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Title: Acculturation, shame, & self-compassion : an examination of mental health service utilisation
Author: Bhatti, Jan-Sher
ISNI:       0000 0004 7658 767X
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2018
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Mental health and immigrant populations: The number of international immigrants has risen by 60% between 1990 and 2015, with the United Nations (2016) estimating 140 million international migrants having arrived to developed regions across Western countries in 2015 alone. Whilst it has been noted that more than 25% of adults experience a diagnosable mental health difficulty within their lifetime (Steel et al., 2014), mental health difficulties for people from ethnic minority backgrounds can be at least twice as prevalent in comparison to the general population (Schwartz & Blakenship, 2014). Moreover, Harris, Edlund, and Larson (2005) note that one's attitudes towards mental health difficulties and help-seeking are strikingly different across cultures and communities. However, research has identified that a higher proportion of individuals from low and middle-income countries with mental health difficulties remain untreated (Wang et al., 2007). The prevalence of mental health difficulties and reduced wellbeing among higher education students is also high in comparison to other population groups (Thorley, 2017), with the rate of students seeking mental health support rising by a third between 2014 and 2017 (Marsh, 2017). Student populations are victim to significant specific stressors, such as the emotional demands of a transitionary period and regular assessments (Dickson & Gullo, 2015). International students are under further pressures given their relocation away from home and existing social networks (Storrie, Ahern, & Tuckett, 2010). Acculturation, social identity, and shame: Gordon (1964) described acculturation as a process of assimilation that immigrants undergo to acquire the practices of their new receiving culture, whilst discarding those of their cultural heritage. Research on acculturative processes has predominantly been explored for populations moving to Western societies, such as the U.S., Canada, Australia, and the U.K. (Salant and Lauderdale, 2003). Such societies adopt individualistic cultural attitudes which emphasise personal goals, promoting independence and a reduced emphasis on group objectives. Collectivistic cultures, found in Asia and Africa, encourage group goals to support development and accomplishments (Hui & Triandis, 1986). Similarly, Tajfel (1972) described the concept of social identity to explain the sense of self developed when thinking about oneself as part of a social group. An individual has an increased sense of purpose and meaning when feeling connected to positive and cohesive social groups (Dingle, Brander, Ballantyne, & Baker, 2013; Haslam, Jetten, & Waghorn, 2009). A meta-analysis illustrated small but significant effects of acculturation processes on help-seeking attitudes among ethnic minority groups (Sun, Hoyt, Brockberg, Lam, & Tiwari, 2016), with acculturation towards a migrant's heritage country being positively related to forms of stigma. Clement and colleagues' (2015) review illustrated that people had reduced help-seeking behaviours and attitudes as their perceptions of mental health-related stigma increased. Luoma and Platt (2015) identify shame as a core emotional attribute of stigma, relating to the fusion of beliefs for being unlovable or flawed. Shame can encompass internal and external components including thoughts and feelings relating to others and the experience of negative self-directed thoughts and emotions (Gilbert & Protor, 2006). Pilkington, Mstefi, and Watson (2012) examined acculturation and a culturally specific form of shame on a South Asian population's intention to seek psychological support. Their findings illustrated such individuals had a reduced intention to access mental health support if they reported higher levels of shame. Self-compassion, described as the interaction of the core elements of kindness, common humanity, and mindfulness (Neff, 2003), may reduce the sensation of shame or stigmatising attitudes. Self-compassion encourages the espousal of a non-judgmental attitude and viewing oneself with kindness (Neff, 2003). It has been found that selfcompassion can buffer against negative external evaluations, which is a key attribute when experiencing shame or stigma (Leary, Tate, Adams, Batts Allen, & Hancock, 2007). Research considering self-compassion and help-seeking behaviours has been extremely limited and self-compassion may further buffer against the negative effects of stigma and shame on accessing support. Heath, Brenner, Vogel, Lannin and Strass (2017) recently investigated whether self-compassion would moderate the internalisation of help-seeking stigma by buffering the relationship between perceived public stigma and anticipated selfstigma. Their findings indicated that people with greater self-compassion had lower selfstigma and fewer perceived barriers to help-seeking in comparison to individuals with lower self-compassion scores. Rationale for study: Investigating psychological factors and help-seeking behaviours among migrant populations and international students improves our understanding for this complex and varied group, supporting the development of effective psychological interventions and approaches (Bochner, Furnham &, Ward, 2001). To the author's knowledge, there is no review of the empirical literature which exclusively focuses on the influence of acculturation and shame in a mental health context. Chapter one aims to synthesise the evidence of acculturation and shame constructs in relation to mental health difficulties. The review aims to identify the relationship between the two concepts, with any implications on mental health and wellbeing considered. The review demonstrates that individuals who assimilate towards individualistic cultures report lower levels of shame, the precursor for mental health related stigma, compared to those who assimilate towards collectivistic cultures. The review also highlights the limited research available which considers the influence acculturation has on mental health help-seeking. Chapter two presents an empirical paper that aims to investigate the influence of self-compassion on psychological help-seeking whilst considering the influence of acculturation and social identity. International students were invited to participate in an online study which incorporated validated measures assessing individuals' trait-self compassion, level of acculturation, social identity, and psychological help-seeking attitudes. Moderated mediation analysis was performed to investigate whether trait-self compassion would mediate the interaction between psychological distress and psychological help-seeking, whilst exploring the moderation effects of social identity to the U.K. and acculturation of British values. The need for further research on helpseeking behaviours in diverse and ethnic populations are discussed. Clinical implications across service development, psychological assessment and interventions are explored.
Supervisor: Eames, Catrin ; Reilly, James Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral