Melanie L. Straiton

Meaning-making through psychological autopsy interviews: the value of participating in qualitative research for those bereaved by suicide.

Too often ethical boards delay or stop research projects with vulnerable populations, influenced by presumed rather than empirically documented vulnerability. The article investigates how participation is experienced by those bereaved by suicide. Experiences are divided into 3 groups: (a) overall positive (62%), (b) unproblematic (10%), and (c) positive and painful (28%). The positive experiences are linked to processes of meaning-making, gaining new insight, and a hope to help others. Objective factors concerning the gender of participants, their relationship to the deceased, the method of suicide, and time since loss were largely unrelated to their experience of the interview.

Immigrants’ use of primary health care services for mental health problems

BackgroundEquity in health care across all social groups is a major goal in health care policy. Immigrants may experience more mental health problems than natives, but we do not know the extent to which they seek help from primary health care services. This study aimed to determine a) the rate immigrants use primary health care services for mental health problems compared with Norwegians and b) the association between length of stay, reason for immigration and service use among immigrants.MethodsNational register data covering all residents in Norway and all consultations with primary health care services were used. We conducted logistic regression analyses to compare Norwegians’ with Polish, Swedish, German, Pakistani and Iraqi immigrants’ odds of having had a consultation for a mental health problem (P-consultation).ResultsAfter accounting for background variables, all immigrants groups, except Iraqi men had lower odds of a P-consultation than their Norwegian counterparts. A shorter length of stay was associated with lower odds of a P-consultation.ConclusionsService use varies by country of origin and patterns are different for men and women. There was some evidence of a possible ‘healthy migrant worker’ effect among the European groups. Together with previous research, our findings however, suggest that Iraqi women and Pakistanis in particular, may experience barriers in accessing care for mental health problems.

Pushing the Boundaries: Understanding Self-Harm in a Non-Clinical Population

This study investigates 122 peoples descriptions of their self-harm experiences using thematic analysis. Analysis revealed four themes: What counts as self-harm, What leads to self-harm, Intentions and Managing stigma. Our participants challenged commonly accepted understandings in terms of method, outcome and intentions. Several difficulties associated with discriminating between suicidal and non-suicidal self-harm were highlighted, which may be important in clinical practice. Few participants mentioned diagnosed psychiatric disorders; they best understood self-harm through their social experiences. Focusing on social understandings of self-harm may help reduce associated stigma and barriers to help-seeking.

Gender Roles, Suicidal Ideation, and Self-Harming in Young Adults

This study investigates whether positive and negative conventional gender roles relate to suicidal ideation and self-harming in different ways among young adults. Participants completed an online survey about previous self-harm, recent suicidal ideation, and positive and negative aspects of conventional masculinity and femininity. Logistic regression analyses showed that negative femininity positively predicted self-harm and recent suicidal ideation status. Positive femininity was unrelated. Positive masculinity was negatively related to suicidal ideation and self-harming while negative masculinity was negatively related to self-harming only. The findings suggest that it is not the conventional feminine gender role per se that is associated with suicidality but specific negatively evaluated aspects. Conceptualizing gender as a multivariate construct may be useful in the gender socialization theory of suicidal behavior.

Mental Health of Refugees and Non-refugees from War-Conflict Countries: Data from Primary Healthcare Services and the Norwegian Prescription Database

High rates of mental health problems are consistently found among immigrants from refugee generating countries. While refugees and their family members may have experienced similar traumas, refugees are more likely to have undergone a stressful asylum period. This study aims to determine whether their mental health differs. Using national registry data, refugees and non-refugees from the same countries were compared on primary healthcare service use for mental health problems and purchase of psychotropic medicine. Refugees had higher odds of using primary health care services than non-refugees. Refugee women were more likely to purchase psychotropic medicine than non-refugee women. Refugee men were more likely to purchase anti-depressants. The findings suggest that refugees have poorer mental health than non-refugees. This may be due to a combination of greater pre-migration trauma and post-migration stressors such as enduring a difficult asylum period.

Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services

Researchers in Norway explore treatment options in primary care for immigrant women with mental health problems compared with nonimmigrant women. Three national registers were linked together for 2008. Immigrant women from Sweden, Poland, the Philippines, Thailand, Pakistan, and Russia were selected for analysis and compared with Norwegian women. Using logistic regression, we investigated whether treatment type varied by country of origin. Rates of sickness leave and psychiatric referrals were similar across all groups. Conversational therapy and use of antidepressants and anxiolytics were lower among Filipina, Thai, Pakistani, and Russian women than among Norwegians. Using the broad term “immigrants” masks important differences in treatment and health service use. By closely examining mental health treatment differences by country of origin, gaps in service provision and treatment uptake may be identified and addressed with more success.

Self-Harm and Conventional Gender Roles in Women.

A total of thirty-two women admitted to a general hospital for medical treatment after self-harming completed measures of conventional positive and negative masculinity and femininity. Comparisons were made with two control groups with no self-harm history; 33 women receiving psychiatric outpatient treatment and a nonclinical sample of 206 women. Multinomial logistic regression analyses showed that those with lower scores on Instrumentality and Unmitigated Agency (positive and negative masculinity) and higher scores on Insecurity (negative femininity) had greater odds of self-harming. Relationships were weaker after accounting for generalized self-efficacy. Results are discussed in relation to previous findings and suggestions for prevention are made.

Learning to navigate the healthcare system in a new country: a qualitative study

Abstract Objective: Learning to navigate a healthcare system in a new country is a barrier to health care. Understanding more about the specific navigation challenges immigrants experience may be the first step towards improving health information and thus access to care. This study considers the challenges that Thai and Filipino immigrant women encounter when learning to navigate the Norwegian primary healthcare system and the strategies they use. Design: A qualitative interview study using thematic analysis. Setting: Norway. Participants: Fifteen Thai and 15 Filipino immigrant women over the age of 18 who had been living in Norway at least one year. Results: The women took time to understand the role of the general practitioner and some were unaware of their right to an interpreter during consultations. In addition to reliance on family members and friends in their social networks, voluntary and cultural organisations provided valuable tips and advice on how to navigate the Norwegian health system. While some women actively engaged in learning more about the system, they noted a lack of information available in multiple languages. Conclusions: Informal sources play an important role in learning about the health care system. Formal information should be available in different languages in order to better empower immigrant women.

“It has not occurred to me to see a doctor for that kind of feeling”: a qualitative study of Filipina immigrants’ perceptions of help seeking for mental health problems

BackgroundImmigrant women face greater barriers to health care, especially mental health care, than non-immigrant women. However, immigrants are a heterogeneous group and bring with them a range of different personal, social, cultural and economic factors, which impact both mental health and access to care. In this study, we explored factors that influence Filipina immigrants’ perceptions of help seeking from a general practitioner for mental health problems in Norway.MethodUsing data from semi-structured interviews, we applied a post-colonial feminist perspective to identify factors that affect perceptions of help seeking.ResultsFindings indicated that a combination of the women’s beliefs and values, stigma, experiences with healthcare services in Norway and familiarity with mental health services influence perceptions of help seeking. Some factors represented structural barriers to healthcare seeking in general, while others related to mental healthcare seeking in particular. The significance of each factor varied depending on the women’s backgrounds.ConclusionsSocioeconomic status, educational background, familiarity with health services and experience of mental health can influence immigrant women’s perceptions of, and barriers for, help seeking for mental health problems. There are a number of barriers to address at a structural level to improve both the propensity to seek healthcare in general, as well as mental healthcare in particular. Efforts to increase awareness of primary mental healthcare services may also help change the perception that professional help is only appropriate for serious mental health disorders.

Socioeconomic status and primary health service use for mental health problems among immigrants with short and long lengths of stay

Purpose – High socioeconomic status (SES) is associated with better health and lower use of health care services in the general population. Among immigrants, the relationship appears less consistent. The purpose of this paper is to determine if the relationship between income level (a proxy for SES) and use of primary health care services for mental health problems differs for natives and five immigrant groups in Norway. It also explores the moderating effect of length of stay (LoS) among immigrants. Design/methodology/approach – Using data from two registers with national-level coverage, logistic regression analyses with interactions were carried out to determine the association between income level and having used primary health care services for mental health problems. Findings – For Norwegian men and women there was a clear negative relationship between income and service use. Interaction analyses suggested that the relationship differed for all immigrant groups compared with Norwegians. When stratify...