Unraveling Trust Issues Towards Mental Health Professionals Among Bedouin-Arab Minority in Israel.

Trust in mental health professionals and services profoundly impacts health outcomes. However, understanding trust in mental health professionals, especially in ethnic minority contexts, is lacking. To explore this within the Bedouin-Arab minority, a qualitative study conducted semi-structured interviews with 25 Bedouins in southern Israel. Participants were primarily female (60%) married (60%), averaging 34.08 years old. Employing grounded theory, three themes emerged. Firstly, concerns about confidentiality were central, eroding trust due to societal repercussions. Secondly, factors influencing confidentiality concerns and distrust were tied to Bedouin-Arab social structures and cultural values rather than professional attributes. Lastly, the consequences of distrust included reduced help-seeking. This study enriches the understanding of trust in mental health professionals among non-Western ethnic minorities, highlighting how cultural factors shape perceptions of mental health services and distrust. Addressing confidentiality worries demands Bedouin mental health professionals to acknowledge hurdles, build community ties, and demonstrate expertise through personal connections and events.

Job satisfaction and well-being among college-educated Bedouin Arab and ultra-Orthodox women in the Israeli workforce: the roles of individual, familial, communal, and organizational resources.

Over the past two decades, increasing numbers of Bedouin Arab and ultra-Orthodox women have been integrated into the Israeli labor market. The integration of these women from traditional and minority communities into the general workforce involves significant coping on the practical, social, and emotional levels. This study examined factors that may facilitate the integration of college-educated Bedouin Arab and ultra-Orthodox women in the Israeli labor market. The sample included 304 ultra-Orthodox women and 105 Bedouin Arab women, who were employed in a variety of fields. Participants completed questionnaires designed to collect data on demographics, sense of personal coherence (SOC), family quality of life, sense of community coherence (SOCC), diversity climate, inclusive management, job satisfaction, and well-being. The ultra-Orthodox women reported higher levels of most of the resources; whereas the Bedouin Arab women reported higher levels only of inclusive management. Hierarchical regressions showed that income, SOC, and inclusive management each contributed significantly to job satisfaction. Levels of well-being were explained by SOC, family quality of life, and inclusive management. This study highlights the importance of individual, familial, and organizational resources for the integration into the workforce of female members of minority groups.

Coping strategies and depression among Bedouin mothers raising an adolescent with a developmental disability.

Many studies have examined the coping strategies and depression of mothers of children with disabilities, but most have involved Western families and only a few refer to unique and traditional cultures. The main goal of the current study was to assess depression among Bedouin Israeli mothers raising children with developmental disability (DD) and how it is linked to their coping strategies. The study included a sample of 95 Bedouin mothers of adolescents with and without DD in Israel. Self-report measures of CES-D and Brief Cope were used to measure depression and coping strategies. Findings revealed an alarmingly high prevalence of severe depression among Bedouin mothers, especially among those raising a child with DD. Mothers raising a child with a developmental disability tended to use avoidant coping more often, while the use of active coping strategies did not differ between the two groups. Adaptivity of planning and behavioral disengagement was found to be context dependent. Findings underscore the vulnerability of Bedouin mothers living in Israel, and particularly Bedouin mothers raising a child with a DD which are a double jeopardy group.

Strength of social ties and perceived tangible support: distinct characteristics and gender differences of older adults' social circles.

Social connections have been found to promote wellbeing among older adults. Studies note gender differences in older adults' social network characteristics and aspects of social support. The present study examined gender differences in the association of social network characteristics (number of strong social ties) and perceived tangible support among a sample of elders (n = 278). Older men reported higher levels of perceived tangible support, while older women had more strong social ties. The number of strong social ties was associated with older women's, but not men's, increased sense of tangible support. Implications for cultivating elders' wellbeing respective of gender particularities are discussed.

Community coherence and acculturation strategies among refugee adolescents: How do they explain mental-health symptoms?

