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Attempted suicide among Inuit youth: psychosocial correlates and implications for prevention.

https://arctichealth.org/en/permalink/ahliterature3655
Source
Can J Psychiatry. 1998 Oct;43(8):816-22
Publication Type
Article
Date
Oct-1998
Author
L J Kirmayer
L J Boothroyd
S. Hodgins
Author Affiliation
Department of Psychiatry, Sir Mortimer B Davis-Jewish General Hospital, Montreal, Quebec. cylk@musica.mcgill.ca
Source
Can J Psychiatry. 1998 Oct;43(8):816-22
Date
Oct-1998
Language
English
Publication Type
Article
Keywords
Adolescent
Culture
Female
Humans
Inuits - psychology
Male
Questionnaires
Research Support, Non-U.S. Gov't
Sex Factors
Social Support
Substance-Related Disorders - psychology
Suicide, Attempted - prevention & control - psychology
Abstract
OBJECTIVE: To identify potential risk and protective factors associated with attempted suicide among Inuit youth, a population known to have a high rate of both attempted and completed suicide in recent years. METHOD: A secondary analysis of data on 203 Inuit youth (aged 15 to 24 years) from a random community survey conducted by Santé Québec in 1992. Factors previously identified in the literature and in clinical consultation and ethnographic research were tested with bivariate statistics and logistic regression models for each gender. RESULTS: At the bivariate level, positive correlates included substance use (solvents, cannabis, cocaine), recent alcohol abuse, evidence of a psychiatric problem, and a greater number of life events in the last year. Regular church attendance was negatively associated with attempted suicide. Multivariate analysis indicated that a psychiatric problem, recent alcohol abuse, and cocaine or crack use were the strongest correlates of attempted suicide for females, while solvent use and number of recent life events were the strongest correlates for males. CONCLUSIONS: Suicide prevention programs can be targeted at youth who are using substances, particularly solvents, cocaine, and alcohol, have psychiatric illness, and have experienced recent negative life events. Involvement in church or other community activities may reduce the risk for suicide. Consideration of gender differences may allow more precise identification of those at risk for attempted suicide.
PubMed ID
9806088 View in PubMed
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Completed suicides among the Inuit of northern Quebec, 1982-1996: a case-control study.

https://arctichealth.org/en/permalink/ahliterature3316
Source
CMAJ. 2001 Sep 18;165(6):749-55
Publication Type
Article
Date
Sep-18-2001
Author
L J Boothroyd
L J Kirmayer
S. Spreng
M. Malus
S. Hodgins
Author Affiliation
Aboriginal Mental Health Research Team, Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Que.
Source
CMAJ. 2001 Sep 18;165(6):749-55
Date
Sep-18-2001
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Case-Control Studies
Female
Humans
Inuits - psychology - statistics & numerical data
Male
Mental Disorders - ethnology
Quebec - epidemiology
Regression Analysis
Research Support, Non-U.S. Gov't
Suicide - statistics & numerical data
Abstract
BACKGROUND: The rate of completed suicide among Inuit in Canada has been alarmingly high in recent years, and the suicide rate among Inuit in northern Quebec has increased since 1982. Our objectives were to describe the characteristics of Inuit people who died by suicide in Nunavik between 1982 and 1996, and to identify the antecedents and correlates of completed suicide. METHODS: We carried out a case-control study of 71 people who died by suicide between 1982 and 1996 and 71 population-based living control subjects matched for sex, community of residence and age within 1 year. Comprehensive medical charts were reviewed for data on sociodemographic characteristics, medical and psychiatric history, childhood separations and family history, and use of health care services. RESULTS: Most of the case subjects were single males aged 15 to 24 years. The two principal means of suicide were hanging (in 39 cases [54.9%]) and gunshot (in 21 cases [29.6%]). About 33% had been in contact with medical personnel in the month before their death. The case subjects were significantly more likely than the control subjects to have received a lifetime psychiatric diagnosis (one or more of depression, personality disorder or conduct disorder) (odds ratio [OR] 4.3 [95% confidence interval (CI) 1.2-15.2]) and to have had a history of psychiatric symptoms, disorder (including solvent sniffing) or treatment (OR 3.5 [95% CI 1.4-8.7]). The case subjects had experienced more severe types of nonpsychiatric illnesses and injuries than the control subjects (p = 0.04). The case subjects had more lifetime contacts with health care services than the control subjects (p = 0.01) and were more likely than the control subjects to have had contact with health care services in the year before death of the case subject (p = 0.03), even when psychiatric diagnoses were controlled for in conditional regression analysis (OR 1.02 [95% CI 1.01-1.04] and 5.0 [95% CI 1.07-23.7] respectively). INTERPRETATION: Since case subjects had frequent contact with health care services, frontline medical personnel may be in a position to identify people at risk for suicide.
PubMed ID
11584562 View in PubMed
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Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment.

