Cross-validation of the very short form of the Physical Self-Inventory (PSI-VS): invariance across genders, age groups, ethnicities and weight statuses.

Body Image. 2011 Sep;8(4):404-10

Authors: Morin AJ, Maïano C

Abstract
In a recent review of various physical self-concept instruments, Marsh and Cheng (in press) noted that the very short 12-item version of the French Physical Self-Inventory (PSI-VS) represents an important contribution to applied research but that further research was needed to investigate the robustness of its psychometric properties in new and diversified samples. The present study was designed to answer these questions based on a sample of 1103 normally achieving French adolescents. The results show that the PSI-VS measurement model is quite robust and fully invariant across subgroups of students formed according to gender, weight, age and ethnicity. The results also confirm the convergent validity and scale score reliability of the PSI-VS subscales.

PMID: 21803009 [PubMed - indexed for MEDLINE]

Food perceptions and concerns of aboriginal women coping with gestational diabetes in Winnipeg, Manitoba.

J Nutr Educ Behav. 2011 Nov;43(6):482-91

Authors: Neufeld HT

Abstract
OBJECTIVE: To describe how Aboriginal women in an urban setting perceive dietary treatment recommendations associated with gestational diabetes mellitus (GDM).
DESIGN: Semi-structured explanatory model interviews explored Aboriginal women's illness experiences with GDM.
SETTING AND PARTICIPANTS: Twenty-nine self-declared Aboriginal women who had received a diagnosis of GDM within the last 5 years in Winnipeg, Manitoba.
MAIN OUTCOME MEASURES: Factors influencing Aboriginal women's prenatal food perceptions with GDM.
ANALYSIS: Thematic analysis was used through coding linkages and matrix queries to assist in identifying and categorizing patterns or relationships.
RESULTS: Participants associated fear, anxiety, and frustration with GDM. Emotional reactions appeared alongside negative relationships with food and other prescribed lifestyle treatments. Collectively, these results suggested that the experience of living with GDM can be overwhelming, as suggested by some of the complex factors influencing women's perceptions and reported behaviors. Discussions indicated many felt socially isolated and had a poor self-image and sense of failure resulting from ineffective GDM management practices.
CONCLUSIONS AND IMPLICATIONS: Future efforts should focus on self-efficacy and security in Aboriginal women's own interpretation of GDM, providing them with the understanding that there is potential for prevention and change.

PMID: 22078771 [PubMed - indexed for MEDLINE]

Symptoms of schizophrenia and psychosis according to foreign birth in a Canadian sample of homeless persons.

Psychiatr Serv. 2011 Oct;62(10):1187-93

Authors: Dealberto MJ, Middlebro A, Farrell S

Abstract
OBJECTIVE: The objective of the study was to examine the relationship between foreign birth and symptoms of schizophrenia and psychosis in a clinical sample of homeless persons.
METHODS: All the charts documented between 2002 and 2007 by a psychiatric outreach team in Ottawa, Canada, were retrospectively reviewed regarding country of birth and psychiatric symptoms identified in a clinical assessment. Data were analyzed by univariate and multivariate logistic regressions.
RESULTS: The sample included 552 men and 333 women with data on psychiatric symptoms and country of birth. A total of 106 individuals (12%) were born outside of Canada. This proportion was lower than that observed in the general population of Ottawa or in Canada. Foreign-born individuals were older and had a higher level of education than Canadian-born individuals. Sixteen percent of the sample presented symptoms of schizophrenia, and 15% presented symptoms of psychosis other than schizophrenia. In univariate analyses persons presenting symptoms of schizophrenia or psychosis were more likely to be foreign-born than native-born (odds ratio [OR]=2.92, 95% confidence interval [CI]=1.74-4.90, and OR=4.79, CI=2.92-7.86, respectively). Multivariate analyses gave very similar results (OR=2.62, CI=1.50-4.58, and OR=4.14, CI=2.44-7.03, respectively). A positive trend or significant association was observed for all regions of origin other than the non-Caribbean Americas.
CONCLUSIONS: This is the first study to report an association between foreign birth and symptoms of schizophrenia and psychosis among homeless persons. These findings are consistent with the increased risk of schizophrenia and psychosis observed among immigrants to European countries.

