Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-22T18:36:08.285Z Has data issue: false hasContentIssue false

Exploring Perceptions of “Wellness” in Black Ethnic Minority Individuals at Risk of Developing Psychosis

Published online by Cambridge University Press:  16 October 2012

Louisa Codjoe*
Affiliation:
King's College London, and South London and Maudsley NHS Trust, UK
Majella Byrne
Affiliation:
King's College London, and South London and Maudsley NHS Trust, UK
Matthew Lister
Affiliation:
Oxford Health NHS Foundation Trust, UK
Philip McGuire
Affiliation:
King's College London, and South London and Maudsley NHS Trust, UK
Lucia Valmaggia
Affiliation:
King's College London, South London and Maudsley NHS Trust, UK, and Maastricht University, Netherlands
*
Reprint requests to Louisa Codjoe, Institute of Psychiatry, Psychosis Studies, PO Box 63, de Crespigny Park, Denmark Hill, London SE5 8AF, UK. E-mail: [email protected]

Abstract

Background: The NICE Schizophrenia guidelines (NICE, 2009, Update) recommend that services should address cultural differences in treatment, expectations and adherence, and clients’ explanatory models of illness should be better understood. Service users from Black African and Black Caribbean communities are overrepresented in psychosis services in the UK, yet there is no literature on how wellness is understood by this group. Aims: This study explored perceptions of wellness in Black African and Black Caribbean individuals with an At Risk Mental State (ARMS) for psychosis. Method: A Q set of potential meanings of wellness was identified from a literature search and interviews with people at risk of developing psychosis. From this, 50 potential definitions were identified; twenty Black African and Black Caribbean ARMS clients ranked these definitions. Results: Following factor analysis of completed Q sorts, six factors emerged that offered insight into perceptions of wellness in this population. These factors included: sense of social purpose explanation, the surviving God's test explanation, the internalization of spirituality explanation, understanding and attribution of symptoms to witchcraft explanation, avoidance and adversity explanation, and seeking help to cope explanation. Conclusions: Although preliminary, differences between the factors suggests that there may be perceptions of wellness specific to these groups that are distinct from the medical view of wellness promoted within early detection services. These differences may potentially impact upon engagement, particularly factors that clients feel may facilitate or aide their recovery. It is suggested that these differences need to be considered as part of the assessment and formulation process.

