Psychological distress among Ethiopian and Russian Jewish immigrants to Israel: a cross-cultural study

Cultural Aspects of Health care for Ethiopian Jewish Immigrants in Israel: A Literature Review

The unique health-related traditions, perceptions, and communication patterns of Ethiopian immigrants are challenging to Israeli healthcare providers who are trained in western medicine. The aim of this review was to conduct a survey of traditions, beliefs, and symptom reporting by Ethiopian immigrants and culturally oriented interventions to improve the care of Ethiopian immigrants. We used the keywords "Ethiopian immigrants Israel" and "Ethiopian Jews." Of 418 articles initially retrieved, 35 satisfied the inclusion and exclusion criteria. We described health-related traditions and their possible complications. Possession syndrome was frequently misdiagnosed as a neurological or psychiatric disorder. The medical staff was unfamiliar with these health and illness beliefs, somatization patterns, and the communication style of Ethiopian immigrants. There were successful interventions that involved liaisons from the Ethiopian community and community-based educational activities. Medical professionals working with African immigrants worldwide can use the Israeli experience to develop effective, culturally oriented interventions to optimize the health care for these immigrants.

Posttraumatic Stress Disorder Upon Admission to Shelters Among Female Victims of Domestic Violence: An Ecological Model of Trauma

The study used the ecological model of trauma and recovery (Harvey, 1996) to examine the rates of probable posttraumatic stress disorder (PTSD) among female victims of domestic violence. Five hundred and five participants completed questionnaires upon entering shelters in Israel. Analysis showed that 61% of the participants reported probable PTSD. Childhood exposure to violence, violence severity, and feeling helpless were all associated with high PTSD levels. By contrast, Ethiopian ethnicity, social support, and a stronger sense of control were associated with lower PTSD levels. However, the interaction between social support and violence duration showed that social support did not moderate PTSD when exposure to violence endured. The study emphasizes that resources deteriorate, and that policy-augmenting prevention programs would increase treatment potential to strengthen survivors' coping capacities.

Intimate Partner Jealousy and Femicide Among Former Ethiopians in Israel

Ethiopian immigrant women in Israel are overrepresented as victims of femicide; they are killed at more than 16 times the rate of the general population. This article suggests integrating current theoretical and empirical models to explain Ethiopian femicide, and stresses that considering psychological or sociocultural explanations as risk factors alone is not enough to understand this phenomenon. We distinguish between risk factors and triggers for femicide against Ethiopian women. While sociocultural and even psychological changes are risk factors for femicide, one, two, or three main triggers may activate such potential risk factors, such as the woman's willingness (WW) to leave the intimate relationship, sexual jealousy (SJ), and formal complaints against the abusive partner. The first two triggers are jealousy oriented. To analyze this phenomenon in Israel, we examined all court decisions on intimate partner homicide (IPH) from 1990 to 2010. After reading former studies on IPH and identifying important variables that could explain the phenomenon, we first catalogued the data in every decision and verdict according to main independent variables mentioned in the literature. The study population consists of first-generation immigrants, N = 194: native Israelis (47%), new immigrants from the former Soviet Union (FSU; 31%), and Ethiopians (16%). Our analysis of court decisions reveals that triggers containing jealousy components are responsible for 83% of femicide cases committed by Ethiopian men, in comparison with native Israelis (77%) and immigrant Russian men (66%) who murdered their intimate partners. In addition, there is a significant correlation among motive (jealousy), method of killing (stabbing), and "overkilling" (excessive force).

Religious differences in self-rated health among US Jews: findings from five urban population surveys

Research findings on religion and health among Jews are in relatively short supply. While recent studies report on the health of Israelis and the mental health of Jews in the USA, little information exists on the physical health of US Jews, especially from population surveys. In this study, data are analyzed from five urban surveys of Jews conducted since 2000: two surveys from New York (N = 4,533; N = 5,993) and one apiece from Chicago (N = 1,993), Philadelphia (N = 1,217), and Boston (N = 1,766). A strategy of two-way ANCOVA with interaction was used to test for differences in self-rated health across five categories of Jewish religious affiliation (secular, Reform, Reconstructionist, Conservative, Orthodox) and four categories of synagogue attendance (from never to at least weekly). Findings, adjusted for age and effects of other covariates, reveal that affiliated and synagogue-attending Jews report moderately better health than secular and non-attending Jews.

Migration and common mental disorder: an improvement in mental health over time?

