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Biomedical subjects

D Bhugra

Publications and source records attributed to D Bhugra.

At least 19 recordsLinked to original sources
PubMed1998

Common mental disorders, explanatory models and consultation behaviour among Indian women living in the UK.

Women of Indian origin are said to have a lower rate of recognized common mental disorders and a higher frequency of consultation in primary care than white British. The aim of this study was to evaluate factors, including explanatory models (patient perspectives) of illness, associated with common mental disorders and with frequency of consultation among women of Indian origin in primary care. The investigation was conducted in a general practice in West London with a large Indian population. Consecutive woman attenders of Indian descent were screened with the General Health Questionnaire-12 to identify probable cases of psychiatric morbidity. 100 patients were interviewed with the Revised Clinical Interview Schedule (CIS-R), a specific tool for the diagnosis of common mental disorders, and the Short Explanatory Model Interview, which elicits the individual's conceptualization of his or her illness. Those patients who satisfied CIS-R criteria were classified as 'cases', the others as 'controls'. Common mental disorders were documented in 30% of patients. The general practitioner's diagnosis of common mental disorders had a sensitivity of 17% and a specificity of 91%. Individuals with common mental disorders had a higher frequency of consultation (P = 0.017), were less likely to see depression as an indication for medical intervention and were more likely to withhold some of their concerns from the general practitioner. Incorrect diagnosis by the GP was most likely to occur when patients did not disclose all their complaints. These associations were all statistically significant after adjustment for possible confounders by multiple linear and logistic regression. Women of Indian origin in this sample had rates of common mental disorders similar to those in other UK populations. Differing conceptualizations of common mental disorders may contribute to their underrecognition in women of Indian origin.

Adult↗
PubMed1997

Experiences of religious healing in psychiatric patients in south India.

A survey was carried out over a 3-month period to determine experiences of religious healing in a group of 198 consecutive psychiatric patients attending a hospital in Tamil Nadu, South India. Of these, 89 (45%) had sought between 1 and 15 sessions from either Hindu, Muslim of Christian healers. The number of patients visiting healers was linked significantly with their income, while a significantly higher number under the age of 17 years had received such help compared with older age groups. A significantly higher consultation rate was observed in those patients with schizophrenia and delusional disorders when compared with other mental illness. An average of 30% of patients claimed some benefit from healer consultation, although the majority (91%) had discontinued such treatment at the time of the hospital attendance. The role of social support, methods of traditional healing and the underlying implications for service delivery are discussed. The implications for service providers to ethnic minorities need to be taken into account while planning services.

Adolescent↗
PubMed1997

The validation of the 12-item General Health Questionnaire among ethnic Indian women living in the United Kingdom.

BACKGROUND: The General Health Questionnaire (GHQ) has been validated in different languages and cultures and in diverse settings. However, the validity of the 12-item version, increasingly used for screening for psychiatric morbidity in primary care, has not been established among ethnic Indians living in the United Kingdom. METHODS: The GHQ-12 was used to screen for psychiatric morbidity in a study of patterns of consultation and explanatory models of mental illness in a general practice in West London. All individuals who scored 2 or more and an equal number of individuals who scored 0 or 1 were interviewed using the Revised Clinical Interview Schedule (CIS-R) to confirm psychiatric morbidity. Hindi versions of the both these instruments were also employed. Thresholds of GHQ were compared against the standard of the CIS-R using the recommended threshold of 12 and above as indicating caseness. A receiver operator characteristic curve was drawn to obtain the best threshold value for screening. RESULTS: The optimal threshold for screening as assessed by receiver operator characteristic analysis was 2/3. This threshold had a sensitivity of 96.7% and a specificity of 90%. CONCLUSIONS: The sensitivity and specificity of the 12-item General Health Questionnaire among women of ethnic Indian origin living in the United Kingdom is high. It can be employed as a screening instrument to identify individuals with psychiatric morbidity in this population.

Adult↗
PubMed1997

Incidence and outcome of schizophrenia in whites, African-Caribbeans and Asians in London.

