M. Ramos

Cultural competency training in psychiatry

Recent reports indicate that the quality of care provided to immigrant and ethnic minority patients is not at the same level as that provided to majority group patients. Although the European Board of Medical Specialists recognizes awareness of cultural issues as a core component of the psychiatry specialization, few medical schools provide training in cultural issues. Cultural competence represents a comprehensive response to the mental health care needs of immigrant and ethnic minority patients. Cultural competence training involves the development of knowledge, skills, and attitudes that can improve the effectiveness of psychiatric treatment. Cognitive cultural competence involves awareness of the various ways in which culture, immigration status, and race impact psychosocial development, psychopathology, and therapeutic transactions. Technical cultural competence involves the application of cognitive cultural competence, and requires proficiency in intercultural communication, the capacity to develop a therapeutic relationship with a culturally different patient, and the ability to adapt diagnosis and treatment in response to cultural difference. Perhaps the greatest challenge in cultural competence training involves the development of attitudinal competence inasmuch as it requires exploration of cultural and racial preconceptions. Although research is in its infancy, there are increasing indications that cultural competence can improve key aspects of the psychiatric treatment of immigrant and minority group patients.

Epidemiology of psychiatric morbidity among migrants compared to native born population in Spain: a controlled study

OBJECTIVE The aim of this paper is to explore the prevalence of psychiatric morbidity in different immigrant groups in Spain. In keeping with prior studies carried out in Europe, it is expected that the immigrant population will have elevated levels of psychopathology, with some variation across immigrant groups. METHOD DESIGN Multicenter, observational, cross-sectional study. SETTING Primary care settings of two Spanish regions. SAMPLE N=1.503 immigrants paired with the same number of Spanish controls, adjusted by gender and age. VARIABLES Demographic variables, MINI International Neuropsychiatric Interview and Standardized Polyvalent Psychiatric Interview, somatic symptoms section. Students t tests, ORs and logistic regressions were used to analyze the data. RESULTS No differences in psychiatric morbidity were found (native born 30.9%, population vs. immigrants 29.6%, OR=.942, CI=.806-1.100) when comparing immigrants to native born Spaniards. Relative to Spaniards (30.9%), Latin American immigrants had significantly higher levels of psychopathology (36.8%), Sub-Saharan Africans (24.4%) and Asians (16%) had significantly lower levels, and Eastern Europeans (31.4%) and North Africans (26.8%) showed no significant difference. CONCLUSIONS The hypotheses were only partially supported. Although overall immigrants did not differ from the native born population, when analyzed by geographic origin, only Latin Americans had higher levels of psychopathology. It is concluded that multiple factors need to be taken into consideration when studying the mental health of immigrants given that different immigrant groups have different levels of psychopathology.

S12-03 Cultural bias in psychiatric and psychological testing

Psychiatric and psychological testing are used extensively in both clinical and research contexts, with the goal of providing an objective indication of the construct being measured. At the same time, it has long been recognized that there is no such thing as a culture free or even fair test, to the extent that cultural bias-the constant and systematic statistical error due not to chance but to ethnic group membership-can seriously undermine the validity of a psychological or psychiatric test. The very construct being measured may not have a culturally compatible equivalent, or, relatedly, the behavior sampled in a given item or combination of items may not be associated with the construct in question in the same way across all cultures. In addition the means by which the behavior is sampled-the instrument construction, the sorts of questions or their structure, for example-can vary in familiarity across cultures. Finally, the individual items themselves may be poorly or ambiguously translated, may be predicated on specific cutlural norms, or, indeed, the meaning of the item can vary cross-culturally. Finally, sampling bias pertains to the representativeness of the sample, however, this is all the more complex given that constructs such as “race”, “ethnic group” and so forth are often poorly defined and ambiguous, and thus who is and who is not included in a given group may further undermine the validity of the test. Despite these difficulties, concrete steps can be taken to increase the cultural validity of the test used.

EPA-0279 – Transcutural study: prevalence and risk factors of substance misuse on a population of foreing non accompanied minors

Introduction The study will assess the risk factors and protective of psychoactive substance misuse in a population of Maghreb immigrant adolescents, Foreign Non Accompanied Minors (FNAM), in juvenile wards of Catalonia. The research hypothesis is that the presence of psychiatric psychopatholy, personality traits related to impulsivity, stressors related to migration, and several sociodemographic factors such as family dysfunction, poor schooling in the country of origin, etc., are related to psychotropic substance misuse. Risk Factors: acculturative stress, impulsiveness, mental health/ psychopathology, family dysfunction, uprooting (social and family), etc. Protective Factors: social support network, social stigma of substance misuse, etc. Methods and Objectives of the study 1- Substance misuse prevalence and pattern, misuse predictors / risk factors / protective factors Determine the prevalence and pattern of substance misuse (abuse and dependence) in a sample of FNAM aged 12 to 17 years and hosted in juvenile facilities in Catalonia. Detect those predictor variables (demographic, psychopathological and social) associated with the substance misuse. Specific objectives of the study 1 study the prevalence of substance abuse (tobacco, alcohol, cocaine, amphetamines, benzodiazepines, hallucinogens, solvents / glue / inhalants, MDMA and heroin) pre and post migration 2 study the presence of psychiatric disorders, ADHD, personality traits and impulsivity as risk factors associated with substance misuse 3 Study the temporal distribution often used for each of the substances 4 Identify the risk factors and / or protective socio-demographic variables such as place of origin, idiomatic level, family and social network, hosting conditions, family dysfunction, acculturative stress and migration experience. Research hypothesis/Results 1 The presence of psychiatric illness is a risk factor for substance misuse in the studied population 2 high impulsivity levels, sensation seeking traits and ADHD is associated with a higher risk for substance misuse 3 the coexistence of high impulsivity levels (above average expected for age and origin group), presence of psychopathology and unfavorable sociodemographic conditions predict greater severity in substance misuse 4 low idiomatic level, a reduced family and social network, difficulties in relationships during youth custody, the family dysfunction in origin, acculturative stress and complications in the migration process are associated with increased risk for substance misuse

P01-463 - Prevalence of psychotic symptoms: comparation of immigrants and native- born primary care service users

Introduction Epidemiological studies reveal higher rates of psychotic disorders among immigrants of ethnic minorities. However, the variation in prevalence of psychosis differs, and the proposed explanations and risk factors vary across the literature. Objectives 1) to examine the prevalence of psychotic symptoms in a sample of immigrants and native-born in a primary care setting context 2) to explore the effect that certain socio-demographic characteristics have in the difference in prevalence. Aims It is expected that the presence of psychotic symptoms will be greater for the immigrant population than for the native-born population. Low educational level, a low socio-economic status and the presence of a physical illness will partly explain these differences. Methods 3000 patients (1500 immigrants and 1500 native-born outpatients paired in age and gender) were interviewed in a primary care setting. They completed the Mini International Neuropsychiatric Interview, including the psychotic disorders sections, and a questionnaire that probed demographic characteristics and physical health status. Results Immigrants showed significantly higher rates of psychotic symptoms than native-born patients in both sections of diagnosis: life-span psychotic symptoms only (9.8% in immigrants and 5.3% in native-born) and life span with current psychotic symptoms (7% of the immigrants and 4.8% of the native-born). Immigrants also showed a lower education level, and a lower socio-economic status. When controlling for these factors, a relationship between these factors and the symptoms was found. Conclusions Findings are discussed in the context of culture and etiology of psychotic symptoms, and suggestions with regard to future research are made.