Transcultural Differences Research Articles

Translation into Brazilian Portuguese and validation of the M-CHAT-R/F scale for early screening of autism spectrum disorder.

ABSTRACTObjective:To translate and validate the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) from English to Brazilian Portuguese, taking transcultural differences into account.Methods:Permission for the translation was obtained from the author of the scale. Translation and back-translation were performed, and the document was then assessed for reference and general equivalence. Specialists in childhood autism evaluated the scale. A preliminary version was prepared and pre-tested in a sample population, and a final version was validated with the target population.Results:Only one question had issues relating to referential equivalence. The 10 individuals questioned in the pre-test all understood most of the instrument, although some suggested substituting certain terms to improve comprehension. The final version was reached following inclusion of pertinent suggestions and was submitted to validation with the target population, indicating a sensitivity of 88.2% for a cutoff point greater than 2 points.Conclusions:A Brazilian version of the M-CHAT-R/F scale, approved by specialists and understandable by the target audience, is now available for use.

Perceptions and knowledge regarding the COVID-19 pandemic between U.S. and China: a mixed methods study

BackgroundSARS-CoV-2, a new coronavirus first reported by China on December 31st, 2019, has led to a global health crisis that continues to challenge governments and public health organizations. Understanding COVID-19 knowledge, attitudes, and practices (KAP) is key for informing messaging strategies to contain the pandemic. Cross-national studies (e.g.: comparing China to the U.S.) are needed to better understand how trans-cultural differences may drive differences in pandemic response and behaviors. The goal of the study is to compare knowledge and perceptions of COVID-19 between adults in China and the U.S. These data will provide insight into challenges these nations may face in coordinating pandemic response.MethodsThis is a convergent mixed methods study comparing responses from China and the U.S. to a multinational COVID-19 KAP online survey. The survey included five quantitative constructs and five open-ended questions. Chinese respondents (n = 56) were matched for gender, age, education, perceived social standing, and time of survey completion with a U.S. cohort (n = 57) drawn from 10,620 U.S. respondents. Quantitative responses were compared using T-test & Fisher-Exact tests. Inductive thematic analysis was applied to open-ended questions.ResultsBoth U.S. and Chinese samples had relatively high intention to follow preventive behaviors overall. Differences in intended compliance with a specific recommendation appear to be driven by the different cultural norms in U.S. and China. Both groups expressed trepidation about the speed of COVID-19 vaccine development, driven by concern for safety among Chinese respondents, and concern for efficacy among U.S. respondents. The Chinese cohort expressed worries about other countries’ passive handling of the pandemic while the U.S. cohort focused on domestic responses from individuals and government. U.S. participants appeared more knowledgeable on some aspects of COVID-19. Different perspectives regarding COVID-19 origins were identified among the two groups. Participants from both samples reported high trust in health professionals and international health organizations.ConclusionsMixed methods data from this cross-national analysis suggests sociocultural differences likely influence perceptions and knowledge of COVID-19 and its related public health policies. Discovering and addressing these culturally-based differences and perceptions are essential to coordinate a global pandemic response.

The role of controlled human-animal interactions in changing the negative perceptions towards white sharks, in a sample of White Shark cage diving tours participants

Quantifying the effect of human-wildlife interactions, and particularly those where negative perceptions exist, can have a benefit towards the conservation of species. The negative perceptions surrounding human-shark interactions can be put forward as a case in point. In this work, we use six relevant statements questions to test human perceptions before and after controlled human interactions with the white shark, Carcharodon carcharias. Questions were adapted from Kellert's typology of human attitudes towards animals. A total of 322 tourists participating in white shark cage diving tours in Gansbaai, South Africa were exposed to two surveys (pre and post-experience) to assess whether a shift in perception can happen. We focused the work on measuring the effect of the shark cage diving tourism activities to change negative perceptions towards white sharks in people who dare to cage diving with sharks. To determine the underlying structure of the statements involved in shark perception, exploratory factor analyses were performed. Two attitudes, Dominionistic and Ecologistic-Scientific explained 52.8% of the variance. In addition, analyses of differences between pre and post-surveys in participants of White Shark cage diving tours indicated a positive change in perception towards white sharks after the activity. No age, gender, or transcultural differences were found, and possible psychological and political approaches were addressed. Controlled human-shark interaction can aid in a positive shift of the attitudes towards this animal, which can have significant potential implications. Ultimately, exposure to sharks could be a valuable tool for promoting public attitudes, especially when paired with the correct interpretation of shark behavior and its impact on the ecosystem.