https://arctichealth.org/en/permalink/ahliterature194176
Source
J Clin Psychiatry. 2001;62 Suppl 13:22-8; discussion 29-30
Publication Type
Article
Date
2001
Author
L J Kirmayer
Author Affiliation
Division of Social and Transcultural Psychiatry, McGill University, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec. laurence.kirmayer@mcgill.ca
Source
J Clin Psychiatry. 2001;62 Suppl 13:22-8; discussion 29-30
Date
2001
Language
English
Publication Type
Article
Keywords
Anxiety Disorders - diagnosis - epidemiology - ethnology
Attitude to Health
Canada - epidemiology
Communication Barriers
Cross-Cultural Comparison
Cultural Characteristics
Depressive Disorder - diagnosis - epidemiology - ethnology
Ethnic groups - psychology - statistics & numerical data
Humans
Medicine, Traditional
Physician-Patient Relations
Physicians, Family
Practice Guidelines as Topic
Primary Health Care - methods - statistics & numerical data
Somatoform Disorders - diagnosis - epidemiology
Syndrome
Terminology as Topic
Treatment Refusal
United States - epidemiology
Abstract
This article reviews cultural variations in the clinical presentation of depression and anxiety. Culture-specific symptoms may lead to underrecognition or misidentification of psychological distress. Contrary to the claim that non-Westerners are prone to somatize their distress, recent research confirms that somatization is ubiquitous. Somatic symptoms serve as cultural idioms of distress in many ethnocultural groups and, if misinterpreted by the clinician, may lead to unnecessary diagnostic procedures or inappropriate treatment. Clinicians must learn to decode the meaning of somatic and dissociative symptoms, which are not simply indices of disease or disorder but part of a language of distress with interpersonal and wider social meanings. Implications of these findings for the recognition and treatment of depressive disorders among culturally diverse populations in primary care and mental health settings are discussed.
PubMed ID
11434415 View in PubMed
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[Culture and mental illness among the Inuit of Nunavik]

https://arctichealth.org/en/permalink/ahliterature6179
Source
Sante Ment Que. 1993;18(1):53-70
Publication Type
Article
Date
1993
Author
L J Kirmayer
E. Corin
A. Corriveau
C. Fletcher
Source
Sante Ment Que. 1993;18(1):53-70
Date
1993
Language
French
Publication Type
Article
Keywords
Adult
Attitude to Health
Culture
English Abstract
Humans
Inuits - psychology
Male
Mental Disorders - epidemiology - ethnology
Quebec
Research Support, Non-U.S. Gov't
Substance-Related Disorders - ethnology
Abstract
While the major psychiatric disorders described in current nosology can be found among the Inuit of Northern Québec (Nunavik), there are important cultural influences on the symptomatology, social response and course of these disorders. A literature review, consideration of experiences with psychiatric consultation among the Inuit and the preliminary results of ongoing ethnographic research underscore the importance of the study of Inuit ethnopsychology and current attitudes toward the mentally ill in developing culturally sensitive psychiatric care.
PubMed ID
8218666 View in PubMed
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Culture and somatization: clinical, epidemiological, and ethnographic perspectives.

