Hoe je dit kan lezen:
Zwart: informatie of vragen vanuit de 'reading guide'
Blauw: mijn uitwerkingen op de vragen
Rood: aanvullingen op mijn uitwerkingen n.a.v. de werkgroep

Cultural diversity 2021, reading guide week 8.

Experiencing emotional or behavioural problems and getting help with them could be viewed as a process with a series of steps: being exposed to risk factors, getting problems, interpreting problems, seeking help, getting help. This process could apply to everyone, but to migrants each of the steps seems to be more complicated. Migration, culture, and cultural differences play a part in each step. An overall picture will be presented during the lecture. Each of the articles of this week is about one of these steps.

Zwirs and Stevens are about risk factors and prevalence, Verhulp is about interpretation and seeking help, and Fassaert is about getting help.

To our international students: the General practitioner (GP) or ‘huisarts’ is an important pillar of the Dutch healthcare system. There is one in every neighbourhood, on average 1 GP to 2300 residents. Access to the GP is free for everyone and the GP can do small interventions and is a gatekeeper to specialized interventions like therapy and surgery.

Fassaert, T., Hesselink, A. E., & Verhoeff. A. P. (2009). Acculturation and use of health care services by Turkish and Moroccan migrants: a cross-sectional population-based study. BMC Public Health, 3, 332. doi: 10.1186/1471-2458-9-332

The articles of Zwirs, Verhulp and Fassaert are based on research: a standard summery will do.

1. What is the main question?

Background: There is insufficient empirical evidence which shows if and how there is an interrelation between acculturation and health care utilisation. The present study seeks to establish this evidence within first generation Turkish and Moroccan migrants, two of the largest migrant groups in present-day Western Europe.

2. In what way is the question answered?

Methods: Data were derived from the Amsterdam Health Monitor 2004, and were complete for 358 Turkish and 288 Moroccan foreign-born migrants. Use of health services (general practitioner, outpatient specialist and health care for mental health problems) was measured by means of selfreport. Acculturation was measured by a structured questionnaire grading (i) ethnic selfidentification, (ii) social interaction with ethnic Dutch, (iii) communication in Dutch within one's private social network, (iv) emancipation, and (v) cultural orientation towards the public domain.

3. Which theories and key concepts are described?

Keywords:

Acculturation

Health care

Language ability

4. What are the main results and or conclusions?

Results: Acculturation was hardly associated with the use of general practitioner care. However, in case of higher adaptation to the host culture there was less uptake of outpatient specialist care among Turkish respondents (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.82-0.99) and Moroccan male respondents (OR = 0.81, 95% CI = 0.71-0.93). Conversely, there was a higher uptake of mental health care among Turkish men (OR = 0.81, 95% CI = 0.71-0.93) and women (OR = 0.81, 95% CI = 0.71-0.93). Uptake of mental health care among Moroccan respondents again appeared lower (OR = 0.74, 95% CI = 0.55-0.99). Language ability appeared to play a central role in the uptake of health care.
Conclusion: Some results were in accordance with the popular view that an increased participation in the host society is concomitant to an increased use of health services. However, there was heterogeneity across ethnic and gender groups, and across the domains of acculturation. Language ability appeared to play a central role. Further research needs to explore this heterogeneity into more detail. Also, other cultural and/or contextual aspects that influence the use of health services require further identification

5. How is the article related to the theme of the week? The theme of the course? To lectures and other articles?

The theme of this week is youth services and care. This article relates tot hat as it investigates wheter accultaration matters fort he use of healt care services by minority gorups (turkish and moroccan migrants), thus relating to diversity as well.

Stevens, G. W., & Vollebergh, W. A. (2008). Mental health in migrant children. Journal of Child Psychology and Psychiatry, 49, 276-294. https://doi.org/10.1111/j.1469-7610.2007.01848.x

The article of Stevens is a review article an should be studied in full.

1. What is the main question?

Is there a relation between migrant children and mental health (problems)?

our main aim was to gain insight into the effects of migration on the development of child problem behaviour

2. In what way is the question answered?

Many factors have been identified to explain differences in mental health problems between migrant and native children: the process of migration, the ethnic minority position of migrants, their specific cultural background and the selection of migrants. In this paper, the international literature regarding mental health of migrant children is reviewed using strict selection criteria. An extensive search was carried out to locate journal articles on the subject of mental health in migrant youth published since the 1990s. Only 20 studies met all inclusion criteria.