Transcultural Aspect of Mental Health Care

Culture is not simply the aggregate of individual traits but a more or less coherent system of shared meanings, institutions and practices (i.e. beliefs, attitudes and values). It is a repository of meaningful symbols that structure experience both implicitly and through explicit models. Culture shapes how and what psychiatric symptoms are expressed, influences the meanings that are given to symptoms and impacts the interaction between the patient and the health care system. Explanatory models are the ways in which individuals in different cultures see the core reasons of their suffering. The DSM-5 cultural formulation interview is developed to be used as clinical instrument and valuable tool. It is evident that phenomena such as the increasing migratory flows and the globalisation of prevailing social criteria referred to the economy, trade, religion and the perception and the attribution of the causes of disease have determined a shift in the world cultural balance that have direct repercussions on World Mental Health. More specifically, it needs to be seen how the transcultural differences in the personality configurations and psychological operations can be correlated with the cross-cultural differences in psychopathology to arrive at an understanding of these. Furthermore, understanding the central role of culture of mental health and illness must, therefore, be central to any vision of the future of psychiatry. In this presentation transcultural aspects of mental health care in psychiatry will be highlighted and discussed.DisclosureNo significant relationships.

Health related quality of life and perceived social support in French and Lebanese MS patients: A comparative study

BackgroundThe perception of diagnosis announcement, the social support and the coping strategies seem to be determining factors for the quality of life of multiple sclerosis (MS) patients, with possible transcultural variations. This study explores these psychosocial dimensions in Lebanese and French MS patients. MethodsFor this cross-sectional multi-center study, 8 questionnaires were used to assess quality of life, family support, coping strategies, mood, fatigue, stress, and hopelessness in MS patients. 7 were translated into Arabic and then back translated into French. These were administered to a group of Lebanese MS patients and compared to an MS sample from France. The data was collected for both populations and analyzed. ResultsA total of 107 patients were included, 46 Lebanese and 61 French. The majority of MS patients were young females with a high level of education, relapsing remitting form of MS and a low level of disability. Both populations exhibited comparable quality of life and answers on the questionnaires regarding mood disorders, hopelessness, and perceived stress. However, the French patients had significantly more fatigue. Perceived social support given by family was considered greater in the French group compared to the Lebanese one. Also, maladaptive coping strategies (such as self-distraction, denial, behavioral disengagement, substance use, self-blame, venting) were used more frequently by the French population compared to the Lebanese, and this correlated with higher anxiety scores. Diagnosis communication was overall brief, informative, and satisfying in both populations. ConclusionThis study highlighted transcultural differences between French and Lebanese MS patients mainly in social support and coping strategies.

Pragmatic issues and prescribing patterns in bipolar disorder: A mental health professional's survey.

There is substantial treatment gap between the suggested guidelines and pragmatic clinical practice for psychotropic usage in bipolar disorder (BD) due to the lack of naturalistic studies and not taking into account the transcultural differences and diverse background. We intend to study this treatment gap and elucidate the preference of psychotropics and prescription patterns, critical clinical issues faced and related pragmatics in BD by conducting the mental health professionals survey. After focused discussions, Canadian Network for Mood and Anxiety Treatments guidelines being the primary anchor, a 46-item online survey questionnaire was prepared. With 25.4% response rate, 127 psychiatrists were evaluated using Survey Monkey® electronic platform on the demographics, predominant polarity; usage of antipsychotics, antidepressants, and electroconvulsive therapy, psychotropic's preference (monotherapy vs. polytherapy) in the acute and maintenance phase of BD. Majority of the participants were males (70.9%) and placed in government institute or medical colleges. Majority agreed that child and adolescent and old age bipolar probands are not routinely seen but subthreshold BD cases are frequent; did not prefer mood stabilizer in pregnancy (61.4%) and antidepressants, preferred polytherapy in acute but monotherapy in maintenance phase (after 3rd episode), seldom preferred ECT as an option (more in suicidality), agreed to a subset of BD being refractory and neuroprogressive. This study elucidates the importance of treatment preferences, prescribing patterns and pragmatic issues faced by the clinicians. These patterns if studied longitudinally in a systematic manner would help in modifying the potential treatment strategies and reduce treatment gap.