https://arctichealth.org/en/permalink/ahliterature204789
Source
Psychosom Med. 1998 Jul-Aug;60(4):420-30
Publication Type
Article
Author
L J Kirmayer
A. Young
Author Affiliation
Sir Mortimer B. Davis-Jewish General Hospital, and Division of Social & Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada. cylk@musica.mcgill.ca
Source
Psychosom Med. 1998 Jul-Aug;60(4):420-30
Language
English
Publication Type
Article
Keywords
Affective Symptoms - ethnology - psychology
Anthropology, Cultural
Canada
Cross-Cultural Comparison
Emigration and Immigration
Humans
Patient Acceptance of Health Care
Sick Role
Somatoform Disorders - ethnology - psychology
Abstract
The cross-cultural prevalence of somatization and the limitations of current nosology and psychiatric theory for interpreting cultural variations in somatization are reviewed.
Selective review was conducted of recent research literature and research findings from an epidemiological survey and ethnographic study of help-seeking and health care utilization of a random sample of 2246 residents in a Canadian urban multicultural milieu.
Somatization is common in all ethnocultural groups and societies studied to date. However, significant differences in somatization across ethnocultural groups persist even where there is relatively equitable access to health care services. Analysis of illness narratives collected from diverse ethnocultural groups suggests that somatic symptoms are located in multiple systems of meaning that serve diverse psychological and social functions. Depending on circumstances, these symptoms can be seen as an index of disease or disorder, an indication of psychopathology, a symbolic condensation of intrapsychic conflict, a culturally coded expression of distress, a medium for expressing social discontent, and a mechanism through which patients attempt to reposition themselves within their local worlds.
Major sources of differences in somatization among ethnocultural groups include styles of expressing distress ("idioms of distress"), the ethnomedical belief systems in which these styles are rooted, and each group's relative familiarity with the health care system and pathways to care. Psychological theories of somatization focused on individual characteristics must be expanded to recognize the fundamental social meanings of bodily distress.
Notes
Comment In: Psychosom Med. 1998 Jul-Aug;60(4):389-939710283
PubMed ID
9710287 View in PubMed
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Fatigue in primary care: prevalence, psychiatric comorbidity, illness behavior, and outcome.

https://arctichealth.org/en/permalink/ahliterature223827
Source
J Gen Intern Med. 1992 May-Jun;7(3):276-86
Publication Type
Article
Author
P J Cathébras
J M Robbins
L J Kirmayer
B C Hayton
Author Affiliation
Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montréal, Québec, Canada.
Source
J Gen Intern Med. 1992 May-Jun;7(3):276-86
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Anxiety - complications - epidemiology
Behavior
Chronic Disease
Comorbidity
Depression - complications - epidemiology
Fatigue - epidemiology - etiology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Prevalence
Primary Health Care - utilization
Quebec - epidemiology
Socioeconomic Factors
Abstract
To identify the prevalence, psychiatric comorbidity, illness behavior, and outcome of patients with a presenting complaint of fatigue in a primary care setting.
686 patients attending two family medicine clinics on a self-initiated visit completed structured interviews for presenting complaints, self-report measures of symptoms and hypochondriasis, and the Diagnostic Interview Schedule (DIS). Fatigue was identified as a primary or secondary complaint from patient reports and questionnaires completed by physicians.
Of the 686 patients, 93 (13.6%) presented with a complaint of fatigue. Fatigue was the major reason for consultation of 46 patients (6.7%). Patients with fatigue were more likely to be working full or part time and to be French Canadian, but did not differ from the other clinic patients on any other sociodemographic characteristic or in health care utilization. Patients with fatigue received a lifetime diagnosis of depression or anxiety disorder more frequently than did other clinic patients (45.2% vs. 28.2%). Current psychiatric diagnoses, as indicted by the DIS, were limited to major depression, diagnosed for 16 (17.2%) fatigue patients. Patients with fatigue reported more medically unexplained physical symptoms, greater perceived stress, more pathologic symptom attributions, and greater worries about having emotional problems than did other patients. However, only those fatigue patients with coexisting depressive symptoms differed significantly from nonfatigue patients. Patients with fatigue lasting six months or longer compared with patients with more recent fatigue had lower family incomes and greater hypochondriacal worry. Duration of fatigue was not related to rate of current or lifetime psychiatric disorder. One half to two thirds of fatigue patients were still fatigued one year later.
In a primary care setting, only those fatigue patients who have coexisting psychological distress exhibit patterns of abnormal illness cognition and behavior. Regardless of the physical illnesses associated with fatigue, psychiatric disorders and somatic amplification may contribute to complaints of fatigue in less than 50% of cases presented to primary care.
Notes
Comment In: J Gen Intern Med. 1993 Mar;8(3):1688455117
PubMed ID
1613608 View in PubMed
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The future of cultural psychiatry: an international perspective.

