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Biomedical subjects

Rob Whitley

Publications and source records attributed to Rob Whitley.

11 recordsLinked to original sources
PubMed2006

Understanding immigrants' reluctance to use mental health services: a qualitative study from Montreal.

OBJECTIVE: Studies suggest that non-European immigrants to Canada tend to under use mental health services, compared with Canadian-born people. Social, cultural, religious, linguistic, geographic, and economic variables may contribute to this underuse. This paper explores the reasons for underuse of conventional mental health services in a community sample of immigrants with identified emotional and somatic symptoms. METHOD: Fifteen West Indian immigrants in Montreal with somatic symptoms and (or) emotional distress, not currently using mental health services, participated in a face-to-face in-depth interview exploring health care use. Interviews were analyzed thematically to discern common factors explaining reluctance to use services. RESULTS: Across participants' narratives, we identified 3 significant factors explaining their reluctance to use mental health services. First, there was a perceived overwillingness of doctors to rely on pharmaceutical medications as interventions. Second, participants perceived a dismissive attitude and lack of time from physicians in previous encounters that deterred their use of current health service. Third, many participants reported a belief in the curative power of nonmedical interventions, most notably God and to a lesser extent, traditional folk medicine. CONCLUSION: The above factors may highlight important areas for intervention to reduce disparities in immigrant use of mental health care. We present our framework as a model, grounded in empirical data, that further research can explore.

Caribbean Region↗
PubMed2005

Can urban regeneration programmes assist coping and recovery for people with mental illness? Suggestions from a qualitative case study.

Researchers and policy-makers are increasingly recognizing that urban socio-environmental conditions can affect the development and course of numerous health problems. The aim of this paper is to investigate the impact an urban regeneration programme can have on everyday functioning, coping and recovery for people with a mental illness. We were also interested in discerning which component parts of the regeneration are the most important in positively affecting people with mental illness. These questions were explored through an in-depth qualitative case study of the Gospel Oak neighbourhood in London, which recently underwent an intensive urban regeneration programme. Interviews and focus groups were conducted with residents living with a mental illness (n = 16). Relevant participant observation was also conducted. Participants reported that interventions that improved community safety were by far the most important in affecting everyday coping and functioning. Interventions that improved the quantity and quality of shared community facilities had a positive, but milder effect on mental health. Component parts that appeared to have little effect included environmental landscaping and greater community involvement in decision-making processes. Most participants reported that their mental illness was a consequence of severe insults over the life-span, for example childhood neglect or family breakdown. Thus, the regeneration was seen as something that could assist coping, but not something that could significantly contribute to complete recovery. Our results thus suggest that urban regeneration can have a mild impact on people with mental illness, but this appears to be outweighed by life-span experience of severe individual-level risk factors. That said, some of our findings converge with other studies indicating that community safety and community facilities can play a role in positively affecting mental health. Further ethnographic and epidemiological research is necessary to explore these two factors.

Adaptation, Psychological↗
PubMed2005

Is there a link between rates of common mental disorder and deficits in social capital in Gospel Oak, London? Results from a qualitative study.

Previous research in Gospel Oak indicates high-rates of common mental disorder. This paper explores how far deficits in social capital may be linked to these rates. Interviews, focus groups and participant observation were conducted to assess social capital in Gospel Oak from the phenomenological experience of residents. The data suggested that most residents perceived the neighbourhood to be rich in well-developed facilities, services and associational activity. Residents also generally expressed satisfaction with local trust and reciprocity. The results do not support the hypothesis that rates of common mental disorder in Gospel Oak are linked to deficits in social capital. Compositional factors may be more important in accounting for these rates.

Female↗
PubMed2005

Fear of crime, mobility and mental health in inner-city London, UK.

This paper examines the relationship between fear of crime and mental health, and assesses the role interventions may have in helping overcome any negative impact arising from this fear. The data were gathered over a 2-year period in the Gospel Oak neighbourhood of North London using in-depth interviews, focus groups and participant observation. The data are analysed primarily by comparing the impact of fear of crime across sub-groups notably divided by gender, age and mental health status. It was found that fear of crime had a disproportionately negative impact on certain sub-groups, most notably low-income mothers, and to a lesser extent the mentally ill. They experienced what we term "time-space inequalities" as a consequence of fear of crime and other related factors. These inequalities describe variation in the ability to access and utilise different times and spaces within both the immediate and the wider environment. These have negative behavioural and affective consequences that appear to impact on overall mental health. They restrict spatial and temporal movement deterring protective social activity, health-promoting community involvement and use of services. Affective consequences include negative mood and low self-esteem. These inequalities were experienced less in other groups such as mentally healthy men or middle-income women. They appeared to be diminished by interventions that encourage spatial and temporal movement. These include comprehensive local transport, government-issued free travel passes for vulnerable populations and neighbourhood community safety measures such as the installation of CCTV. We suggest that experience of time-space inequalities may be damaging to mental health and that interventions which lessen them may help prevent, ameliorate or shorten episodes of mental illness.

Crime↗
PubMed2005

Are inner-cities bad for your health? Comparisons of residents' and third parties' perceptions of the urban neighbourhood of Gospel Oak, London.