3. Which theories and key concepts are described?

Keywords:
Adolescents
children
externalising problems
internalising problems
mental health
migrant
review
ethnicity

4. What are the main results and or conclusions?

The included studies did not unequivocally confirm that migrant youth are at high risk of developing mental health problems

Our analysis of the selected studies revealed numerous other complicating factors hampering the drawing of sound conclusions. Our review confirmed earlier notions that the assessment of problem behaviour in immigrant youth depends upon the informant used in the study, which may be explained by large differences in child behaviour in the school and at home, differences in cultural standards of what constitutes tolerable behaviour and biases in teacher-, parent-, and self-reports. In addition, we showed that the development of problem behaviour varies with the migrant group studied, possibly due to differences in socioeconomic position, family stress and original culture between immigrant groups. Finally, generalised conclusions in this research field may not be warranted since particular characteristics of the host countries may also influence the level of mental health problems in immigrant children. More specifically, the ways in which receiving countries select migrants, the attitudes of these countries towards migrants, and international differences in child wellbeing in host countries may account for the differences. As these factors are not taken into account in most studies, the results of our selected studies are difficult to interpret, as all the above-mentioned factors may blur their results and confound their main findings.

5. How is the article related to the theme of the week? The theme of the course? To lectures and other articles?

The theme of this week is youth services and care. This article relates tot hat as its about mental health issues. It relates to diversity as its about migrant children.

Verhulp, E. E., Stevens, G. W., Pels, T. V., Van Weert, C., & Vollebergh, W. A. (2017). Lay beliefs about emotional problems and attitudes toward mental health care among parents and adolescents: Exploring the impact of immigration. Cultural Diversity and Ethnic Minority Psychology, 23(2), 269-280. doi: 10.1037/cdp0000092

The articles of Zwirs, Verhulp and Fassaert are based on research: a standard summery will do.

1. What is the main question?

Objective: Individuals’ lay beliefs about mental health problems and attitudes toward mental health care are thought to be influenced by the cultural background of these individuals. In the current study, we investigated differences between immigrant Dutch and native Dutch parents and adolescents in lay beliefs about emotional problems and attitudes toward mental health care. Additionally, among immigrant Dutch parents, we examined the associations between acculturation orientations and lay beliefs about emotional problems as well as attitudes toward mental health care.

2. In what way is the question answered?

Method: In total, 349 pairs of parents and their adolescent children participated in our study (95 native Dutch, 85 Surinamese-Dutch, 87 Turkish-Dutch, 82 Moroccan-Dutch). A vignette was used to examine participants’ lay beliefs.

3. Which theories and key concepts are described?

Keywords:
lay beliefs: Lay beliefs about mental health problems reflect people’s own ideas and beliefs about the causes of and solutions to mental health problems and the treatments of those problems
attitudes
mental health care
immigration

4. What are the main results and or conclusions?

Results: Immigrant Dutch and native Dutch parents differed in their lay beliefs and attitudes toward mental health care, whereas hardly any differences were revealed among their children. Turkish-Dutch and Moroccan-Dutch parents showed more passive and fewer active solutions to emotional problems compared to native Dutch parents. Additionally, Moroccan-Dutch and Surinamese-Dutch parents reported greater fear of mental health care compared to native Dutch parents. Furthermore, the results showed that immigrant Dutch parents who were more strongly oriented toward the Dutch culture reported less fear of mental health care.
Conclusion: Our results showed clear differences in lay beliefs and attitudes toward mental health care between immigrant Dutch and native Dutch parents but not between their children. Substantial differences were also found between parents from different immigrant Dutch populations as well as within the population of immigrant Dutch parents.

Lay beliefs about emotional problems: Support for the hypothesis that immigrant Dutch parents would be more likely to make external causal attributions and less likely to make internal causal attributions to emotional problems compared to native Dutch parents was lackin
attitudes toward mental health care: Although no differences between ethnic groups were found with regard to the rejection of mental health care (providers, e.g., “mental health care providers have nothing to do with these problems”), Surinamese-Dutch and Moroccan-Dutch parents did report considerably higher levels of fear of mental health care compared to native Dutch parents. This fear partly focused on the expected shame it would bring to the family if others were to find out about these problems

Acculturation orientations: Furthermore, within the immigrant Dutch populations, parents’ orientations toward the Dutch and ethnic culture were clearly associated with their lay beliefs and attitudes toward mental health care. In line with our expectations, stronger orientations among immigrant Dutch parents toward the Dutch culture were associated with less-passive solutions to emotional problems, with less fear of care, with lower rejection of care, and with a lower preference for informal compared to formal help. Additionally, whenever immigrant Dutch parents were more strongly oriented toward their ethnic culture, they were more likely to agree with passive solutions to emotional problems and to prefer informal (instead of formal) help. Contrary to our expectations, a stronger orientation toward the Dutch culture was also associated with more environmental solutions to problems and a stronger orientation toward the ethnic culture was associated with a higher tendency to agree with active solutions to emotional problems.

Associations with mental health service use: this study only found a relationship between active and passive solutions to emotional problems and mental health service use (as reported by parents).

