Stress, depression, stigma, lack of cultural sensitivity—haven’t we heard about all these “old problems” many times before? Yes, but they are all still with us. And I am grateful that articles in this issue are proposing some fresh perspectives and approaches to them—while acknowledging continued challenges. I am also pleased that the writers hail from many diverse cultures and regions of the world, including nations in Africa, Europe, and North America. We have so much to learn from one another! For example, the article by Dardas et al. reminds us that conditions like “depression” are understood and manifested differently in different cultures; this article contributes to the depression literature by its discovery that a commonly used tool for measurement of depression required modification to be valid for Arab adolescents.
Three of the articles in this issue present fresh thoughts about promotion of mental health recovery: (1) Wastberg article from Sweden on a turning point toward recovery; (2) Laranjeira et al. article from Portugal on promotion of recovery through art therapy in the acute inpatient setting; and (3) Hybholt, Buus, Erlangsen, Fleischer, Havn, Kristensen, et al. article on psychosocial rehabilitation of Danish elderly persons bereaved by suicide. The Hybholt et al. paper describes a co-operative inquiry study protocol. For readers who are unfamiliar with the practice of publishing protocols, the researchers are sharing their study plans with the scientific community prior to data collection, followed by stepwise publishing of additional papers at all stages of the research process, until the project conclusion in 2020. The research team plans to disseminate their work not only in peer-reviewed journals but also in newsletters, a guideline for those who care for bereaved elderly persons, and even a movie about the guideline. Commendably, the bereaved persons themselves are involved in all stages of the study.
The chief contribution of some of the articles in this issue may be consciousness-raising about issues that are not often examined by psychiatric-mental health nurse researchers, such as the stresses of grandparenting. For example, I have not previously encountered the concern raised by authors Serafica and Reyes about the acculturative stress experienced by aging Filipino grandparents who have immigrated to America. While the aging grandparents are useful to their adult children by caregiving for the grandchildren and helping with household tasks, they are lonely and isolated. “Wishing for a different reality” was a particularly poignant theme among the grandparents who participated in the study.
The overwhelming burden of caring for orphaned grandchildren in Uganda was examined by Matovu and colleagues. Mental health symptoms of these grandparent-caregivers included anguish over death of their adult children (often HIV-related) and other biopsychosocial distress manifestations such as somatization. Some of the study participants had lost multiple children or family members to disease or war, including extended family who could have helped them financially. Unlike the grandparents studied by Serafica and Reyes, participants in the Ugandan study had the added stress of woefully inadequate financial resources to maintain the household.
Continued challenges for psychiatric-mental health care providers are evident in several other articles in this issue. The ugliness of stigmatization, a perennial topic throughout mental health literature, is evident in Salifu-Yendork’s study of professional and family caregivers of persons with mental illness in Ghana. The well-known phenomenon of “stigmatization by association” affects psychiatric nurses in Ghana, as shown in the words of one inpatient unit nurse who sadly reported that “even our own colleagues (nurses) sometimes call us ‘abodam nurses’ [mad people’s nurses].” The mental health nurses on the inpatient units who wore uniforms were more heavily stigmatized than those nurses who worked in community facilities.
Some nurses themselves still hold pejorative attitudes about persons with mental illness for whom they provide care, as shown in Ceylan and Kocoglu-Tanyer’s research on Turkish nurses’ attitudes about reproductive health needs of individuals with schizophrenia. The study revealed a disturbingly high percentage of nurses (58.8%) who do not believe that women with schizophrenia can decide on their own about abortion, with 39.6% supporting involuntary abortion or sterilization for women with schizophrenia. Tubal ligation was considered the most suitable family planning method. Discouragingly, the researchers found negative attitudes toward the reproductive health of individuals with schizophrenia among nurses who worked psychiatric clinics as well as those who worked in primary care.
Two articles in this issue focus on power in male-female relationships, with the research by Champion examining romantic relationships of younger Mexican-American women and the study by Gary and colleagues focusing on midlife African-American women. Lack of power in sexual decision-making can be a significant variable in acquisition of sexually transmitted infectious diseases and HIV/AIDS. Interestingly, despite the age difference of the participants in the two studies, the women experienced a similar power imbalance in their relationships with men. Both of these studies were conducted in the USA, but power imbalance in male–female relationships is a universal issue across the globe. In no country do women have equal power with men.
It is my hope that the articles in this issue provoke much thought and discussion. Join the ongoing discussion by submitting your research or opinion pieces!