Validation of Social Responsiveness Scale for Korean Preschool Children With Autism.

ObjectiveThis cross-cultural study aims to examine the psychometric properties of the Social Responsiveness Scale (SRS) and to determine the best-estimate-cut-off scores for the diagnosis of autism spectrum disorder (ASD) in Korean preschool children. MethodsA total of 563 children was recruited from multiple sources, including Seoul National University Bundang Hospital. Participants were assessed by a multidisciplinary research team using multiple diagnostic tools based on DSM-5 diagnostic criteria. Discriminative validity was tested by comparing the difference in SRS scores between ASD and non-ASD groups. Convergent validity was tested by examining correlations between SRS scores with other diagnostic instruments. A receiver operation characteristic curve analysis was conducted to test the sensitivity and specificity of SRS and to determine the best-estimate-cut-off scores for screening ASD in Korean preschool children. ResultsThere were significant differences in the total SRS scores between the ASD (n=242) and non-ASD group (n=321) (p<0.01, 95% confidence interval [CI]: 14.08–17.24). The differences were significant even after adjusting for age. SRS scores were significantly correlated with other prescreening diagnostic tools for ASD. The best-estimate cut-off score to screen ASD was 55 (area under curve=0.88, sensitivity 78.1%, specificity 86.6%).ConclusionThe SRS is a valid and reliable instrument to screen and aid in the diagnosis of ASD in Korean preschool children. The adjusted cut-off scores, notably lower than in the original U.S. version, may yield a more accurate diagnosis by reflecting transcultural differences.

Perceptions of Modulatory Factors in Migraine and Epilepsy: A Multicenter Study.

Background: Migraine and epilepsy are both common episodic disorders, typically precipitated or inhibited by some modulatory factors (MFs).Objective: To assess the self-perception of MFs in patients with migraine (PWM) compared to patients with epilepsy (PWE) with a standardized protocol in different countries.Methods: Transcultural multicenter comparative cross-sectional study. All consecutive patients who fulfilled the ICHD-3 criteria for migraine and ILAE's criteria for epilepsy, with at least 1 year of follow-up were interviewed with a semi-structured questionnaire on clinical and epidemiological data and were asked to identify all experienced MFs from a provided list.Results: A total of 608 individuals were surveyed at five university referral centers in Brazil, Guatemala, Lithuania and Turkey. Two hundred and nineteen (91.6%) PWM and 305 (82.7%) PWE identified attack precipitating factors (PFs; p < 0.001). The most frequent three PFs reported by epilepsy patients were: “lack of sleep” (56.6%), “emotional stress” (55.3%), “negative feelings” (53.9%), while among migraine patients “emotional stress” (81.6%), “lack of sleep” (77.8%), “negative feelings” (75.7%) were cited. Inhibitory factors (IFs) for the episodes were reported by 68 (28.5%) PWM and 116 (31.4%) PWE. “Darkness” was the most common one, described by 35.6% of PWM whereas “positive feelings” reported by 10.6% of PWE. Most MFs are concordant across the countries but some transcultural differences were noted.Conclusion: The MFs of migraine and epilepsy attacks and their varying frequencies according to different countries were investigated with the same standardized questionnaire, for the first time. MFs were recognized very often in both migraine and epilepsy cohorts, but in distinct disease-specific prevalence, being more frequent in migraine. Recognition of self-perceived MFs may be helpful for the management of both illnesses.