BACKGROUND: Against the backdrop of 10 years of civil war in Syria, with millions of refugees, this study aimed to explore sense of community coherence and the acculturation strategies of separation and competition as factors that might explain mental-health problems among adolescent Syrian refugees in Greece. METHODS: Data were gathered from 173 adolescents aged 13-18 (M = 15.85; SD = 1.49); female adolescents accounted for 60.7% of the sample. Participants filled out a self-reported questionnaire regarding internalizing and externalizing problems, as well as posttraumatic stress disorder (PTSD). They were also asked about their sense of community coherence, their use of different acculturation strategies, and sociodemographic factors (i.e., gender, age, amount of time spent in the camp, and parents' education), as well as contextual factors such as exposure to war events, appraisal of danger, and whether they had received aid from various organizations. RESULTS: The female adolescents reported a stronger sense of community coherence and that they had received more aid from organizations than the male adolescents reported receiving. The male adolescents reported more externalizing problems. Exposure and appraisal of danger, as well as sense of community coherence and the use of the acculturation strategies of separation and competition all significantly explained the various mental-health problems. CONCLUSIONS: This article underscores the significance of gender, community coherence, and acculturation strategies in the prediction of mental health. It presents the results of this research in the context of the salutogenic and acculturation models.

Perceived social support, loneliness, and hope during the COVID-19 Pandemic: Testing a mediating model in the UK, USA, and Israel.

OBJECTIVES: The COVID-19 epidemic is affecting the entire world and hence provides an opportunity examine how people from different countries engage in hopeful thinking. The aim of this study was to examine the potentially facilitating role of perceived social support vis-à-vis hope as well as the mediating role of loneliness between perceived social support and hope. This mediating model was tested concurrently in the UK, the USA, and Israel. METHODS: In April 2020, as the first wave of the virus struck the three aforementioned countries, we assessed perceived social support, loneliness, and hope in 400 adults per country (N = 1,200). Assessments in the UK/USA were conducted via the Prolific platform, whereas in Israel they were conducted via Facebook/WhatsApp. RESULTS: In all three countries, perceived social support predicted elevated hope, although the effect was smallest in the UK. Loneliness mediated this effect in all three countries, although full mediation was attained only in the UK. CONCLUSIONS: Perceived social support may facilitate hope in dire times, possibly through the reduction of loneliness. PRACTITIONER POINTS: Findings are consistent with respect to the potentially protective role of perceived social support vis-à-vis hope. Perceived social support may increase hope through decreasing loneliness. In the UK, the above-noted mediating effect of loneliness appears to be stronger than in Israel and the USA. Elevated levels of perceived social support should serve as a desired outcome in individual and group psychotherapy, as well as in community based interventions.

Sense of coherence among Bedouin women in polygamous marriages compared to women in monogamous marriages.

We compared sense of coherence (SOC) among Bedouin women in polygamous with those in monogamous marriages. SOC is a global orientation toward life as comprehensible, manageable, and meaningful, and is derived from generalized resistance resources that promote effective coping in stressful life situations. Strong SOC may be a resource for strengthening resilience and promoting health. We administered questionnaires to 464 Indigenous Arab Bedouin women (ages 18-49 years) in 2008-2009 using the 13-item SOC questionnaire. Contrary to our hypothesis, SOC was higher among women in polygamous compared to monogamous marriages. Husband's education, husband's abandonment of the household, living in unrecognized villages, and low mastery (perception of one's ability to control life situations) were associated with higher SOC. These results might suggest that polygamy may provoke new coping mechanisms among women as they reappraise life amidst low mastery, accept cultural norms, and marshal new resources, thereby increasing key elements of SOC, including comprehensibility, manageability, and meaningfulness. Interventions and services seeking to empower women in polygamous marriages should build on their resilience.

Association between Knowledge about How to Search for Mental Health Information and Emotional Distress among Older Adults: The Moderating Role of Immigration Status.

Mental health literacy (MHL) provides a framework to overcome barriers to service use and reduce mental health disparities through public education. Acquiring basic knowledge about mental health problems can guide subsequent help-seeking behavior. Improving knowledge about how to search for mental health information is a critical first step in improving MHL. In this study, we examined the association between knowledge about how to search for mental health information and emotional distress among older adults. We further examined the moderating role of immigration status in this association. A sample of 605 older adults participated in the study (N = 357 Native Israelis; N = 222 Immigrants from the Former Soviet Union). Participants completed self-report measures assessing MHL and emotional distress. Our findings show that Native Israelis reported significantly lower levels of emotional distress and higher levels of knowledge about how to search for mental health information compared to immigrants. Moreover, while among native older adults, increased knowledge about how to search for mental health information was associated with lower emotional distress, among immigrant seniors there was no significant association between these variables. Our findings suggest that differences among immigrant and native older adults can impact the effectiveness of the mental health knowledge that is accessed.

