Sokratis Dinos

A systematic review of chronic fatigue, its syndromes and ethnicity: prevalence, severity, co-morbidity and coping

BACKGROUND Chronic Fatigue Syndrome (CFS) is characterized by unexplained fatigue that lasts for at least 6 months alongside a constellation of other symptoms. CFS was historically thought to be most common among White women of higher socio-economic status. However, some recent studies in the USA suggest that the prevalence is actually higher in some minority ethnic groups. If there are convincing differences in prevalence and risk factors across all or some ethnic groups, investigating the causes of these can help unravel the pathophysiology of CFS. METHODS A systematic review was conducted to explore the relationship between fatigue, chronic fatigue (CF--fatigue lasting for 6 months), CFS and ethnicity. Studies were population-based and health service-based. Meta-analysis was also conducted to examine the population prevalence of CF and CFS across ethnic groups. RESULTS Meta-analysis showed that compared with the White American majority, African Americans and Native Americans have a higher risk of CFS [Odds Ratio (OR) 2.95, 95% confidence interval (CI): 0.69-10.4; OR = 11.5, CI: 1.1-56.4, respectively] and CF (OR = 1.56, CI: 1.03-2.24; OR = 3.28, CI: 1.63-5.88, respectively). Minority ethnic groups with CF and CFS experience more severe symptoms and may be more likely to use religion, denial and behavioural disengagement to cope with their condition compared with the White majority. CONCLUSIONS Although available studies and data are limited, it does appear that some ethnic minority groups are more likely to suffer from CF and CFS compared with White people. Ethnic minority status alone is insufficient to explain ethnic variation of prevalence. Psychosocial risk factors found in high-risk groups and ethnicity warrant further investigation to improve our understanding of aetiology and the management of this complex condition.

Medical Student Attitudes About Mental Illness: Does Medical-School Education Reduce Stigma?

BackgroundReducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students’ attitudes toward patients with mental health problems deteriorate as they progress through medical school.ObjectiveAuthors examined medical students’ attitudes to mental illness, as compared with attitudes toward other medical illness, and the influence of the number of years spent in medical school, as well as of several key socio-demographic, ethnic, and cultural variables.MethodsA group of 760 U.K. medical students completed a nationwide on-line survey examining their attitudes toward patients with five conditions (pneumonia, depression, psychotic symptoms, intravenous drug use, long-standing unexplained abdominal complaints), using the Medical Condition Regard Scale (MCRS). Students were also asked whether they had completed the psychiatry rotation or had personal experience of mental disorders themselves or among their friends or family members. They were also asked about their ethnic group (using U.K. national census categories), religious affiliation, and how important religion was in their lives. Independent-samples t-tests and one-way ANOVA were used to compare differences between groups on the MCRS.ResultsStudents showed the highest regard for patients with pneumonia and lowest regard for patients with long-standing, unexplained abdominal complaints. Although attitudes toward pneumonia were more positive in fifth-year students than in first-year students, attitudes toward unexplained chronic abdominal pain were worse in fifth-year students than in first-year students. Personal experience of mental health treatment, or that among family and friends, were associated with less stigmatizing attitudes. Men showed more stigmatization than women for nearly all conditions; Chinese and South Asian students showed more stigmatizing attitudes toward delusions and hallucinations than their white British counterparts.ConclusionMedical students in this survey showed the lowest regard for patients with unexplained abdominal pain, and these attitudes were worse in the most experienced medical students. Students’ gender, culture and direct or indirect experience of mental illness influenced stigmatizing attitudes.

Chronic fatigue syndrome in an ethnically diverse population: the influence of psychosocial adversity and physical inactivity

BackgroundChronic fatigue syndrome (CFS) is a complex multifactorial disorder. This paper reports the prevalence of chronic fatigue (CF) and CFS in an ethnically diverse population sample and tests whether prevalence varies by social adversity, social support, physical inactivity, anxiety and depression.MethodsAnalysis of survey data linking the Health Survey for England (1998 and 1999) and the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) study undertaken in 2000. The study population comprised a national population sample of 4,281 people ages 16 to 74 years. CF and CFS were operationally defined on the basis of an interview in the EMPIRIC study, alongside questions about psychosocial risk factors. Previous illnesses were reported in the Health Survey for England during 1998 and 1999, as was physical inactivity.ResultsAll ethnic minority groups had a higher prevalence of CFS than the White group. The lowest prevalence was 0.8% in the White group, and it was highest at 3.5% in the Pakistani group (odds ratio (OR), 4.1; 95% confidence interval (95% CI), 1.6 to 10.4). Anxiety (OR, 1.8; 95% CI, 1.4 to 2.2), depression (OR, 1.4; 95% CI, 1.1 to 1.8), physical inactivity (OR, 2.0; 95% CI, 1.1 to 3.8), social strain (OR, 1.24; 95% CI, 1.04 to 1.48) and negative aspects of social support (OR, 2.12; 95% CI, 1.4 to 3.3) were independent risk factors for CFS in the overall sample. Together these risk factors explained ethnic differences in the prevalence of CFS, but no single risk factor could explain a higher prevalence in all ethnic groups.ConclusionsThe prevalence of CFS, but not CF, varies by ethnic group. Anxiety, depression, physical inactivity, social strain and negative aspects of social support together accounted for prevalence differences of CFS in the overall sample.

