Steven Klimidis

The Treated Prevalence of Mental Disorder Amongst Immigrants and the Australian-Born: Community and Primary-Care Rates

The objective of the study was to explore the relationship between birthplace and the treated prevalence of mental disorder in Australia. Treated prevalence rates were derived from two surveys. These were the 1989-1990 National Health Survey, carried out by the Australian Bureau of Statistics, and the general practice component of a one-day mental health census carried out in the state of Victoria by the authors in 1993. Differences due to the age and sex composition of birthplace groups were controlled statistically. Treated rates of mental disorder, and the use of psychotropic medication, were consistently high amongst those born in Greece, and low amongst those born in the U.K./Ireland or in South East Asia, compared to the Australian-born. Country of birth has a significant effect on the treated prevalence of mental disorder, as reported by patients or their doctor. Further research is needed to reveal the underlying causes of these differences.

The three-syndrome model of schizophrenia: meta-analysis of an artefact.

In two recent studies, Smith et al. (Smith, D.A., Mar, C.M., Turoff, B.K., 1998. The structure of schizophrenic symptoms: a meta-analytic confirmatory factor analysis. Schizophr. Res. 31, 57-70) and Grube et al. (Grube, B.S., Bilder, R.M., Goldman, R.S., 1998. Meta-analysis of symptom factors in schizophrenia. Schizophr. Res. 31, 113-120) used meta-analysis to examine the syndromal structure of schizophrenia. A limitation of both these studies is that the nine subscale scores from Andreasens Scales for Assessment of Positive and Negative symptoms formed the basis of the analyses. These nine ratings, only four of which represent positive symptoms, do not adequately respresent the diversity of positive symptoms. A review of studies that examined the correlation between the individual items of these scales failed to support the classification of symptoms into these nine subgroups. Studies that indicated low numbers of syndromes suffered from one or more of the following limitations: (1) samples that were restricted to chronic schizophrenia, (2) exclusion of many items from analysis, and (3) a poor fit of the symptom model to the data. Studies not limited in these ways indicated the presence of at least 11 major dimensions of schizophrenic symptomatology, not including affective symptoms. It is concluded that the three-syndrome model of schizophrenia is largely an artefact of inadequate measurement at the symptom level.

Depression and Anxiety: A Comparison of Older-Aged Greek-Born Immigrants and Anglo-Australians

OBJECTIVE To compare depressive and anxiety illness in an older-aged sample of Greek-born (GB) immigrants who were likely to have been excluded from the National Survey of Mental Health and Wellbeing due to their lack of fluency in the English language and for whom rates of mental disorder are unknown, with a comparably recruited sample of Anglo-Australians (AA). METHOD One hundred and forty-six GB and 146 AA respondents with a mean age of 68 years living in Melbourne and recruited through social clubs, completed the Beck Depression Inventory-II (BDI-2) and the State-Trait Anxiety Inventory (STAI) in addition to socio-demographic and other background questions. RESULTS Greek-born respondents exhibited higher depression and anxiety scores and reported more depressive and anxiety symptomatology than the AA respondents. More GB respondents (17.1%) were likely to be included in the moderate to severe BDI-2 depression categories than AA (4.1%). Greek-born respondents (43.1%) were more likely to be included in the higher anxiety categories (i.e. score 41-80) of the STAI than the AA (15.8%). However, when controlling for health, economic and social factors there was no difference in the BDI-2 measures between the two groups. Despite controlling for these factors the GB still scored more highly on STAI measures than AA respondents. CONCLUSIONS No differences were found between groups on measures of depression once controlling for age, education and occupational level, current financial status, marital status, household composition, current work status, physical health and stress. Such factors were also shown to influence group-differences anxiety but they not entirely explain group differences. Higher anxiety in GB respondents were likely to have been determined through the effects of additional but unmeasured cultural and immigrant status factors. Psychological morbidity in immigrants is best accounted for by considering the influence of social, health and other living conditions in addition to the effects of culture or immigrant status.

Illness causal beliefs in Turkish immigrants

BackgroundPeople hold a wide variety of beliefs concerning the causes of illness. Such beliefs vary across cultures and, among immigrants, may be influenced by many factors, including level of acculturation, gender, level of education, and experience of illness and treatment. This study examines illness causal beliefs in Turkish-immigrants in Australia.MethodsCausal beliefs about somatic and mental illness were examined in a sample of 444 members of the Turkish population of Melbourne. The socio-demographic characteristics of the sample were broadly similar to those of the Melbourne Turkish community. Five issues were examined: the structure of causal beliefs; the relative frequency of natural, supernatural and metaphysical beliefs; ascription of somatic, mental, or both somatic and mental conditions to the various causes; the correlations of belief types with socio-demographic, modernizing and acculturation variables; and the relationship between causal beliefs and current illness.ResultsPrincipal components analysis revealed two broad factors, accounting for 58 percent of the variation in scores on illness belief scales, distinctly interpretable as natural and supernatural beliefs. Second, beliefs in natural causes were more frequent than beliefs in supernatural causes. Third, some causal beliefs were commonly linked to both somatic and mental conditions while others were regarded as more specific to either somatic or mental disorders. Last, there was a range of correlations between endorsement of belief types and factors defining heterogeneity within the community, including with demographic factors, indicators of modernizing and acculturative processes, and the current presence of illness.ConclusionResults supported the classification of causal beliefs proposed by Murdock, Wilson & Frederick, with a division into natural and supernatural causes. While belief in natural causes is more common, belief in supernatural causes persists despite modernizing and acculturative influences. Different types of causal beliefs are held in relation to somatic or mental illness, and a variety of apparently logically incompatible beliefs may be concurrently held. Illness causal beliefs are dynamic and are related to demographic, modernizing, and acculturative factors, and to the current presence of illness. Any assumption of uniformity of illness causal beliefs within a community, even one that is relatively culturally homogeneous, is likely to be misleading. A better understanding of the diversity, and determinants, of illness causal beliefs can be of value in improving our understanding of illness experience, the clinical process, and in developing more effective health services and population health strategies.