PMID: 21969645 [PubMed - indexed for MEDLINE]

Commentary: Money and models: double-edged swords.

Int J Epidemiol. 2011 Aug;40(4):1091-3

Authors: Kaufman JS

PMID: 21642349 [PubMed - indexed for MEDLINE]

Alcohol use in polish 9/11 responders: implications for cross-cultural treatment.

J Psychiatr Pract. 2012 Jan;18(1):55-63

Authors: Katz CL, Jutras-Aswad D, Kiliman M, Pilatowicz I, Akerele E, Marrone K, Ozbay F

Abstract
More than 35,000 individuals are estimated to have responded to the World Trade Center (WTC) site following the terrorist attacks of September 11, 2001. The federally funded WTC Medical Monitoring and Treatment Program (WTCMMTP) provides medical monitoring and occupational medicine treatment as well as counseling regarding entitlements and benefits to the workers and volunteers who participated in the WTC response. A major component of the WTCMMTP is the WTC Mental Health Program (WTCMHP), which offers annual mental health assessments and ongoing treatment for those found to have 9/11 associated mental health problems. In the program's 9.5 years of evaluating and treating mental health problems in thousands of Ground Zero responders, diversity in multiple domains (e.g., gender, family, profession and employment status, state of physical health, cultural identity, and immigration status) has been a hallmark of the population served by the program. To illustrate the types of issues that arise in treating this diverse patient population, the authors first present a representative case involving a Polish asbestos worker with an alcohol use disorder. They then discuss how accepted alcohol treatment modalities can and often must be modified in providing psychiatric treatment to Polish responders, in particular, and to foreign-born patients in general. Treatment modalities discussed include cognitive and behavioral therapy, relapse prevention strategies, psychodynamic therapy, motivational approaches, family therapy, group peer support, and pharmacotherapy. Implications for the practice of addiction psychiatry, cultural psychiatry, and disaster psychiatry are discussed. (Journal of Psychiatric Practice 2012;18:55-63).

PMID: 22261985 [PubMed - in process]

The influence of target and perceiver race in the categorisation of male sexual orientation.

Perception. 2011;40(7):830-9

Authors: Rule NO

Abstract
Although sexual orientation can be judged from faces, in previous work Caucasian or racially unspecified targets and perceivers have been primarily studied. Here, target and perceiver race were considered in the accurate categorisation of male sexual orientation. Asian, Black, and Caucasian participants categorised the sexual orientations of Asian, Black, and Caucasian men. Accuracy was significantly above chance and consistent across all combinations of perceivers and targets. Response bias scores showed that targets were significantly more likely to be categorised as straight, rather than gay, regardless of target or perceiver race. Moreover, judgments of individual targets were significantly correlated for perceivers from all three groups, suggesting cross-race consistency in target legibility. The perception of sexual orientation from faces therefore appears to be robust against variations in target and perceiver race.

PMID: 22128555 [PubMed - indexed for MEDLINE]

Psychological morbidity and quality of life of ethnic minority patients with cancer: a systematic review and meta-analysis.

