Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario.

OBJECTIVE: To compare the pathways to care and duration of untreated psychosis (DUP) for people of Black-African, Black-Caribbean, or White-European origin with first-episode psychosis (FEP). METHODS: We recruited a sample of 171 patients with FEP of Black-African, Black-Caribbean, and White-European origin from hospital- and community-based early intervention services (EIS) in the cities of Toronto and Hamilton. We compared the 3 groups on DUP and key indicators of the pathway to care. RESULTS: We observed differences in pathways to care across the 3 groups. Black-Caribbean participants had an increased odds of referral from an inpatient unit to EIS (OR 3.33; 95% CI 1.46 to 7.60) and a decreased odds of general practitioner involvement on the pathway to care (OR 0.17; 95% CI 0.07 to 0.46), as well as fewer total contacts (exp[ß] 0.77; 95% CI 0.60 to 0.99) when compared with White-European participants. Black-African participants had an increased odds of contact with the emergency department at first contact (OR 3.78; 95% CI 1.31 to 10.92). The differences in the DUP between groups were not statistically significant. CONCLUSIONS: Our findings suggest that there are significant differences in the pathways to EIS for psychosis for people of African and Caribbean origin in our Canadian context. It is essential to gain a comprehensive understanding of the pathways that different population groups take to mental health services, and the reasons behind observed differences, to inform the development of equitable services, targeting patients in the critical early stages of psychotic disorder.

The impact of hepatitis B knowledge and stigma on screening in Canadian Chinese persons.

BACKGROUND: Chronic hepatitis B (CHB) infection is endemic in East Asia, and those who emigrate to North America have higher rates of CHB infection when compared with the general population. To date, Chinese persons residing in Canada have not been mandated to be screened for CHB infection. OBJECTIVE: To understand factors that influence hepatitis B screening behaviour among the Chinese community in Toronto, Ontario, and to determine whether stigma acts as a barrier to screening. METHODS: Self-identified Chinese individuals at a family physician's office and at English as a second language (ESL) classes in Toronto completed a questionnaire with demographic questions, a hepatitis B virus (HBV) stigma scale and an HBV knowledge scale. Pearson product moment correlation and multiple regression techniques were used to analyze the data. RESULTS: The study group included 343 individuals. Their mean (± SD) age was 48.76 ± 17.49 years and the majority were born in China (n=229 [68%]). The mean score on the HBV knowledge scale was 10.13 ± 1.76 (range 0 to 15), with higher scores indicating greater HBV knowledge. The mean score on the stigma scale was 54.60 ± 14.18 (range 20 to 100), with higher scores indicating more stigma. Being an immigrant, having a family physician and having greater knowledge of HBV were associated with increased rates of screening for this infection. In contrast, greater levels of HBV stigma were associated with decreased likelihood of screening for HBV infection. CONCLUSIONS: HBV stigma is associated with reduced rates of screening for this infection.

Impact of life events and difficulties on the mental health of Chinese immigrant women.

This study examined the life events and difficulties inherent to the immigration process and the sources of social support that influenced mental health. A six-month longitudinal study, utilizing a detailed semi-structured interview protocol and standardized questionnaires, was conducted with a group of Chinese women who had migrated to Canada with their spouses in the last decade. All of the women and all of their spouses experienced major downward mobility. Correspondingly, the most frequent negative life event was employment-related and the most frequent difficulty was the financial strain of living below the poverty line, factors which significantly predicted the women's mental health. Social support had neither a main effect on mental health nor a buffer effect on the relationship between life events and difficulties and mental health. Implications for immigration and settlement policy are discussed.

Post-migration changes in gender relations among Ethiopian couples living in Canada.

The Ethiopian community ofToronto, Canada, has identified the prevention of marital conflict and partner abuse as a priority issue. Previous research and community discussions suggested that changes in gender relations following migration contribute to both marital conflict and partner abuse. The objective of this community-based pilot study was to explore post-migration changes in gender relations among Ethiopian couples in order to inform the development of violence-prevention strategies. Qualitative research methods and analyses were used. In-depth interviews and focus-group discussions were conducted with 8 couples who had been married in Ethiopia and migrated to Toronto. The findings indicate changes in gender relations following migration as well as concordant and discordant patterns of change. Change was found to be associated with factors such as age, number of years married, experience in a third country, and gender-role socialization. Implications for future research and nursing practice are discussed.

Role occupancy, role quality, and psychological distress in Chinese women.

This study explored the associations between role occupancy, role quality, and psychological distress in 897 Chinese women in Hong Kong. Results showed that employed as compared to nonemployed women reported a lower level of psychological distress. Never married as compared to married women, and mothers as compared to childless women, did not differ in their levels of psychological symptoms. Correlation results indicated that a net gain of rewards over concerns about social roles was negatively related to psychological distress. The number of social roles was related to the balance between rewards and concerns between social roles, but had no significant association with mental health status of women. Results of the hierarchical regression analyses showed that good mother role quality and the occupancy of the paid worker role were significant predictors of a low level of psychological distress. Findings based on a subsample of employed mothers failed to support the compensatory and spillover hypotheses. Limitations and implications for future studies were discussed.