https://arctichealth.org/en/permalink/ahliterature197883
Source
Can J Psychiatry. 2000 Jun;45(5):438-46
Publication Type
Article
Date
Jun-2000
Author
L J Kirmayer
H. Minas
Author Affiliation
Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec. cylk@musica.mcgill.ca
Source
Can J Psychiatry. 2000 Jun;45(5):438-46
Date
Jun-2000
Language
English
Publication Type
Article
Keywords
Cross-Cultural Comparison
Cultural Diversity
Culture
Forecasting
Humans
International Cooperation
Mental Health Services - organization & administration
Psychiatry - trends
Abstract
Cultural psychiatry has evolved along 3 lines: 1) cross-cultural comparative studies of psychiatric disorders and traditional healing; 2) efforts to respond to the mental health needs of culturally diverse populations that include indigenous peoples, immigrants, and refugees; and 3) the ethnographic study of psychiatry itself as the product of a specific cultural history. These studies make it clear that culture is fundamental both to the causes and course of psychopathology and also to the effectiveness of systems of healing. The provision of mental health services in multicultural societies has followed different models that reflect their specific histories of migration and ideologies of citizenship. Globalization has influenced psychiatry through socioeconomic effects on the prevalence and course of mental disorders, changing notions of ethnocultural identity, and the production of psychiatric knowledge. A cultural perspective can help clinicians and researchers become aware of the hidden assumptions and limitations of current psychiatric theory and practice and can identify new approaches appropriate for treating the increasingly diverse populations seen in psychiatric services around the world.
PubMed ID
10900523 View in PubMed
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Inuit attitudes toward deviant behavior: a vignette study.

https://arctichealth.org/en/permalink/ahliterature5568
Source
J Nerv Ment Dis. 1997 Feb;185(2):78-86
Publication Type
Article
Date
Feb-1997
Author
L J Kirmayer
C M Fletcher
L J Boothroyd
Author Affiliation
Department of Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montréal, QC.
Source
J Nerv Ment Dis. 1997 Feb;185(2):78-86
Date
Feb-1997
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Attitude to Health
Educational Status
Factor Analysis, Statistical
Female
Humans
Inuits - psychology
Male
Mental Disorders - diagnosis - psychology
Middle Aged
Prognosis
Quebec
Research Support, Non-U.S. Gov't
Semantics
Sex Factors
Social Distance
Terminology
Abstract
Attitudes toward deviant behavior that might indicate psychiatric disorder were investigated among the Inuit of Northern Québec (Nunavik). In a convenience sample of 137 Inuit adults, respondents were randomly presented with one of six different vignettes that described a man with "strange" behavior who was either threatening or withdrawn and whose problem was labeled either "isumaluttuq" ("burdened or weighed down by thoughts"), "demon possession," or "mental illness." Respondents rated their willingness to live, work, or hunt with this person and allow him into their family on a social distance scale. Significant predictors of greater social distance were female gender, more education, less familiarity with the behavior, and perception of the person as less likely to recover. There were no significant effects of vignette behavior or label on social distance ratings. Rating of likelihood of recovery was influenced by the vignette label, with isumaluttuq associated with less chance of recovery. Ascribing strange behavior to morally wrong action and to spirits or demons were highly inter-correlated and each was associated with perception of greater likelihood of recovery. Results suggest that Inuit attitudes toward deviant behavior are influenced more by perceived familiarity and likelihood of recovery than by labels, causal attributions, or explanations. The indigenous psychological concept of isumaluttuq does not serve to reduce social stigma. Efforts to promote the community integration of psychiatric patients through education should aim to increase familiarity with the problematic behavior and emphasize potential for recovery.
PubMed ID
9048699 View in PubMed
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The mental health of Aboriginal peoples: transformations of identity and community.