Mental health literacy as a barrier and facilitator for service use: Qualitative inquiry among Palestinian Bedouins in Israel.

BACKGROUND: Mental health literacy (MHL) has been related to health behaviors and outcomes. However, studies examining MHL as a barrier and facilitator to service use are limited, especially among minority groups. AIMS: This study examined MHL as a barrier and facilitator to mental health service use among the Palestinian Bedouin minority in Israel. METHODS: Twenty-five Bedouins (15 women) from southern Israel participated in semi-structured, in-depth interviews. The participants were recruited by publishing an ad on social media about the study, then through a snowball technique. The data were analyzed thematically using ATLAS.ti.9, and the intercoder reliability was 92%. RESULTS: We identified four major themes in the interviews: (1) MHL as a barrier to service use, due to lack of knowledge about professionals in the field, mental health services, or reasons and risk factors for mental health problems; (2) traditional attitudes that acted as barriers to service use, including a preference for informal treatment, a lack of faith in mental health treatment, aversion to discussing private feelings, and the perception that mental health is a luxury; (3) MHL as a facilitator to service use by enabling accurate identification of mental distress and suggesting practical avenues for seeking help; and (4) ways to improve MHL that should be culturally sensitive and under the government agencies' responsibility. CONCLUSIONS: Interventions aimed at increasing the use of mental health services among Bedouins and reducing racial/ethnic disparities should increase knowledge in culturally adapted ways, especially regarding professionals and services, and change negative attitudes such as mental health treatment as ineffective or bonus.

A scoping review of studies examining mental health literacy among Arabs worldwide.

BACKGROUND: There is growing interest in Mental health literacy (MHL) worldwide, given its important role in overcoming barriers to service use and reducing mental health disparities. However, little is known about MHL among Arabs. AIM: We conducted a scoping review to examine MHL levels and correlates among Arabs in both Arab and non-Arab countries, based on Jorm's MHL framework. METHODS: We conducted a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using six electronic databases: PubMed, PsycINFO, CINAHL, Soc Index, Web of Science, and Scopus. Data were summarized and synthesized. RESULTS: Nine studies examining MHL among Arabs met our inclusion criteria. Seven of them used a quantitative cross-sectional design. Four studies were conducted in Arab, and five were in non-Arab countries. Five studies were conducted among university students. The studies included indicate moderate to high levels of MHL. Higher MHL was associated with female gender, personal experience of mental health illness, and with help-seeking behaviours. CONCLUSIONS: Our review shows a significant lack of empirical studies on Arabs' MHL. These findings should be considered as a call for action for public health researchers, mental health workers, and policymakers to prioritize research in this field.

Mental Health Underutilization by Palestinian-Arabs in Israel: Stigma-Related, Attitudinal, and Instrumental Barriers.

BACKGROUND: Many studies show that members of minority groups underutilize mental health services and report more barriers to such utilization than majority groups. However, very little is known about these barriers and their relation to mental health service use among the Palestinian-Arab minority in Israel. AIMS: This study examined barriers to mental health service use in this population based on the stigma-related, attitudinal, and instrumental barriers dimensions of the Barriers to Care Evaluation scale (BACE v3) and its correlates to mental health service use. METHODS: The participants were a convenience sample of 231 Palestinian Arabs. They completed measures of BACE v3, mental health service use, and sociodemographic characteristics. RESULTS: The findings showed that participants who reported using mental health services had lower levels of barriers in all dimensions compared to those who did not use such services. Attitudinal barriers were found to be the main determinants of mental health service use. CONCLUSIONS: This study underscored the role of attitudinal barriers to the utilization of mental health services. The findings indicated that interventions addressing such barriers might be helpful in increasing mental health service use among the Palestinian-Arab minority in Israel as well as other minorities in Israel and elsewhere, who might share similar backgrounds and perceptions.

