Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature
Travellers
Travellers are a minority ethnic group who have historically experienced high levels of unemployment, discrimination, and disadvantage. A number of studies have found that Travellers are susceptible to higher levels of anxiety and depression compared to the general population. In Ireland, Travellers are six times more likely to die by suicide than the general population, prompting a research team from Galway to explore perceptions of mental health among the Irish Traveller community.1 The centrality of cultural identity and social–emotional skills emerged as key factors in promoting positive mental health among Travellers. The authors suggest that Travellers’ mental health is multidimensional and community mental health promotion initiatives should focus on reducing discrimination, enhancing social and emotional wellbeing and self-esteem, improvement of living conditions, and the promotion of Traveller culture and positive self-identity.
Obstructive sleep apnoea
Health policymakers around the world are considering new delivery models for obstructive sleep apnoea (OSA) care. A recent Canadian study sought to identify perspectives on barriers and facilitators to optimal, patient-centred management of OSA in a primary care setting through an online survey of primary care ‘providers’, focus groups, and interviews with patients living with OSA, and workshops with primary care and sleep ‘providers‘.2 Several barriers were identified, including poor specialist access, variable primary care knowledge of OSA, and lack of clarity about roles in OSA management. Barriers contributed to patients being poorly informed about OSA, leading them to separate OSA from their overall health and eroding their trust in the system. The researchers suggest a more comprehensive model of care is needed, which will need to make effective use of technology, in particular.
Sex workers
A recent Australian study sought to examine how sex workers experience stigma related to their employment and the impacts of such stigma on their mental health.3 They found that the need to manage risks through selective disclosure of sex work was a pervasive experience. Participants reported poor treatment from mental health practitioners who saw sex workers as victims lacking agency, imposed beliefs that sex work was the pathological root cause of mental health issues, or approached the issue with fascination or voyeurism. Other presenting issues (especially mental health) were lost or obscured in therapeutic encounters resulting in suboptimal care. The authors conclude that action from governments, such as enabling legal environments, stigma reduction programmes, and structural protections from sex work stigma, are needed.
Post-stroke aphasia
Aphasia is a communication disability that affects around a third of patients after a stroke and can have a significant impact on self-identity and social relationships. A recent Australian study looked at current practice for managing depression after post-stroke aphasia from the perspective of stroke health professionals.4 They identified four core themes: 1) concomitant aphasia and depression after stroke is a challenging area of rehabilitation; 2) mood difficulties and depression are not always a high stroke rehabilitation priority; 3) approaches to identification and management are ad hoc; and 4) stroke health professionals are trying to bridge the gap between clients’ psychological care needs and limited services. Key clinical recommendations included the need for routine mood screening using aphasia-specific clinical tools and the increased involvement of family members in aphasia rehabilitation and psychological care.
- © British Journal of General Practice 2021
