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A Culture-Sensitive and Person-Centred Approach: Understanding and Evaluating Cultural Factors, Social Background and History When Working with Refugees

  • Hanna Kienzler
  • Cameron Spence
  • Thomas Wenzel
Chapter

Abstract

In recent years, research methods and data from cultural anthropology and transcultural psychiatry have highlighted the importance of paying attention to the ways in which culture shapes expressions of distress and help- and health-seeking. This chapter builds on these insights and offers an overview of selected major aspects of the role culture plays in refugee mental healthcare. It will also summarise concrete tools that can be used to explore the needs, expressions of distress and help-seeking behaviours among the diverse ethnic and religious groups. We suggest that these tools can be used to guide interventions and treatment models in practical but culture-sensitive ways.

Keywords

Transcultural medicine Transcultural psychiatry Qualitative research Idioms of distress Health belief models 

References

  1. 1.
    Tol WA, Kohrt BA, Jordans MJ, Thapa SB, Pettigrew J, Upadhaya N, et al. Political violence and mental health: a multi-disciplinary review of the literature on Nepal. Soc Sci Med. 2010;70(1):35–44.CrossRefPubMedGoogle Scholar
  2. 2.
    Groen S. Recognizing cultural identity in mental health care: rethinking the cultural formulation of a somali patient. Transcult Psychiatry. 2009;46(3):451–62.CrossRefPubMedGoogle Scholar
  3. 3.
    Kirmayer LJ. Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. J Clin Psychiatry. 2001;62(Suppl 13):22–8. discussion 9–30PubMedGoogle Scholar
  4. 4.
    Castañeda H. Im/migration and health: conceptual, methodological, and theoretical propositions for applied anthropology. Napa Bull. 2010;34(1):21.CrossRefGoogle Scholar
  5. 5.
    Miller KE, Rasmussen A. War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Soc Sci Med. 2010;70(1):7–16.CrossRefPubMedGoogle Scholar
  6. 6.
    Marsella AJ, Friedman M, Spain H. Ethnocultural aspects of PTSD: some closing thoughts. In: Marsella AJ, Friedman MJ, Gerrity ET, Scurfield RM, editors. Ethnocultural aspects of posttraumatic stress disorder: issues, research, and clinical applications. Washington, DC: American Psychological Association; 1996. p. 529–38.CrossRefGoogle Scholar
  7. 7.
    Summerfield D, Hume F. War and posttraumatic stress disorder: the question of social context. J Nerv Ment Dis. 1993;181(8):522.CrossRefPubMedGoogle Scholar
  8. 8.
    Bracken PJ, Giller JE, Summerfield D. Psychological responses to war and atrocity: the limitations of current concepts. Soc Sci Med. 1995;40(8):1073–82.CrossRefPubMedGoogle Scholar
  9. 9.
    Tay AK, Rees S, Chen J, Kareth M, Silove D. Factorial structure of complicated grief: associations with loss-related traumatic events and psychosocial impacts of mass conflict amongst West Papuan refugees. Soc Psychiatry Psychiatr Epidemiol. 2016;51(3):395–406.CrossRefPubMedGoogle Scholar
  10. 10.
    Kohrt BA, Hruschka DJ. Nepali concepts of psychological trauma: the role of idioms of distress, ethnopsychology and ethnophysiology in alleviating suffering and preventing stigma. Cult Med Psychiatry. 2010;34(2):322–52.CrossRefPubMedGoogle Scholar
  11. 11.
    Boasso AM, Steenkamp MM, Fox AB, Nash WP, Larson JL, Litz BT. The structure of PTSD in active-duty marines across the deployment cycle. Psychol Trauma. 2016;8(2):127–34.CrossRefPubMedGoogle Scholar
  12. 12.
    Groleau D, Kirmayer LJ. Sociosomatic theory in Vietnamese immigrants’ narratives of distress. Anthropol Med. 2004;11(2):117–33.CrossRefPubMedGoogle Scholar
  13. 13.
    Nichter M. Idioms of distress revisited. Cult Med Psychiatry. 2010;34(2):401–16.CrossRefPubMedGoogle Scholar
  14. 14.