Lancet Oncol. 2011 Dec;12(13):1240-8

Authors: Luckett T, Goldstein D, Butow PN, Gebski V, Aldridge LJ, McGrane J, Ng W, King MT

Abstract
BACKGROUND: Ethnic minority is associated with higher cancer incidence and poorer survival than is being in the majority group. We did a systematic review and meta-analysis to assess whether psychological morbidity and health-related quality of life (HRQoL) were affected by minority status.
METHODS: We searched Medline, AMED, PsycINFO, Embase, CENTRAL, CINAHL, PubMed, Sociological Abstracts, and Web of Science for English-language articles published between Jan 1, 1995, and October, 2009. Articles were eligible if they reported original data on anxiety, depression, distress (for psychological morbidity), or HRQoL in minority and majority cancer patients or survivors. Minority status was defined as being an immigrant or having an ethnic, linguistic, or religious background different to the majority of the population in the country where the research was done. We excluded African Americans and indigenous groups. Eligible articles were rated for quality of reporting, external validity, internal validity, sample size, and power. Each quality criterion was rated independently by two reviewers until inter-rater reliability was achieved. In a meta-analysis we compared mean scores adjusted for socioeconomic status and other sociodemographic and clinical variables, where available. Effect sizes greater than 0·5 and 95% CI that included 0·5 or -0·5 were deemed clinically important, with negative values indicating worse outcomes in minority patients. We assessed publication bias by estimating the number of potential unpublished studies and the number of non-signficant studies with p=0·05 required to produce a non-significant overall result.
FINDINGS: We identified 21 eligible articles that included 18 datasets collected in the USA and one in each of Canada, Romania, and the UK. Ethnic minority groups were Hispanic, Asian or Pacific Islander, or Hungarian (one dataset). Overall, we found minority versus majority groups to have significantly worse distress (mean difference -0·37, 95% CI -0·46 to -0·28; p<0·0001), depression (-0·23, -0·36 to -0·11; p=0·0003), and overall HRQoL (-0·33, -0·58 to -0·07; p=0·013). Further analyses found disparities to be specific to Hispanic patients in the USA, in whom poorer outcomes were consistent with potentially clinically important differences for distress (effect size -0·37, 95% CI -0·54 to -0·20; p<0·0001), social HRQoL (-0·45, -0·87 to -0·03; p=0·035), and overall HRQoL (-0·49, -0·78 to -0.20; p=0·0008). Results were significantly heterogeneous for overall HRQoL and all domains. Tests for interaction, for adjusted versus unadjusted and comparisons of high-quality, medium-quality, and low-quality articles, were generally non-significant, which suggests no bias. We found no evidence of any substantive publication bias.
INTERPRETATION: Hispanic cancer patients in the USA, but not other ethnic minority groups, report significantly worse distress, depression, social HRQoL, and overall HRQoL than do majority patients, of which all but depression might be clinically important. Heterogeneous results might, however, have limited the interpretation. Data for other minority groups and for anxiety are scarce. More studies are needed from outside the USA. Future reports should more clearly describe their minority group samples and analyses should control for clinical and sociodemographic variables known to predict outcomes. Understanding of why outcomes are poor in US Hispanic patients is needed to inform the targeting of interventions.
FUNDING: Prince of Wales Hospital, Sydney, Australia.

PMID: 21996168 [PubMed - indexed for MEDLINE]

Prevalence, risk indicators and outcomes of bullying among on-reserve First Nations youth.

Can J Public Health. 2011 Nov-Dec;102(6):462-6

Authors: Lemstra M, Rogers M, Redgate L, Garner M, Moraros J

Abstract
OBJECTIVE: Bullying is common and multifaceted. There is no published literature focusing on bullying in First Nations youth on-reserve in Canada. The purpose of this paper is to examine the prevalence, risk indicators and impact of bullying within a First Nations youth population currently living on-reserve.
METHODS: Students in grades 5 through 8 (age 10 to 16 years) within the Saskatoon Tribal Council were asked to complete a youth health survey. Among the seven schools, 271 students were eligible to participate.
RESULTS: 204 youth completed the eight-stage consent protocol and the school survey for a response rate of 75.3%. Overall, 35.8% of youth reported being physically bullied, 59.3% verbally bullied, 47.5% socially bullied and 30.3% electronically bullied at least once or twice in the previous four weeks. After regression analysis, having a father who works in a professional occupation, doing well in school, and having the perception that parents expect too much from them were found to be independent risk indicators of being bullied. Irrespective of the type of bullying, youth who were bullied were at least twice as likely to suffer from depressed mood.
DISCUSSION: We have found that bullying is more common for First Nations youth living on-reserve, compared to other Canadian youth. Given that the independent risk indicators also appear to be different, we hope that this new information can aid in the design of effective bullying strategies.

