Culture, Community and Health Studies: Research Annual Report 2003

Acting section Head: Dr. Louis Gliksman

An integrated research, training and consultation unit, the Culture, Community and Health Studies (cchs) Research Section takes a psychiatric epidemiology perspective to understanding cultural and social determinants of population health, with a focus on immigrant and refugee populations.

The team includes scholars from psychiatry, sociology, clinical and developmental psychology, social epidemiology, anthropology, demography, medicine, nursing and public health. Detailed project and staff information may be found on the CAMH website under Culture, Community and Health Studies or at http://www.utpsychiatry.ca/programs/cchs.cfm.

Research

The CCHS attracts funding through the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, Citizenship and Immigration Canada, Health Canada, Human Resources and Development Canada and Canadian Heritage in support of its research programs.

Faculty and scientists of the CCHS section are leading 25 different research initiatives. The ongoing research activities of the CCHS include a national longitudinal study of the health and development of immigrant and refugee children; epidemiological studies in Toronto's Ethiopian and Tamil communities; youth acquisition of ethnocultural identity; the mental health effects of discrimination; long-term mental health impact of exposure to traumatic stress; multicultural meanings of social support; the development of a community resource guide to assist newcomers to Canada; stress and tuberculosis; depression and suicide among people from Pakistan living in the UK; and a randomized double-blind trial on raloxifene as an adjunct in the treatment of psychosis.

Recent research highlights include: (1) Although immigrant families are three times more likely to have low income than non-immigrant families, immigrant children have fewer mental health and behavioural problems than their non-immigrant counterparts; (2) The prevalence of depression among Ethiopians in Toronto roughly equals that found among the general population of Ontario, but it is three times higher than the rates in Ethiopia; (3) Approximately one-quarter of people who are visible minority immigrants experience discrimination, and those experiences jeopardize mental health.

Education, Training and Clinical Initiatives

The CCHS educates and trains future generations of health researchers and health care providers in appropriate policy and practice responses to the challenges of diversity and equity.

The CCHS offers an Inter-Faculty Research Seminar series, with topics such as immigrant and refugee mental health, cross-cultural research, economic and social determinants of health and general topics of mental health and addictions. The seminars are open to researchers, staff and students at the University of Toronto and the Centre for Addiction and Mental Health.

Faculty of the CCHS research section also contribute to the development, implementation and delivery of graduate and post-graduate courses offered by the Department of Psychiatry, the Institute of Medical Sciences (IMS) and other university departments. Dr. Ted Lo conducts a cultural competence training program for residents, psychiatrists and mental health staff.

The CCHS also offers resident and medical student training, clinical service consultations and public education on culture and mental health, including training in research methodologies for doctoral students and post-doctoral fellows through thesis supervision.

Dr. Lisa Andermann's completed post-doctoral work, jointly sponsored by the CCHS and the Psychological Trauma Clinic at Mt. Sinai Hospital, focused on cross-cultural perceptions of mental health. Rani Srivastava, Director of Clinical Resources in the Faculty of Nursing at the University of Toronto, continues PhD studies at the IMS through the CCHS section, with her research focusing on institutional and individual cultural competence. Through the CCHS, Dr. Kenneth Fung completed a study of alexithymia among Chinese people, in fulfilment of master's degree requirements inIMS, and continues to expand this research area.

Finally, research institutions and universities are increasingly recognising an obligation to provide information about their scholarship and its implications for improved clinical practices. Members of the CCHS section participated in the development of an ethno-racial initiative in the Joint General Psychiatry Program; implementing a Cultural Consultation Program that provides clinician training in cultural issues relevant for patient assessment and management. The CCHS also created partnerships with settlement agencies, public health units and CAMH to develop a community education program on mental health and addiction for ethno-racial groups.

Consultations and Review Panels

The CCHS provides community, policy and scientific consultations at national and international levels. Through affiliations with the Joint Centre of Excellence for Research on Immigration and Settlement-Toronto, a tri-university centre supported by sshrc through agreements with eight departments of the federal government, the CCHS contributes to a national agenda of policy-oriented research, focusing on immigration and mental health.

As part of a Canadian Heritage initiative, Dr. Anneke Rummens continues to develop a database on identities in Canada. Dr. Ted Lo provides cultural consultation to hospitals and education on integrative medicine. In collaboration with professionals in China, he is also planning an international conference on traditional medicines. Dr. Lo also serves on the Toronto/Peel Mental Health Reform Implementation Task Force.

Dr. Violet Kaspar is a member of the Canadian Institutes of Health Research peer review committee for Strategic Programs -- Reducing Health Disparities and Promoting Equity for Vulnerable Populations.

Visiting Scholars

Dr. Francis Lu, Professor of Clinical Psychiatry and Director of the Cultural Competence and Diversity Program, Department of Psychiatry, San Francisco General Hospital and University of California, San Francisco, visited CAMH as the 2002-03 Beverley Professor. This visit was hosted by the CCHS section, through support from CAMH's Beverley Professorship fund. The Professorship brings distinguished researchers and clinicians to CAMH to promote and participate in academic discussion on a topic relevant to research, clinical care and teaching activities.

As the 2002-03 Beverley Professor, Dr. Lu provided lectures, workshops and consultation groups on cultural competence in academic research, clinical care and teaching, focusing on the role of systems' cultural competence in understanding mental health disparities.

International Initiatives 

The CCHS has developed a memo of understanding involving the University of Port Harcourt, the University of Toronto and CAMH, and is continuing this initiative to establish a Centre for Stress and Health in the Niger Delta region of Nigeria. This work is being expanded to include methods of enhancing capacity to combat health hazards in the Niger Delta.

Another initiative is an ongoing collaboration between the University of Toronto, CAMH and the American University of Beirut, for a comparative study of adolescent mental health.

Finally, the CCHS has created an education elective in Addis Ababa, Ethiopia. The elective will allow two staff psychiatrists and one resident from the University of Toronto to travel to Addis Ababa three times per year, for one month per visit, to teach in the newly formed Ethiopian psychiatry residency program.

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