Global migration is reaching record high levels and UK migrant groups comprise an increasing proportion of the total population. The migratory process causes stress that can affect mental health. There is limited consistent empirical evidence of a longitudinal nature to explain the association between migration and mental health. This review aims to examine the evidence of a relationship between migration and common mental disorder (CMD) amongst migrants over time. A comprehensive search of medical and psychiatric databases for global quantitative empirical studies investigating incidence of CMD amongst adult migrants from 1975 to July 2012 was conducted. Declines in rates of CMD amongst migrants over time were reported by two thirds of the 18 studies reviewed, less than one third of which were statistically significant. On the contrary, three studies showed an increased rate of CMD, one statistically significant. Individual psychological resources, social support, the acculturation process, cultural variations and time since relocation are identified as statistically significant protective factors against the development of CMD amongst migrants. New enlightening points include the significant impact of varying patterns of psychological distress, of which negative is the most adverse for CMD. Migration is an extremely complex process. Further clarification is needed to gain deeper understanding of the relationship between migration and CMD to address contradictions in the literature and health inequalities amongst migrants.

Culture transition, acculturation and intimate partner homicide

This article suggests an up-to-date, integrative theoretical/empirical model to explain IPH against Ethiopian women, as an example of IPH against women from patriarchal cultures in general, emphasizing the fact that psychological explanations, as well as socio-cultural ones alone, are insufficient for an understanding of this phenomenon. A full analysis requires the combination of the different points of view of all the parties involved. Only an integrative model, incorporating these different mindsets, can clarify the complex phenomenon of IPH among Ethiopian immigrants. Following a comprehensive review of the original characteristics of Ethiopian culture and its transformation after immigration to Israel, this article introduces the risk factors and triggers for IPH against Ethiopian women.

Level of distress, somatisation and beliefs on health-disease in newly arrived immigrant patients attended in primary care centres in Catalonia and definition of professional competences for their most effective management: PROMISE Project

Background

Newly arrived immigrant patients who frequently use primary health care resources have difficulties in verbal communication. Also, they have a system of beliefs related to health and disease that makes difficult for health care professionals to comprehend their reasons for consultation, especially when consulting for somatic manifestations. Consequently, this is an important barrier to achieve optimum care to these groups. The current project has two main objectives: 1. To define the different stressors, the level of distress perceived, and its impact in terms of discomfort and somatisation affecting the main communities of immigrants in our area, and 2. To identify the characteristics of cross-cultural competence of primary health care professionals to best approach these reasons for consultation.

Methods/Design

It will be a transversal, observational, multicentre, qualitative-quantitative study in a sample of 980 people from the five main non-European Union immigrant communities residing in Catalonia: Maghrebis, Sub-Saharans, Andean South Americans, Hindustanis, and Chinese. Sociodemographic data, level of distress, information on the different stressors and their somatic manifestations will be collected in specific questionnaires. Through a semi-structured interview and qualitative methodology, it will be studied the relation between somatic manifestations and particular beliefs of each group and how these are associated with the processes of disease and seeking for care. A qualitative methodology based on individual interviews centred on critical incidents, focal groups and in situ questionnaires will be used to study the cross-cultural competences of the professionals.

Discussion

It is expected a high level of chronic stress associated with the level of somatisations in the different non-European Union immigrant communities. The results will provide better knowledge of these populations and will improve the comprehension and the efficacy of the health care providers in prevention, communication, care management and management of resources.

Psychological distress and social support are determinants of changing oral health status among an immigrant population from Ethiopia

OBJECTIVES

To examine associations between psychosocial profile (psychological distress and social support) and changing oral health status (dental caries and periodontal disease), among a group of immigrants from Ethiopia to Israel.

METHODS

Three hundred and forty immigrants, aged 18-75 years, with a mean age of 38.4±13.5 years, comprised the study population and were followed over a 5-year period. Dental caries was recorded employing the DMFT index. Periodontal health status was recorded employing the Community Periodontal Index (CPI). Participants were interviewed using a structured written questionnaire which included two validated psychosocial scales, for psychological distress and social support. Bivariate and multivariate analyses were performed.

