Treating Depression among Haitians Guerda Nicolas PhD University of Miami

Transcription

1 Treating Depression among Haitians Guerda Nicolas PhD University of Miami

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3 Haitians in the U.S. In the 1920 s there were approximately 500 documented Haitians in the US 37, 520 during the 1950 s and 1960 s 58,700 in the late 1970 s 140,200 in the 1980 s In 1991 alone there were 47,500 entrants (Zephir, 1996). As of 1996, Haitians were the third largest ethnic immigrant group in the United States (Bureau of Statistics, 1997) Currently, 548,199 documented Haitian Americans live in the U.S. (Migration Information Source, 2004).

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9 Somatic Depression Most common form of depression Comes to mental health services after many visits to medical doctors Typical symptoms: feelings of weakness (faiblesse) and faintness, stomach problems ( gaz ), digestion difficulties, pain in the stomach, headaches, etc Sense of helplessness and hopelessness Case Illustration Treatment Recommendations

10 Depression with Hope Associated with specific times, circumstances, and situations in a person s life Typical Symptoms: feeling weak, feeling down, crying frequently, being unable to sleep, and continuously thinking about their problems no report of feeling of irritable or restless not preclude them from their daily work, education, and/or household responsibilities No decrease in their appetites or sex drives Case Illustration Treatment Recommendations

11 Depression without Hope Excessive complaints of their lives and the various tragedies and suffering they have endured accept the stressors and suffering that characterize their lives Not suicidal Waiting for their time to come Case Illustration Treatment Recommendations

12 Conclusion Depression among Haitians can take many different forms. Haitian forms of depression are different from Western types. Efficacy of interventions is dependent on the type of depression presented with.

13 Coping Resources for Haitians

14 The Strengths of the Haitian People Cultural traditions and customs Family Religion Community

15 Cultural Traditions & Cultural pride Customs capable of overcoming many obstacles and that they have the inner strength to cope with most challenges Strong work ethic & dependable Kindness and hospitality Use food to connect with, educate, and soothe others

16 Lakou Family Support an extended-referred not only to the family members, but also to the cluster of houses in which they lived. Families (one s relatives) and households (with whom one lives) include parents and children, but also grandparents and grandchildren, uncles and aunts, cousins, and even non-blood relatives from one s hometown in Haiti (Stepick, 1998). Haitian families constitute a transitional community as they link individuals in different countries not only in Haiti and in the United States, but also in the Bahamas and Canada(Stepick, 1998). Family members support and assist each other, both instrumentally and emotionally, regardless of the distance and the individual hardship such support entails.

17 Religious Support In a recent study with Haitian immigrants in the United States, Nicolas and DeSilva (2008) found that Catholicism and Protestantism are the two primary religious affiliations reported by the participants. In addition, Voodoo is prevalent and has a tremendous impact on the lives of Haitians (EchodHaiti, 2004). In fact, Voodoo was formally recognized in 2003 as a religion in Haiti (Bellegarde Smith, 2003). Although religion serves many functions for the individual who practices it, the overall impact of religion and spirituality transcends beyond individuals to families and communities. Research has found a high connection between family and church attendance, suggesting that religion is probably a shared experience among Haitians (Nicolas & DeSilva, 2008). Religion has also been shown to be associated with coping in dealing with poverty, illness, and death (Bibb & Casimir, 1996; Stepick, 1998).

18 Religious Support (cont ) Haitians may look towards religion as a way to cope. By having a religious or spiritual leader, people can feel as if they are getting the help they need to survive in the face of having nothing. Churches can offer support not only by providing spiritual guidance and support, but also a means of monetary and material services. It is clear that religion and the church are integral aspects of Haitians lives that need further exploration to fully understand its influence and impact in the lives of Haitians and their communities.

19 Community Support Perceived commonalities, which include sharing a common interest in educational and economic advancement, similar experiences of adjustment and acculturation, shared experience. Hence the Haitian community works together to take care of their own, even in troubled and desperate times.

20 Recommendations First, inquire about the patient s health beliefs and other maladies that may impact their mental health. Haitians perception of illnesses directly impacts their help seeking behavior and whom they go to for assistance Understanding the clients perceptions about the cause of their symptoms will assist in determining the best treatment options for the client. Haitians perception of illness has direct implications for the assessment of symptoms among them

21 Recommendations Become knowledgeable about the health beliefs and practices of Haitians, how symptoms are often treated in the Haitian community This communicate to Haitian clients an understanding of their culture and more importantly indicates an appreciation for such a culture. This may lead to more acceptance and adherence of mental health treatment by Haitian clients. Providers need to be aware, understand, and integrate folk medicine practices used by Haitians such as root medicine in the treatment process.

22 Take Home Message Recognize customs and traditions for: Dealing with trauma and loss (based on religious belief systems) Healing ( i.e. rituals, faith healers) Natural support networks (family, sense of identity with family or community)

23 The bamboo symbolizes the Haitian people The bamboo is really weak, but when the wind comes, it bends, but it doesn t t break. Bamboo takes whatever adversity comes along that that s s what resistance is for us Haitians; we might get bent but but we re able to straighten up and stand (Bell, 2001, p. 23).

24 References Berry, J.W. (1980). Introduction to methodology. In H. C. Triandis&J.W. Berry (Eds.), Handbook of cross-cultural psychology (Vol. 2, pp. 1-24). Boston: Allyn & Bacon. Berry, J. W. (1990). Imposed etics, emics, and derived etics: Their conceptual and operational status in cross-cultural psychology. In T. N. Headland, K. L. Pike, & M. Harris (Eds.), Emics and etics: The nsider/outsider debate. Newbury Park, CA: Sage. Brislin, R.W. (1986). The wording and translation of research instruments. InW. J. Lonner& J.W. Berry (Eds.), Field methods in cross-cultural research (Cross-Cultural Research and Methodology Series, Vol. 8, pp ). Beverly Hills, CA: Sage. Butcher, J. N., & Han, K. (1996). Measures of establishing cross-cultural equivalence. In J. N. Butcher (Ed.), International adaptations of the MMPI-2: Research and clinical applications. Minneapolis: University of Minnesota Press. Caprara, G. V., Barbaranelli, C., Bermudez, J., Maslach, C., & Ruch, W. (2000). Multivariate methods for the comparison of factor structures in cross-cultural research: An illustration with the Big Five questionnaire. Journal of Cross-Cultural Psychology, 31(4), Cavusgil, S. T.,&Das, A. (1997). Methodological issues in empirical cross-cultural research: A survey of the management literature and a framework. Management International Review, 37,

25 Guerda Nicolas Ph.D. Chairperson Department of Educational and Psychological Studies School of Education and Human Development University of Miami P.O. Box Coral Gables, Florida (305) o (305) f nguerda@miami.ed