Dropout from Mental Health Treatment Among Asylum-Seekers in Israel: A Retrospective Chart Study.

Dropout from psychiatric treatment and psychotherapy is common among asylum-seekers, even though they are at increased risk of emotional distress and psychiatric disorders. We aimed to define the associations between demographic and clinical variables and dropout among asylum-seekers in Israel. In this retrospective chart review we initially examined 271 files from Gesher (Bridge, in Hebrew), a government psychiatric clinic for asylum-seekers. All cases were considered eligible provided data were sufficient and asylum-seeker status could be ascertained. Of the 101 files included in the analysis, comparisons between patients who dropped out and patients who continued treatment were made, and logistic regression for dropout risk was conducted. In the study sample, 27 patients (26.7%) dropped out of treatment. Diagnosis of psychotic spectrum disorder and shorter time in Israel were significantly associated with dropout. Parenthood was significantly associated with dropout for men, but not for women. Defining factors associated with dropout and adherence to therapy for asylum-seekers may help improve ambulatory mental health services and the outcomes of treatment for this population.

Immigrant generation, acculturation, and mental health literacy among former Soviet Union immigrants in Israel.

BACKGROUND: Research on Mental Health Literacy (MHL) has been growing in different geographical and cultural contexts. However, little is known about the relationship between immigrant generations, acculturation, stigma, and MHL among immigrant populations. AIMS: This study aims to examine differences in MHL among immigrant generations (first, 1.5, and second) from the former Soviet Union (FSU) in Israel and to assess whether differences are accounted for by immigration generation or acculturation. METHOD: MHL was assessed among 420 participants using a cross-sectional survey adapted from the Australian National Survey. Associations of immigrant generation, socio-demographic characteristics, and acculturation with MHL indices were examined using bivariate and multivariable analyses. RESULTS: First generation immigrants reported poorer identification of mental disorders and higher personal stigma than both 1.5- and second-generation immigrants. Acculturation was positively associated with identification of mental disorders and negatively associated with personal stigma across all immigrants' generations. When all variables were entered into a multivariate model predicting MHL indices, acculturation and gender were associated with personal stigma and only acculturation was associated with better identification of mental disorders. CONCLUSION: Differences in MHL among FSU immigrants in Israel are mainly explained by acculturation rather than by immigrant generation. Implications for policy makers and mental health professionals working with FSU immigrants are discussed.

Resource Threat versus Resource Loss and Emotional Well-Being of Ethnic Minorities during the COVID-19 Pandemic.

This paper used Hobfoll's conservation of resources theory as a theoretical framework to investigate which kinds of resource loss predicted the emotional well-being (EWB) of ethnic minorities and majority populations during a period of crisis. Data were collected from a national representative survey conducted by the Israel Central Bureau of Statistics during the COVID-19 pandemic. The sample included 1157 respondents, including 174 Israeli Palestinian citizens (ethnic minority) and 983 Israeli Jews (majority population). Measures of EWB, actual losses and threats of losses of economic, social, and health resources were examined. The results showed that the losses of economic, social, and health resources reduced the EWB of individuals. Negative effects of the actual losses of resources on EWB were greater than those of the perceived threats of loss. The largest effect was for economic resources. There were differences in effects between the ethnic minorities and the majority populations. The study revealed that for the ethnic minorities, who are less powerful and more disadvantaged than ethnic majorities, the depletion of already deficient resources during time of crisis is more important for predicting their EWB than for the majority populations.

Trauma, Post-Traumatic Stress Disorder, and Mental Health Care of Asylum Seekers.

Asylum seekers in Israel from East Africa frequently experienced traumatic events along their journey, particularly in the Sinai Peninsula, where they were subjected to trafficking and torture. Exposure to trauma has implications for rights that are contingent on refugee status. This retrospective chart review aimed to characterize the types of traumas experienced by 219 asylum seekers (149 men) from Eritrea and Sudan who sought treatment at a specialized mental health clinic in Israel, and to compare the mental health of trauma victims (n = 168) with that of non-trauma victims (n = 53). About 76.7% of the asylum seekers had experienced at least one traumatic event, of whom 56.5% were diagnosed with post-traumatic stress disorder (PTSD). Most reported traumas were experienced en route in the Sinai, rather than in the country of origin or Israel. Few clinical differences were observed between trauma victims and non-trauma victims, or between trauma victims with and without a PTSD diagnosis. Our findings emphasize the importance of accessibility to mental and other health services for asylum seekers. Governmental policies and international conventions on the definition of human trafficking may need to be revised, as well as asylum seekers' rights and access to health services related to visa status.

