Interventions to promote mental health in the Occupied Palestinian Territories and Palestinian refugees: A scoping review.

BACKGROUND: The long history of the Palestinian-Israeli conflict has resulted in a public and mental health crisis. Despite the significant mental health burdens facing the Palestinian population in the Occupied Palestinian Territories (OPT) and refugee camps, this issue remains comprehensively unexplored. AIMS: This scoping review identified mental health interventions and assessed their effectiveness among populations in the OPT and Palestinian refugee camps, while addressing delivery challenges. METHOD: A scoping review was conducted using 14 databases to include relevant studies published through March 2024 using PRISMA guidelines for scoping reviews. RESULTS: Analyzing 31 intervention studies meeting the inclusion/exclusion criteria, revealed varied outcomes in interventions targeting post-traumatic stress disorder, depression, and overall mental well-being. CONCLUSIONS: While some interventions showed potential, others had limited effectiveness, underscoring the complexity of mental health needs in conflict zones. Gender- and risk-specific effectiveness was observed, emphasizing the need for tailored approaches. Challenges like low attendance rates and systemic barriers hindered intervention success. The profound impact of war on children stresses the urgency for targeted interventions. Empowerment and community connectedness are vital for resilience, along with the importance of family and community involvement and research that balances the need for strong evaluation designs with the need for ongoing mental health services. Advocacy for systemic changes is crucial to implement the complex sustainable interventions necessary to assure mental health in any population. This review highlights the importance of holistic, contextually relevant approaches for mental health intervention in OPT and refugee camps, emphasizing rigorous evaluations and community-driven approaches.

The Prevalence and Correlates of Depression, Anxiety, and Insomnia among Camp Residing Palestinian Women Migrants during the Outbreak of the War on Gaza: A Cross-Sectional Study from Jordan.

Background and Objectives: The current war on the Gaza strip and the circulating violent content is believed to negatively impact the mental health of the Palestinians living in refugee camps outside their homeland. This study explores the prevalence and correlates of depression, anxiety, and insomnia in a cohort of female Palestinian refugees in Jordan who have family members entangled in the persistent conflict in the Gaza strip. Materials and Methods: This cross-sectional study employed validated tools to assess depression, anxiety, and insomnia in women residing in a Gaza camp located in Jerash, Jordan. The correlates were determined by regression analysis. Results: The study unearths disconcerting statistics from 177 recruited women, revealing alarmingly high rates of severe depression (73%), anxiety (60%), and insomnia (65%). Multivariable analysis revealed that severe depression was significantly associated with prior diagnosis with chronic diseases (OR = 3.0, CI = 1.36-6.58), and having a first-degree relative in Gaza (OR = 0.42, CI = 0.20-0.85). Additionally, severe insomnia was associated with "losing relatives or friends in the war" (OR = 3.01, CI = 1.41-6.44), and "losing connection with families and friends" (OR = 3.89, CI = 1.58-9.53). Conclusions: The implications of these results are profound, underscoring the immediate and imperative need for both medical and psychiatric interventions aimed at addressing the substantial psychological burden borne by this population because of the ongoing conflict.

Perceptions of breast cancer screening programs and breast health among immigrant women: Qualitative study in Alberta.

OBJECTIVE: To examine how women who have emigrated from the Middle East and North Africa (MENA) region perceive breast cancer risk and screening in Canada and how they approach breast health, and to explore barriers to breast cancer screening in this population. DESIGN: Focused ethnography. SETTING: Edmonton, Alta. PARTICIPANTS: Women who were born in MENA countries (eg, Egypt, Iraq, Lebanon, Libya, Saudi Arabia, Somalia, Sudan, and Syria) and had immigrated to Canada less than 5 years prior to study recruitment and lived in Edmonton, Alta. METHODS: Six focus groups were conducted over a 6-week period in July and August 2018 with 6 participants in each group (N=36); results were analyzed thematically. MAIN FINDINGS: Three broad themes were identified: knowledge about breast health, cancer risk, and screening services; barriers to maintaining breast health and to screening; and potential solutions for overcoming these barriers. Findings indicated participants have limited knowledge about breast cancer screening practices in Alberta and that multiple barriers to screening remain. CONCLUSION: This study can help inform the development of culturally appropriate interventions to overcome barriers and to motivate women from MENA countries to use breast cancer screening.

Participation in physical activity and sport in adolescent girls from Middle Eastern backgrounds.

OBJECTIVES: This study investigated the barriers and facilitators to physical activity and sport participation among adolescent girls from Middle Eastern backgrounds. These factors were explored through the perspectives of both adolescent girls and parents of adolescent girls, living in Australia. DESIGN: A qualitative study design was used to understand perceived barriers and facilitators to physical activity and sport in adolescent girls. Participants were 18 adolescent girls and 9 parents of adolescent girls, all of Middle Eastern backgrounds, living in Western Sydney, Australia. Data were collected through five focus groups and four one-on-one interviews, separated for girls and parents. Data were analysed using an inductive approach and thematic analysis. RESULTS: Three main themes (family, social support, religion and culture) and nine subthemes were identified. The main facilitators for physical activity and sport included the values and presence of an active family role model, religion to encourage lifelong physical activity skills, and promotion of physical activity from peers, school, and social media. The predominant barriers to physical activity and sport included established cultural norms and traditional gender roles, which were often influenced by religion and culture, and extended time using technology. CONCLUSION: The findings of the current study show the complex relationships between family, religion, and culture when promoting physical and sport participation. Such factors highlight the need to develop culturally tailored physical activity interventions that consider the perceived barriers and facilitators for adolescent girls' participation from Middle Eastern backgrounds.

