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Background: The current literature on the relationship between cultural adaptation and mental health is premature to offer a comprehensive explanation about the ways acculturation exerts either positive or adverse effects on the mental health of migrants. Aim: This study is an empirical approach towards understanding the magnitude of the relationship between consequences of cultural adaptation and psychological distress. Methods: Two samples of Ghanaian migrants in the Netherlands were included: a clinical group ( n = 36) and a non-clinical community group ( n = 97). Data were acquired by administering a semi-structured interview. Quantified data were analysed using multivariate techniques. Results: Contradictory to our hypotheses, the reported level of mental health symptoms in both groups was relatively low, suggesting a substantial resilience among the Ghanaian group. Confirming our hypotheses, specific dimensions of the acculturation process were associated with health status, particularly affiliation with cultural traditions and feelings of loss concerning the country of birth. Conclusions: Acculturation demands capture critical elements of migrants' experiences that warrant professional interventions tailored to their specific needs. A subtle balance between holding on to the supportive cultural traditions together with moderate involvement in ruminating about pre-migration life, in conjunction with acquiring instrumental skills of the host culture, is a starting position for better health.

Background: Ethnic minority groups differ in the pattern of their seeking help, and in their use of and attitude towards mental health systems. To meet the mental health needs of ethnic minority populations, insights into determinants of their help-seeking orientations are of great concern. Aim: To investigate help-seeking behaviour regarding mental health problems in terms of familiarity, attitude and service use among Mediterranean migrants in the Netherlands. Methods: Samples of Mediterranean citizens in the general population (N 1/4 292) and of Mediterranean (N 1/4 114) and indigenous Dutch outpatients (N 1/4 59) currently treated in mental health care were included. Data were acquired by administering a semi-structured interview. Quantified data were analysed using multivariate techniques. Results: More recently arrived participants were less familiar with mental health services. Moroccan, lower educated and recently arrived respondents reported a more negative attitude towards consulting these agencies. The help-seeking behaviour of the Mediterranean participants was relatively similar to that of the indigenous Dutch subjects. Conclusions: With regard to care-seeking routes and use of mental health services, more inter-ethnic similarities than differences emerged. Sociodemo-raphic variables like age, education and length of residence shape the process of help-seeking and service use.

This article discusses the experiences of mental health professionals who applied the Cultural Formulation (CF) of the DSM-IV for assessment of psychopathology and treatment needs of refugees in the Netherlands. The CF approach proved to be a useful tool in the assessment and diagnostic phase of clinical treatment. However, patients reported problems with defining their own culture and providing explanations of illness and therapists had difficulty identifying culturally-based difficulties in the clinical relationship. Additional information was needed about working with interpreters, therapists' attitudes towards the culture of the patient and towards their own culture, patients' previous experiences with discrimination and inaccessibility of care, gender issues, and specific cultures and subcultures. A more structured approach to conducting the CF is recommended. We developed the "Cultural Formulation Interview" for this purpose. The adaptations are aimed at improving the CF for use with refugee populations, as well as for more general use in transcultural psychiatry.

Exposure to mass trauma may bring about increased sensitivity to new or ongoing stressors. It is unclear whether sensitivity to stress associated with ethnic minority/immigrant status may be affected by severe exposure to mass trauma. We examined whether the loss of loved ones or home due to a disaster is associated with more persistent disaster-related distress in ethnic minorities compared with Dutch natives in the Netherlands. In residents affected by a fireworks disaster ( N = 1029), we assessed disaster-related distress after 3 weeks, 18 months, and 4 years. The effects of loss of loved ones or home and ethnic minority/immigrant status on distress were analyzed using latent growth modeling. After controlling for age, gender, education, employment, and post-disaster stressful life events, the loss of loved ones was associated with more persistent disaster-related distress in ethnic minorities compared with natives at 18 months, and the loss of home was associated with more persistent disaster-related distress in ethnic minorities compared with natives between 18 months and 4 years. Our results suggest that the loss of loved ones may increase sensitivity to stress associated with ethnic minority/immigrant status during the early phase of adaptation to a disaster. Loss of home may lead to further resource loss and thereby increase sensitivity to stress associated with ethnic minority/immigrant status in the long term. Efforts to prevent stress-related psychopathology following mass trauma should specifically target ethnic minority groups, notably refugees and asylum seekers, who often experienced multiple losses of loved ones as well as their homes.