differences in prevalence of phobic disorders

Few community-based field studies have examined racial differences in the prevalence of phobia disorders. Using data from two sites of a large epidemiologic survey, this study investigates risk factors associated with the one-month prevalence of phobia disorders from 2340 black and 3936 white respondents. Findings indicate that recent prevalence is higher for blacks than whites, with racial differences remaining even when demographic and socioeconomic factors are held constant. Additional significant risk factors for recent phobia pertained to site and being female, being young, and having low education attainment.

Herbal medicine on Mauritius

Summary A preliminary study was conducted on the medical beliefs and practices on the Indian Ocean island of Mauritius. Mauritius is a plural society consisting of Indo-Mauritians, Sino-Mauritians, Creoles, and Franco-Mauritians. There are several types of healing specialists found on the island including at least three types of herbalists. In this paper, I report on home remedies used by individuals in the village in which I lived and on the patients and remedies of two Indo-Mauritian herbalists located in the central market in the capital city of Port Louis. The two herbalists were observed for a total of 10 hours on two working days and data were collected on the age, ethnic group, sex, and illness of each patient treated and on the ingredients of each remedy sold. The use of home herbal remedies appears to be widespread among Mauritians and is frequently the first form of treatment utilized for common ailments. The Indo-Mauritian herbalists I observed treat a wide variety of ailments and utilize approximately 150 plant species. On the days of observation, their clients consisted of all age groups, sexes, and ethnic groups except for Franco-Mauritians. The data on medicinal plants are presented in table form.

A tool to organize instructions at discharge after treatment of asthmatic children in an Emergency Department

Asthma exacerbations continue to be a major cause of visits to emergency departments (ED). Comprehensive care in the outpatient setting, with planning for early intervention for exacerbations, can reduce emergency visits. Thus, a major goal of ED intervention is to establish a link between the patient and the provider of ongoing asthma care, where complete education can be achieved and reinforced over time. When designing the Asthma 1-2-3 Plan discharge teaching tool for the ED, consideration was given to educational format, readability, patient population, and setting in which education was to be delivered. To evaluate use of the plan, ED records of patients enrolled in a separate asthma study, the Neighborhood Asthma Coalition (NAC), were audited for two 8-month intervals, May-December 1993 (before initiation of the plan) and May December 1994 (starting 1 month after completion of pilot testing on the plan in the ED). To evaluate effectiveness of the plan, records of physicians who cared for children in the NAC were evaluated. The database was reviewed for the date of the first visit for planned review of asthma that occurred after the acute asthma ED visit. After introduction of the plan, the proportion of children told to return to the physician for follow-up increased from 54% to 81%. The proportion of children given advice to return to their physician within the recommended 3 days or less increased from 11% to 54%. Chi2 Analyses showed that these changes were both statistically significant (p<0.0001). The plan was not effective in achieving increased follow-up visits for regular asthma care, in that 7% returned for follow-up within 7 days after an ED visit before the plan and only 6% returned for such a visit after the Plan. Successful initiation of a focused discharge teaching tool into the routine of the ED increased appropriate advice given at time of discharge from the ED. Although unsuccessful in increasing appropriate follow-up, the present intervention uses the ED not as a base for asthma education, but as a point for contacting patients in need of regular care and education, and for promoting access to that regular care.

Acceptability and Feasibility of a Community Approach to Asthma Management: The Neighborhood Asthma Coalition (NAC)

Understanding of asthma and co-management between patient and physician improves outcome. Feasibility of programs to achieve these goals in underserved settings is not documented. We used the Precede-Proceed model to document (a) community acceptance of a program to engage peer support of asthma management and care; (b) program revision to emphasize greater attention to availability of care and promotional events as channels for education; (c) engagement of intended audiences in planning and implementation; (d) participation of parents in program activities; and (e) peer-based education/support to reach parents, including socially isolated parents whose children experience heightened morbidity.

Unity in diversity in a polyethnic society: the maintenance of medical pluralism on Mauritius.

Abstract Mauritius is a polyethnic society that provides an ideal situation in which to study medical pluralism. The population of this Indian Ocean island predominantly consists of individuals of Indian African. French, and Chinese origin; Hinduism. Christianity, Islam, and Buddhism are all represented on the island. A wide variety of both secular and religious healing resources are encountered on Mauritius, many of which are associated with particular ethnic and/or religious traditions. However, except for a few of the religious specialists, most practitioners are consulted by individuals of diverse ethnic and religious backgrounds. In this paper I examine the medical belief system and health-seeking behavior of Mauritians in order to delineate both the conceptual and behavioral mechanisms contributing to the maintenance of medical pluralism. Despite the heterogeneity of the population, lay individuals tend to hold similar beliefs about the causes of illness and to construct similar categories of illness. Mauritians believe that illness may result from a wide variety of factors and that no single healing tradition is capable of dealing with all of these. Therefore, the medical belief system and the distribution of medical knowledge require and promote the maintenance of diverse healing traditions. The decision-making process during quests for cure is structured in such a way that it allows patients to consult a variety of healing traditions for particular illness episodes and to utilize over their lifetimes a diversity of healing resources. The medical belief system on Mauritius is a consistent, unified system that promotes the maintenance of ideologically diverse healing traditions and the acceptance of newly developed or newly introduced therapeutic resources. It is, thus, well adapted to the social history and social heterogeneity of the island. It does, however, exhibit some characteristics that are not usually reported in other less heterogeneous societies, and the question arises as to whether these correspond to the extent of medical pluralism and or ethnic heterogeneity in other sociocultural contexts.

Use of Prospective Disease Management to Minimize Asthma Symptoms and Maximize Potential

Asthma is a common chronic illness in all age groups. The goal of treatment of asthma is to allow those with asthma to lead full lives (i.e., sleeping through the night, exercising to their physical capacity without interference from asthma symptoms, and missing no more than the usual amount of school or work). Fundamental to this goal is the issue of prevention, or prospective disease management. From the physiologic perspective, prospective disease management includes having regular visits to review progress and goals of therapy, using medications prophylactically, avoiding precipitating factors by controlling the environment, maintaining physical fitness to reduce exercise-induced asthma, and good communication during asthma exacerbations. Prospective disease management can also be viewed in a much broader psychological context and includes issues of attitude of patient toward the disease, the capacity of the family to adapt to the chronic illness, support for asthma care by the family, and social support of the patient and understanding of the disease by peers and the community in general. Other chapters will deal with the use of medications. Hence, we focus on other medical and educational interventions for prospective disease management.