RESULTS

Among subjects with psychological distress, the adjusted mean caries (DMFT) increment in 2004-2005, since baseline (1999-2000), was 3.52±0.19 when compared to 0.35±0.15 among subjects with no psychological distress (P<0.001). Correspondingly, the percentage of people with increased periodontal pockets was 40%, when compared to 7%, respectively (P<0.001). In multiple linear regression analysis employing the DMFT as a continuous variable, and in multiple logistic regression analysis employing the DMFT as a dichotomous variable (% caries versus % caries-free), the four variables that reached statistical significance as predictors of caries status were previous caries experience, psychological distress, social support, and age. Gender, income, and education were not significantly related to current caries prevalence. In a multiple logistic regression analysis, the three variables that reached statistical significance as predictors of periodontal disease (shallow and deep pockets) were previous periodontal disease experience, psychological distress, and age. Social support, gender, income, and education were not significantly associated with periodontal disease prevalence.

CONCLUSIONS

This study presents persuasive evidence that supports the role of psychological distress and social support as determinants of changing oral health levels, among a low socioeconomic, relatively homogenous immigrant minority population.

Are immigrant populations aware about their oral health status? A study among immigrants from Ethiopia

Background

Evidence from Western countries indicates that there are fundamental discrepancies between self-perceived illness of immigrants and the provision of health care, according to the Western bio-medical health service model. These need to be understood in the planning and implementation stages of public health care programs for new immigrants. The objectives of the present study were to investigate self-perceived versus clinically diagnosed dental and periodontal health status among immigrants from Ethiopia.

Methods

During 2004–2005, dental and periodontal health status was recorded among 340 Ethiopian immigrants, utilizing the DMFT and CPI indices. Additionally, participants were interviewed using a questionnaire which included perceived dental and periodontal health status. Sensitivity and specificity levels of this perception were calculated and compared with the published scientific literature.

Results

Regarding dental caries, according to the three operational cut-off points, sensitivity ranged from 70% to 81%, and specificity ranged from 56% to 67%. Regarding periodontal status, 75% of the subjects clinically diagnosed with periodontal pockets self-perceived a "bad" health status of gums (sensitivity) and 54% of the subjects diagnosed without periodontal pockets, reported a "good" health status of gums (specificity). These indications of perception levels were higher than a previous study conducted among native born Israelis.

Conclusion

Minority ethnic groups should not be prejudicially regarded as less knowledgeable. This is illustrated by the unexpected high level of oral health status perception in the present population. Oral health promotion initiatives among immigrants should be based upon optimal descriptive data in order to accomplish the inherent social commitment to these diverse populations.

Psychological distress and its demographic associations in an immigrant population: findings from the Israeli National Health Survey

OBJECTIVE

This study compared psychological distress and its sociodemographic correlates in immigrant and veteran Israeli populations using data from the Israel National Mental Health Survey, the first nationwide study designed to estimate the prevalence rates of psychological distress and mental disorders in the Israeli adult population, which was carried out in 2003-2004, in conjunction with the World Mental Health survey initiative.

METHOD

Personal interviews were held with 3906 veteran Israelis, 845 immigrants from the former Soviet Union (FSU) and 107 immigrants from other countries (all the immigrants immigrated after 1989). Psychological distress was measured on the General Health Questionnaire-12.

RESULTS

Psychological distress among FSU immigrants was significantly higher than among veteran Israelis and immigrants from elsewhere. FSU immigrants were almost twice as likely to report severe psychological distress. Factors associated with psychological distress were female gender, age above 50, being divorced/widowed, being secular, having higher education and being either unemployed or 'not in workforce'.

CONCLUSION

The results support the acculturation stress hypothesis as an explanation for psychological distress in immigrants only in immigrants from the FSU, indicating that policymakers should plan services and prevention programmes differentially for different immigrant populations.

Prevalence and risk factors of threshold and sub-threshold psychiatric disorders in primary care

OBJECTIVE

Prevalence rates of mental health problems in primary care vary according to population and the type of measure used. This study examined the prevalence of a full range of mental health problems, including sub-threshold diagnoses, and the socio-demographic risk factors for psychiatric disorders among a population with low out-of-pocket expenditures for medical care.

METHOD

Four validated mental health assessment instruments, including the CIDI-SF, were administered to a sample of 976 users of primary care in Israel between the ages of 25-75 in eight clinics throughout the country. Prevalence estimates were obtained for seven psychiatric diagnoses, two "other mental health disorders" (somatization and disordered eating) and five sub-threshold conditions.