Ultra-Orthodox Women in the Job Market: What Helps Them to Become Healthy and Satisfied?

This study explored the mental health and job satisfaction of Ultra-Orthodox women who work in different cultural environments. Data were gathered from 304 Ultra-Orthodox women who belong to various streams in this society and who were recruited by the Midgam research panel. The participants filled out self-reported questionnaires that assessed their family quality of life, community sense of coherence, diversity climate, inclusive leadership, job satisfaction, and mental health. The participants ranged in age between 19 and 64 years (M = 30.86, SD = 8.71); 43.1% worked within the Ultra-Orthodox enclave, while 22.4% worked with both Ultra-Orthodox and secular individuals and 34.5% worked in mainly secular environments. We observed differences and similarities among the three groups of women. Community sense of coherence was weakest among those who worked outside the enclave, while diversity perception and inclusive leadership were highest among that group. In all three groups, family and community were the most important resources for mental health. Both traditional resources (i.e., family and community) and other resources (i.e., perception of diversity climate and inclusive leadership) were important for job satisfaction.

Social Support and Psychological Distress among the Bedouin Arab Elderly in Israel: The Moderating Role of Gender.

In Israel, as in other developed countries, mental health problems are common among older adults who are members of disadvantaged ethnic minorities that are experiencing cultural and social changes. The main goals of the current study were: (a) to examine gender differences in the levels of psychological distress and social support among Bedouin elders, and (b) to examine the moderating role of gender in the associations between social support indices and psychological distress. We used a cross-sectional design, and independent t-tests and hierarchical linear regression analysis were performed. The study was conducted in homes and in social clubs and community centers for elderly people and involved face-to-face interviews and self-administered questionnaires. A convenience sample of 170 Bedouin Arab elderly people living in Israel participated in the study. Participants completed self-report questionnaires that assessed psychological distress, perceived social support, instrumental social support, and socio-demographic characteristics. Male elders reported lower levels of psychological distress and higher levels of instrumental support. Female elders, who reported low levels of both perceived and instrumental support, also reported higher levels of psychological distress. Among the women, there were significant associations between psychological distress and perceived social support, and instrumental support only when the levels of support were low. This study underscores the moderating role of gender in the associations between different types of social support and psychological distress among elderly people belonging to ethnic and cultural underprivileged minority groups.

Barriers to Mental Health Service Use among Palestinian-Arab Women in Israel: Psychological Distress as Moderator.

BACKGROUND: Many studies indicate that ethnic minority women, including women from the disadvantaged Palestinian-Arab minority in Israel, experience higher rates of psychological distress but are less likely to use mental health services. This study examined psychological distress and its role as a moderator in the relationship between mental health service use and stigma-related, attitudinal, and instrumental barriers. METHOD: Cross-sectional study of 146 Palestinian-Arab women who completed measures of psychological distress, mental health service use, the Barriers to Care Evaluation scale, and sociodemographic characteristics. RESULTS: Participants who did not utilize mental health services reported higher levels of all barrier types compared to participants who reported previous use, but lower levels of psychological distress. Psychological distress was a significant moderator only in the relationship between attitudinal barriers and mental health service use. CONCLUSIONS: This study highlights the role of psychological distress in the relationship between barriers to and utilization of mental health services, helping professionals and policymakers increase mental health service use among Palestinian-Arab women in Israel and other vulnerable women elsewhere.

Nature and happiness in an individualist and a collectivist culture.

According to the attention restoration theory, exposure to nature (ETN) renews one's capacity to focus attention, which decreases cognitive fatigue and therefore may increase positive emotions. Indeed, natural settings have been associated with high prevalence of happy facial expressions (HFE). However, how universal the association is, remains unclear. We explored the ETN-HFE association in Boston, US, representing a less collectivistic culture, and Yokohama, Japan, representing a more collectivistic one. Evidence from satellite images and social network data, using geoinformatics and statistical tools, revealed that individuals from both societies exhibited more happiness when they were photographed in more natural settings. These associations varied with temporal variations expressed through weekly and annual effects. In addition, we found that the presence of others was also associated with prevalence of HFE in natural settings at Yokohama and Boston but the relation was significantly stronger in Boston. Despite some relatively minor differences between the countries, these results support the universality of the association between ETN and HFE.

