VOLUME 10 SUPPLEMENT 1VOLUME 12 NUMBER 1-2
Tenth anniversary of the WCPRR
- Tenth anniversary of the WCPRR
Editorial – Mario H. Braakman
- Culture and psychiatric classification
Original Paper – Roberto Lewis-Fernández
Culture shapes every aspect of patient care in psychiatry, influencing when, where, how, and to whom patients narrate their experiences of illness and distress, the patterning of symptoms, and the models clinicians use to interpret and understand symptoms in terms of psychiatric diagnoses. This article presents the rationale for the changes related to the role of culture in psychiatric diagnosis that were included in DSM-5 and describes examples of these changes. The DSM-5 Cross-Cultural Issues Subgroup took into account the recommendations of neurobiologists and anthropologists who have criticized the rigidity of DSM-IV diagnostic criteria, which exclude alternate illness presentations and do not account for the role of context in the emergence and characteristics of psychopathology. Revisions in DSM-5 include a Cultural Issues section in the introduction, the inclusion of culture in the definition of mental disorder, material related to culture that was incorporated into the criteria and description of selected disorders, a new chapter on Cultural Formulation that includes the Cultural Formulation Interview and a description of the revised construct of cultural concepts of distress, and a Glossary illustrating this revised construct. The intent of these revisions was to enhance the validity and reliability of psychiatric diagnosis across cultural groups in the United States and around the world.
- Melancholy in Muslim cultures
Original Paper – M. Fakhr El-Islam
Depressive disorder in Muslims has cultural inputs that affect its genesis, prevention, symptomatology and management. Cousin marriage which is favoured in Muslim cultures is associated with greater family incidence. On the other hand early adequate substitution of parental care deprivation in childhood may have primary preventive effects on the development of depression in adulthood. Somatic symptoms form the front of many depressive disorders. Guilt feelings lay in the background of as many Muslim depressives as Christian depressives in an Egyptian study. However suicidal thoughts are considered blasphemous and severely depressed Muslims stop at the level of death wishes. Family contributes to the triangular family-patient-doctor relationship instead of the dyadic Western patient- doctor relationship. Community care of the depressed includes the family much more than any other welfare agency.
- “Illnesses of the Mind” and “Illnesses of the Spirit” among the Ñu’u savi indigenous people that inhabit the Metropolitan Area of Guadalajara (MAG) City in Mexico
Original Paper – Sergio J. Villaseñor-Bayardo, Martha Patricia Aceves Pulido, María Dolores Ruelas Rangel, Isaura M. García Hernández
Ethnic diversity brings along problems derived from coexistence and different worldviews. It seems necessary to make an analysis of the Mental Health consequences from the point of view of those who face a forced process of Acculturation. With funding of Mexico’s National Council for Science and Technology (CONACYT), we are conducting research work aimed to generate knowledge in order to create a model for mental health care which focuses on the problems and the needs of the migrant indigenous population from different ethnic groups in the MAG. This paper shows the results of the research done with the Mixteca population. Mixteca (named so by the non-indigenous population) or, more properly, Ñu’u savi (People of the Rain) are one of the migrant indigenous groups with more population in the MAG. They arrived here in the 1980s. Nowadays there are 2001 speakers of their language. This article show the results of a qualitative research aimed to characterize the illnesses and therapeutic methods described by this population and related somehow to Mental Health. It has been made semi-structured and non-structured interviews to migrant Ñu’u savi indigenous people living in the MAG. There were identified cases that could be diagnosed by psychiatry and others that the community had an interpretation related to spiritual causes, as witchcraft and susto.It is essential to know the patients’ culture in order to be able to intervene with efficacy. Psychiatry and Western medicine should adapt to and understand the population studied.