Transcultural differences in suicide attempts among children and adolescents with and without migration background, a multicentre study: in Vienna, Berlin, Istanbul

While suicide can occur throughout the lifespan, worldwide suicide is the second leading cause of death among young people aged between 15 and 29 years. The aim of this multicentre study, conducted in Austria, Germany and Turkey, is to investigate the transcultural differences of suicide attempts among children and adolescents with and without migration background. The present study is a retrospective analyses of the records of 247 young people, who were admitted after a suicide attempt to Emergency Outpatient Clinics of Departments of Child and Adolescent Psychiatry of the collaborating Universities including Medical University of Vienna, Charité University Medicine Berlin and Cerrahpaşa School of Medicine and Bakirkoy Training and Research Hospital for Mental Health in Istanbul over a 3-year period. The results of the present study show significant transcultural differences between minors with and without migration background in regard to triggering reasons, method of suicide attempts and psychiatric diagnosis. The trigger event “intra-familial conflicts” and the use of “low-risk methods” for their suicide attempt were more frequent among patients with migration background. Moreover among native parents living in Vienna and Berlin divorce of parents were more frequent compared to parents living in Istanbul and migrants in Vienna. These results can be partly explained by cultural differences between migrants and host society. Also disadvantages in socio-economic situations of migrants and their poorer access to the healthcare system can mostly lead to acute and delayed treatments. Larger longitudinal studies are needed to understand better the impact of migration on the suicidal behaviour of young people.

Exploration of the Spanish Version of the Attachment Style Questionnaire: A Comparative Study between Spanish, Italian, and Japanese Culture.

Nowadays, there are several human attachment measures, most in the form of questionnaires that assess adult attachment styles. This study investigates the use of Feeney, Noller, Hanrahan, Sperling and Berman’s five-factors Attachment Style Questionnaire (ASQ, 1994), based on Bartholomew’s four-factors model (1991), and Hazan and Shaver’s three-factors model (1987). Nevertheless, no robust study has explored the ASQ questionnaire in Spanish compared to other cultures, such as Italian and Japanese. Therefore, the linguistic translation of the Spanish version of the ASQ was performed, based on the back-translation methodology. The results indicate that 5-factors ASQ Spanish version explains 43.67% of the variance, similar to the original English-Australian ASQ version. The Italian and Japanese versions explain 49.37% and 52.27% of the variance, respectively. No age correlation for any ASQ factors in the Japanese sample was found; meanwhile, the Spanish and Italian cultures showed a positive correlation with age and “Confidence” and negative correlation with age and “Relationships as Secondary” ASQ factors. Some transcultural differences and possible research approaches are addressed.

Transcultural Differences in Risk Factors and in Triggering Reasons of Suicidal and Self-Harming Behaviour in Young People with and without a Migration Background.

Minors with and without migration background can have different risk factors and triggering reasons for self-harming and suicidal behaviour. We retrospectively analysed the data of 192 children and adolescents to investigate the transcultural differences in self-harming, as well as suicidal behaviour in Austrian, Turkish, and Bosnian/Croatian/Serbian (BCS)-speaking patients, who were treated in an emergency out-patient clinic in Vienna. Our results showed transcultural differences in both behaviours. In all groups, females had higher rates of suicide attempts and self-harming behaviour than males. While Turkish-speaking patients received treatment more often, after attempted suicide, Austrians and BCS-speaking patients needed treatment more often for acute stress disorder. Suicide attempts and self-harming behaviours were triggered most frequently by intrafamilial problems, but more frequently in migrant patients. Turkish-speaking patients were at a more than 2 times (OR = 2.21, 95%CI: 1.408–3.477) higher risk for suicide attempts, and were triggered almost 3 times (OR = 2.94, 95%CI: 1.632–5.304) more often by interfamilial conflicts. The suicide attempts of BCS-speaking minors were more often caused by relationship and separation crises (OR = 2.56, 95%CI: 1.148–5.705). These transcultural differences in suicidal and self-harming behaviour of minors, demand an increase of transcultural competence to provide optimal treatment of migrant children.

