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PLoS Medicine Dec 2022Evidence regarding the presence and persistence of ethnic inequalities in mental healthcare is well established. The reasons for these inequalities and lack of progress... (Review)
Review
BACKGROUND
Evidence regarding the presence and persistence of ethnic inequalities in mental healthcare is well established. The reasons for these inequalities and lack of progress in diminishing them are less understood. This meta-ethnography aims to provide a new conceptual understanding of how ethnic inequalities are created and sustained; this is essential to develop effective interventions. Specifically, we sought to understand why people from ethnic minority groups are underrepresented in primary care mental health service provision and overrepresented in crisis pathways and detention.
METHODS AND FINDINGS
Following eMERGe guidelines for meta-ethnographies, we searched OpenGrey, Kings Fund, CINAHL, Medline, PsycINFO, and Social Care Online databases for qualitative articles published from database inception until October 2, 2022, using broad categories of search terms relating to "ethnicity AND (mental illness/mental health/emotional distress) AND (help-seeking/service utilisation/experience/perception/view)." We included all conceptually rich articles that used qualitative methods of data collection and analysis and excluded non-UK studies and those that focused solely on causation of mental illness. Our patient, public, and practitioner lived experience advisory group provided feedback and input on key stages of the project including search terms, research questions, data analysis, and dissemination. A total of 14,142 articles were identified; 66 met the inclusion criteria. We used reciprocal, refutational, and line of argument analytical approaches to identify convergence and divergence between studies. The synthesis showed that current models of statutory mental healthcare are experienced as a major barrier to the delivery of person-centred care to those in ethnic minority groups due to the perceived dominance of monocultural and reductionist frameworks of assessment and treatment (described as "medical" and "Eurocentric") and direct experiences of racist practice. The lack of socially oriented and holistic frameworks of knowledge and understanding in medical training and services is experienced as epistemic injustice, particularly among those who attribute their mental illness to experiences of migration, systemic racism, and complex trauma. Fear of harm, concerns about treatment suitability, and negative experiences with health providers such as racist care and medical neglect/injury contribute to avoidance of, and disengagement from, mainstream healthcare. The lack of progress in tackling ethnic inequalities is attributed to failures in coproduction and insufficient adoption of existing recommendations within services. Study limitations include insufficient recording of participant characteristics relating to generational status and social class in primary studies, which prevented exploration of these intersections.
CONCLUSIONS
In this study, we found that the delivery of safe and equitable person-centred care requires a model of mental health that is responsive to the lived experiences of people in ethnic minority groups. For the people considered in this review, this requires better alignment of mental health services with social and anti-racist models of care. Our findings suggest that intersections related to experiences of racism, migration, religion, and complex trauma might be more relevant than crude ethnic group classifications. Strategies to tackle ethnic inequalities in mental healthcare require an evaluation of individual, systemic, and structural obstacles to authentic and meaningful coproduction and implementation of existing community recommendations in services.
Topics: Humans; Ethnicity; Minority Groups; Delivery of Health Care; Anthropology, Cultural; Mental Health Services; United Kingdom
PubMed: 36512523
DOI: 10.1371/journal.pmed.1004139 -
Journal of Clinical Child and... Jan 2008This article reviews research on evidence-based treatments (EBTs) for ethnic minority youth using criteria from Chambless et al. (1998), Chambless et al. (1996), and... (Meta-Analysis)
Meta-Analysis Review
This article reviews research on evidence-based treatments (EBTs) for ethnic minority youth using criteria from Chambless et al. (1998), Chambless et al. (1996), and Chambless and Hollon (1998). Although no well-established treatments were identified, probably efficacious or possibly efficacious treatments were found for ethnic minority youth with anxiety-related problems, attention-deficit/hyperactivity disorder, depression, conduct problems, substance use problems, trauma-related syndromes, and other clinical problems. In addition, all studies met either Nathan and Gorman's (2002) Type 1 or Type 2 methodological criteria. A brief meta-analysis showed overall treatment effects of medium magnitude (d = .44). Effects were larger when EBTs were compared to no treatment (d = .58) or psychological placebos (d = .51) versus treatment as usual (d = .22). Youth ethnicity (African American, Latino, mixed/other minority), problem type, clinical severity, diagnostic status, and culture-responsive treatment status did not moderate treatment outcome. Most studies had low statistical power and poor representation of less acculturated youth. Few tests of cultural adaptation effects have been conducted in the literature and culturally validated outcome measures are mostly lacking. Recommendations for clinical practice and future research directions are provided.