    Sameer M, Menon V, Chandrasekaran R. Is ‘Pure’ Dhat syndrome a stable diagnostic entity? A naturalistic long term follow up study from a tertiary care centre. J Clin Diagn Res. 2015;9(8):VC1–3.Google Scholar
  15. 15.
    Ventriglio A, Ayonrinde O, Bhugra D. Relevance of culture-bound syndromes in the 21st century. Psychiatry Clin Neurosci. 2016;70(1):3–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Abramowitz SA. Trauma and humanitarian translation in Liberia: the tale of open mole. Cult Med Psychiatry. 2010;34(2):353–79.CrossRefPubMedGoogle Scholar
  17. 17.
    Hinton DE, Lewis-Fernandez R. Idioms of distress among trauma survivors: subtypes and clinical utility. Cult Med Psychiatry. 2010;34(2):209–18.CrossRefPubMedGoogle Scholar
  18. 18.
    Pedersen D, Kienzler H, Gamarra J. Llaki and nakary: idioms of distress and suffering among the highland Quechua in the Peruvian Andes. Cult Med Psychiatry. 2010;34(2):279–300.CrossRefPubMedGoogle Scholar
  19. 19.
    Davis D, Joakimsen L. Nerves as status and nerves as stigma: idioms of distress and social action in Newfoundland and Northern Norway. Qual Health Res. 1997;7(3):20.CrossRefGoogle Scholar
  20. 20.
    Kienzler HL, Locke P. The effects of societal violence in war and post-war contexts. In: White RG, Jain S, David MR, editors. The Palgrave handbook of global mental health: socio-cultural perspectives. Basingstoke: Palgrave Macmillan; 2017. p. 285–305.CrossRefGoogle Scholar
  21. 21.
    Jenkins J. Culture, emotion, and PTSD. In: Marsella AJ, Friedman MJ, Gerrity ET, Scurfield RM, editors. Ethnocultural aspects of posttraumatic stress disorder: issues, research and clinical applications. Washington, D.C.: American Psychological Association; 1996.Google Scholar
  22. 22.
    Hinton DE, Hofmann SG, Rivera E, Otto MW, Pollack MH. Culturally adapted CBT (CA-CBT) for Latino women with treatment-resistant PTSD: a pilot study comparing CA-CBT to applied muscle relaxation. Behav Res Ther. 2011;49(4):275–80.CrossRefPubMedGoogle Scholar
  23. 23.
    Hinton DE, Hofmann SG, Pollack MH, Otto MW. Mechanisms of efficacy of CBT for Cambodian refugees with PTSD: improvement in emotion regulation and orthostatic blood pressure response. CNS Neurosci Ther. 2009;15(3):255–63.CrossRefPubMedGoogle Scholar
  24. 24.
    Otto MW, Hinton DE. Modifying exposure-based CBT for Cambodian refugees with posttraumatic stress disorder. Cogn Behav Pract. 2006;13(4):261–70.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Bhugra D. Cultural identities and cultural congruency: a new model for evaluating mental distress in immigrants. Acta Psychiatr Scand. 2005;111(2):84–93.CrossRefPubMedGoogle Scholar
  26. 26.
    Kohrt BA, Luitel NP, Acharya P, Jordans MJ. Detection of depression in low resource settings: validation of the Patient Health Questionnaire (PHQ-9) and cultural concepts of distress in Nepal. BMC Psychiatry. 2016;16:58.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    American Psychiatric Association, American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5, vol. xliv. 5th ed. Washington, D.C.: American Psychiatric Association; 2013. p. 947.CrossRefGoogle Scholar
  28. 28.
    Lewis-Fernandez R, Aggarwal NK. Culture and psychiatric diagnosis. Adv Psychosom Med. 2013;33:15–30.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Stephenson C. The epistemological significance of possession entering the DSM. Hist Psychiatry. 2015;26(3):251–69.CrossRefPubMedGoogle Scholar
  30. 30.
    Hinton DE, Kredlow MA, Bui E, Pollack MH, Hofmann SG. Treatment change of somatic symptoms and cultural syndromes among Cambodian refugees with PTSD. Depress Anxiety. 2012;29(2):147–54.CrossRefPubMedGoogle Scholar
  31. 31.
    Wenzel T, Frewer A, Mirzaei S. The DSM 5 and the Istanbul Protocol: diagnosis of psychological sequels of torture. Torture. 2015;25(1):51–61.PubMedGoogle Scholar
  32. 32.