Living safely with epilepsy: a key learning review.

This review focusses on counselling to reduce the risks of seizures in epilepsy patients. Risk reduction, whilst maximising the independence of persons with epilepsy, is a core element of epilepsy practice. The importance of the issue is reflected by the inclusion of risk assessment and reduction in the recent International League Against Epilepsy Curriculum for epileptology. This article addresses the key elements of epilepsy risk and provides practical guidance for counselling and risk reduction. A review of key publications was performed focusing on: (1) the risk of injury associated with seizures; (2) safety issues related to seizures and lifestyle; (3) SUDEP risk and avoidance; and (4) assessing individual risks. Risk is common in epilepsy and is multifactorial. Clinicians should be aware of the risk factors associated with different epilepsy features, such as seizure type, as well as those related to lifestyle and common indoor and outdoor activities. In addition, transcultural differences should be considered in risk assessment and counselling, e.g. regarding SUDEP or even driving, for which regulations vary across nations. Assessment of individual risk is evolving through a better understanding of risk factors and methodologies which can improve communication and empower patients to help identify and manage their individual risks.

The Behavioral Economics of Alcohol Demand in French and American University Students.

Behavioral economic approaches have revealed several characteristics of alcohol demand (e.g., intensity, elasticity, and essential value) in university students; however, these approaches have not yet examined alcohol demand among students outside of the United States. The current study examined alcohol demand among student samples in the United States and France using a hypothetical alcohol purchase task (APT) and a novel APT Choice task, in which nonalcoholic beverages were concurrently available at a fixed low price. Participants at each site (United States, n=132; France, n=132) were asked to complete an Internet-based survey including the APT, APT Choice, Alcohol Use Disorders Identification Test, Daily Drinking Questionnaire, and Drinking Motives Questionnaire-Revised Short Form. Group demand functions were produced for each of the 2 samples in both country-specific and standardized drink units, and the exponential demand equationwas fitted to each of the APT and APT Choice demand curves. Slope analyses were performed on the Non-Alcoholic Cross-Price demand to assess substitutability. APT data revealed that in both samples, alcohol price and consumption were inversely related and demand measures were significantly associated with other alcohol measures. In addition, the availability of a nonalcoholic alternative reduced alcohol demand in both samples, with evidence of substitutability revealed by increases in cross-price consumption. Low-cost alcohol is associated with increased alcohol consumption in both French and U.S. university students, and concurrent availability of a nonalcoholic beverage within the APT both reduces alcohol demand and demonstrates behavioral economic substitutability. These findings will inform future studies investigating behavioral and environmental factors underlying transcultural differences and specific prevention efforts.

Transcultural differences of psychologically traumatised children and adolescents.

SummaryBackgroundThe symptoms following a traumatic event as well as the coping strategies can be culture specific. The objective of the present study was to analyse the transcultural differences of psychologically traumatized children and adolescents with and without migration background.MethodsThe medical files of 199 psychologically traumatized children and adolescents (99 native Austrian, 100 Turkish-speaking) who were treated at the Department of Child and Adolescent Psychiatry in Vienna were retrospectively analysed.ResultsThe most frequently observed causes of trauma in patients with Turkish migration background were intra-familial conflicts, forced separation from parent(s), and conforming to a new environment. In native Austrian patients, forced separation from parent(s) and divorce or separation of parents were the leading causes of trauma. Trauma-related symptoms like changed mood, cognitive and perceptual disturbance, social withdrawal, sleeping problems, somatisation and behavioural problems were similarly observed in both groups; “sleeping problems” were more often observed in Austrian patients, and “behavioural problems” were more often observed in Turkish patients. More Austrian patients (32.7%) obtained psychiatric and psychotherapeutic treatment. Turkish-speaking patients mostly obtained psychiatric treatment only. Patients with migration background were more compliant compared to indigenous patients.ConclusionsBoth study groups differed in type, causes and symptoms of trauma, and in preferred therapy. Turkish-speaking patients were more compliant with therapy, as they received culture and language-sensitive medical advice and treatment in their mother tongue. Considering the cultural background of patients can optimize service delivery and therapy outcomes among children and adolescents with stressful and traumatic experiences.