RESULTS

The most common types of morbidity were depression and disordered eating (20.6% and 15.0%, respectively), followed by somatization (11.8%) and general anxiety (11.2%). Among respondents, 31.1% had at least one psychiatric diagnosis, 24.3% had 'other mental disorders' and 15.5% had sub-threshold conditions. Panic attack, disordered eating and somatization, as well as a global measure of any psychiatric diagnosis were significantly more prevalent among women than men. Psychiatric diagnoses were also more common among those in the age group 45-64, with less education and insufficient income, the never married and separated/divorced and those not working. No significant differences were found between recent immigrants, veteran immigrants and Israeli-born, between Arab and Jewish Israelis or between secular or religious sectors of the population.

CONCLUSIONS

This study establishes the prevalence of the most common disorders in primary care including PTSD, somatization and disordered eating behaviors. The additional of other mental disorders suggests that a more accurate picture of mental disorders in primary care requires an expanded assessment procedure.

Psychological distress in migrants in Australia over 50 years old: a longitudinal investigation

BACKGROUND

Although it is a well-known fact that migration is a risk factor contributing to psychopathology, little is known in migrants who migrated in their old age. The present study examined whether origin of countries and visa types predicted psychological distress over a period of 1 year and whether their association changed after factors in health, social roles, cohort effect and social support were adjusted.

METHODS

A nationwide representative sample of 431 migrants who aged 50 and above were interviewed in 2000-2001 and 359 of them were re-interviewed 1 year after the baseline assessment. 12-item General Health Questionnaire (GHQ-12) was used measure psychological distress and a series of questions regarding socio-demographic characteristics (age, gender, living alone), days in Australia, origin of countries, visa types, health, social role, cohort effect, and social support were also included.

RESULTS

GHQ-12 scores did deteriorate over a period of 1 year among older migrants to Australia. In multiple regression analyses, origin of countries and visa types were significant predictors of future GHQ-12 scores. Baseline GHQ-12 scores, age, gender, living alone, days in Australia, poor self-rated health, the presence of heart disease, diabetes, and asthma, being a student or economically inactive, widowhood or divorce, as well as education were also significant predictors of GHQ-12 scores at 1-year follow-up.

CONCLUSIONS

The status of refugees predicts future psychological distress in older migrants even when other known correlates of psychological distress are controlled.

Psychotropic drug use in Israel: results from the national health survey

BACKGROUND

Despite increasing psychotropic drug prescriptions worldwide, little is known about utilization of these medications in the general population in Israel. We examined psychotropic drug use in the general population of Israel and the patterns of use among individuals with different DSM-IV diagnoses of 12-month mental disorders.

METHOD

A representative sample was derived from the National Population Register of noninstitutionalized residents aged 21 and older. Face-to-face interviews were conducted from May 2003 to April 2004. Individuals were asked about any psychotropic drug use in the past 12 months. DSM-IV disorders were assessed using a revised version of the World Health Organization's Composite International Diagnostic Interview.

RESULTS

Psychotropic drug utilization was observed in 6.9% of the general population and in 19.6% of individuals with any 12-month psychiatric disorder. The extent of use varied according to sociodemographic variables and the specific DSM-IV diagnostic categories. Among individuals with a 12-month diagnosis of pure major depression, only 13.6% received any antidepressants within the same period; exclusive use of antidepressants was 5.7%, while 3.3% of the individuals used only anxiolytics.

CONCLUSION

Similar to findings in other European countries, our findings suggest that the majority of individuals diagnosed with a common mental disorder are not being treated with psychotropic drugs or are being inappropriately treated.

Trends in involuntary psychiatric hospitalization in Israel 1991-2000

BACKGROUND

Though information about involuntary psychiatric hospitalizations (IPH) is crucial for the planning of Israel's National Mental Health Care Policy, very few studies have been carried out to date on this subject.

AIMS

To identify trends in first IPH to all inpatient psychiatric settings in Israel.

METHOD

The sample included all admissions of adults (18 years and older) over the ten-year period, 1991-2000, according to the registration of such admissions in the National Psychiatric Case Registry.

RESULTS

A 2.4-fold increase was found in first IPH over the decade studied. The typical profile of the involuntarily admitted patient was that of a native-born Jewish male, aged 18-24 or 65 and older, single, with less than 8 years of education, and with a diagnosis of schizophrenia or delusional psychosis.

CONCLUSIONS

These findings suggest the need for improving the interfaces between hospital and community services, and for preparing specific guidelines to extend the use of involuntary ambulatory treatment orders. Further study is needed to explore the respective roles of involuntary inpatient and outpatient treatment.