https://arctichealth.org/en/permalink/ahliterature3320
Source
Can J Psychiatry. 2000 Sep;45(7):607-16
Publication Type
Article
Date
Sep-2000
Author
L J Kirmayer
G M Brass
C L Tait
Author Affiliation
Division of Social and Transcultural Psychiatry, McGill University. cylk@musica.mcgill.ca
Source
Can J Psychiatry. 2000 Sep;45(7):607-16
Date
Sep-2000
Language
English
Publication Type
Article
Keywords
Anthropology, Cultural
Canada
Cultural Diversity
Humans
Indians, North American - psychology
Inuits - psychology
Mental Disorders - ethnology
Social Environment
Social Identification
Abstract
This paper reviews some recent research on the mental health of the First Nations, Inuit, and Métis of Canada. We summarize evidence for the social origins of mental health problems and illustrate the ongoing responses of individuals and communities to the legacy of colonization. Cultural discontinuity and oppression have been linked to high rates of depression, alcoholism, suicide, and violence in many communities, with the greatest impact on youth. Despite these challenges, many communities have done well, and research is needed to identify the factors that promote wellness. Cultural psychiatry can contribute to rethinking mental health services and health promotion for indigenous populations and communities.
PubMed ID
11056823 View in PubMed
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Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics.

https://arctichealth.org/en/permalink/ahliterature211190
Source
Psychol Med. 1996 Sep;26(5):937-51
Publication Type
Article
Date
Sep-1996
Author
L J Kirmayer
J M Robbins
Author Affiliation
Culture and Mental Health Research Unit, Sir Mortimer B. Davis-Jewish General Hospital, Montréal, Québec, Canada.
Source
Psychol Med. 1996 Sep;26(5):937-51
Date
Sep-1996
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Analysis of Variance
Anxiety - epidemiology
Attitude to Health
Chi-Square Distribution
Depression - epidemiology
Discriminant Analysis
Female
Follow-Up Studies
Humans
Male
Middle Aged
Primary Health Care
Psychiatric Status Rating Scales
Quebec - epidemiology
Sampling Studies
Self-Assessment
Sick Role
Somatoform Disorders - epidemiology
Abstract
We examined the cognitive and sociodemographic characteristics of patients making somatic presentations of depression and anxiety in primary care. Only 15% of patients with depressive symptomatology on self-report, and only 21% of patients with current major depression or anxiety disorders on diagnostic interview, presented psychosocial symptoms to their GP. The remainder of patients with psychiatric distress presented exclusively somatic symptoms and were divided into three groups-initial, facultative and true somatizers-based on their willingness to offer or endorse a psychosocial cause for their symptoms. Somatizers did not differ markedly from psychologizers in sociodemographic characteristics except for a greater proportion of men among the true somatizers. Compared to psychologizers, somatizers reported lower levels of psychological distress, less introspectiveness and less worry about having an emotional problem. Somatizers were also less likely to attribute common somatic symptoms to psychological causes and more likely to endorse normalizing causes. In the 12 months following their initial visit, somatizers made less use of speciality mental health care and were less likely to present emotional problems to their GP. Somatizers were markedly less likely to talk about personal problems to their GP and reported themselves less likely to seek help for anxiety or sadness. Somatization represents a persistent pattern of illness behaviour in which mental health care is not sought despite easily elicited evidence of emotional distress. Somatization is not, however, associated with higher levels of medical health care utilization than that found among patients with frank depression or anxiety.
PubMed ID
8878327 View in PubMed
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13 records – page 1 of 2.