Language plays a crucial role in health care and especially in mental health, since the use of the native language helps to make a good diagnosis as several studies have shown.

We studied the influence of language on the accurate detection of psychotic and affective symptoms, exploring differences in the severity of reported symptomatology in a bilingual Basque-Spanish population.

The study uses the Prodromal Questionnaire-Brief for the detection of psychosis and the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, and Depression, Anxiety and Stress Scale-42 for the assessment of stress, anxiety and depression. Basque versions of the scales were developed and their psychometric properties were evaluated in a sample of 623 individuals, including 521 from the general population and 102 psychiatric patients. Possible relations between questionnaire scores and four linguistic factors, namely first language (L1), proficiency, age of acquisition and language exposure, were examined.

The four translated questionnaires showed adequate sensitivity, goodness-of-fit, and reliability indices, thus validating their suitability for general and clinical settings. The results showed that reporting of depressive symptoms seemed to be modulated by linguistic variables, mainly L1, whereas the severity of psychotic symptoms was less reliably associated with the gathered linguistic factors.

Overall, our results suggest that language of assessment by means of written instruments may have a limited impact on healthcare outcomes in balanced bilingual populations. The study enriches the understanding by considering various linguistic factors beyond L1, and by exploring the effect of these factors on affective symptoms, apart from psychotic ones.

Despite the importance of spoken language in psychotherapy processes with clients whose native language is distinct from the language of therapy, there is a dearth of research on mental health practitioners (MHPs) language competence. This research aimed to develop the Perceptions of Cross-lingual Practice (PCLP) scale designed to aid MHPs' cross-lingual practice.

Study 1 developed items and collected data from Australian MHPs (n = 155) to test the scale's factor structure through exploratory factor analysis. Study 2 (n = 257) confirmed the emergent factor structure of the scale through confirmatory factor analysis and further assessed its reliability and convergent validity.

The final 23-item measure had good reliability and validity. Three factors emerged; MHPs' perceptions of self-competence, MHPs' perceptions of difficulties faced by clients, and MHPs' perceptions of barriers for themselves imposed by language. The perceptions of self-competence subscale was weakly related to the other subscales highlighting a disconnect between MHPs' self-perceptions and perceptions of contextual factors.

The PCLP is a reliable and valid measure of MHPs' perceptions of cross-lingual practice composed of three subscales each with good psychometric properties that can be used for various purposes in the evaluation and development of MHPs in post-graduate and professional settings.

The percentage of individuals who are functionally bilingual in the United States has grown substantially in the last 3 to 4 decades. Nevertheless, bilingual mental health providers remain relatively scarce and bilingualism in psychosis or schizophreniaspectrum disorders remains relatively unexplored. Here, we present a clinical case study of a man with schizophrenia who presented his psychotic symptoms differently in his primary and secondary languages. We also consider this case in the context of other published cases with similar themes. Based on our review, we hypothesize that the presentation of psychotic symptoms may be influenced by the language a person uses, and more specifically, by their cognitive abilities to speak that language and/or their emotional attachment to that language. We outline the importance of obtaining a thorough language background of each patient with psychosis and investigate the ways in which a second language could serve as a protective factor against functional decline in psychotic and healthy populations. We suggest that attempts to engage bilingual patients with psychosis clinically in each language could lead to a more holistic evaluation of psychotic and disorganized symptoms and thus lead to more multidimensional intervention strategies.