Involuntary psychiatric hospitalizations in Israel 2001-2018 and risk for immigrants from different countries.

Since 2000, the Israeli mental health system has undergone a reduction in hospital beds, initiation of community-based rehabilitation, and transfer of governmental services to health maintenance organizations. This study examined trends, predictors and outcomes of involuntary psychiatric hospitalizations (IPH), in particular for immigrants. All first psychiatric hospitalizations of adults, 2001-2018, in the National Psychiatric Case Registry were used. Involuntary and voluntary hospitalizations were analyzed by demographic and clinical characteristics, and age-adjusted rates calculated over time. Multivariate logistic regression models were used to investigate IPH predictors and first IPH as a risk factor for one-year suicide after last discharge, and a Cox multivariate regression model to examine its risk for all-cause mortality. Among 73,904 persons in the study, age-adjusted rates of IPH were higher between 2011 and 2015 and then decreased slightly until 2018. Ethiopian immigrants had the highest risk for IPH, immigrants from the former Soviet Union a lower risk, and that of Arabs was not significantly different, from non-immigrant Jews. IPH was not significantly associated with one-year suicide or all-cause mortality. These findings demonstrate the vulnerability of Ethiopian immigrants, typical of disadvantaged immigrants having a cultural gap with the host country and highlight the importance of expanding community mental health services.

Suicide rates and risk factors for suicide among Israeli immigrants from Ethiopia (1985-2017).

BACKGROUND: Suicide rates among Ethiopian immigrants to Israel (EI) are relatively high. This study sought to identify suicide-risk factors in this population in order to suggest some potentially preventive measures to mental health policymakers who are struggling to prevent suicide among EI. METHOD: Nationwide age-adjusted suicide rates were calculated for EI, Former Soviet Union immigrants (FSUI) and Israeli-born (IB) Jews by age, gender, and year of death and, for EI, by marital status and immigration period in the years 1985-2017 (1990-2017 for FSUI). RESULTS: Age-adjusted suicide rates for the period 1990-2017 confirmed the significantly higher rate among EI--3.1 times higher than for FSUI and 4.1 times higher than for IB. Similar rates were obtained for both genders, within each age group, and in all study years. Comparable male/female rate ratios were found among EI and IB (3.3, 3.6, respectively). Over the years of the study, only among the Ethiopian immigrants were there large fluctuations in suicide rates: a decrease (1992-2001), followed by an increase (2001-2006), and then a progressive decrease (from 2006). The secular changes differed greatly according to age. Among females, these fluctuations were smaller, the decrease began earlier and was greater, and the subsequent increase was much smaller. Marriage was found to be less protective for Ethiopian immigrants than for the other surveyed populations. CONCLUSIONS: The considerable gap between the EI's and FSUI's suicide rates highlights the critical role of immigrants' integration difficulties. These difficulties among EI lead to ongoing conflict within the family, which may explain why marriage is less protective for EI. Nevertheless, progressive integration is occurring as indicated by the decline in suicide rates since 2006. The fluctuations in EI suicide rates over time seem to be associated with modifications in social welfare allowances, which are crucial for EI of low socioeconomic status. Groups at risk, particularly EI men facing socioeconomic challenges and EI with considerable family conflict, typically identified by HMOs and welfare services, should be screened for suicide risk, and those identified as at risk referred to tailored workshops sensitive to Ethiopian culture.

Income as a resilience factor for the impact of discrimination and institutional unfairness on minorities' emotional well-being.