BACKGROUND: Several previous studies have indicated high rates of schizophrenia in African-Caribbeans in the UK compared to White population. METHOD: All people aged 18 to 64 years residing in two health districts in London who made contact with hospital or community services over a 1-year (Whites) or 2-year (ethnic minorities) period were screened for psychotic symptoms. RESULTS: One hundred and twenty-three patients passed the screen, of whom 100 were assigned a schizophrenic class by the CATEGO program. Of these, 38 were White, 38 African-Caribbean and 24 Asian. The incidence rate for broad schizophrenia was significantly higher for African-Caribbeans than for Whites. Asians showed a high rate among people age 30 and over, particularly women. Poor outcome at 1-year follow-up was significantly more common for African-Caribbeans than for the other two groups. The proportion of African-Caribbeans with a poor outcome was two and a half times greater than that of Whites. On a range of seven socio-demographic variables, African-Caribbeans differed from the other two groups only on unemployment. CONCLUSIONS: A multitide of factors play a role in the aetiology of schizophrenia. Comparison of environmental factors in these groups may identify factors that contribute to the aetiology of schizophrenia.

Adolescent↗
PubMed1997

Coming out by south Asian gay men in the United Kingdom.

The process of coming out among Western gay men and women is well described. The present study is the first to explore the experiences of coming out among gay men of South Asian origin in the U.K. South Asian is defined here as originating from the Indian subcontinent. Members of a homophile organization were given a questionnaire designed to assess the experiences of coming out to family and friends and the degree of compartmentalization in their lives. Information obtained from 52 questionnaires was supplemented by detailed interviews with 9 respondents. Families and religion played important roles in the process of coming out. Sisters were most likely to be told first. Some degree of dissonance between cultural and sexual identity was noted. In addition, each step taken in revealing one's sexual orientation to friends, family, and colleagues was dictated by the strength of the relationships and the desire for intimacy. Further areas of research are highlighted.

Adolescent↗
PubMed1997

Setting up psychiatric services: cross-cultural issues in planning and delivery.

There is convincing evidence that in the UK, various ethnic minorities are over-represented in psychiatric hospitals, prisons and special hospitals. Various explanations have been put forward for this picture. The expanding emphasis on community care means that models for looking after ethnic communities should be innovative and work from a bottom-up approach. Psychiatric emphasis on clinical diagnoses means that services are developed according to the diagnoses rather than needs.

Cross-Cultural Comparison↗
PubMed1997

Users' views of a drop-in project for the homeless.

Homeless adults attending a drop-in voluntary project were approached to assess their views on the project, pathways into homelessness, physical and mental health needs and history of substance misuse. Over a six week period, 70 users were interviewed. Of these 54 (77%) were men and the rest women. Twenty five (35%) were living in insecure accommodation. A significant proportion 61% (43) acknowledged having suffered from emotional or mental health problems in the past and nearly half (47%) admitted to having received a psychiatric diagnosis. Nearly one third reported past criminal record. The use of substances (drugs and alcohol) was fairly common. There were no ethnic differences in the findings although the numbers from ethnic minorities remain small. This is not a typical homeless sample but the findings suggest vulnerability of such a group. The group was by and large satisfied with the open access and flexible approach of the project. The findings are discussed in relation to the acceptable services provided by voluntary organisations and suggestions made for further studies.

Adult↗
PubMed1997

Increased rate of psychosis among African-Caribbeans in Britain is not due to an excess of pregnancy and birth complications.

BACKGROUND: It has been suggested that the increased rate of psychotic illness among African-Caribbeans living in Britain is due to an excess of pregnancy and birth complications (PBCs). METHOD: We therefore compared the frequency of PBCs in a group of White psychotic patients (n = 103) and a comparable group of patients of African-Caribbean origin (n = 61); the latter consisted of 30 first-generation (born in the Caribbean) and 31 second-generation (born in Britain) individuals. RESULTS: White psychotic patients were more than twice as likely to have a history of PBCs as their African-Caribbean counterparts (odds ratio = 2.34, 95% confidence interval (CI) 0.88-6.47, P = 0.062). The same trend was observed among patients with a DSM-III diagnosis of schizophrenia (odds ratio = 1.65, 95% CI 0.56-4.97, P = 0.32). The rate of PBCs was similar among the first- and second-generation Caribbean psychotic patients. CONCLUSIONS: The increased rate of psychotic illness that has been reported among the African-Caribbean population in Britain is not due to an increased prevalence of PBCs.

Adult↗
PubMed1996

Computers, communication and confidentiality: tales of Baron Munchausen.

The aim was to examine the use of computer and paper based systems in accident and emergency (A&E) departments in the management of patients who are frequent attenders. More than half of the A&E consultants in the Thames regions who were sent a questionnaire responded (44 of the 80). 82% of the respondents use such systems predominantly to monitor violent patients, those with Munchausen syndrome, and children on the "at risk" register. Systems currently in use fail to fulfil many of the functions that would be required of an ideal system. When using computers to store and communicate clinical data, several ethical problems were identified but these appeared to be outweighed by the practical need and were also present with paper based systems. Safeguards could also be built into computer based systems to reduce some of the ethical problems. Computer systems should be deliberately chosen and implemented in response to a specific management problem. The potential benefits should be weighed against possible damaging side effects, such as a breach of confidentiality.