This paper analyses representations of the neighbourhood of Gospel Oak (London, UK), by contrasting views of residents with views expressed by third parties. Data from residents were gathered through in-depth qualitative methods. Data from third parties were gathered through documentary analysis. Third parties' descriptions of Gospel Oak were significantly more negative than residents'. In contrast, residents were overwhelmingly positive about the neighbourhood, often taking a diametrically opposed view to third parties on the same factor, for example, quality of housing. We argue that third parties' negative social construction of Gospel Oak is functional rather than descriptive; a pathological orientation is usually taken to assist efforts to win regeneration funding. Though this is sometimes successful, we discuss possible negative affects of this social construction, for example, stigmatisation. Finally, we warn against making assumptions of collective social and physical pathology in urban neighbourhoods, urging a more critical approach to the study of the inner-city in the health sciences.

Crime↗
PubMed2005

Thinking inside the bubble: evidence for a new contextual unit in urban mental health.

OBJECTIVE: Previous quantitative research has suggested that there is a link between housing, the urban environment, and mental health. However, methodological and design issues make it difficult to disentangle the relative influence of dwelling specific and wider urban environmental influences on individual mental health. The aim of this study was to explore the link between the dwelling, the immediate urban environment, and mental health to generate a new conceptual framework by which understanding of dwelling and urban environmental influences on mental health can be advanced. DESIGN AND PARTICIPANTS: Qualitative interviews and focus groups were conducted with 32 inner city residents. Participants, stratified by sex and mental health status, were randomly recruited from a wider quantitative survey. An almost equal number of men and women as well as people with or without mental health problems participated, allowing for comparison of experience. Data were analysed inductively to generate an appropriate theoretical framework regarding dwelling and urban environmental influences on mental health. SETTING: An inner city neighbourhood of about 6200 people in north west London. Most of that population live in public housing. MAIN RESULTS: The principal study finding is that between the dwelling unit and the neighbourhood unit, evidence was found for another meaningful contextual unit of analysis, the "residential bubble" through which effects on mental health can be mediated. The residential bubble describes a limited area of three dimensional space that surrounds a dwelling, encompassing immediate neighbours (above, below, and adjacent) and shared public space bordering the dwelling. Positive events and processes within the bubble had a beneficial influence on mental health whereas negative ones tended to have a damaging influence. These seemed to disproportionately have an impact on people with pre-existing mental health problems. CONCLUSION: The concept of the "residential bubble" may be a meaningful new contextual unit of analysis in urban mental health. This may have important implications with regards to interventions and measurement development.

Environment↗
PubMed2005

The role of Afro-Canadian status in police or ambulance referral to emergency psychiatric services.

OBJECTIVE: This study tested the hypothesis that among patients admitted to a hospital with psychosis, Afro-Canadian patients would be more likely than Euro-Canadian or Asian-Canadian patients to be brought to emergency services by police or ambulance. METHODS: Data on psychotic patients admitted to the psychiatry ward in 1999 were extracted from records of a general hospital in Montreal. Logistic regression models examined the relationship between being Afro-Canadian and being brought to the emergency service by police or ambulance, while controlling for age, gender, marital status, and number of psychotic symptoms. RESULTS: Of the 351 patients with psychosis, 59 percent were Euro-Canadian, 11 percent were Afro-Canadian, and 18 percent were Asian Canadian. Most Afro-Canadian patients in the study were immigrants from the Caribbean and Africa. Being Afro-Canadian was independently and positively associated with police or ambulance referral to emergency services. CONCLUSIONS: Afro-Canadians admitted to the hospital with psychosis are overrepresented in police and ambulance referrals to emergency psychiatric services.

Adult↗
PubMed2005

Qualitative research in psychiatry.

This paper is an overview of qualitative research and its application to psychiatry. It is introductory and attempts to describe both the aims of qualitative research and its underlying philosophical basis. We describe the practice and process of qualitative research and follow this with an overview of the 3 main methods of inquiry: interviews, focus groups, and participant observation. Throughout the paper, we offer examples of cases where qualitative research has illuminated, or has the potential to illuminate, important questions in psychiatric research. We describe methods of sampling and follow with an overview of qualitative analysis, appropriate checks on rigour, and the presentation of qualitative results. The paper concludes by arguing that qualitative methods may be an increasingly appropriate methodology to answer some of the demanding research questions being posed in 21st century psychiatry.

Bias↗
PubMedDate not supplied

Social capital and psychiatry: review of the literature.

Social capital is an umbrella term used to describe aspects of social networks, relations, trust, and power, as a function of either the individual or a geographical entity (e.g., a city neighborhood). Increased attention is being paid to the role that social capital can play in determining a variety of physical health outcomes, though less attention has been paid to its role in determining mental health outcomes. This relative inattention continues despite a long historical tradition in psychiatry of exploring the role that socio-environmental factors can play in the etiology and course of mental illness. In this review, we begin by tracing the historical development of the concept of social capital, describing and analyzing competing definitions. We then proceed to review the published studies that examine the relationship between social capital and mental health-looking first at studies that focus on depression and anxiety, and second at studies that focus on psychoses. After briefly exploring whether social capital can have a detrimental effect on mental health, we discuss how knowledge regarding social capital may aid the clinician and mental health services. We go on to make a number of suggestions relevant to methodological, theoretical, and empirical advancement. These suggestions include refining the definitions of social capital, paying attention to communities without propinquity, and constructing contextual indicators of social capital. We conclude by remarking that social capital may be a promising heuristic for studies in community psychiatry and may even help individual clinicians in designing treatment plans. Despite all this promise, however, there is a lack of strong evidence supporting the hypothesis that social capital protects mental health.

Cognition↗