281 million people were recorded as having migrated across national borders by the United Nations in 2021, this equates to approximately 3.6 percent of the world's population. Forced migrants/refugees account for 12 per cent of all international migrants. A percentage of these people will not speak the language of their new country fluently. If they are to access and utilize mental health services, they will require access to an interpreter. This paper provides guidance on working with interpreters in health settings when the work is either face to face or on-line. These guidelines are based on those written by the authors for the British Psychological Society. Working effectively with interpreters should be a skill in the repertoire of every clinician. This is to ensure that equal opportunities are upheld and that certain groups (including forced migrants) are not denied access to mental health services. Interpreters may also assist with teaching clinicians about diverse cultural views surrounding mental health and well-being. They may also advise on idioms of distress, cultural meanings and expression of emotional problems across cultures, explanatory health models and contextual factors which may help extend the repertoire of clinicians. The guidelines cover key recommendations for practice, booking and finding an interpreter, preparation before the consultation/meeting, practical considerations, preparation with the interpreter, during the meeting/consultation, issues to address after the meeting, written translations, psychometric testing, working by telephone or online and other issues to consider when working with an interpreter. These are reproduced below (with the permission of the BPS) in a shortened and updated form.Key recommendations for practiceUndertake a language needs analysis of the population covered by your service or Trust and consider how you will best meet needs.If you have not undertaken training in working with interpreters, undertake a training course. If you are working with an interpreter unexpectedly and training is not feasible, read these or other relevant guidelines and allocate time to consider the issues or discuss them with a more experienced colleague.Check that the interpreter is qualified and appropriate for the consultation/meeting and speaks the service user's first language.Allocate 10-15 minutes in advance of the session to brief the interpreter about the purpose of the meeting and to enable them to inform you about any cultural issues which may have bearing on the session.Be mindful of issues of confidentiality and trust when working with someone from a small language community as the service user may be anxious about being identifiable and mistrustful of an interpreter's professionalism. This has particular relevance when working with forced migrants.State clearly that you alone hold clinical responsibility for the meeting.Commit to a collaborative working relationship based on trust and mutual respect.Match if appropriate for gender, age or religion, avoid using relatives and never use a child.Create an atmosphere where each member of the triad feels able to ask for clarification if anything is unclear and be respectful to your interpreter, they are an important member of the team who makes your work possible.Be aware of the well-being of your interpreter and mindful of the risk of vicarious traumatization. Consider what support they will be offered, and if they are subcontracted from an external agency, be aware that there is often little support provided by their employer.At the end of the session always allocate 10-15 minutes to debrief the interpreter about the session and offer support and supervision as appropriate.Extreme caution should be exercised when considering the use of translated assessment measures as languages and concepts are not interchangeable and results may therefore not be valid or meaningful.All written translations used should have been back translated to ensure they are fit for purpose.Commissioners of health services need to ensure that there are clear pathways to support for all members of their local community including those who do not speak the majority language.

Objective: The prevailing scientific literature aggregates Asians living in America into one omnibus category and thus can problematically result in a subpar and at times inaccurate understanding of health, social and cultural factors necessary for competent and informed medical care. Method: A literature search was conducted by cultural experts familiar with Asian Indian culture with a focus on immigrants from this community living in the US. Database using search engines was sought in the following domains: immigration patterns, prevalence for key medical and neurological conditions commonly associated with cognitive dysfunction, psychiatric/psychological needs in the community, some preliminary neuropsychological testing considerations while working with this community, and treatment considerations that could affect adherence and efficacy of outcomes. Articles were selected from 2000 to the most recent date, with emphasis on compiling information from review papers and meta-analysis from the past decade. Conclusions: Asian Indians living in the US are distinct from the larger Asian American community. Immigration trends underscore that Asian Indians have a bimodal distribution of wealth. Regarding medical conditions, a key and highly concerning finding is the higher prevalence of cardiovascular risk factors, especially in young males. The lack of non-existent cognitive data in this community is glaring and should serve as an impetus for conducting high-priority research in this community. Preliminary neuropsychological testing considerations are discussed from a practical perspective with emphasis on multilingualism and region of origin. Finally, treatment considerations include understanding attitudes and beliefs regarding traditional medicine.

Language plays an important role in psychiatric conditions. Language disturbances are core symptoms of psychiatric ailments, and language is the main diagnostic tool to assess psychopathological severity. Although the importance of language in psychiatry, the effect of bilingualism, and more specifically of using the mother language or a later acquired language at the time of assessing psychotic symptoms, has been scarcely studied and, thus, remains unclear. We conducted a systematic review and meta-analysis to ascertain whether differences exist in the severity of psychopathology in psychotic patients when assessed either in the mother language or in an acquired language. Of 3121 retrieved references from three databases (PsycINFO, MEDLINE, Embase) and complementary searches, four studies-including 283 psychotic patients-were included in the review. The meta-analytical combined effect suggested that more overall symptomatology is detected when clinical assessment is conducted in the mother language rather than in the acquired language (very low quality evidence, random effects model standardized mean difference (SMD) 0.44, 95% CI = 0.19 to 0.69, p value = 0.0006, I2 = 90%). Considering the growing migration flows and the increasing number of bilingual people in the world population, the effect of the chosen language to conduct at the time of conducting psychopathological assessments of psychotic patients is a clinically relevant issue. Based on our findings, we recommend that clinical interviews with bilingual psychotic patients should be conducted, when feasible, in the patient's mother language.