- Association of delirious mania with Jinn possession phenomenon- A study from Pakistan
Original Paper – Qurat ul Ain Khan, Aisha Sanober, Mariam Opel, Mohammad Zaman
Objectives To study association of delirious mania with Jinn Possession Phenomenon in Pakistan. Methods The study was conducted at the Aga Khan University Hospital, Karachi. A retrospective chart review was done on all patients, from both inpatient and outpatient settings who were diagnosed with bipolar I, manic or mixed episode, with or without psychosis according to DSM IV-TR from Nov 2013 until July 2014. For diagnosing Delirious Mania we included presence of 2 or more of the following features: disorientation, confusion, altered consciousness, severe cognitive dysfunction, and fluctuations in these states, in the presence of mood disorder. Catatonia was diagnosed by the presence of 2 or more catatonic signs in the last 24 hours according to DSM IV-TR. A semi-structured pro-forma was used to collect demographic and clinical details about the presence or absence of delirium, catatonic features, and Jinn Possession. Results Of the total 73 people diagnosed with bipolar I disorder, 17 had delirious mania, and 5 out of 17 had Jinn possession. Catatonic features were present in most of the patients who had Delirious Mania and Jinn Possession. All 5 cases with Jinn possession were females, had poor compliance with treatment, and continued religious treatment by faith healers. Conclusion Presentation of delirious mania may be associated with phenomenon of Jinn possession in Pakistan. Knowledge of possible association of psychopathology with Jinn possession phenomenon needs to be promoted among the general public and physicians to reduce associated morbidity and mortality. Collaborations with faith healers may be useful to improve compliance.
- 30 Years longitudinal follow-up study of mental health status in Jinuo Nationality in China: A case of the development and challenge of transcultural psychiatry in China
Original Paper – Jianzhong Yang, ChuanYuan Kang and XuDong Zhao
Since 1978 Chinese society has experienced rapid and dramatic socio-economic development, especially apparent in rapid technical modernization and urbanization. All Chinese people, those of the Han majority population as well as those of the 55 ethnic nationalities in China, have been directly and indirectly impacted by these changes. However, rapid development and social change have generated new problems of acculturative stress and social isolation in large cities to which many millions have migrated from rural communities.
From the perspective of transcultural psychiatry, both the economic and the sociocultural changes of the past thirty years have caused large numbers of people to feel disconnected from their previous lives and norms of behavior; leading to an increased prevalence of psychiatric symptoms and disorders, including increased incidence of alcohol and drug-related disorders, major depressive disorder, anxiety disorders and rising rates of suicide in rural communities such as shown in Jinuo Nationality over the past 30 years longitudinal follow-up study, as well as in urban populations.
The resilience of ethnic minority populations in coping with and adapting to these massive changes has not been subject to detailed study, and it is a new task for current transcultural psychiatry research in China to explore those psychosocial mechanisms that both help and hinder the adaptation of specific ethnic groups faced with the rapid and intense changes of the past three decades.
- Observations and reflections on clinical and socio- psychological aspects of psychosomatic disorders in Russia and Kazakhstan
Original Paper – Nikolay Bokhan, Valentina Lebedeva, Sagat Altynbekov
The article gives an analysis of the role of various pathogenetic (ethnic, personality, personality-biological, social-economic, organizational) factors of somatic pathology associativity in formation of clinical dynamics of psychosomatic diseases in patients of the Kazakh and Russian nationality in primary care. Comparative data are given about indicators (prevalence, medical aid appealability, staffing with mental health professionals, motivational traits of patients of the Kazakh and Russian nationality) reflecting efficiency of the existing models of mental health services in Kazakhstan and Russia.
The reliable importance of hysterical, asthenic, sensitive personality traits in formation of psychosomatic disorders in persons of both nationalities with prevalence of cenesthopathic disorders in Russians and anxiety disorders in Kazakhs is ascertained. Influence of ethnocultural factors on clinical dynamics, efficiency of therapy, and outcome of psychosomatic disorders is emphasized. The used rehabilitation programs and algorithm of medical care for patients of general somatic network are in detail described. Use of this algorithm allows reducing unreasonable medical aid appealability of patients with mental disorders to doctors-somatologists by 3.5 times, improving the quality of social functioning, reducing terms of the rehabilitation period.