PMID: 22164560 [PubMed - indexed for MEDLINE]

A Comparative and Exploratory Analysis of Socio-cultural Factors and Immigrant Women's Mental Health within a Canadian Context.

J Immigr Minor Health. 2012 Jan 6;

Authors: Alvi S, Zaidi A, Ammar N, Culbert L

Abstract
The purpose of this study was to explore the influence of macro-level factors on immigrant and non-immigrant women's mental health status in a Canadian context. This study was part of a larger study examining women's quality of life in south eastern Ontario. Using survey research methods, data were collected through face-to-face interviews with 91 women of whom 66 identified their country of origin as "other" than Canada. Descriptive, bivariate and regression analysis of this data revealed that immigrant and non-immigrant women's macro-level predictors of mental health status vary. Overall, for immigrant women's perceptions of neighbourhood social cohesion was a stronger predictor influencing mental health status, while for non-immigrant women social support was more influential. Research with larger, representative samples should explore the findings to ascertain generalizability.

PMID: 22223121 [PubMed - as supplied by publisher]

First-generation immigrants and hospital admission rates for psychosis and affective disorders: an ecological study in Ontario.

Can J Psychiatry. 2011 Jul;56(7):418-26

Authors: Durbin A, Lin E, Taylor L, Callaghan RC

Abstract
OBJECTIVE: The immigrant population in Canada, and particularly in Ontario, is increasing. Our ecological study first assessed if there was an association between areas with proportions of first-generation immigrations and admissions rates for psychotic and affective disorders. Second, this study examined if area-level risks would persist after controlling for area socioeconomic factors in census-derived geographical areas-Forward Sortation Areas (FSAs)-in Ontario.
METHODS: Ontario's inpatient admission records from 1996 to 2005 and census data from 2001 were analyzed to derive FSA rates of first admissions for psychotic disorders and affective disorders per 100 000 person-years. Negative binomial regression models were adjusted, first, for FSA age and sex and, second, also for FSA population density and average income.
RESULTS: Using age- and sex-adjusted models, admission rates for psychotic disorders were higher in areas with greater proportions of immigrants. These areas were associated with lower admission rates for affective disorders. When FSA average income and population density were added to the models, the influence of immigrants was attenuated to nonsignificant levels in models predicting psychotic disorders admission rates. However, greater proportions of immigrants remained significantly protective when predicting rates of affective disorders.
DISCUSSION: Our study provides insight about the influence of area-level variables on risk of admission for psychotic and affective disorders in high immigrant areas. There is a dearth of current Canadian research on immigrant admission for psychotic disorders at the individual or area level. Future area- and individual-level studies may better identify groups at risk and possible explanations.

PMID: 21835105 [PubMed - indexed for MEDLINE]

Adapting ACT to serve culturally diverse communities: a comparison of a Japanese and a Canadian ACT team.

Psychiatr Serv. 2011 Aug;62(8):971-4

Authors: Chow W, Shiida M, Shiida T, Hirosue A, Law S, Leszcz M, Sadavoy J

Abstract
OBJECTIVE: The assertive community treatment (ACT) teams of Mount Sinai Hospital in Toronto and the KUINA Center, Hitachinaka, Japan, were compared with regard to ACT fidelity, organizational structure, populations served, and treatment outcomes. Ethnocultural adaptations to the ACT model made by both teams included enhanced family support and intervention, culturally and linguistically matched staff and patients when possible, culturally informed therapy, routine cultural assessments, culturally matched housing and community support, and flexible funding models.
METHODS: Data were gathered by chart reviews (66 patients in Toronto and 40 patients in Japan), a satisfaction measure, a standard measure of ACT fidelity, and a pre-post measure of treatment outcomes (the Brief Psychiatric Rating Scale), and hospitalization days.
RESULTS: Both teams achieved good fidelity to ACT and reductions in hospitalization and symptom severity. Family satisfaction scores were high.
CONCLUSIONS: With culturally informed adaptations, ACT can be effective in a Canadian mixed ethnocultural population and a homogeneous Japanese population.