    Mikhail BI, Petro-Nustas WI. Transcultural adaptation of Champion’s Health Belief Model Scales. J Nurs Scholarsh. 2001;33(2):159–65.CrossRefPubMedGoogle Scholar
  33. 33.
    Tamez EG, Vacalis TD. Health beliefs, the significant other and compliance with therapeutic regimens among adult Mexican American diabetics. Health Educ. 1989;20(6):24–31.CrossRefPubMedGoogle Scholar
  34. 34.
    Alidu L, Grunfeld EA. Gender differences in beliefs about health: a comparative qualitative study with Ghanaian and Indian migrants living in the United Kingdom. BMC Psychol. 2017;5(1):8.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Federman AD, Wolf M, Sofianou A, Wilson EA, Martynenko M, Halm EA, et al. The association of health literacy with illness and medication beliefs among older adults with asthma. Patient Educ Couns. 2013;92(2):273–8.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Smith A, MacEntee MI, Beattie BL, Brondani M, Bryant R, Graf P, et al. The influence of culture on the oral health-related beliefs and behaviours of elderly chinese immigrants: a meta-synthesis of the literature. J Cross Cult Gerontol. 2013;28(1):27–47.CrossRefPubMedGoogle Scholar
  37. 37.
    Stefanovics EA, He H, Cavalcanti M, Neto H, Ofori-Atta A, Leddy M, et al. Witchcraft and biopsychosocial causes of mental illness: attitudes and beliefs about mental illness among health professionals in five countries. J Nerv Ment Dis. 2016;204(3):169–74.CrossRefPubMedGoogle Scholar
  38. 38.
    Wenzel T, Kinigadner S. Auf der Flucht [To be fleeing]. Psychol Österreich. 2016;36(3):135–43.Google Scholar
  39. 39.
    Neuner F, Pfeiffer A, Schauer-Kaiser E, Odenwald M, Elbert T, Ertl V. Haunted by ghosts: prevalence, predictors and outcomes of spirit possession experiences among former child soldiers and war-affected civilians in Northern Uganda. Soc Sci Med. 2012;75(3):548–54.CrossRefPubMedGoogle Scholar
  40. 40.
    van Duijl M, Kleijn W, de Jong J. Are symptoms of spirit possessed patients covered by the DSM-IV or DSM-5 criteria for possession trance disorder? A mixed-method explorative study in Uganda. Soc Psychiatry Psychiatr Epidemiol. 2013;48(9):1417–30.CrossRefPubMedGoogle Scholar
  41. 41.
    Shoeb M, Weinstein HM, Halpern J. Living in religious time and space: Iraqi refugees in Dearborn, Michigan. J Refug Stud. 2007;20(3):29.CrossRefGoogle Scholar
  42. 42.
    Kwong EW, Lam IO. Chinese older people in Hong Kong: health beliefs about influenza vaccination. Nurs Older People. 2008;20(7):29–33.CrossRefPubMedGoogle Scholar
  43. 43.
    Nan X, Kim J. Predicting H1N1 vaccine uptake and H1N1-related health beliefs: the role of individual difference in consideration of future consequences. J Health Commun. 2014;19(3):376–88.CrossRefPubMedGoogle Scholar
  44. 44.
    Alqahtani AS, Sheikh M, Wiley K, Heywood AE. Australian Hajj pilgrims' infection control beliefs and practices: insight with implications for public health approaches. Travel Med Infect Dis. 2015;13(4):329–34.CrossRefPubMedGoogle Scholar
  45. 45.
    Smith RM, Nelsen LA. Hmong folk remedies: limited acetylation of opium by aspirin and acetaminophen. J Forensic Sci. 1991;36(1):280–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Carruth L. Camel milk, amoxicillin, and a prayer: medical pluralism and medical humanitarian aid in the Somali Region of Ethiopia. Soc Sci Med. 2014;120:405–12.CrossRefPubMedGoogle Scholar
  47. 47.