This study investigated the impact of personal vs. institutional discrimination on the emotional well-being (EWB) of immigrant and ethnic minorities, and a possible protective mechanism of economic achievements that may buffer the negative effects of discrimination. Data were collected from the Israeli 2015 Social Survey. Immigrant minorities were those who came to Israel after 1980. Israeli Palestinians were regarded as an ethnic minority. The study showed that perceived unfairness and discrimination in public institutions, which were not necessarily directed towards individuals or their minority group, threatens EWB of minorities to an extent similar to that of personally experienced discrimination. Income moderated the effects of common and personal discrimination on EWB of immigrant and ethnic minorities, but not in the same way across the various groups. The study provides evidence that income may be a resilience factor, which buffers and compensates for the negative effect of discrimination on minorities' EWB.

The emotional distress of asylum seekers in Israel and the characteristics of those seeking psychiatric versus medical help.

Israel has become a destination for asylum seekers. Asylum seekers often experience emotional distress, but have limited access to health services and rarely use psychiatric services. This study sought to understand and characterize the use of psychiatric versus medical services by asylum seekers in Israel. We compared the emotional distress, stressful life events and previous treatment consultations of 21 psychiatric service users (PSU) and 55 medical service users (MSU) at the Open Clinic of Physicians for Human Rights in Tel-Aviv. Participants completed a socio-demographic questionnaire, the General Health Questionnaire (GHQ-12), the Stressful Life Events Scale and the Health Care Utilization Questionnaire. PSU and MSU did not have significantly different levels of emotional distress. PSU reported significantly more stressful life events during the past year than MSU ( M = 5.81, SD 3.47 vs. M = 3.8, SD 2.35, p < 0.01). In comparison to MSU, PSU utilized more medical ( M = 4.33, SD 2.28) and non-medical ( M = 2.38, SD 1.92) services ( p < 0.001) than MSU. Asylum seekers who consulted multiple treatment agencies in the last year were 1.55 times more likely to seek psychiatric treatment than those who had consulted only a few treatment agencies. Emotional distress in asylum seekers appears to be under-diagnosed in the Open Clinic and under-treated by mental health professionals. To better detect this distress, a thorough screening is recommended at assessment. Collaboration with mental health professionals and community and religious leaders consulted in the past is important and can contribute to good health care outcomes in this population.

Cultural Impact on SAD: Social Anxiety Disorder among Ethiopian and Former Soviet Union Immigrants to Israel, in Comparison to Native-born Israelis.

BACKGROUND: Social Anxiety Disorder (SAD) is linked to social norms and role expectations which are culture dependent, such as the construal of one's self as independent or interdependent in relation to others. The current study is the first to examine SAD symptoms among Ethiopian and former Soviet Union immigrants to Israel compared to a sample of native Israelis. We investigated the relationship between SAD, ethnicity and independent/ interdependent self-construals. METHODS: A total of 261 students (151 native-born Israelis, 60 Ethiopian immigrants and 50 students from the former USSR) were administrated the Liebowitz Scale (LSAS), the Self-construal Scale (SCS), Beck Depression Inventory (BDI) and a socio-demographic questionnaire. RESULTS: Ethiopians exhibited highest SAD scores while no differences were found between the FSU immigrants and native-born Israelis. Additionally, Ethiopians and native-born Israeli students exhibited similar high interdependence scores. Finally, SAD scores were predicted by gender, origin, independent and interdependent self-construals. CONCLUSION: Immigration per se is not a universal risk factor of SAD and ethnological-cultural factors do contribute specifically to SAD. A possible psychological mediator between culture and the susceptibility to SAD are the interdependence and independent self-construals. When treating immigrants, clinicians and health care providers are advised to consider the effect of cultural influence on the mental well-being and integration process of immigrants in to their host country.

Utilization patterns of ambulatory psychiatric services by Ethiopian immigrants in Israel.

BACKGROUND: Ethiopian immigrants in Israel (EI) have limited familiarity with western psychiatric care and, reciprocally, their culture is hardly known by mental health professionals. OBJECTIVE: to compare utilization patterns of ambulatory psychiatric services in Israel by EI and other population groups. METHODS: EI, former Soviet Union immigrants and Israel-born users of the 64 psychiatric governmental clinics and of the nationwide psychiatric rehabilitation services were compared on demographic and clinical data. Data were obtained from the Ministry of Health for the years 1997-2003. RESULTS: Among the EI cared in psychiatric clinics, there was a greater proportion of users with psychotic disorders; a lesser proportion was referred by self, family or friends; a greater proportion was prescribed psychotropic medications; and a lesser proportion received individual psychotherapy. EI used more protected housing facilities and less social and leisure services. DISCUSSION: Patterns of utilization of both types of services were found to be different among EI, suggesting a need to develop culturally-sensitive programs for both the Ethiopian immigrants and the mental health professionals.