Need of use of ethnocultural features in the complex of medical activities as a possible aspect of efficiency of therapy is emphasized. The main perspective strategies of efficiency of medical care to patients with psychosomatic disorders are formulated.
- The impact of international migration on the mental health of Honduran teenagers
Original Paper – Américo Reyes Ticas, Farah Archaga, Jose Luis Cruz, Rolando López, Aaron Rodríguez, Manuel Sierra, Mario Aguilar
The main causes of international migration in Honduras are poverty and personal insecurity. Approximately 800,000 Hondurans have left the country, out of which 80% are located on the United States. One of the largest economical incomes in Honduras are remittances, however there is no information on the impact that leads to the family disintegration caused by this social phenomenon.
Objective. To determine the mental health of teenagers, at a secondary school in Tegucigalpa, coming from households with and without parental migration. Methods and Materials: The first screening phase is to determine the degree of functionality and select teenagers with migrant parents, establishing cases, assigning two controls one for separated parents and another for both parents present. Results: Out of 3608 students, 449 (12.4%) had migrant parents. 550 teenagers were interviewed in the second phase. The perception of communication is better in families with both parents present. “Mara” or Gang membership was 4.4% higher in families with migrants. The relationship of teenagers with parents was better in families with migration. The percentage of physical, psychological and sexual abuse found was higher (p.009) in families with migration. Households with both parents present were a protective factor in abuse. A statistical significance in depression and anxiety disorders was found in teenagers from families with migration when comparing the three groups. Conclusion: Parental migration is a risk factor for teenagers to become victims of abuse, suffer from depression and anxiety disorders, as well as for the initiation in dissocial groups.
- An evidence-based framework for cultural adaptation of Cognitive Behaviour Therapy: Process, methodology and foci of adaptation
Original Paper – Farooq Naeem, Peter Phiri, Amina Nasar, Ashley Gerada, Tariq Munshi, Muhammad Ayub, Shanaya Rathod
Currently there is no evidence-based framework for culturally adapting CBT for clients from the Non- Western cultural background. We adapted CBT for black and ethnic minority communities in the UK and local population in Pakistan. This paper describes the framework that evolved from this work, with a focus on the process of adaptation, details of methods used and the areas that need to be focused in order to culturally adapt CBT in a given culture. As far as we are aware this is the first adaptation framework that is evidence based and has been tested through field testing. A series of mixed method studies were conducted in Pakistan and the UK. Adaptation process starts with (a) background information gathering (b) in-depth interviews and focus groups with the stake holders; i.e., patients, carers, community leaders and health professionals (c) development of guidelines (d) cultural adaptation of therapy material, and (e) field testing adapted therapy. Through an iterative process we developed semi structured interviews that can be used now in low resource settings. The cultural adaptation of CBT should focus on three fundamental areas; (1) awareness of relevant cultural issues and preparation for therapy, (2) assessment and engagement, and; (3) adjustments in therapy. The adapted CBT was found to be effective in RCTs. Recently; the above methodology was used to culturally adapt CBT in China, Middle East and Morocco.