PMID: 21807841 [PubMed - indexed for MEDLINE]

A brief measure of core religious beliefs for use in psychiatric settings.

Int J Psychiatry Med. 2011;41(3):253-61

Authors: Rosmarin DH, Pirutinsky S, Pargament KI

Abstract
Results from several national studies in the United States suggests that: (1) religious beliefs and practices are highly prevalent; (2) spirituality and religion are statistically and clinically relevant to mental health and symptoms; and (3) many patients have a preference for spiritually integrated care. However, existing protocols that assess for salient religious themes in psychiatric settings are time-consuming to administer, relevant only to specific populations (e.g., Christians), and have poor psychometric properties. Further, evidence suggests that religious beliefs can take on a positive and negative valence, and both of these dimensions are worthy of assessment. We, therefore, developed a brief (six-item) self-report measure of positive and negative core beliefs about God which is uniquely suited for use with a broad range of religious patients. Across three studies, we evaluated its psychometric properties and ability to predict symptoms of anxiety and depression. Results provide support for the validity and reliability of our measure and further highlight the salience of both positive and negative religious beliefs to psychiatric symptoms. It is hoped that this measure will help to decrease the burden of spiritual assessment in psychiatric and medical settings, and further have research utility for this area of study.

PMID: 22073764 [PubMed - indexed for MEDLINE]

Strengthening the Kawa model: Japanese perspectives on person, occupation, and environment.

Can J Occup Ther. 2011 Oct;78(4):230-6

Authors: Wada M

Abstract
BACKGROUND: The Kawa model emerged to meet a need for occupational therapy models and theories relevant to Japanese clients and since its inception has evolved considerably.
PURPOSE: To provide an overview of the Kawa model and to contribute to a critique of the model from Japanese perspectives on person, occupation, and environment.
KEY ISSUES: The paper notes that the Kawa model does not portray inner self nor does it integrate one's active belonging; the author identifies the challenges of addressing issues related to occupations, and introduces the concept of seken (day-to-day community).
IMPLICATIONS: The model would be strengthened by presenting inner self and a discrete layer of seken in the environment to effectively articulate belonging. The ways of presenting occupation need to be improved to capture relationships between occupation and belonging, effects of occupations, and positive and negative meanings attributed to an occupation. Exploring relationships between self occupation, life flow, and harmony is warranted.

PMID: 22043554 [PubMed - indexed for MEDLINE]

English proficiency, symptoms, and quality of life in Vietnamese- and Chinese-American breast cancer survivors.