    Volpato G, Kourkova P, Zeleny V. Healing war wounds and perfuming exile: the use of vegetal, animal, and mineral products for perfumes, cosmetics, and skin healing among Sahrawi refugees of Western Sahara. J Ethnobiol Ethnomed. 2012;8:49.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    van Andel T, Westers P. Why Surinamese migrants in the Netherlands continue to use medicinal herbs from their home country. J Ethnopharmacol. 2010;127(3):694–701.CrossRefPubMedGoogle Scholar
  49. 49.
    Villa-Torres L, Gonzalez-Vazquez T, Fleming PJ, Gonzalez-Gonzalez EL, Infante-Xibille C, Chavez R, et al. Transnationalism and health: a systematic literature review on the use of transnationalism in the study of the health practices and behaviors of migrants. Soc Sci Med. 2017;183:70–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Ramzan S, Soelberg J, Jager AK, Cantarero-Arevalo L. Traditional medicine among people of Pakistani descent in the capital region of Copenhagen. J Ethnopharmacol. 2017;196:267–80.CrossRefPubMedGoogle Scholar
  51. 51.
    Mizzi C, Dalabira E, Kumuthini J, Dzimiri N, Balogh I, Basak N, et al. A European spectrum of pharmacogenomic biomarkers: implications for clinical pharmacogenomics. PLoS One. 2016;11(9):e0162866.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Straka RJ, Hansen SR, Walker PF. Comparison of the prevalence of the poor metabolizer phenotype for CYP2D6 between 203 Hmong subjects and 280 white subjects residing in Minnesota. Clin Pharmacol Ther. 1995;58(1):29–34.CrossRefPubMedGoogle Scholar
  53. 53.
    Arriaza P, Nedjat-Haiem F, Lee HY, Martin SS. Guidelines for conducting rigorous health care psychosocial cross-cultural/language qualitative research. Soc Work Public Health. 2015;30(1):75–87.CrossRefPubMedGoogle Scholar
  54. 54.
    Bellamy K, Ostini R, Martini N, Kairuz T. Erratum to: seeking to understand: using generic qualitative research to explore access to medicines and pharmacy services among resettled refugees. Int J Clin Pharm. 2016;38(2):469.CrossRefPubMedGoogle Scholar
  55. 55.
    Saadi A, Bond BE, Percac-Lima S. Bosnian, Iraqi, and Somali refugee women speak: a comparative qualitative study of refugee health beliefs on preventive health and breast cancer screening. Womens Health Issues. 2015;25(5):501–8.CrossRefPubMedGoogle Scholar
  56. 56.
    Szajna A, Ward J. Access to health care by refugees: a dimensional analysis. Nurs Forum. 2015;50(2):83–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Ingvarsson L, Egilson ST, Skaptadottir UD. I want a normal life like everyone else: daily life of asylum seekers in Iceland. Scand J Occup Ther. 2016;23(6):416–24.CrossRefPubMedGoogle Scholar
  58. 58.
    Kay M, Wijayanayaka S, Cook H, Hollingworth S. Understanding quality use of medicines in refugee communities in Australian primary care: a qualitative study. Br J Gen Pract. 2016;66(647):e397–409.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Weine S, Muzurovic N, Kulauzovic Y, Besic S, Lezic A, Mujagic A, et al. Family consequences of refugee trauma. Fam Process. 2004;43(2):147–60.CrossRefPubMedGoogle Scholar
  60. 60.
    Jirovsky E, Hoffmann K, Maier M, Kutalek R. "Why should I have come here?"--a qualitative investigation of migration reasons and experiences of health workers from sub-Saharan Africa in Austria. BMC Health Serv Res. 2015;15:74.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Kowal SP, Jardine CG, Bubela TM. If they tell me to get it, I’ll get it. If they don't...: immunization decision-making processes of immigrant mothers. Can J Public Health. 2015;106(4):e230–5.CrossRefPubMedGoogle Scholar
  62. 62.
    Bellamy K, Ostini R, Martini N, Kairuz T. Perspectives of resettled African refugees on accessing medicines and pharmacy services in Queensland, Australia. Int J Pharm Pract. 2016;25:358–64.CrossRefPubMedGoogle Scholar
  63. 63.
    Berg B. Qualitative research methods for the social sciences. 6th ed. Boston: Pearson Allyn Bacon; 2007.Google Scholar
  64. 64.
    Folch-Lyon E, Trost JF. Conducting focus group sessions. Stud Fam Plan. 1981;12(1):7.Google Scholar
  65. 65.