"Mapokeo ya utafiti wa WCPRR na Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Makala hii inaelezea sababu za mabadiliko yanayohusiana na jukumu la utamaduni katika utambuzi wa kisaikolojia ambao ulijumuishwa katika DSM-5 na inaelezea mifano ya mabadiliko haya. DSM-5 Subgroup ya Masuala ya Utamaduni wa Kati ilizingatia mapendekezo ya neurobiologists na anthropologists ambao wamekosoa ugumu wa vigezo vya utambuzi wa DSM-IV, ambayo huondoa maonyesho ya ugonjwa wa mbadala na haijalishi jukumu la muktadha katika kuibuka na sifa za psychopathology. "Kama ilivyoelezwa katika DSM-V, ""Mazingira ya Utamaduni"" ni sehemu ya utangulizi, ""Utamaduni"" ni sehemu ya ufafanuzi wa ""ugonjwa wa akili,"" ""Vitu vinavyohusiana na utamaduni"" ni sehemu ya ""Mazingira ya Utamaduni"" na ""Mazingira ya Utamaduni"" ni sehemu ya ""Mazingira ya Utamaduni"" na ""Mazingira ya Utamaduni"" ni sehemu ya ""Mazingira ya Utamaduni.""" Lengo la marekebisho haya lilikuwa kuongeza uhalali na kuegemea kwa utambuzi wa kisaikolojia katika vikundi vya kitamaduni nchini Marekani na ulimwenguni kote. - Melancholy katika tamaduni za Kiislamu Karatasi ya awali <unk> M. Fakhr El-Islam Ugonjwa wa kushuka moyo katika Waislamu una pembejeo za kitamaduni ambazo zinaathiri asili yake, kuzuia, dalili na usimamizi. Ndoa ya binamu ambayo hupendwa katika tamaduni za Kiislamu inahusishwa na matukio makubwa ya familia. Kwa upande mwingine, badala ya mapema ya kutosha ya ukosefu wa utunzaji wa wazazi katika utoto inaweza kuwa na athari za kuzuia za msingi juu ya maendeleo ya unyogovu katika utu uzima. Dalili za mwili hufanyiza sehemu ya mbele ya magonjwa mengi ya kushuka moyo. Hisia za hatia zilikuwa msingi wa watu wengi wa Kiislamu walio na mshuko wa moyo kama vile Wakristo walio na mshuko wa moyo katika utafiti wa Misri. Hata hivyo mawazo ya kujiua yanachukuliwa kuwa ya kuchafua na Waislamu walio na mshuko mkubwa wa moyo huacha katika kiwango cha matakwa ya kifo. Familia huchangia uhusiano wa pembetatu wa familia-mgonjwa-daktari badala ya uhusiano wa magharibi wa mgonjwa-daktari. Utunzaji wa jamii wa watu walioshuka moyo hutia ndani familia zaidi ya shirika lingine lolote la ustawi. "Makosa ya akili na ya roho miongoni mwa watu wa asili wa Ñu-sui wanaoishi katika eneo la mji mkuu wa Guadalajara, Mexico, ni ""mzigo"" wa jamii ya watu wa asili, ambao ni pamoja na watu wa asili wa Mexico, ambao wanaishi katika maeneo ya asili ya Mexico, na ambao wanaishi katika maeneo ya asili ya Mexico." Inaonekana ni muhimu kufanya uchambuzi wa matokeo ya Afya ya Akili kutoka kwa mtazamo wa wale ambao wanakabiliwa na mchakato wa kulazimishwa wa Acculturation. Kwa ufadhili wa Baraza la Kitaifa la Sayansi na Teknolojia la Mexico (CONACYT), tunafanya kazi ya utafiti inayolenga kuzalisha maarifa ili kuunda mfano wa huduma ya afya ya akili ambayo inazingatia matatizo na mahitaji ya wahamiaji wa asili kutoka makundi tofauti ya kikabila katika MTA. Karatasi hii inaonyesha matokeo ya utafiti uliofanywa na idadi ya Mixteca. Mixteca (jina la watu wasio wenyeji) au, kwa usahihi zaidi, Ñu<unk>u savi (Watu wa Mvua) ni moja ya vikundi vya wenyeji wahamiaji wenye idadi kubwa zaidi katika