Topics: Acculturation; Adolescent; Black People; Child; Cultural Competency; Ethnicity; Evidence-Based Medicine; Hispanic or Latino; Humans; Mental Disorders; Minority Groups; White People
PubMed: 18444061
DOI: 10.1080/15374410701820174 -
Perspectives on Psychological Science :... Jul 2015Contact between people from different groups triggers specific individual- and group-level responses, ranging from attitudes and emotions to welfare and health outcomes.... (Review)
Review
Contact between people from different groups triggers specific individual- and group-level responses, ranging from attitudes and emotions to welfare and health outcomes. Standard social psychological perspectives do not yet provide an integrated, causal model of these phenomena. As an alternative, we describe a coalitional perspective. Human psychology includes evolved cognitive systems designed to garner support from other individuals, organize and maintain alliances, and measure potential support from group members. Relations between alliances are strongly influenced by threat detection mechanisms, which are sensitive to cues that express that one's own group will provide less support or that other groups are dangerous. Repeated perceptions of such threat cues can lead to chronic stress. The model provides a parsimonious explanation for many individual-level effects of intergroup relations and group-level disparities in health and well-being. This perspective suggests new research directions aimed at understanding the psychological processes involved in intergroup relations.
Topics: Cognition; Fear; Group Processes; Humans; Interpersonal Relations; Minority Groups; Models, Psychological; Safety; Social Perception; Stress, Psychological
PubMed: 26177946
DOI: 10.1177/1745691615583133 -
The American Psychologist Sep 2018Morality, a central dimension of culture, is crucial for research on the development of youth experiencing marginalization. In this article, we discuss two main...
Morality, a central dimension of culture, is crucial for research on the development of youth experiencing marginalization. In this article, we discuss two main meta-narratives as moral frameworks that provide different meaning to the past and to cultural change: liberal progress, focused on the struggle of those who have historically experienced marginalization (e.g., racial/ethnic minorities), and community lost, focused on those who are experiencing some forms of marginalization in response to cultural and economic changes (e.g., rural Whites). Because these two meta-narratives represent a false dichotomy, we use relational epistemology principles-holism, identity of opposites, opposites of identity, and synthesis of wholes-to formulate an integrated metanarrative, community progress, to overcome this polarity and promote research on the development of all youth experiencing marginalization. Acknowledging and understanding these moral meta-narratives is crucial because they influence scientific discourse, political action, and policy that impacts marginalization and youth development. (PsycINFO Database Record
Topics: Adolescent; Culture; Humans; Minority Groups; Morals; Social Identification
PubMed: 30188169
DOI: 10.1037/amp0000252 -
The Journal of Sexual Medicine Dec 2022Female sexual dysfunction (FSD) is a significant cause of distress for an estimated 12-24% of women, and over the past 5 decades several questionnaires have been... (Review)
Review
BACKGROUND
Female sexual dysfunction (FSD) is a significant cause of distress for an estimated 12-24% of women, and over the past 5 decades several questionnaires have been developed for clinical practice.
AIM
The purpose of this scoping review is to evaluate the ethnic representation of sample populations used in the studies to validate FSD questionnaires.
METHODS
A scoping review was performed using electronic databases, including PubMed and Scopus, to identify FSD questionnaires validated between 1976 and 2021. Weighted averages from the combined ethnicity data were compared to population data from 2019 US census data and 2018 healthcare workforce reports to evaluate epidemiologic diversity. Ethnicity data from each questionnaire were also investigated longitudinally to evaluate trends in representation over the past 50 years.
OUTCOMES
Our outcome of interest was comparison of the weighted averages for ethnicity categories from validation populations to the US female general population, US female health care workforce, and US census data.
RESULTS
48 validation studies were reviewed and showed that the average ethnic representation of the study populations relative to the US general population and US female health care workforce, respectively, was: Caucasian (83.7% vs 62.7% and 68.5%), Black (7.8% vs 13.3% and 8.3%), Hispanic (3.6% vs 16.0% and 9.6%), Native American (0.1% vs 0.8% and 0.3%), Asian (0.6% vs 6.4% and 6.2%), and Other (3.1% vs 0.7% and 1.4%).
CLINICAL IMPLICATIONS
FSD questionnaires are relied upon in research and clinical settings, so lack of diversity in validation populations could lead to under recognition and undertreatment in ethnic minority women.
STRENGTHS & LIMITATIONS
Our results are dependent on the quality of data available from previously published validation studies. We attempted to account for biases in lack of data and size of validation populations by using weighted averages for making comparisons. We chose the US general population and female healthcare workforce for comparison and analyzed validation populations across multiple decades and geographic locations. Many of the validation studies were performed at least 10 years ago and may not reflect the current state of FSD and potential of questionnaire responses of ethnic minority women. This manuscript raises critical awareness regarding the lack of validated instruments for FSD in ethnically diverse women.
CONCLUSION
Study populations used to validate FSD questionnaires demonstrate a trend of ethnic minority underrepresentation relative to the US female general and healthcare workforce populations. Battle CR, Rubin RS, Kingsberg SA, et al. Ethnic Minority Representation in Female Sexual Dysfunction Questionnaire Validation: A Scoping Review. J Sex Med 2022;19:1824-1838.