    Baum F, MacDougall C, Smith D. Participatory action research. J Epidemiol Community Health. 2006;60(10):854–7.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Groleau D, Young A, Kirmayer LJ. The McGill illness narrative interview (MINI): an interview schedule to elicit meanings and modes of reasoning related to illness experience. Transcult Psychiatry. 2006;43(4):671–91.CrossRefPubMedGoogle Scholar
  67. 67.
    Aggarwal NK, Desilva R, Nicasio AV, Boiler M, Lewis-Fernandez R. Does the cultural formulation interview for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site. Ethn Health. 2015;20(1):1–28.CrossRefPubMedGoogle Scholar
  68. 68.
    Rohlof H, Knipscheer JW, Kleber RJ. Use of the cultural formulation with refugees. Transcult Psychiatry. 2009;46(3):487–505.CrossRefPubMedGoogle Scholar
  69. 69.
    Aggarwal NK, Glass A, Tirado A, Boiler M, Nicasio A, Alegria M, et al. The development of the DSM-5 cultural formulation interview-fidelity instrument (CFI-FI): a pilot study. J Health Care Poor Underserved. 2014;25(3):1397–417.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Padilla A, Benjamin S, Lewis-Fernandez R. Assessing cultural psychiatry milestones through an objective structured clinical examination. Acad Psychiatry. 2016;40(4):600–3.CrossRefPubMedGoogle Scholar
  71. 71.
    Luciano M, De Rosa C, Del Vecchio V, Sampogna G, Sbordone D, Atti AR, et al. Perceived insecurity, mental health and urbanization: results from a multicentric study. Int J Soc Psychiatry. 2016;62(3):252–61.CrossRefPubMedGoogle Scholar
  72. 72.
    Mills S, Wolitzky-Taylor K, Xiao AQ, Bourque MC, Rojas SM, Bhattacharya D, et al. Training on the DSM-5 cultural formulation interview improves cultural competence in general psychiatry residents: a multi-site study. Acad Psychiatry. 2016;40(5):829–34.CrossRefPubMedGoogle Scholar
  73. 73.
    Aggarwal NK, Lam P, Castillo EG, Weiss MG, Diaz E, Alarcon RD, et al. How do clinicians prefer cultural competence training? Findings from the DSM-5 cultural formulation interview field trial. Acad Psychiatry. 2016;40(4):584–91.CrossRefPubMedGoogle Scholar
  74. 74.
    Groen SP, Richters A, Laban CJ, Deville WL. Implementation of the cultural formulation through a newly developed brief cultural interview: pilot data from the Netherlands. Transcult Psychiatry. 2017;54(1):3–22.CrossRefPubMedGoogle Scholar
  75. 75.
    Ventevogel P, De Vries G, Scholte WF, Shinwari NR, Faiz H, Nassery R, et al. Properties of the Hopkins symptom checklist-25 (HSCL-25) and the self-reporting questionnaire (SRQ-20) as screening instruments used in primary care in Afghanistan. Soc Psychiatry Psychiatr Epidemiol. 2007;42(4):328–35.CrossRefPubMedGoogle Scholar
  76. 76.
    Gautam S, Nijhawan M, Kamal P. Standardisation of hindi version of goldbergs general health questionnaire. Indian J Psychiatry. 1987;29(1):63–6.PubMedPubMedCentralGoogle Scholar
  77. 77.
    Bhui K, Bhugra D. Transcultural psychiatry: some social and epidemiological research issues. Int J Soc Psychiatry. 2001;47(3):1–9.CrossRefPubMedGoogle Scholar
  78. 78.
    Kirmayer LJ, Groleau D, Guzder J, Blake C, Jarvis E. Cultural consultation: a model of mental health service for multicultural societies. Can J Psychiatr. 2003;48(3):145–53.CrossRefGoogle Scholar
  79. 79.
    Kirmayer LJ, Rousseau C, Guzder J, Jarvis GE. Training clinicians in cultural psychiatry: a Canadian perspective. Acad Psychiatry. 2008;32(4):313–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Global Health and Social MedicineKing’s College LondonLondonUK
  2. 2.World Psychiatric Association Scientific SectionPsychological Aspects of Persecution and TortureGenevaSwitzerland

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