Suicide in Ethiopian immigrants in Israel: a case for study of the genetic-environmental relation in suicide

Immigration is a major life stress event, which has been associated with increased levels of mental health problems. The linkage between immigration and suicide has been studied in various societies, with conflicting results. Extremely high rates of suicide have been found repeatedly among the population of the Ethiopian immigrants in Israel. These rates were significantly higher than other immigrant populations in the country. Possible explanations for this disparity are discussed, and future directions for further study of this area are suggested.

Demography, immigration background, difficulties with living in Japan, and psychological distress among Japanese Brazilians in Japan

This study examined the relationship of demography, immigration background, and concerns and difficulties associated with living in Japan to nonpsychotic psychological disturbance (i.e., "caseness") measured by the GHQ-12. Data are from a sample of 265 Japanese Brazilians (JB) residing outside the Tokyo Metropolitan area. Employing multiple logistic regression analyses, it was found that JB who experienced lower economic conditions, lived alone, stayed relatively longer in Japan, migrated to Japan due to their dissatisfaction with the socio-economic conditions in Brazil, and who experienced severe family life concerns had a significantly higher ratio of "caseness," that is psychologically distressed. In contrast, JB over the age of 25 years, who acquired moderate Japanese language proficiency and decided to return to Brazil as soon as possible, were observed to have a significantly lower ratio of psychological distress. Socio-cultural and situational interpretations of the findings are presented.

Psychological distress among recent Russian immigrants in the United States

BACKGROUND

The purpose of this study was to examine the psychological status of Russian immigrants who have recently come to the United States.

AIMS

The project included creation of a Russian version of the Hopkins Symptom Checklist-25 (HSCL-25) in order to identify anxiety and depression in members of the Russian-speaking immigrant population.

METHODS

Translation and adaptation included (a) cross-cultural adaptation; (b) translation; (c) pre-testing; and (d) analysis of validity, reliability and internal consistency. Seventeen Russian-speaking patients at a Russian psychiatric clinic were recruited for the study and were compared with a sample of 42 Russian-speaking members of the community.

RESULTS

The instrument showed internal consistency when evaluated with coefficient alpha. Clinic patients had significantly higher anxiety and depression symptom scores than community subjects. Russian immigrants' scores on the anxiety and depression scales were less than comparative data for the United States and notably less than similar measures for Russian immigrants to Israel.

CONCLUSIONS

Recent Russian immigrants to the United States appear to have low prevalences of anxiety and depression.

Acculturation, social alienation, and depressed mood in midlife women from the former Soviet Union

Level of acculturation has been linked to depressed mood in studies across culturally diverse immigrant groups. The purpose of this study was to determine the effects of acculturation, social alienation, personal and family stress, and demographic characteristics on depressed mood in midlife immigrant women from the former Soviet Union. Structural equation modeling showed that higher acculturation scores, measured by English language and American behavior, were indirectly related to lower scores for depressed mood. Higher acculturation levels promoted mental health indirectly by reducing social alienation and, subsequently, lowering family and personal stress, both of which had direct relationships to symptoms of depression. These findings support the ecological framework that guided our research and point to the importance of focusing on contextual factors in developing interventions for new immigrants.

Age differences in stress process of recent immigrants

In the present study we sought to examine whether age affects the relationship between stress/social support and psychological distress in community residents in Israel who recently emigrated from the former Soviet Union (FSU). A cross-sectional and partly longitudinal design was used to compare emotional distress, stressor, and social support measures in three age groups (18 to 29, 30 to 59, and 60 to 86 years) of adult immigrants (N = 563). Age-related differences in the parameters of interest and their changes over time were examined with analysis of variance (ANOVA), t tests, and multiple regression analyses. We found that older immigrants reported higher levels of health-related stressors, but did not differ on total social support from younger immigrants. Specific predictors of elevated distress differed by age. For the youngest cohort, these included climate changes and anxiety for the future. For the middle-aged immigrants, these included female gender, lower education, unemployment, and longer time in Israel. For the oldest immigrants, predictors of distress included being divorced, separated, or widowed, and perceiving long-time residents of Israel as hostile. Only the middle-aged cohort showed a significant decline in levels of perceived stressors and distress during a 1-year follow-up. Thus, age differences in the stress process of recent immigrants are associated with age-specific perceived adjustment difficulties and demographic characteristics.