The meaning of pain: A cultural formulation of a Syrian woman in Sweden

Bäärnhielm, Sofie

doi:10.1177/1363461511427781

Cited by 8 publications

(8 citation statements)

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“…Indeed, only two studies sought to evaluate the effects of treatment interventions on somatization in immigrants (Nickel et al, 2006; Van Wyk et al, 2012). In addition, as patients and health care professionals face differences in cultural backgrounds (e.g., linguistic barriers, variant health/illness beliefs, different medical practices, lack of knowledge about health care systems), understanding and treating somatization in multicultural settings is particularly challenging (Perron and Hudelson, 2006; Bäärnhielm, 2012; Dastjerdi, 2012). Based on the available literature, there is a clear need for better access to healthcare services for immigrants that is both culturally and linguistically appropriate and, as well, affordable for low-income individuals (Radl-Karimi et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

A Clinical-Psychological Perspective on Somatization Among Immigrants: A Systematic Review

2019

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Background: Somatic and psychopathological conditions (e.g., anxiety, depression, post-traumatic stress disorder, and somatization) are frequent among immigrants belonging to various ethnic groups. Worldwide findings on the epidemiology regarding specific mental conditions still vary with respect to different migration samples and migration contexts. This inconsistency also holds true in the incidence of somatization among migrants. We carried out a systematic review analyzing the relationship between migration and somatization by providing a qualitative data synthesis of original research articles on the topic.Methods: According to PRISMA guidelines, we conducted a systematic search of the literature on PubMed, Scopus, ISI Web of Science, PsycINFO, Google Scholar, and ScienceDirect. The articles were selected using multiple combinations of relevant search terms (e.g., defined somatization and related disorders, and migration status). Each database was searched systematically from January 2000 to December 2017.Results: The initial search identified 338 records, of which 42 research reports met the predefined inclusion criteria and were analyzed. Most studies (n = 38; 90%) were cross-sectional. The main findings of this study are that migrants with somatization exhibited more psychological distress, had an increased perceived need for healthcare service utilization, and reported more post-migration living difficulties and/or post-traumatic stress disorder than those without somatization. It was also found that specific individual features mediate the association between somatization and migration. The prevalence and correlates of somatization were found to vary across the immigrant groups, depending on cultural variation in reasons for migration, stress exposure, explanatory models of illness, coping, and other individual variables.Conclusion: Somatization is a challenge for health professionals due to its vague nature. In this regard, clinical management of immigrant patients should include further efforts to address emotional distress, with special attention to social, cultural, and linguistic differences.

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Section: Discussionmentioning

confidence: 99%

A Clinical-Psychological Perspective on Somatization Among Immigrants: A Systematic Review

2019

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“…These included the following interventions: cultural formulation, 93 restructuring illness narratives, 94 cultural sensitivity, 95 multicultural competence and evidence-based group therapy practice, 96 a community-based treatment for Native Americans, 97 adapted CBT for traumatised refugees (other papers from the same author were included in the review as they provided evidence), 98 culturally sensitive CBT for psychosis in ethnic minorities (other papers from the same author were included in the review as those provided evidence for this intervention), 99 components of cultural competence in three mental health programmes (service intervention across programmes and not focused on the TCs), 100 culturally relevant psychoeducation for Korean American families, 101 psychosocial counselling in Nepal, 102 cultural considerations in CBT with Chinese people, 103 and adaptation of solution-focused therapy in Chinese culture. 102 These interventions were described often as serving an educative role about constructing interventions or sharing how to deliver an intervention and so did not enter the review.…”