MAG. Waliwasili hapa katika miaka ya 1980. Kwa sasa kuna watu 1,002 wanaozungumza lugha hiyo. Makala hii inaonyesha matokeo ya utafiti wa ubora uliolenga kuelezea magonjwa na mbinu za matibabu zilizoelezwa na idadi hii na zinazohusiana kwa njia fulani na Afya ya Akili. Mkutano huo ulijumuisha mahojiano ya nusu-mfumo na yasiyo ya muundo na wahamiaji wa asili wa Nguo Savi wanaoishi katika MAG. "Kama ilivyoelezwa hapo juu, kuna uwezekano wa kuwa na ""mwisho wa majaribio"" ya kisaikolojia, ambayo inaweza kuathiri athari za magonjwa ya akili, kama vile uchawi, na kuathiri afya ya binadamu, na inaweza kusababisha athari mbaya kwa jamii." Tiba ya akili na ya Magharibi inapaswa kuzoea na kuelewa idadi ya watu wanaochunguzwa. - Ushirikiano wa mania ya delirious na Jinn possession phenomenon- A utafiti kutoka Pakistan Original Paper  Qurat ul Ain Khan, Aisha Sanober, Mariam Opel, Mohammad Zaman Malengo Kujifunza ushirika wa mania ya delirious na Jinn Possession Phenomenon nchini Pakistan. Mbinu Utafiti huo ulifanywa katika Hospitali ya Chuo Kikuu cha Aga Khan, Karachi. Uchunguzi wa retrospective ulifanywa kwa wagonjwa wote, kutoka kwa mazingira ya wagonjwa wa ndani na wa nje, ambao walipatikana na ugonjwa wa bipolar I, manic au mchanganyiko, na au bila psychosis kulingana na DSM-IV-TR, kuanzia Novemba 2013 hadi Julai 2014. Kwa kugundua Delirium Mania, tulijumuisha uwepo wa sifa mbili au zaidi zifuatazo: kutofautisha, kuchanganyikiwa, kubadilika kwa ufahamu, dysfunction kali ya utambuzi, na mabadiliko katika hali hizi, kwa uwepo wa ugonjwa wa hisia. Ugonjwa wa katatonia ni ugonjwa unaosababishwa na dalili mbili au zaidi za katatonia katika masaa 24 yaliyopita kulingana na DSM-IV. Pro-forma ya nusu-iliyoundwa ilitumiwa kukusanya maelezo ya idadi ya watu na kliniki kuhusu uwepo au kutokuwepo kwa delirium, sifa za catatonic, na Jinn Possession. Katika jumla ya watu 73 waliopatikana na ugonjwa wa bipolar I, 17 walikuwa na mania ya kupotea, na 5 kati ya 17 walikuwa na Jinn. Sifa za catatonic zilikuwapo katika wagonjwa wengi waliokuwa na Delirious Mania na Jinn Possession. Watu watano waliopatikana na roho waovu walikuwa wanawake, walishindwa kufuata matibabu, na waliendelea kupata matibabu ya kidini na waganga wa imani. Hitimisho Uwasilishaji wa mania ya delirious inaweza kuhusishwa na jambo la kumiliki Jinn nchini Pakistan. Ujuzi wa uwezekano wa uhusiano wa psychopathology na Jinn kumiliki jambo linahitaji kukuza miongoni mwa umma kwa ujumla na madaktari kupunguza kuhusiana ugonjwa na vifo. Ushirikiano na waponyaji wa imani waweza kuwa wenye manufaa ili kuboresha utii. "Mwaka wa 1980: ""Jiang Zhong, Chuan Yuan Kang, na Xu Dongzhao"" waliandika kitabu cha ""Jinhua: A Case of the Development and Challenge of Transcultural Psychiatry in China"" na ""Jiang Zhong, Chuan Yuan Kang, and Xu Dongzhao: A Case of the Development and Challenge of Transcultural Psychiatry in China"" na ""Jinhua: A Case of the Development and Challenge of Transcultural Psychiatry in China"" na ""Jinhua: A Case of the Development and Challenge of Transcultural Psychiatry in China.""" Watu wote wa China, wale wa idadi kubwa ya watu wa Han na wale wa mataifa 