Diversity Climate, Salutogenic Theory, and the Occupational Health of College-Educated Women from Conservative Communities.

Over the past four decades, there have been significant changes in workplaces around the world, including a workforce that has become more diverse as the relative proportion of women in the workforce has increased. This trend has included the increased workforce participation of women from conservative minority groups. This article discusses the significance of the integration of college-educated women from conservative minority groups into the workforce in terms of their own personal health and well-being. This work focuses on two groups of college-educated women from conservative minority groups that have joined the Israeli workforce: Ultra-Orthodox women and Bedouin Arab women. This qualitative study was based on five focus groups, which included 16 women from the two examined groups. The main themes raised in those focus groups were categorized and analyzed. The data analysis was guided by the diversity-climate approach and salutogenic theory. The research findings indicate that a diversity climate that included most of the different aspects of this approach was present in the participants' statements regarding their workplaces. In practice, diversity climate supported sense of coherence, such that both diversity climate and a sense of coherence led directly to the occupational health of these college-educated, minority women.

What factors explain anger and mental health during the COVID-19 pandemic? The case of Israeli society.

BACKGROUND: What factors affected the levels of anger and emotional distress experienced during the coronavirus disease 2019 (COVID-19) pandemic? We hypothesized that (1) sociodemographic factors and resiliency factors would partially explain psychological distress and anger, with stronger resiliency associated with lower levels of distress and anger; (2) women would report more trust in national leadership, as well as more psychological problems; (3) individuals of low socioeconomic status would report less resiliency, less trust in national leadership, and greater distress than individuals of higher socioeconomic status; and (4) hope would mediate the relationships between the other resiliency factors and both anger and distress. AIM: To explore whether community resilience, hope, and trust in leaders were associated with lower levels of anger and emotional distress during the COVID-19 pandemic. METHODS: For this observational study, data were gathered in Israel during the second wave of the COVID-19 pandemic, just before the Jewish New Year (mid-September 2020), as a second lockdown was announced. Data were gathered from 636 Israeli adults, who were recruited by the Midgam research panel. The participants filled out self-reported questionnaires including one on state anger, the Brief Symptom Inventory as a measure of mental-health problems (i.e., somatization, depression, and anxiety), and questionnaires about trust in the state's leaders, community resilience (CCRAM), and hope as measures of coping resources and resiliency. t-tests were used to explore differences between men and women and between those of lower and higher socioeconomic status. A hierarchical multiple regression analysis was then used to examine whether and how the sociodemographic and resiliency variables explained state anger and psychological distress. A Sobel test was used to evaluate the possible effects of hope on community resilience and trust in leadership in the context of both distress and anger. RESULTS: Our results revealed differences between women and men in terms of anger and mental-health problems, but not in terms of coping resources. Women reported higher levels of both anger and mental-health problems. Participants of lower socioeconomic status reported more mental-health problems, more anger, and greater trust in the state's leaders; whereas those of higher socioeconomic status reported greater hope. Furthermore, hierarchical multiple regression analyses revealed that the sociodemographic factors of gender, age, and socioeconomic status, as well as community resilience, trust in the state's leaders, and hope explained mental health with a total of 19% of the variance and anger with a total of 33% of the variance. The Sobel tests showed that hope mediated the relationships between community resilience and mental health (z = 3.46, P < 0.001), community resilience and anger (z = 2.90, P < 0.01), and trust in leaders and anger (z = 3.26, P < 0.01), but did not affect the relationship between trust in leaders and mental health (z = 1.53, P > 0.05). CONCLUSION: Personal and communal factors affect psychological distress. Personal resilience is an important factor that should be strengthened throughout life. Trust in leadership is important for citizens' mental health.

Effective Ways to Encourage Health-Care Practices among Cultural Minorities in Israel during the COVID-19 Pandemic.

