How do people of South Asian origin with long-term physical conditions understand, experience and seek help for emotional distress? A systematic review.

Talk Code: 
P.2
Presenter: 
Hassan Awan
Co-authors: 
Dr Faraz Mughal, Dr Tom Kingstone, Professor Carolyn A. Chew-Graham, Dr Nadia Corp
Author institutions: 
University of Keele

Problem

People with long-term conditions (LTCs) are twice as likely to suffer from depression than the general population. People with physical-mental comorbidity have a poorer quality of life, worse clinical outcomes and increased mortality than those with physical conditions alone. People from some ethnic groups are less likely to recognise symptoms which may represent mental health problems and perceive a need for support. Furthermore, they are an under-served group within health services. South Asians (SAs) are the largest minority group in the UK, and are more likely to have certain LTCs such as diabetes and heart disease. There is limited research of the experience of SAs with comorbid physical and mental health problems in primary care. This systematic review seeks to synthesise studies that explore perceptions of emotional distress in SAs with LTCs. The term emotional distress encompasses distress which can cause significant suffering and may or may not be diagnosed. The systematic review will inform a qualitative study interviewing SA males with diabetes and cardiovascular conditions, to explore their understanding of emotional distress and perceived care needs; and primary care clinicians to explore experiences of supporting SA males with mental-physical comorbidity.

Approach

A systematic review is being undertaken to answer the following question: How do SAs with LTCs understand, experience and seek help for emotional distress? An ethnically appropriate PPIE group has been convened, and has reviewed the systematic review question and terms. A search strategy was formulated for eight databases. This included the population of SAs with diabetes or coronary heart disease. The outcome of interest was conceptualisation of emotional distress. The setting included qualitative studies within primary and community care settings worldwide. 3,910 studies were imported into RefWorks which reduced to 2,609 after deduplication. Two reviewers separately undertook title and abstract screening. Once agreed, 27 full texts were dual screened and disagreements at both stages resolved through discussion or referral to a third reviewer. Data extraction is currently occurring independently and the CASP quality checklist for qualitative data will be used to review the quality of the papers. A PRISMA flow chart has been constructed to summarise the review process. Thematic synthesis will then be undertaken, based on Thomas and Harden’s three stages. GRADE-CERQual will be used to review the overall strength of evidence.

Findings

The systematic review is in process and the synthesis will be presented for the first time at SAPC 2020.

Consequences

The review will provide a greater understanding of SAs understanding and conceptualisation of emotional distress in the context of physical LTCs. This work will lead to improvement in the recognition and management of emotional distress in SAs with LTCs. The research has the potential to influence policy-makers and commissioners about service provision for this patient group.

Submitted by: 
Hassan Awan
Funding acknowledgement: 
Wellcome funded