Topics: Humans; Female; Ethnicity; Ethnic and Racial Minorities; Minority Groups; Surveys and Questionnaires; White People
PubMed: 36272968
DOI: 10.1016/j.jsxm.2022.09.004 -
Diabetes Care Jul 2018
Topics: Adolescent; Diabetes Mellitus, Type 1; Ethnicity; Humans; Minority Groups; Prognosis; Racial Groups
PubMed: 29934487
DOI: 10.2337/dci18-0017 -
Journal of Agromedicine 2006
Topics: Adult; Child; Disaster Medicine; Female; Humans; Male; Minority Groups; Pesticides; Public Health
PubMed: 19274892
DOI: 10.1300/J096v11n03_01 -
The Journal of Nursing Education Oct 2018Stereotype threat describes the apprehension individuals experience from the prospect of confirming negative self-relevant stereotypes. Due to their minority status,...
BACKGROUND
Stereotype threat describes the apprehension individuals experience from the prospect of confirming negative self-relevant stereotypes. Due to their minority status, male nurses are believed to be susceptible to stereotype threat effects in the field of nursing.
METHOD
One hundred eighty-three male nursing students were randomly assigned to one of three evaluative frames (patient management, empathy, or control) and tasked with completing an online patient simulation experiment. With empathy serving as a form of stereotype threat, participant responses were analyzed for tentative language use.
RESULTS
An interaction effect (patient gender × frame) was observed, where participants were most tentative when the simulation involved a male patient in the empathy frame.
CONCLUSION
Findings from the study offer encouragement as the communicative abilities of participants were not consistently influenced under conditions of stereotype threat. This provides support for the need to forearm male nurses against the pernicious effects of gender-based stereotypes. [J Nurs Educ. 2018;57(10):614-619.].
Topics: Empathy; Humans; Male; Minority Groups; Nurse's Role; Nurse-Patient Relations; Nurses, Male; Nursing Education Research; Prejudice; Random Allocation; Stereotyping; Students, Nursing
PubMed: 30277547
DOI: 10.3928/01484834-20180921-08 -
Psychoneuroendocrinology Jul 2021Sexually-diverse individuals (those who seek sexual or romantic relationships with the same and/or multiple genders) and gender-diverse individuals (those whose gender... (Review)
Review
Sexually-diverse individuals (those who seek sexual or romantic relationships with the same and/or multiple genders) and gender-diverse individuals (those whose gender identity and/or expression differs from their birth-assigned sex/gender) have disproportionately high physical health problems, but the underlying biological causes for these health disparities remain unclear. Building on the minority stress model linking social stigmatization to health outcomes, we argue that systemic inflammation (the body's primary response to both physical and psychological threats, indicated by inflammatory markers such as C-reactive protein and proinflammatory cytokines) is a primary biobehavioral pathway linking sexual and gender stigma to physical health outcomes. Expectations and experiences of social threat (i.e., rejection, shame, and isolation) are widespread and chronic among sexually-diverse and gender-diverse individuals, and social threats are particularly potent drivers of inflammation. We review research suggesting that framing "minority stress" in terms of social safety versus threat, and attending specifically to the inflammatory consequences of these experiences, can advance our understanding of the biobehavioral consequences of sexual and gender stigma and can promote the development of health promoting interventions for this population.
Topics: Gender Identity; Health Status Disparities; Humans; Inflammation; Minority Groups; Sexual Behavior; Sexual and Gender Minorities; Social Marginalization; Social Stigma
PubMed: 34090051
DOI: 10.1016/j.psyneuen.2021.105215 -
Global Health Promotion Jun 2021Irish Travellers and Roma are two ethnic minorities experiencing high levels of health inequities. These communities are at greater risk of developing COVID-19 and of...
Irish Travellers and Roma are two ethnic minorities experiencing high levels of health inequities. These communities are at greater risk of developing COVID-19 and of suffering more severe symptoms due to poor living environments and higher rates of comorbidities. This study explores the strategies adopted by community-health partnerships and NGOs to minimise the potential widening of Travellers' and Roma's health inequities during the initial response to the COVID-19 pandemic in Ireland. A descriptive qualitative approach was employed to provide a detailed account of three different community and partnership-led responses. Data were gathered from multiple sources and through first-hand participation in the COVID-19 responses. Data were analysed using thematic analysis. This study found that the main pandemic mitigation interventions implemented were public health measures, culturally sensitive communications, lobbying for policy change and economic and social support. These interventions, supported by the health promotion strategies of partnership, advocacy and empowerment, have proven to be extremely important to reduce potential inequities in exposure to the virus and in access to healthcare. The findings suggest that community-health partnerships between minority groups' organizations and healthcare professionals represent a viable approach to mitigate the disproportionate effects of a pandemic on Travellers and Roma.
Topics: COVID-19; Community Health Services; Health Status Disparities; Humans; Ireland; Minority Groups; Pandemics; Public Health; Roma; Socioeconomic Factors
PubMed: 33657936
DOI: 10.1177/1757975921994075