Section: Thematic Analysis Of Interventionsmentioning

confidence: 99%

Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness

Bhui

Aslam

Palinski

et al. 2015

Health Technology Assessment

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BackgroundBlack and minority ethnic (BME) people using psychiatric services are at greater risk of non-engagement, dropout from care and not receiving evidence-based interventions than white British people.ObjectivesTo identify effective interventions designed to improve therapeutic communications (TCs) for BME patients using psychiatric services in the UK, to identify gaps in the research literature and to recommend future research.ParticipantsBlack African, black Caribbean, black British, white British, Pakistani and Bangladeshi patients in psychiatric services in the UK, or recruited from the community to enter psychiatric care. Some studies from the USA included Hispanic, Latino, Chinese, Vietnamese, Cambodian and African American people.InterventionsAny that improve TCs between BME patients and staff in psychiatric services.Data sourcesThe published literature, ‘grey’ literature, an expert survey, and patients' and carers’ perspectives on the evidence base. Databases were searched from their inception to 4 February 2013. Databases included MEDLINE, Applied Social Sciences Index and Abstracts, The Cochrane Library, Social Science Citation Index, Allied and Complementary Medicine Database, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, EMBASE, The Campbell Collaboration and ProQuest for dissertations.Review methodsStudies were included if they reported evaluation data about interventions designed to improve therapeutic outcomes by improving communication between BME patients and psychiatric professionals. Qualitative studies and reports in the grey literature were included only if they gave a critical evaluative statement. Two members of the team selected studies against pre-established criteria and any differences were resolved by consensus or by a third reviewer, if necessary. Data were extracted independently by two people and summarised in tables by specific study designs. Studies were subjected to a narrative synthesis that included a thematic analysis contrasting populations, countries and the strength of evidence for any intervention. The components of the interventions were compared. Patient perspectives on acceptability were considered alongside quality scores and methodological strengths and weaknesses.ResultsTwenty-one studies (19 from the published literature and two from the grey literature) met the inclusion criteria. There were 12 trials, two observational quantitative studies, three case series, a qualitative study and three descriptive case studies. Only two studies, one a pilot trial and one a case series, included economic data; in both, a favourable but weak economic case could be made for the intervention. The trials tested interventions to prepare patients for therapeutic interventions, variable levels of ethnic matching (of professional to patient), cultural adaptation of therapies, and interventions that included social community systems in order to facilitate access to services. Empowering interventions favoured by patients and carers included adapted cognitive–behavioural therapy, assessments of explanatory models, cultural consultation, ethnographic and motivational interviews, and a telepsychiatry intervention.LimitationsStudies tended to have small sample sizes or to be pilot studies, and to use proxy rather than direct measures for TCs.ConclusionsEmpowering interventions should be further researched and brought to the attention of commissioners. Several promising interventions need further evaluative research and economic evaluations are needed.Study registrationThe study is registered as PROSPERO CRD42011001661.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…There is still a lack of research evaluating the clinical applications of the OCF (Alarco´n et al, 2002;Lewis-Fernandez, 2009). A few series of case formulations on the OCF have been published, for the most part in the journals Culture, Medicine and Psychiatry and Transcultural Psychiatry (e.g., Ba¨a¨rnhielm, 2012).…”

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confidence: 99%

Revising psychiatric diagnostic categorisation of immigrant patients after using the Cultural Formulation in DSM-IV

Bäärnhielm

Wistedt

Rosso

2014

Transcult Psychiatry

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This study evaluated the use of the Outline for Cultural Formulation (OCF) from the DSM-IV in the diagnosis of immigrants and refugee patients at an outpatient psychiatric clinic in Sweden. Using the OCF in conjunction with standard diagnostic procedures led to major revisions of diagnoses for 56.5% of patients. Anxiety disorders, especially PTSD, constitute the disorder group in which the most changes were made. In order to understand how information from the OCF interview led clinicians to revise diagnoses, data from clinical discussions were analysed through qualitative content analysis. This revealed four major themes related to the reevaluation, and at times confirmation, of given clinical psychiatric diagnoses: new information; expression of distress in emotional language; expression of distress in relation to life experiences; and improved understanding of the patient's suffering. The findings suggest that the OCF may be useful for: (a) formulating culture in relation to illness experiences, (b) contextualising diagnostic categorisation, and (c) improving overall understanding of the patient that may facilitate individualised planning of treatment and therapy.

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The meaning of pain: A cultural formulation of a Syrian woman in Sweden

Cited by 8 publications

References 32 publications

A Clinical-Psychological Perspective on Somatization Among Immigrants: A Systematic Review

A Clinical-Psychological Perspective on Somatization Among Immigrants: A Systematic Review

Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness

Revising psychiatric diagnostic categorisation of immigrant patients after using the Cultural Formulation in DSM-IV

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