Type
Empirically Grounded Clinical Interventions
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adams, T., Bezner, J. and Steinhardt, M. (1997). The conceptualization and measurement of perceived wellness: integrating balance across and within dimensions. American Journal of Health Promotion, 11, 208218.Google Scholar
Aldrich, S. and Eccleston, C. (2000). Making sense of everyday pain. Social Science and Medicine, 50, 16311641.CrossRefGoogle ScholarPubMed
Becker, M. H. and Maimon, L. A. (1983). Models of health related behaviour. In Mechanic, D. (Ed.), Handbook of Health, Health Care and the Health Professions (pp. 539568). New York: Free Press.Google Scholar
Berry, K. K. L., Wearden, A. J. and Barrowclough, C. (2007). Adult attachment styles and psychosis: an investigation of associations between general attachment styles and attachment relationships with specific others. Social Psychiatry and Psychiatric Epidemiology, 42, 972976.CrossRefGoogle ScholarPubMed
Broome, M. R., Woolley, J. B., Johns, L. C., Valmaggia, L. R., Tabraham, P., Gafoor, R., et al. (2005). Outreach and support in south London (OASIS): implementation of a clinical service for prodromal psychosis and the at risk mental state. European Psychiatry, 20, 372378.Google Scholar
Cantor-Graee, E. and Selten, , , J-P. (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry, 162, 1224.Google Scholar
Cantor-Graee, E. and Pedersen, C. B. (2007). Risk of schizophrenia in second-generation immigrants: a Danish population-based cohort study. Psychological Medicine, 37, 485494.Google Scholar
Collins English Dictionary (2012). Complete and Unabridged 10th Edition. Retrieved 14 May, 2012 from Dictionary.com: http://dictionary.reference.com/browse/culture.Google Scholar
Diener, E., Diener, M. and Diener, C. (2009). Factors Predicting the Subjective Well-being of Nations. Social Indicators Research Series. Netherlands: Springer.Google Scholar
Diener, E. and Lucas, R. E. (2000). Subjective emotional well-being. In Lewis, M. and Haviland, J. M. (Eds.), Handbook of Emotions (2nd ed.) (pp. 325337). New York: Guilford.Google Scholar
Dudley, R., Siitarinen, J., James, I. and Dodgson, G. (2009). What do people with psychosis think caused their psychosis? A Q methodology study. Behavioural and Cognitive Psychotherapy, 37, 1124.CrossRefGoogle ScholarPubMed
Fallot, R. D. (2001). Spirituality and religion in psychiatric rehabilitation and recovery from mental illness. International Review of Psychiatry, 13, 110116.CrossRefGoogle Scholar
Fearon, P. and Morgan, C. (2006). Environmental factors in schizophrenia: the role of migrant studies. Schizophrenia Bulletin, 32, 405408.Google Scholar
Garety, P. A., Kuipers, E. and Fowler, D. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189195.Google Scholar
Gumley, A. and Schwannauer, M. (2006). Staying Well After Psychosis: a cognitive interpersonal approach to recovery and relapse prevention. Chichester: Wiley and Sons Ltd.Google Scholar
Henquet, C., Krabbendam, L., Spauwen, J., Kaplan, C., Lieb, R., Wittchen, H. U., et al. (2005). Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. British Medical Journal, 330 (7481), 11.CrossRefGoogle ScholarPubMed
Jones, S. T., Guy, A. and Ormrod, J. A. (2003). A Q-methodological study of hearing voices: a preliminary exploration of voice hearers’ understanding of their experiences. Psychology and Psychotherapy: Theory Research and Practice, 76, 189209.Google Scholar
Kessler, R. C., McGonagle, K. A. and Zhao, S. (1994). Lifetime and 12-month prevalence of DSMIII-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 819.CrossRefGoogle Scholar
Kinderman, P., Setzu, E., Lobban, F. and Salmon, P. (2006). Illness beliefs in schizophrenia. Social Science and Medicine, 63, 19001911.Google Scholar
Kitzinger, C. (1987). The Social Construction of Lesbianism (Inquiries in Social Construction series). London: Sage Publications.Google Scholar
Koenig, H. G. (2007). Religion and remission of depression in medical inpatients with heart failure/pulmonary disease. Journal of Nervous and Mental Disease, 195, 389395.CrossRefGoogle ScholarPubMed
Lloyd, P. and Moodley, P. (1992). Psychotropic medication and ethnicity: an inpatient survey. Social Psychiatry and Psychiatric Epidemiology, 27, 95101.Google Scholar
Lysaker, P. H. (2003). Movement towards coherence in the psychotherapy of schizophrenia: a method for assessing narrative transformation. The Journal of Nervous and Mental Disease, 191, 538541.Google Scholar
Mallett, R., Leff, J. and Bhugra, D. (2004). Social environment, ethnicity and schizophrenia: a case-control study. Social Psychiatry Epidemiology, 37, 329335.CrossRefGoogle Scholar
Markus, H. R. and Kitayama, S. (1991). Culture and the self: implications for cognition, emotion, and motivation. Psychological Review, 98, 224253.CrossRefGoogle Scholar
McCabe, R. and Priebe, S. (2004). Explanatory models of illness in schizophrenia: a comparison of four ethnic groups. British Journal of Psychiatry, 185, 2530.Google Scholar