J Pain Symptom Manage. 2011 Jul;42(1):83-92

Authors: Yi JK, Swartz MD, Reyes-Gibby CC

Abstract
CONTEXT: In the United States, limited English proficiency has been shown to have a negative influence on effective functioning in the health care environment. Minority immigrant populations, therefore, may be especially vulnerable to poorer symptom management and quality of life (QOL) during and after cancer treatment, given their limited language skills. Breast cancer is the most prevalent cancer in Asian-American women but little is known about its adverse consequences in this population.
OBJECTIVES: We examined the extent to which English proficiency was associated with symptoms and QOL in Chinese- (n = 72) and Vietnamese-American (n = 25) breast cancer survivors in Houston, Texas.
METHODS: Data were collected through face-to-face interviews. Symptoms and QOL were assessed using the Edmonton Symptom Assessment Scale and the Quality of Life Instrument-Breast Cancer Patient Version (QOL-BC), respectively.
RESULTS: The most commonly reported severe symptoms (≥ 7 on a 0-10 scale) were lack of well-being (38%), fatigue (26%), pain (18%), lack of appetite (14%), anxiety (14%), and feeling depressed (14%). For the QOL-BC, the physical (mean = 6.78; standard deviation [SD] = 1.28) and spiritual subscales (mean = 6.01; SD = 2.18) had the highest and lowest mean scores, respectively. Of the whole sample, 33% reported having the ability to understand, read, speak, and write in English very well. English proficiency was significantly associated with symptom distress (coefficient = -0.257; P = 0.011) and QOL (coefficient = -0.390; P = 0.002).
CONCLUSION: English proficiency has a significant impact on symptom distress and QOL. These findings may help the development of services to meet the unique needs of Vietnamese- and Chinese-American breast cancer survivors.

PMID: 21227634 [PubMed - indexed for MEDLINE]

Stresses of passage, balms of resettlement, and posttraumatic stress disorder among Sri Lankan Tamils in Canada.

Can J Psychiatry. 2011 Jun;56(6):333-40

Authors: Beiser M, Simich L, Pandalangat N, Nowakowski M, Tian F

Abstract
OBJECTIVES: To explore the salience of pre- and postmigration stresses as risk factors for posttraumatic stress disorder (PTSD) and to identify resilience factors and explore their mental health salience.
METHODS: We conducted a mental health survey of 1603 Sri Lankan Tamils in Toronto, incorporating the World Health Organization Composite International Diagnostic Interview for PTSD.
RESULTS: According to the International Classification of Diseases, 10th Revision, criteria, lifetime prevalence for PTSD was 12%; according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria it was 5.8%. Female sex and the number of stresses of passage increased the probability of PTSD, whereas satisfaction with life and the availability of nonfamily social relations reduced it.
CONCLUSIONS: Consideration of pre- and postmigration stresses of passage and of the nature of resilience contributes to an improved understanding of PTSD among refugees.

PMID: 21756447 [PubMed - indexed for MEDLINE]

A comparison study of psychological, family function marital and life satisfactions of polygamous and monogamous women in Jordan.

Community Ment Health J. 2011 Oct;47(5):594-602

Authors: Al-Krenawi A, Graham JR, Al Gharaibeh F

Abstract
This study surveyed a 2009 convenience sampling of 199 women, 93 of whom were first (or senior) wives in polygamous marriages and 106 were wives in monogamous marriages. We deployed the McMaster Family Assessment Device (FAD), ENRICH marital satisfaction questionnaire, SCL-90 mental health symptoms checklist, Rosenberg self-esteem (SE) scale, and Diener, Emmons, Larsen, and Griffin life satisfaction scale, a basic sociodemographic scale, including attitudes towards polygamy. Women from polygamous families experienced more problems in family functioning, marital relations, and reported low self-esteem, less satisfaction with life, and more somatization, interpersonal sensitivity, depression, anxiety, hostility, paranoid ideation, psychoticism and their general severity index was higher (GSI). More women in polygamous marriages agreed with the practice of polygamy, as compared to their monogamous counterparts. The conclusion considers implications for mental health practice, policy, and further research.

PMID: 21573772 [PubMed - indexed for MEDLINE]

Common mental health problems in immigrants and refugees: general approach in primary care.

CMAJ. 2011 Sep 6;183(12):E959-67

Authors: Kirmayer LJ, Narasiah L, Munoz M, Rashid M, Ryder AG, Guzder J, Hassan G, Rousseau C, Pottie K,

Abstract
BACKGROUND: Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care.
METHODS: We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health.
RESULTS: The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations.
INTERPRETATION: Systematic inquiry into patients' migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.

PMID: 20603342 [PubMed - indexed for MEDLINE]

Women who jump into wells: Reflections on suicidality in women from conflict regions of the Indian subcontinent.

