The Queensland Transcultural Mental Health Centre (QTMHC)’s Transcultural Approach to Honouring the Mind & Body Program aims to tackle the problem of chronic disease and depression amongst people from CALD backgrounds through exercise, self-management skills and better links with CALD communities.

The past decade has witnessed increasing prevalence of chronic disease around the world. Chronic disease prevention requires the constant examination of the changing social and physical environments to better understand the aetiologies of chronic diseases and to determine the most effective prevention strategies. Since chronic diseases reflect the accumulation of exposure to disadvantageous experiences and environments over the lifespan, they reveal disparities in health status among populations that correspond with patterns of social inequalities.

Although chronic diseases can affect any segment of the population, they are especially burdensome among certain culturally and linguistically diverse (CALD) communities (Australian Institute of Health and Welfare, 2006; Black, 2002). Despite the so-called ‘healthy migrant effect’, the culturally and socioeconomically disadvantaged environment in which CALD communities live is associated with a higher prevalence of, and a higher mortality from major chronic diseases (Black, 2002).

Added to this is the fact that culturally and linguistically diverse people are less likely to receive timely and adequate health care, and to benefit from broad health communication strategies (Black, 2002; Blignault & Haghshenas, 2005). Not surprisingly, and despite the fact that overseas-born persons are admitted to hospital at lower rates than Australian-born individuals, some CALD communities are hospitalised at significantly higher rates for conditions such as diabetes, heart attack, heart failure and renal disease, among others (Australian Institute of Health and Welfare, 2006).

As the management of chronic disease has been assumed as a public health issue, the recognition of the importance of depressive disorders has also grown. According to the World Health Organisation, by 2020 depression is expected to be second only to heart disease as a source of the global burden of disease.

Nowadays, it is clear that depression assumes an important role in the aetiology, course, and outcomes associated with chronic diseases (Astle, 2007; Jiang et al., 2005). Untreated depression adds to the burden of chronic disease since it adversely affects the course and complicates the treatment of chronic disease.

If we consider the panorama of CALD communities, the reality is not promising. Depression, as with chronic diseases, is associated with social isolation, lower income, unemployment, poorer education and housing disadvantages, all of which are more common in CALD populations (Australian Bureau of Statistics, 2001).

Despite this growing recognition of the importance of both chronic disease and depression to the health of individuals and disadvantaged communities, much needs to be done in order to tackle the burden these conditions represent to individuals and communities from CALD background.

As a consequence, the Queensland Transcultural Mental Health Centre (QTMHC) has set out to try and combat the prevalence of chronic diseases and depression through a unique program.

Mind & Body is part of the Queensland Strategy for Chronic Disease 2005-2015, which aims to reduce the incidence and prevalence of chronic disease by better managing healthcare, improving people’s quality of life and avoiding hospitalisations.

Self-management programs, such as Mind & Body, have been shown to be useful in maintaining and improving people’s health behaviour and health status, while lowering their reliance on healthcare services (Lorig et al., 1999). However, few programs have addressed the needs of people from CALD backgrounds or have effectively dealt with conditions such as depression.

Mind & Body is underpinned by several principles:

1. people with depression and different chronic diseases have similar problems and concerns
2. people with depression and chronic disease can learn to take responsibility for the management of their disease
3. informed and activated people will experience improved health status, and
4. reach and equitable implementation is more important than creating substantially different preventive strategies for different cultural groups.

Mind & Body includes:

1. depression and chronic disease self-management group sessions where participants work on cognitions, goal setting and problem solving
2. bilingual community health promoters to provide cultural mediation between the culturally diverse communities and the health system, and
3. a focus on making physical activity more accessible to CALD communities.

The program will commence in July 2008 and will run for 4 years. It will be facilitated by bilingual allied health professionals. Initially, it will target adults living with a chronic condition and depression from Indian, Vietnamese, Filipino; and Arabic and Spanish-speaking backgrounds.

The first component of Mind & Body will be a depression and chronic disease self-management program comprised of 8 weekly sessions. Participants will gain skills, such as goal setting and problem solving to help them manage their condition and emotions. They will also learn about the overall benefits of exercise – how it maintains healthy weight and helps improve mental wellbeing.

Bilingual community health promoters will support participants in-between sessions. They will also provide culturally appropriate health education, advocate for individual and community needs; and coordinate existing resources, group programs and other health services. For this, QTMHC is partnering with the Ethnic Communities Council of Queensland.

The final component of the program will aim to ensure physical activity is more accessible to culturally diverse communities. This will entail making existing community exercise programs and information more appropriate to the needs of people from CALD backgrounds.

The evaluation plan will comprise both process evaluation to determine the success of the program implementation (reach, attendance, adherence) and impact evaluation to determine the program’s effectiveness for improving depressive symptoms, quality of life, and self-management behaviours.

If you require further information or if you know someone from the Spanish-speaking, Arabic-speaking, Indian, Vietnamese or Filipino community, who may benefit from the program please contact QTMHC at 07 3167 8333 or e-mail the program coordinator:

 Stop the Cycle of Chronic Disease (274KB) Queensland Transcultural Mental Health Centre, 2008. A Brochure describing depression and the Transcultural Mind and Body Program.

 A Transcultural approach to honouring the mind and body: A self-management program with multicultural communities (70KB) Queensland Transcultural Mental Health Centre, 2008. A Fact sheet on depression and the services available for multicultural communities, including the Transcultural Mind and Body Program.

• Astle, F. (2007). Diabetes and depression: a review of the literature. Nursing Clinics of North America, 42, 67-78.
• Australian Bureau of Statistics (2001). Socioeconomic Indexes for Areas Canberra: Australian Bureau of Statistics.
• Australian Institute of Health and Welfare (2006). Australia's Health 2006 Canberra: AIHW.
• Black, S. A. (2002). Diabetes, diversity, and disparity: what do we do with the evidence? American Journal of Public Health, 92, 543-548.
• Blignault, I. & Haghshenas, A. (2005). Identification of Australians from culturally and linguistically diverse backgrounds in national health data collections. Australian Health Review, 29, 455-468.
• Jiang, W., Glassman, A., Krishnan, R., O'Connor, C. M., & Califf, R. M. (2005). Depression and ischemic heart disease: what have we learned so far and what must we do in the future? American Heart Journal, 150, 54-78.
• Lorig, K. R., Sobel, D. S., Stewart, A. L., Brown, B. W., Jr., Bandura, A., Ritter, P. et al. (1999). Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Medical Care, 37, 5-14.
• Queensland Health (2005). Queensland Strategy for Chronic Disease 2005-2015 Brisbane: Queensland Health.