Confidentiality↗
PubMed1996

First-contact incidence rates of schizophrenia in Trinidad and one-year follow-up.

BACKGROUND: Incidence rates of schizophrenia among UK African-Caribbeans have been reported as high. Various explanations including selective migration and genetic vulnerability have been proposed. METHOD: In one calendar year, all new cases of psychosis presenting to various psychiatric services in two clearly defined geographical catchment areas in Trinidad-one in the rural south and the other an urban area-were studied. Standardised diagnostic instruments were applied and information collected using WHO screening and measurement instruments. RESULTS: A total of 56 cases were collected, giving an incidence rate of 2.2/1000 of broad schizophrenia with a rate of 1.6 for S+ schizophrenia. CONCLUSION: These rates are similar to those from the WHO study in Honolulu and Aarhus, and much lower than the rates for African-Caribbeans in London. The cases were followed up for one year and the poor outcome rate for schizophrenia was 19%. The findings are discussed in a cross-cultural context and suggestions for future research made.

Adult↗
PubMed1996

Morbid risk of schizophrenia in first-degree relatives of white and African-Caribbean patients with psychosis.

BACKGROUND: The high rate of schizophrenia among the second-generation African-Caribbean population in Britain has prompted much concern and speculation. Sugarman and Craufurd have reported that the morbid risk in the siblings of second-generation African-Caribbean schizophrenic patients was unusually high compared with that of the siblings of White patients. METHOD: We sought to replicate these findings by comparing the morbid risk for schizophrenia in the first-degree relatives of 111 White and 73 African-Caribbean psychotic probands. The latter comprised 35 first-generation (born in the Caribbean) and 38 second-generation (born in Britain) probands. RESULTS: The morbid risk for schizophrenia was similar for the parents and siblings of White and first-generation African-Caribbean patients, and for the parents of the second-generation African-Caribbean probands. However, the siblings of second-generation African-Caribbean psychotic probands had a morbid risk for schizophrenia that was seven times that of their White counterparts (P = 0.007); similarly, the siblings of second-generation African-Caribbean schizophrenic probands had a morbid risk for schizophrenia that was four times that of their White counterparts (P = 0.05). CONCLUSIONS: These findings replicate those of the earlier report of Sugarman and Craufurd, and suggest either that the second-generation African-Caribbean population in Britain is particularly vulnerable to some environmental risk factors for schizophrenia, or that some environmental factors act selectively on this population in Britain.

Adult↗
PubMed1995

The essential elements of culturally sensitive psychiatric services.

The recent re-structuring of the British National Health Service (NHS) involving a greater emphasis on community treatment has not specifically taken account of the unequal access to mental health services experienced by black people. The greater use amongst black people of compulsory orders, police involvement and reliance on psychotropic medication, although well established, has not influenced policy or led to a strategy to ensure that services appropriately meet the needs of the culturally diverse population in this country. We present the literature on service utilisation by black people and emphasise potential solutions in areas with which black people are dissatisfied. The service structures, ideology and mechanisms presented form the foundations of good practice.

Black or African American↗
PubMed1993

Brief family therapy with alcohol-dependent men in Trinidad and Tobago.

This study--the first of its kind in the English-speaking Caribbean--investigated the efficacy of modified brief family therapy in the treatment of alcoholism. Thirty men were treated with family therapy and milieu therapy and compared with 30 sex- and age-matched patients treated with milieu therapy alone. Follow-up over a period of 1 year showed significant levels of improvement in those treated with family therapy. The treatment group did not revert to their original drinking pattern. This can be attributed to family therapy. Family therapy was brief and involved seeing all significant members for 3 sessions, each session lasting 90 min. The role of family therapy and importance of culture in management of these patients are discussed. Our study confirms that a time-limited problem-solving family therapy approach is of use in these ethnic groups.

Adult↗
PubMed1992

Attitude of the medical profession to psychiatry.

The attitude of the medical profession to psychiatry carries important implications for the quality of personnel attracted into the specialty and for the treatment, in a general medical setting, of patients with mental disorders. This article examines the components of doctors' attitudes and reviews the literature with regard to their attitudes to psychiatrists themselves, psychiatric patients and psychiatry as a vocation. The implications of these findings for psychiatrists are discussed.

Attitude of Health Personnel↗