Conclusion In summary, the findings of the current study indicated that differences in lay beliefs and attitudes toward mental health care between Dutch immigrants and native Dutch are to be expected. Furthermore, differences in lay beliefs and attitudes toward mental health care also emerged between different immigrant groups, between generations, and within immigrant groups. Hence, this variation between immigrant groups, between generations, and within groups should be accounted for in future research to be able to study the multifaceted effect of culture on lay beliefs, attitudes toward, and use of mental health care more consistently. Finally, the findings of the current study may also have several practical implications. On the one hand, our findings suggest that lay beliefs and attitudes toward mental health care may not be as important for the actual mental health care use of immigrant adolescents in the Netherlands as expected. Thus, interventions aimed at increasing the mental health care use of these adolescents should potentially focus on other processes (such as the extent to which parents identify emotional problems and disorders for their children; see Verhulp et al., 2013). Still, replication studies on this topic are necessary, especially considering the specific character of the current study (i.e., using a fictitious vignette about child problem behavior instead of asking parents about their lay beliefs on their children’s own problems). On the other hand, our study did find considerable differences between immigrant and nonimmigrant (adult) populations in lay beliefs and attitudes toward mental health care. Gaining insight in these lay beliefs and attitudes may be of importance to provide successful mental health care (e.g., Bhui et al., 2006). The Cultural Formulation Interview, for example, may be a relevant instrument for assessing clients’ lay beliefs and attitudes toward mental health care in clinical practice (American Psychiatric Association, 2013).

5. How is the article related to the theme of the week? The theme of the course? To lectures and other articles?

The theme of this week is youth services and care. This article discusses they way people from different cultures might differ lay beliefs towards youth services and care, thereby also relating to cultural diversity.

Zwirs, B. W. C., Burger, H., Schulpen, T. W. J., Wiznitzer, M., Fedder, H., & Buitelaar, J. K. (2007). Prevalence of psychiatric disorders among children of different ethnic origin. Journal of Abnormal Child Psychology, 35, 556-566

The articles of Zwirs, Verhulp and Fassaert are based on research: a standard summery will do.

1. What is the main question?

Abstract The present study assesses the population prevalence of DSM-IV disorders among native and immigrant children living in low socio-economic status (SES) innercity neighborhoods in the Netherlands.

The second aim of the study was to examine associated mechanisms of psychiatric disorders across the four ethnic groups

2. In what way is the question answered?

In the first phase of a two-phase epidemiological design, teachers screened an ethnically diverse sample of 2041 children aged 6–10 years using the Strengths and Difficulties Questionnaire (SDQ). In the second phase, a subsample of 253 children was psychiatrically examined, while their parents were interviewed. In addition, teachers completed a short questionnaire about 10 DSM-IV items. Prevalence was estimated using the bestestimate diagnosis based on parent, child and teacher information.

3. Which theories and key concepts are described?

Keywords:
Keywords Prevalence
Psychiatric disorders
Ethnicity

4. What are the main results and or conclusions?

Projected to the total population, 11% of the children had one or more impairing psychiatric disorders, which did not differ between native and non-native children. In the total group a clear relationship was observed between the prevalence of psychiatric disorders and gender, parental psychopathology, peer problems and school problems, but not among all ethnic groups separately. This study suggests that the prevalence of psychiatric disorders among non-treated minority and native children in low SES inner-city neighborhoods does not materially differ. However, associated mechanisms may be influenced by ethnicity.

Extra van discussion:
No association was observed between the prevalence of psychiatric disorders and age which may be explained by the restricted age range of the sample (6–10 years). Gender differences in the prevalence of psychiatric disorders appeared to be crossculturally invariant, as boys had more psychiatric disorders than girls in all ethnic groups, except for the Turks, accounted for largely by a relatively lower prevalence among Turkish boys.

In contrast with previous results (Verhulst & Achenbach, 1995a), we observed no association between the prevalence of psychiatric disorders and SES, i.e. parents’ highest educational level.

Consistent with previous results (Johnson et al., 2006), parental psychopathology was related to psychiatric disorders in the total group. This association was also observed in the Dutch and Turkish group, but not in the other ethnic groups

In accordance with previous findings (Sowa et al., 2000; Stevens et al., 2005a; b), school problems were positively related to psychiatric disorders among all ethnic groups.

5. How is the article related to the theme of the week? The theme of the course? To lectures and other articles?

The theme of this week is youth services and care. This article investigates prevalence of psychiatric disorders among native and immigrant children and its association mechanisms, thereby providing guidance for youth services and care, relating to diversity as well.

[In the design of preventive interventions and treatment programs for youth, policy makers need to know the prevalence of psychiatric disorders among children. With the increasing ethnic diversity of populations worldwide, comparing the prevalence of psychiatric disorders in children of different ethnic background is of particular interest]