Psychological models of voice-hearing propose that auditory-verbal hallucinations occur when inner speech is attributed to a source external to the self. Approximately half of the world's population is multilingual, and the extent to which they use a second language for inner speech depends on their experience and competency in it. Bilingualism therefore provides a natural window into the processes operating in auditory-verbal hallucinations, but no systematic study of voice-hearing in bilinguals has hitherto been conducted.

A mixed-methods observational study of psychiatric service users who hear voices and who are Welsh-English bilingual.

Thirty-seven participants were interviewed about their history and use of Welsh and English and divided into three groups: those who learnt Welsh first (L1 Welsh), those who learnt English first (L1 English), and those who learnt the two languages simultaneously. Detailed phenomenological data were collected using The Mental Health Research Institute Unusual Perceptions Schedule.

Both qualitative and quantitative data indicated very considerable variation in the extent to which voices were in Welsh, English, or both, with some voice-hearers reporting that the predominant language of their voices had changed with time. There were modest but statistically significant associations between the predominant language of voices and age of language acquisition (late Welsh learners did not hear voices in Welsh), frequency of language use (more frequent use of Welsh was associated with more Welsh voices), and subjective language proficiency (proficiency in English was associated with a tendency to hear English voices).

Although this was a small study, it was the first of its kind. There is a need for more research on the implications of bilingualism for psychosis in particular and mental illness more generally. The results are broadly consistent with the hypothesis that hallucinated voices are misattributed inner speech.

Assessments of people with mental health difficulties should routinely inquire whether they are multilingual and, if so, which language they prefer to use. People with mental health difficulties may have difficulty expressing complex issues and emotions in a second language, despite apparent fluency. When working with bilingual people who hear voices, mental health professionals should consider the language used by the voices when conducting assessments and proposing formulations.

A hypothesis offering diglossia as a potential risk factor for schizophrenia is presented. This is supported primarily by an account of the numerous co-occurrences between the diglossic phenomenon and the established risk factors and features of schizophrenia, such as language impairment, working memory dysfunction, social adversity, urbanicity, migration, and ethnicity, as well as some of the broader educational elements including illiteracy, reading deficits, and poor academic attainment. With an emphasis on the inherent role of language in schizophrenia and the demand for elucidating a mechanism behind its risk factors, we propose that a diglossic environment in childhood may constitute a neurodevelopmental insult predisposing to the development of the disorder. This relationship may be mediated by the reduced lateralization of language in the brain, which has been observed in relation to schizophrenia.

A background of migration is an established risk factor for psychosis. At the same time, over the last 25 years, many countries have developed specialized services for the assessment and care of people with early psychosis. Evaluation of these services often focuses on the duration of untreated psychosis (DUP).

We conducted a systematic review with an electronic search of key words in 3 databases to determine the extent to which studies measuring DUP consider transcultural variables, including migration status, national origin, ethnicity and language.

We identified 18 studies that included transcultural variables and measured DUP. They differed in their design, aims and methodology, and could not be directly compared. Common themes nonetheless appeared.

Most of the studies exploring DUP took little account of transcultural variables. Definitions of transcultural indicators were heterogeneous and often vague. Lack of language proficiency was often an exclusion criterion, and none of the studies used interpreters. We propose some basic transcultural variable and recommendations to include in future studies and recommendations to improve their internal and external validity.

Although a bilingual advantage has been described for neurodegenerative disease in general, it is not known whether such an advantage could accrue to individuals suffering from schizophrenia, since language networks are known to be disrupted in this condition. The aim of this minireview was to scan the existing literature to determine: (1) whether individuals with schizophrenia are able to learn a second language as adults; (2) whether clinical assessment, both for the purpose of accurate diagnosis and for the prediction of treatment response, should be carried out in both languages in bilinguals with schizophrenia; (3) whether psychotherapy in schizophrenia is affected by bilingualism; and (4) whether speaking a second language improves outcome in schizophrenia. The literature to date is too sparse to make definitive statements, but: (1) individuals with schizophrenia appear to be capable of learning a new languages as adults; and (2) it is possible that teaching a foreign language may serve as a form of cognitive rehabilitation for this condition. This literature review recommends research into the effects of bilingualism on the outcome of schizophrenia. Included in this review is a retrospective pilot study conducted in Canada, which suggests that employment opportunities for patients with schizophrenia are improved when they speak more than one language. This is important to note because employment is generally problematic in the context of schizophrenia while, at the same time, the ability to obtain work contributes significantly to quality of life.