55 ya kikabila nchini China, wameathiriwa moja kwa moja na kwa njia isiyo ya moja kwa moja na mabadiliko haya. Hata hivyo, maendeleo ya haraka na mabadiliko ya kijamii yamezalisha matatizo mapya ya mkazo wa utamaduni na kutengwa na jamii katika miji mikubwa ambayo mamilioni mengi wamehamia kutoka jamii za vijijini. Kutokana na mtazamo wa magonjwa ya akili ya kiuchumi, mabadiliko ya kiuchumi na kijamii ya miaka thelathini iliyopita yamesababisha idadi kubwa ya watu kuhisi kutounganishwa na maisha yao ya zamani na kanuni za tabia, na kusababisha kuongezeka kwa dalili na matatizo ya akili, ikiwa ni pamoja na kuongezeka kwa ugonjwa wa pombe na madawa ya kulevya, ugonjwa mkubwa wa kushuka moyo, matatizo ya wasiwasi na kuongezeka kwa viwango vya kujiua katika jamii za vijijini. Uwezo wa watu wa makabila madogo kukabiliana na kubadilika kwa mabadiliko haya makubwa haujahusishwa na utafiti wa kina, na ni kazi mpya kwa utafiti wa sasa wa kisaikolojia wa kiutamaduni nchini China kuchunguza taratibu hizo za kisaikolojia ambazo husaidia na kuzuia kubadilika kwa makundi maalum ya kikabila yanayokabiliwa na mabadiliko ya haraka na kali ya miongo mitatu iliyopita. - Uchunguzi na tafakari juu ya masuala ya kliniki na kijamii-psychological ya matatizo ya kisaikolojia katika Urusi na Kazakhstan Original Paper <unk> Nikolay Bokhan, Valentina Lebedeva, Sagat Altynbekov Makala inatoa uchambuzi wa jukumu la mbalimbali pathogenetic (kabila, utu, utu-biolojia, kijamii-kiuchumi, shirika) mambo ya somatic pathology associativity katika malezi ya kliniki dynamics ya magonjwa ya kisaikolojia katika wagonjwa wa Kazakh na Urusi. Takwimu za kulinganisha zinatolewa kuhusu viashiria (kuenea, msaada wa matibabu, utajiri wa wataalamu wa afya ya akili, sifa za motisha za wagonjwa wa utaifa wa Kazakh na Urusi) zinazoonyesha ufanisi wa mifano iliyopo ya huduma za afya ya akili nchini Kazakhstan na Urusi. Umuhimu wa kuaminika wa hysterical, asthenic, nyeti utu sifa katika malezi ya psychosomatic matatizo katika watu wa mataifa yote mawili na kuenea kwa matatizo cenesthopathic katika Warusi na matatizo ya wasiwasi katika Kazakhs ni alibainisha. Ushawishi wa sababu za etnocultural juu ya dynamics kliniki, ufanisi wa tiba, na matokeo ya matatizo ya kisaikolojia ni alisisitiza. Programu kutumika ukarabati na algorithm ya huduma ya matibabu kwa wagonjwa wa mtandao wa jumla somatic ni kwa undani ilivyoelezwa. Matumizi ya algorithm hii inaruhusu kupunguza unreasonable matibabu msaada appealability ya wagonjwa na matatizo ya akili kwa madaktari-somatologists na 3.5 mara, kuboresha ubora wa utendaji wa kijamii, kupunguza muda wa kipindi cha ukarabati. Uhitaji wa matumizi ya sifa ethnocultural katika tata ya shughuli za matibabu kama kipengele iwezekanavyo ya ufanisi wa tiba ni alisisitiza. Mikakati kuu ya mtazamo wa ufanisi wa huduma ya matibabu kwa wagonjwa wenye matatizo ya kisaikolojia ni formulated. - Athari za uhamiaji wa kimataifa juu ya afya ya akili ya vijana wa Honduras Karatasi ya awali <unk> Américo Reyes Ticas, Farah Archaga, Jose Luis Cruz, Rolando López, Aaron Rodríguez, Manuel Sierra, Mario Aguilar Sababu kuu za uhamiaji wa kimataifa nchini