Following the worldwide outbreak of COVID-19, policymakers have been occupied with the questions of whether and how to specially address unique cultural groups coping with the pandemic. This study aimed to evaluate the potential for a culturally tailored approach to the transmission of health messages in a time of crisis among two minority populations within Israeli society: the Ultra-Orthodox population and the Arab population. To that end, 380 individuals from Israeli Ultra-Orthodox society and 360 individuals from Israeli Arab society completed a self-reported questionnaire in early April 2020, in the midst of the COVID-19 pandemic. The findings of this study reveal differences between these groups in terms of the effectiveness of different channels for conveying messages and the channels that were preferred, as well as significant relationships between community sense of coherence and the study variables. We found that advocacy and motivation based on values, on the one hand, and recognition of the effectiveness of a culturally tailored approach, on the other, may be the best approach for persuading members of minority populations, who belong to collectivist societies, to comply with epidemic-control instructions.

Hope and Resilience During a Pandemic Among Three Cultural Groups in Israel: The Second Wave of Covid-19.

The aim of this study was to explore the coping resources of hope and sense of coherence, which are rooted in positive-psychology theory, as potential resilience factors that might reduce the emotional distress experienced by adults from three cultural groups in Israel during the chronic-stress situation of a pandemic. The three cultural groups examined were secular Jews, Ultra-Orthodox Jews, and Arabs. We compared these cultural groups during the second wave of the Covid-19 pandemic, just before the Jewish New Year (mid-September 2020) as a second lockdown was announced. Data were gathered from 248 secular Jews, 243 Ultra-Orthodox Jews, and 203 Arabs, who were 18-70 years old (M = 37.14, SD = 12.62). The participants filled out self-reported questionnaires including the Brief Symptom Inventory as a measure of emotional/psychological distress (i.e., somatization, depression, and anxiety) and questionnaires about sense of coherence and different types of hope (i.e., intrapersonal, interpersonal, and transpersonal) as measures of coping resources and resiliency. Differences were found between the three groups in terms of several variables. The Arab participants reported the highest levels of emotional distress and the lowest levels of interpersonal and transpersonal hope; whereas the Ultra-Orthodox participants revealed the highest levels of sense of coherence and other resilience factors. A structural equation model revealed that, in addition to the sociodemographic factors, only sense of coherence and intrapersonal hope played significant roles in explaining emotional distress, explaining 60% of the reported distress among secular Jews, 41% among Ultra-Orthodox Jews, and 48% among Arabs. We discuss our findings in light of the salutogenic and hope theories. We will also discuss their relevancy to meaning-seeking and self-transcendence theory in the three cultural groups.

Correlates of psychological distress and self-rated health among Palestinian citizens of Israel: findings from the health and environment survey (HESPI).

OBJECTIVES: Psychological distress is a problem strongly associated with socio-economic conditions. This study aims to assess rates of psychological distress and 'poor' self-rated health among Palestinian citizens of Israel, who constitute 21% of the population and nearly 50% live in poverty, and compare their psychological distress scores with those of the general Israeli population. DESIGN: The Health and Environment Survey among Palestinian citizens of Israel (HESPI-2015), included a representative sample of this minority; 2018 individuals aged ≥18 were interviewed. The questionnaire included socio-demographic and health-related information, the General Health Questionnaire-12, (GHQ-12) and Self-rating of health (SRH). RESULTS: Subjects with GHQ-12 global scores of ≥17 were considered to have high distress. Low education, female gender, obesity and the presence of chronic diseases were significantly associated with high psychological distress over and above the effect of the other variables. Poor SRH was strongly associated with having a chronic disease and additional risk factors were older age group, low education and high psychological distress. Comparing psychological distress scores of Arabs in Israel with those of the general population showed that 30% of the former were classified as asymptomatic, as compared to 75% in the general population while the proportion of symptomatic or highly symptomatic was 14% in the latter as compared with 45% in the former. CONCLUSIONS: It appears that the burden of poverty, chronic disease and low education in this population, which suffers from multiple stressors, is disproportionate and should be addressed by the authorities, together with concrete plans to improve the education of the younger generations. Clearly, the association between discriminating policies and deprivation with psychological distress is not unique to the case of the Palestinian minority in Israel and therefore this study will allow for the examination and generalization of the current findings to other discriminated and disadvantaged minorities.