Preventive psychiatry: a paradigm to improve population mental health and well-being

The governments Public Health White Paper for England sets out a utopian vision of how to prevent and remedy mental health problems. The public health approach relies on primary prevention, promoting individual responsibilities and resilience, while also sustaining existing services and tackling inequalities. These ambitions are consistent with the preventive psychiatric paradigm, and with the best of evidence-based psychiatric practice. Although the evidence on cost-effectiveness of public mental health interventions is growing, the challenge is to ensure that specialist knowledge informs policy, practice and research so that inequalities are not compounded. Specialist mental health professionals are needed to inform and lead public health reforms.

Health Beliefs and Culture

Culture is linked to the way emotions, mental distress, social problems, and physical illness are perceived, experienced, and expressed. Beliefs about what constitutes illness and what can be done about it vary considerably across cultures. Defining mental health and measuring mental health outcomes have been the focus of academics and mental health professionals across a number of disciplines from psychiatry and psychology to anthropology and sociology.Mental health diagnostic constructs and subsequent treatment practices designed in developed countries are often used in the provision of care in the developing world and in care practices for ethnic minorities, asylum seekers, and refugees. However, there are concerns about the limitations of using mono-cultural outcome measures in these culturally diverse contexts. This article reviews the role of health beliefs and culture in the development and use of mental health outcome measures. Suggestions are made for criteria to improve the reliability and validity of mental health outcome measures used in multicultural contexts. In particular, the role of language in describing salience and severity of symptoms is discussed alongside a number of methodological approaches to improve the development of mental health outcomes in cross-cultural contexts.

Ethnicity and its influence on suicide rates and risk

Objectives. To investigate the influence of ethnicity on suicide, and related risk indicators including psychiatric symptoms, among patients committing suicide whilst admitted to psychiatric hospitals. Design. The suicide rates and standardized mortality ratios (SMRs) for inpatient suicides between 1996 and 2001 were calculated from national suicide data on the four largest ethnic groups in England and Wales: Black Caribbean, Black African, South Asian (Indian, Pakistani, and Bangladeshi), and a White British comparison group. The symptoms and risk indicators at the time of the suicide were retrospectively reported by the lead clinician who was responsible for the hospital care of the patient. Results. Classical suicide risk indicators such as suicidal ideas, depressive symptoms, emotional distress, and hopelessness were significantly more common among White British inpatients than other ethnic groups. Male inpatients from Black African backgrounds were significantly more likely to have committed suicide than White British men (SMR 2.05, 95% confidence interval (CI): 1.12–3.43). Women committing suicide as inpatients were significantly less likely to be of South Asian (SMR 0.4, 95% CI: 0.17–0.78) and Black Caribbean (SMR 0.26, 95% CI: 0.09–0.62) backgrounds than White British women. Conclusions. Suicide rates and classical indicators of suicide risk among inpatients committing suicide vary by ethnic group. Black African men have the highest rates of suicide compared to the White British group.

Stigma creating stigma: a vicious circle.

Despite anti-stigma campaigns in the UK in recent years, the experiences of people with mental health problems indicate that stigma is still a major problem. The stigma of being a member of a socially excluded group, based on socioeconomic, personal or cultural/ethnic characteristics, should be considered alongside the stigma of mental illness. Membership of a stigmatised group (not based on mental illness) is often itself a risk factor for developing mental health problems. This article discusses the experiences of people from Black and minority ethnic and lesbian, gay and bisexual groups to explore how stigma can create more stigma.

Psychological Process and Pathways to Radicalization

The recent emphasis on ‘home-grown’ terrorism has resulted in a vigorous discourse on radicalization as a process that might explain how seemingly ordinary people become terrorists. This paper explores the psychological influences, group and individual identity in young people during maturation, when transitions of identity may make them vulnerable to recruitment to violent radicalization. This paper specifically focuses on the recent phenomena of home grown terrorism in Western democracies. This requires investigation without assumptions of similarity with other global and historical acts of terrorism. Studies of terrorism have focused on those identified as engaged with terrorist organizations or convicted of terrorist crimes, with little attention given to populations that are vulnerable to recruitment to terrorist action. Therefore, this paper focuses on home grown terrorism and the psychological processes and pathways to radicalization as a pre-cursor of terrorist acts.

Stigma and self-esteem across societies: avoiding blanket psychological responses to gay men experiencing homophobia

Aims and method The relationship between homophobia (varying from actual and perceived to internalised) and measures of well-being is well documented. A study in Athens, Greece and London, UK attempted to examine this relationship in two cities with potentially different levels of homophobia. One-hundred and eighty-eight men who have sex with men (MSM) living in London and 173 MSM living in Athens completed a survey investigating their views on their sexuality, perceptions of local homophobia and their identity evaluation in terms of global self-esteem. Results The results confirmed a negative association between homophobia and self-esteem within each city sample. However, Athens MSM, despite perceiving significantly higher levels of local homophobia than London MSM, did not differ on most indicators of internalised homophobia and scored higher on global self-esteem than London MSM. The city context had a significant impact on the relationship. Clinical implications The findings are discussed in relation to the implications they pose for mental health professionals dealing with MSM from communities experiencing variable societal stigmatisation and its effect on a positive sense of self.

Culturally adapted mental healthcare: evidence, problems and recommendations

Evidence suggests disparities in the prevalence of mental health problems and access to mental healthcare for a number of minority groups. The main response from mental health services falls into two related categories: (a) cultural adaptations of existing evidence-based interventions (EBIs) and/or (b) cultural competence of mental health professionals. This editorial looks at the evidence on culturally adapted EBIs and argues that although such interventions can be effective, they also carry the risk of alienating members of the groups they are aimed at. Recommendations focus on identifying issues that pertain to being from a racial minority and/or possessing other stigmatised identities that can have an impact on mental health problems, which may be overlooked by mental health services by assuming an overarching predominant cultural identity.