Honduras ni umaskini na ukosefu wa usalama wa kibinafsi. Takriban watu 800,000 wa Honduras wameondoka nchini humo, kati ya hao 80% wako nchini Marekani. "Hakuna hata moja ya mapato makubwa ya kiuchumi nchini Honduras ni ""mauzo ya fedha,"" lakini hakuna habari juu ya athari ambayo inaongoza kwa kuvunjika kwa familia inayosababishwa na jambo hili la kijamii." Kusudi. Utafiti wa afya ya akili ya vijana katika shule ya sekondari ya Tegucigalpa, kutoka kwa familia zilizo na uhamiaji wa wazazi na bila. Mazoezi ya kwanza ya uchunguzi ni kuamua kiwango cha utendaji na kuchagua vijana wenye wazazi wahamiaji, kuanzisha kesi, kugawa udhibiti mbili moja kwa wazazi waliotenganishwa na nyingine kwa wazazi wote waliopo. Katika wanafunzi wote 3,608 waliohudhuria, 449 (12.4%) walikuwa na wazazi wahamiaji. Vijana hao 550 walihojiwa katika kipindi cha pili. Maoni ya mawasiliano ni bora katika familia ambazo wazazi wote wawili wakopo. <unk>Mara<unk> au uanachama wa Genge ulikuwa 4.4% zaidi katika familia zilizo na wahamiaji. Uhusiano wa matineja na wazazi ulikuwa bora katika familia zenye uhamiaji. Asilimia ya unyanyasaji wa kimwili, kisaikolojia na kingono uligunduliwa kuwa ya juu (kurasa ya 009) katika familia zilizo na uhamiaji. Nyumba zenye wazazi wote wawili walikuwapo zilikuwa sababu ya ulinzi katika unyanyasaji. Uwezekano wa kuathiriwa na matatizo ya wasiwasi na kushuka moyo uligunduliwa kwa vijana kutoka familia za wahamiaji wakati wa kulinganisha makundi matatu. Uhamiaji wa wazazi ni sababu ya hatari kwa vijana kuwa waathirika wa unyanyasaji, wanateseka na unyogovu na matatizo ya wasiwasi, na pia kwa ajili ya kuanzishwa katika makundi ya dissocial. "Kutokana na utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti.""" Timu ya CBT imewekwa katika jamii za watu weusi na wachache wa kikabila nchini Uingereza na watu wa ndani nchini Pakistan. Karatasi hii inaelezea mfumo ambao ulibadilika kutoka kwa kazi hii, na kuzingatia mchakato wa marekebisho, maelezo ya mbinu zilizotumiwa na maeneo ambayo yanahitaji kuzingatia ili kubadilisha utamaduni wa CBT katika utamaduni fulani. Kwa kadiri tunavyojua, hii ni mfumo wa kwanza wa marekebisho ambayo inategemea ushahidi na imepimwa kupitia majaribio ya shamba. Mfululizo wa masomo ya mbinu mchanganyiko ulifanywa nchini Pakistan na Uingereza. Mchakato wa marekebisho huanza na (a) kukusanya habari ya msingi, (b) mahojiano ya kina na vikundi vya lengo na wadau, yaani, wagonjwa, watunzaji, viongozi wa jamii na wataalamu wa afya, (c) maendeleo ya miongozo, (d) marekebisho ya kitamaduni ya vifaa vya matibabu, na (e) majaribio ya uwanja ya matibabu yaliyotengenezwa. Kupitia mchakato iterative sisi maendeleo mahojiano nusu muundo kwamba inaweza kutumika sasa katika mazingira ya rasilimali ya chini. Utaratibu wa utunzaji wa kitamaduni wa CBT unapaswa kuzingatia maeneo matatu ya msingi: (1) ufahamu wa masuala muhimu ya kitamaduni na maandalizi ya matibabu; (2) tathmini na ushiriki; na (3) marekebisho katika matibabu. CBT iliyobadilishwa iligunduliwa kuwa yenye ufanisi katika RCTs. Hivi karibuni; mbinu ya juu ilitumiwa kurekebisha utamaduni wa CBT nchini China, Mashariki ya Kati na Morocco.