Mental Health Act Commission (1999). Eighth Biennial Report. London: The Stationery Office.Google Scholar
Morgan, C., Mallett, R. and Hutchinson, G. (2005). Pathways to care and ethnicity. 2. Source of referral and help-seeking. Report from the AESOP study. British Journal of Psychiatry, 186, 290296.CrossRefGoogle ScholarPubMed
Morrison, A. P., French, P., Parker, S., Roberts, W., Stevens, H., Bentall, R. P., et al. (2005). Three-year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultra high risk. Schizophrenia Bulletin, 33, 682687.Google Scholar
National Institute for Health and Clinical Excellence, Update (NICE) (2009). Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care. Ref: CG82. http://www.nice.org.uk/CG001.Google Scholar
Parish, J. (2005). From Liverpool to Freetown: West African witchcraft, conspiracy and the occult. Culture and Religion, 6, 353368.Google Scholar
Rathod, S., Kingdon, D., Phiri, P. and Gobbi, M. (2010). Developing culturally sensitive cognitive behaviour therapy for psychosis for ethnic minority patients by exploration and incorporation of service users’ and health professionals’ views and opinions. Behavioural and Cognitive Psychotherapy, 38, 511533.Google Scholar
Reger, G. M. and Rogers, S. A. (2002). Diagnostic differences in religious coping among individuals with persistent mental illness. Journal of Psychology and Christianity, 21, 341348.Google Scholar
Ryff, C. D. and Keyes, C. L. M. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69, 719727.CrossRefGoogle ScholarPubMed
Sainsbury Centre for Mental Health (2002). Breaking the Circles of Fear: a review of the relationship between mental health services and African and Caribbean communities. London: Sainsbury Centre for Mental Health.Google Scholar
Schmolck, P. (2002). PQMethod (Version 2.11). Adapted from mainframe-program Qmethod written by John Atkinson, 1992) [Computer Software]. Neubiberg, University of the Bundeswehr, Munich. Available as freeware at://www.rz.unibwmuenchen.de/~p41bsmk/qmethod/.Google Scholar
Selten, J. P., Veen, N., Feller, W., Blom, J. D., Schols, D., Camoenië, W., et al. (2001). Incidence of psychotic disorders in immigrant groups to the Netherlands. British Journal of Psychiatry, 178, 367372.Google Scholar
Sharpley, M. S., Hutchinson, G. and Murray, R. M. (2001). Understanding the excess of psychosis among the African Caribbean population in England: review of current hypotheses. British Journal of Psychiatry, 178, s6068.Google Scholar
Shinebourne, P. and Adams, M. (2009). Therapists’ understandings and experiences of working with clients with problems of addiction: a pilot study using Q methodology. Counselling and Psychotherapy Research, 7, 211219.Google Scholar
Stenner, P. and Marshall, H. (1995). A Q methodological study of rebelliousness. European Journal of Social Psychology, 25, 621636.Google Scholar
Stainton Rogers, R. (1995) Q methodology. In Smith, J. A., Harre, R. and Longenhove, I. Van (Eds.), Rethinking Methods in Psychology (pp. 178193). London: Sage.Google Scholar
Summerfield, S. and Veale, D. (2008). Proposals for massive expansion of psychological therapies would be counterproductive across society. The British Journal of Psychiatry, 192, 326330.CrossRefGoogle ScholarPubMed
Tepper, L., Rogers, S. A. and Coleman, E. M. (2001). The prevalence of religious coping among persons with persistent mental illness. Psychiatric Services, 52, 660665.Google Scholar
Triandis, H. C. (2000). Cultural syndromes and subjective well-being. In Diener, E. and Suh, E. M. (Eds.), Subjective Well-Being Across Cultures (pp. 1337). Cambridge, MA: MIT Press.CrossRefGoogle Scholar
Veenhoven, R. (2007). Measures of Gross National Happiness. Paper presented at OECD conference on Measurability and Policy Relevance of Happiness, 2–3 April, Rome. http://www.oecd.org/document/12/0,2340,en_21571361_31938349_37720396_1-1_1_1,00.html. Accessed January 2010.Google Scholar
Veling, W., Selten, J-P., Veen, N., Laan, W., Blom, J. D. and Hoek, H. W. (2006). Incidence of schizophrenia among ethnic minorities in the Netherlands: a four-year first-contact study. Schizophrenia Research, 86, 189193.Google Scholar
Warner, R. (2009). Recovery from schizophrenia and the recovery model. Current Opinion in Psychiatry, 22, 374380.Google Scholar
Watts, S. and Stenner, P. (2005). Doing Q methodology: theory, method and interpretation. Qualitative Research in Psychology, 2, 6791.CrossRefGoogle Scholar
Yung, A. R., Yuen, H. P., McGorry, P. D., Phillips, L. J., Kelly, D., Dell'Olio, M., et al. (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry, 39, 964971.Google Scholar
Ziguras, S., Klimidis, S., Lewis, J. and Stuart, G. (2003). Ethnic matching of clients and clinicians and use of mental health services by ethnic minority clients. Psychiatric Services, 54, 535541.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.