Control perceptions in epilepsy: A transcultural case–control study with focus on auras

ObjectiveGeneral Locus of Control (GLoC) is used to measure the extent to which people perceive life events as results of their own actions or external factors. This study analyzes the relationship between GLoC and people with epilepsy's (PWE) clinical characteristics, levels of anxiety, depression, religiosity/spirituality, and quality of life, with particular attention to possible influences of auras. MethodsA case–control study was carried out with 186 consecutive patients with a definite diagnosis of epilepsy in Brazil and Lithuania. Besides clinical and demographic data, all patients answered to internationally validated scales: Rotter's GLoC, Hospital Anxiety and Depression Scale (HADS), Quality of Life in Epilepsy (QOLIE-31), and Index of Core Spiritual Experiences-Revised (INSPIRIT-R). ResultsPatient's mean age was 36.15 ± 13.75 years, 61.3% were female, mean age at onset of epilepsy was 17.27 ± 13.59 years, and monthly seizure frequency was 8.22 ± 20.00. People with epilepsy were more depressed than controls, (p = 0.03). Within the group with epilepsy, patients reporting auras and reacting to them had higher levels of depression (p = 0.002) and anxiety (p = 0.004) and lower QOLIE-31 (p = 0.01) score but did not differ in GLoC (p = 0.73) or INSPIRIT-R (p = 0.71). Patients with perceived ability to prevent seizures in response to auras had no increased levels of depression and anxiety. ConclusionsGeneral Locus of Control externalization in PWE was not confirmed. To perceive and be able to react to auras is associated with increased anxiety and depressive symptoms in PWE but not if it results in preventing seizures. No transcultural differences in these parameters were found.

A core avenue for transcultural research on dementia: on the cross-linguistic generalization of language-related effects in Alzheimer's disease and Parkinson's disease.

Language is a key source of cross-cultural variability, which may have both subtle and major effects on neurocognition. However, this issue has been largely overlooked in two flourishing lines of research assessing the relationship between language-related neural systems and dementia. This paper assesses the limitations of the evidence on (i) the neuroprotective effects of bilingualism in Alzheimer's disease and (ii) specific language deficits as markers of Parkinson's disease. First, we outline the rationale behind each line of research. Second, we review available evidence and discuss the potential impact of cross-linguistic factors. Third, we outline ideas to foster progress in both fields and, with it, in cross-cultural neuroscience at large. On the one hand, studies on bilingualism suggest that sustained use of more than one language may protect against Alzheimer's disease symptoms. On the other hand, insights from the embodied cognition framework point to syntactic and action-verb deficits as early (and even preclinical) markers of Parkinson's disease. However, both fields share a key limitation that lies at the heart of cultural neuroscience: the issue of cross-linguistic generalizability. Relevant evidence for both research trends comes from only a handful of (mostly Indo-European) languages, which are far from capturing the full scope of structural and typological diversity of the linguistic landscape worldwide. This raises questions on the external validity of reported findings. Greater collaboration between linguistic typology and cognitive neuroscience seems crucial as a first step to assess the impact of transcultural differences on language-related effects across neurodegenerative diseases. Copyright © 2017 John Wiley & Sons, Ltd.

Identifying Fear-evoking Pictures from the International Affective Picture System (IAPS) in a Chilean Sample

The goal of this study was to identify a valid set of fear-evoking pictures from IAPS images (Lang, Bradley, & Cuthbert, 2008) in a Chilean Sample. To do so, categorical and dimensional ratings of pictures made by our participants were analyzed, considering potential sex differences. We also evaluated potential transcultural differences by comparing our results with the results of Barke, Stahl, & Kroner-Herwig (2012), whose methodology was followed in the present study, but incorporating new statistical criteria for the valid identification of pictures that evoke fear. Sixty Chilean volunteers (30 women) with a mean age of 22.3 years rated 146 pictures of the IAPS regarding to the choice of discrete emotions and the ratings of valence, arousal and dominance. Six pictures were identified that evoked fear significantly more than any other emotion. Compared to the German sample, the Chilean group evaluated images with more arousal and valence.