Cultural diversity in Australian medical education

The present study sought to explore the relevance of cultural dimensions and cultural diversity among overseas and local medical students. The main comparison among the fourth year medical students studied was between Asian origin and Anglophone background students. The measures used included cultural variation, reasons for studying medicine, learning approaches and strategies, patient interaction confidence, and medical practices anxieties. Results indicated cultural differences between the two groups, and relationships between cultural variables and, in particular, reasons for studying medicine, learning approaches and strategies, and patient interaction confidence. Results were interpreted according to Hofstedes(1980, 1986) theory of cultural dimensions as they may apply in the educational setting.

‘Nobody Can Help Me...I am Living Through it Alone’: Experiences of Caring for People Diagnosed with Mental Illness in Ethno-Cultural and Linguistic Minority Communities

Caregivers of people diagnosed with mental illness in ethno-cultural and linguistic minority communities (ECLMCs) face considerable demands and difficulties in their day-to-day caring role. Data from interviews with 20 caregivers from Polish, Croatian, Bosnian, and Chinese communities, undertaken in Perth, Western Australia, explore the roles caregivers play in the lives of their relatives and illustrate their use and non-use of support services. A diverse array of challenges confronts caregivers across the different ECLMCs. Although not an unequivocally negative experience, caring for a relative diagnosed with mental illness was found to frequently disrupt family relationships and to lead to physical and mental exhaustion as well as social isolation. The stigma associated with mental illness in ECLMCs is a significant factor dissuading people from seeking assistance from external agencies. Many mainstream services are seen as inappropriate, which appears to be a factor in their under-utilization. If mental health policies and community services are to seriously address the issue of appropriate support for caregivers from ECLMCs, it is important that they are aware of the nature of the considerable demands placed on such caregivers as they endeavor to support their dependent relatives.

Depression in multicultural Australia: Policies, research and services

BackgroundDepression is one of the leading causes of disability in Australia. The cultural and linguistic diversity of the Australian population poses a significant challenge to health policy development, service provision, professional education, and research. The purpose of this study is to explore the extent to which the fact of cultural and linguistic diversity has influenced the formulation of mental health policy, the conduct of mental health research and the development of mental health services for people with depression from ethnic minority communities.MethodsThe methods used for the different components of the study included surveys and document-based content and thematic analyses.ResultsPolicy is comprehensive but its translation into programs is inadequate. Across Australia, there were few specific programs on depression in ethnic minority communities and they are confronted with a variety of implementation difficulties. The scope and scale of research on depression in Ethnic minority communities is extremely limited.ConclusionA key problem is that the research that is necessary to provide evidence for policy and service delivery is lacking. If depression in Ethnic minority communities is to be addressed effectively the gaps between policy intentions and policy implementation, and between information needs for policies and practice and the actual research that is being done, have to be narrowed.

Relative prevalence of psychological morbidity in older immigrants

This study examined the rates of psychological morbidity in Australian-born elderly and three immigrant elderly groups. The prevalence of psychological morbidity (as estimated by scores on the General Health Questionnaire-28, the Rosenberg Self-Esteem Scale and a brief treatment-use screening instrument) was examined in community samples of English-speaking (mostly Australian-born), Italian-speaking, Macedonian-speaking and Spanish-speaking elderly people living in the community. Morbidity levels were shown to be quite variable. Italian-speaking elderly (particularly women) had the highest levels. Immigrant elderly groups of non-English speaking background tended to have higher levels of pathology than did the English-speaking group. Women were found to have higher levels of morbidity than men. Variable morbidity levels across groups suggest the need to examine the complex factors that may result in differential risk in various populations. Potential risk factors for immigrant elderly populations are discussed. There is a need for greater research attention to this area given increasing populations of elderly immigrants in many nations with long-term immigration programmes.

Mental health research, ethics and multiculturalism.

AbstractIn this paper we examine ethical issues relevant to conducting mental health research with refugees and immigrant communities that have cultural orientations and social organisation that are substantially different to those of the broader Australian community, and we relate these issues to NH&MRC Guidelines. We describe the development and conduct of a mental health research project carried out recently in Melbourne with the Somali community, focusing on ethical principles involved, and relating these to the NH&MRC National Statement on Ethical Conduct in Research Involving Humans, and the NH&MRC document Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research.The experience of conducting mental health research with the Somali community highlights the fact that the principles of inclusion and benefit enunciated in the NH&MRC document Values and Ethics are particularly pertinent when conducting research with refugees and immigrant communities that are culturally distant to those of the broader Australian community. These principles inform issues of research design and consent, as well as guiding respectful engagement with the participating community and communication of the research findings.

Brief functional English proficiency measure for health survey research

Through three studies we develop a brief measure of functional English proficiency intended for use in health survey research and particularly with older adults. The samples involved in these studies included adults aged 18 to 93 years whose language of origin was Turkish (n = 497, 53% women); Macedonian (n = 209, 49% women); Spanish (n = 205, 68% women); Italian (n = 212, 52% women); Turkish (n = 201, 51% women), and Greek (n = 150, 53% women). The resulting instrument, comprising four items is a good brief measure of English proficiency, with capacity to discriminate between high and low levels of proficiency in all language groups.