Regional effects on the mental health of immigrant children: results from the New Canadian Children and Youth Study (NCCYS).

Children in immigrant families from Hong Kong, Mainland China, and the Philippines living in Toronto and Montreal are at higher risk of Emotional Problems than children in immigrant families in Winnipeg, Calgary, Edmonton, and Vancouver (Beiser et al., 2010). The current publication explores human capital, social capital, institutional receptivity, and perceptions of welcome as explanations for regional disparities. Parent's lack of linguistic fluency, and depressive symptoms provided the most likely explanation for Montreal's mental health disadvantage. Immigrant human and social capital, poor home-school relationships, marginalization, and lack of neighborhood organization contributed to the prediction of risk for emotional problems among immigrant children in Toronto, but may not fully account for differences between Toronto and Vancouver.

Patterns of psychiatric hospitalization among ethiopian and former soviet union immigrants and persons born in Israel.

OBJECTIVE: This study compared the prevalence and patterns of psychiatric hospitalization for persons who immigrated to Israel from Ethiopia and the Former Soviet Union (FSU) and the Israel-born population. METHODS: Data were extracted from the Israel Psychiatric Case Register for six population groups: Operation Moses 1980s immigrants, who emigrated from Ethiopia, January 1, 1980-August 31, 1985 (178 had at least one psychiatric hospitalization within five years of immigration); Operation Moses immigrants in the 1990s, the same group ten years later (194 were hospitalized ten to 14 years after immigration); Operation Solomon 1990s immigrants, who emigrated from Ethiopia in 1990-1991 (184 had at least one hospitalization within five years of immigration); FSU 1990s immigrants, who emigrated from the FSU in 1990-1991 (2,082 had at least one hospitalization within five years of immigration); Israel born 1980s (10,120 had at least one psychiatric hospitalization between January 1, 1980, and August 31, 1985); and Israel born 1990s (11,241 had at least one psychiatric hospitalization in 1990-1994). RESULTS: Operation Moses 1980s immigrants differed from the other groups; they had higher rates of hospitalization, less severe diagnoses, and shorter lengths of stay, compared with Israel born 1980s. Ten years later, this group's rates of hospitalization were lower and similar to those of non-Ethiopian populations, and the individuals in this group were more likely to have a diagnosis of schizophrenia or other psychosis, compared with the other groups. The hospitalization pattern for Operation Solomon 1990s immigrants fell between that of Operation Moses 1980s immigrants and Operation Moses immigrants in the 1990s. For immigrants from the FSU, the hospitalization rate was similar to that of Israel born 1990s and Operation Moses immigrants in the 1990s and much lower than that of Operation Solomon 1990s immigrants. CONCLUSIONS: Marked sociocultural differences between immigrants and the host society and the understanding of these differences by mental health professionals may influence rates and patterns of psychiatric hospitalization more than the immigration experience itself.

Adapting the SRQ for Ethiopian populations: a culturally-sensitive psychiatric screening instrument.

The objective of the study was to develop a culturally sensitive psychiatric screening instrument valid for Ethiopians in Ethiopia and Israel. The study sample was composed of 356 Amharic-speaking Ethiopians from Ethiopia and Israel, aged 18-55, divided into three groups: i) general population; ii) people in non-psychiatric treatment; iii) people in psychiatric treatment. They were interviewed with the Self-Reporting Questionnaire (SRQ), modified to include 10 culturally specific items, and the Brief Psychiatric Research Scale (BPRS) as a criterion of psychopathology. Physicians also completed an encounter form about the presence of mental health symptoms in participants. To make the questions more culturespecific, the translation of 12 items on the SRQ was changed. The content, construct, and criterion validity of each question were also examined, leading to the deletion of five items. The validity of the revised instrument (SRQ-F) was superior to that of the original instrument (SRQ). This study demonstrates the need for psychiatric screening instruments to be adapted to different cultures by incorporating meaningful translations and adding culturally specific items.