Paving the road for a European postgraduate training curriculum

The ‘Project for Achieving Consensus in Training’ has been initiated by the European Board & College of Obstetrics and Gynaecology to harmonise training in Obstetrics and Gynaecology throughout Europe. In this project called the EBCOG-PACT, a state of the art pan-European training curriculum will be developed.Implementation of a pan-European curriculum will enhance harmonisation of both quality standards of women's healthcare practice and standards of postgraduate training. Secondly, it will assure equal quality of training of gynaecologists, promoting mobility throughout Europe. Thirdly, it will enhance cooperation and exchange of best practices between medical specialists and hospitals within Europe.The project is expecting to deliver (1) a description of the core and electives of the curriculum based on previously defined standards of care, (2) a societally responsive competency framework based on input from societal stakeholders and (3) strategies for education and assessment based on the current literature. Also, the project focuses on implementation and sustainability of the curriculum by delivering (4) a SWOT-analysis for the implementation based on insights into transcultural differences, (5) recommendations for implementation, change management and sustainability based on the SWOT analysis (6) and finally a handbook for other specialties initiating European curriculum development.The development and the implementation of this modern pan-European curriculum in Obstetrics and Gynaecology aims to serve as an example for the harmonisation of postgraduate training in Europe.

Resilience, internalized stigma, self-esteem, and hopelessness among people with schizophrenia: Cultural comparison in Austria and Japan

Resilience is becoming an important topic in people with schizophrenia since there is evidence that it increases the probability for long-term recovery. The current study investigated transcultural differences in resilience across schizophrenia patients from two different geographical regions, Austria and Japan. Another objective was to examine transcultural differences in internalized stigma, self-esteem, and hopelessness, which can be expected to be relevant in this context, as well as the interrelations between these subjective elements of recovery and symptom severity. To this end, patients from outpatient mental health services in Innsbruck, Austria (N=52) and Tokyo, Japan (N=60) as well as 137 healthy comparison subjects from both countries were included into this cross-sectional study. Notably, we detected a significant country effect with markedly lower resilience (F=74.4, p<0.001) and self-esteem scores (F=226.0, p<0.001) as well as higher hopelessness scores (F=37.4, p<0.001) among Japanese subjects in general. In addition, both Austrian and Japanese patients indicated significantly lower degrees of resilience (F=57.5, p<0.001), self-esteem (F=51.8, p<0.001), and hope (F=29.5, p<0.001) compared to healthy control subjects. The inter-correlations between subjective elements of recovery were comparable in size in the two patient samples, but the inter-correlations between these issues and residual symptoms of schizophrenia as objective domains of recovery were markedly higher in Austrian subjects. This suggests that schizophrenia patients from Western European and Japanese cultures may have different needs to achieve recovery. In conclusion, it will be critical to develop culture-specific psychosocial programs and to examine their feasibility and effectiveness among these patients.

What Does the Digital Student Want? Cross-Cultural Collaboration and Wikis in Academic Literacy

New online educational tools have opened new possibilities for cross-cultural collaboration which supports critical thinking and encourages learner autonomy. Nevertheless, the success of a crosscultural collaborative experience cannot be taken for granted, since it inevitably involves the need to bridge transcultural differences. This paper presents an American-Slovene cross-cultural collaborative project with a focus on the perceptions of the Slovene student-participants. In particular, it examines their views of one of the components of the collaborative project, specifically, the collaborative wiki writing assignment, introduced to develop the students’ academic literacy skills. The findings of the questionnaire study show that the participants’ experiences with the cross-cultural collaboration were positive, although their answers reveal a slight preference for less challenging activities. Nevertheless, even the fairly demanding writing assignment was generally perceived to be interesting and useful: while its full interactive potential was not realized due to the participants’ reluctance to engage in editing, the wiki is clearly an efficient tool for promoting academic literacy.