Transcult Psychiatry. 2011 Nov;48(5):585-603

Authors: Guzder J

Abstract
This paper examines narratives of women from the Indian subcontinent, including Canadian refugee claimants, emerging from the conflict regions of Pakistan, Punjab, Bangladesh, and Sri Lanka, who have presented suicidal ideation or attempts or died by suicide. The focus is on the relationship of suicide and suicide behavior to particular systemic stressors related to familial, social, and group agendas. The vulnerability of individual women is presented in the context of gender issues, deeply embedded group trauma, historical legacies, and intragenerational dynamics, as well as acute stressors that contribute to the underlying distress of these women.

PMID: 22123835 [PubMed - in process]

Evidence-based medicine: opportunities and challenges in a diverse society.

Can J Psychiatry. 2011 Sep;56(9):514-22

Authors: Whitley R, Rousseau C, Carpenter-Song E, Kirmayer LJ

Abstract
In this article we explore the discourse and practice of evidence-based medicine (EBM) in the context of social and cultural diversity. The article consists of 2 parts. First, we begin by defining EBM, describing its historical development and current ascendance in medical practice. We then note its importance in contemporary psychiatry, comparing dynamics between the United States and Canada. Secondly, we offer a constructive critique of the application of EBM and evidence-based practices in the context of ethnocultural diversity, as one consistent reflection on the EBM literature is that it is does not adequately address issues of diversity. In doing so, we use the situation here in Canada as an extended case study, though our observations will likely be applicable in other diverse nations, such as the United States, the United Kingdom, and Australia. We critically examine the following 6 issues related to the practice of EBM in a diverse society: generalizability and transferability of evidence-based interventions; diversifying standards of evidence in EBM; strategies to address diversity in EBM research; cultural adaptations of evidence-based interventions; integrating idiographic knowledge; and, training and health service delivery. Concurrent with our critique, we offer research and practice suggestions that may address outstanding challenges vis-à-vis the practice of EBM in a diverse society. These include a need for more effectiveness research, more openness to diverse sources of knowledge, better integration of idiographic and nomothetic knowledge, and a critical approach to extrapolation and transfer of knowledge.

PMID: 21959026 [PubMed - in process]

Assessing the measurement invariance of the Center for Epidemiologic Studies Depression Scale across immigrant and non-immigrant women in the postpartum period.

Arch Womens Ment Health. 2011 Oct;14(5):413-23

Authors: Van Lieshout RJ, Cleverley K, Jenkins JM, Georgiades K

Abstract
To assess the measurement invariance of the Center for Epidemiologic Studies Depression Scale (CES-D) 2 months after delivery in 656 English-speaking immigrant and non-immigrant women who had at least one other child under 16 and who gave birth in one of two urban Canadian centers. We also compared levels of depression in these two groups using this scale. Multiple group confirmatory factor analysis showed that configural, metric and partial scalar invariances were present and allowed for meaningful substantive comparisons to be made between immigrants and non-immigrants using linear and logistic regressions on an invariant 15-item version of the scale. We observed a novel 4-factor structure for the CES-D in postpartum women and established a 15-item version of this scale that was invariant across immigrant and non-immigrant groups. This suggests that women conceptualize postpartum depression (PPD) in similar ways using the 15-item version of this scale and that meaningful substantive comparisons can be made using it. Indeed, immigrants manifested higher levels of depressive symptoms than non-immigrants (unstandardized b = 1.34, p = 0.02) and an increased risk of being a potential case of PPD (OR = 2.16, 95%CI 1.10-4.19), even after adjustment for other risk factors. Immigrant and non-immigrant women appear to conceptualize PPD in similar ways using this 15-item version of the CES-D. Immigrants may develop more depressive symptoms and be at increased risk of developing an episode of PPD.

PMID: 21932024 [PubMed - indexed for MEDLINE]