Peace between Israel and Palestine?

Talking to a relative of mine who lives in Israel, we exchanged by email about the Hamas terrorist attack and the brutal re-sponse of the Israeli Armed Forces that affected the entire Pal-estinian population of Gaza. He spoke to me about the moral right of the Jewish people to exist and I replied that the Pales-tinian people also had the moral right to exist. That ended the respectful dialogue we had. The Palestinian people's right to ex-ist remained unanswered.

Social support as perceived, provided and needed by family-members of migrants with type 2 diabetes - a qualitative study.

BACKGROUND: Social support provided by a family member has been found to have a buffering effect on distress and is associated with better diabetes self-care. This study explores the meaning of social support, as described by close family members of foreign-born people living with type 2 diabetes (PWDM) in Sweden. It also explores the support provided by family members, and the support they need to be able to support the PWDM. METHODS: Qualitative explorative study, semi-structured interviews for data collection. Qualitative content analysis based on a theoretical framework on social support. Purposive sample of 13 family members, 18-52-years-old, born in countries in the Middle East, Africa, and Russia. RESULTS: The meaning of support was described as social and emotional. Most participants described a stressful situation; feelings of sadness/worry about the risk of the PWDM developing complications added to a strained life situation from which one could not opt out. Frequent daily contacts in a family network were evident, particularly by children trained as healthcare professionals. Caring for a family member was considered a filial piety, but it was also a chance to reciprocate. The support provided was mainly informational (e.g., reminders about nutritional intake), but it was also instrumental/practical (administering medicines, helping with economy/logistics, planning/cooking meals, basic care) and emotional (sharing meals, thoughts, and activities). The support the family members needed was getting first-hand information by attending the physician visits, being able to book appointments themselves at suitable times, and preventing the withholding of important information about the PWDM. They also desired an open telephone-line, oral and written information, particularly on diet. CONCLUSIONS: To family-members, supporting the PWDM was normal and a filial piety. Support provided and needed was not only informational but also instrumental/practical and emotional. In diabetes care, addressing foreign-born individuals, diabetes education needs to be developed, also including family members. Informational material, particularly on diet, and improved access to healthcare and information about the healthcare system have the potential to increase family members' control over the situation and prevent a negative trajectory in caregiving with perceived demands causing high levels of stress.

Nutritional Beliefs and Practices of Arabic-Speaking Middle Eastern Mothers Living in the United States.

INTRODUCTION: Culture and acculturation influence nutritional beliefs. Little is known about the Arabic population in the United States. In this study, Arabic-speaking Middle Eastern mothers' perceptions of motherhood and childhood nutritional beliefs and practices are explored. METHOD: Semi-structured interviews with 12 mothers from Arabic-speaking Middle Eastern countries. RESULTS: Food and family are central to everyday life. Mothers worked hard to maintain traditional nutritional practices with their school-age children. DISCUSSION: Findings can enhance school nurses' ability to collaborate with mothers in nutritional education and address any issues in the classroom.

Disparities in Health Insurance Among Middle Eastern and North African American Children in the US.

OBJECTIVE: To estimate and compare the proportion of foreign-born Middle Eastern/North African (MENA) children without health insurance, public, or private insurance to foreign- and US-born White and US-born MENA children. METHODS: Using 2000 to 2018 National Health Interview Survey data (N = 311 961 children) and 2015 to 2019 American Community Survey data (n = 1 892 255 children), we ran multivariable logistic regression to test the association between region of birth among non-Hispanic White children (independent variable) and health insurance coverage types (dependent variables). RESULTS: In the NHIS and ACS, foreign-born MENA children had higher odds of being uninsured (NHIS OR = 1.50, 95%CI = 1.10-2.05; ACS OR = 2.11, 95%CI = 1.88-2.37) compared to US-born White children. In the ACS, foreign-born MENA children had 2.11 times higher odds (95%CI = 1.83-2.45) of being uninsured compared to US-born MENA children. CONCLUSION: Our findings have implications for the health status of foreign-born MENA children, who are currently more likely to be uninsured. Strategies such as interventions to increase health insurance enrollment, updating enrollment forms to capture race, ethnicity, and nativity can aid in identifying and monitoring key disparities among MENA children.

[Vaccine hesitancy during the COVID-19 pandemic among young people with an ethnic background in east Oslo ­ a qualitative study]. / Vaksinenøling under koronapandemien blant unge med etnisk minoritetsbakgrunn i Oslo øst ­ en kvalitativ studie.

Background: Few studies have been conducted on young people's attitudes to the COVID-19 vaccine during the pandemic. We wished to examine how young people with an ethnic minority background decided whether to have the COVID-19 vaccine, based on the concept of vaccine hesitancy. Vaccine hesitancy involves uncertainty with regard to vaccination, irrespective of the decision taken. Material and method: Fourteen qualitative in-depth interviews with young people aged 16-25 years with an ethnic minority background and from the east side of Oslo were analysed and categorised into main themes. The participants also had links to the Middle East, South Asia and Africa. Results: Several of the study participants were hesitant to be vaccinated. Their hesitation was linked to the impression that the vaccine had been developed rapidly, false rumours, long travel times to vaccination centres and fear of adverse effects. A number called for better information. Vaccination through the school was described as a facilitating factor. Family and friends were less crucial in their assessment of whether to have the COVID-19 vaccine. The majority had trust in the authorities. Interpretation: Insufficient knowledge about the vaccine and fear of adverse effects, as well as practical barriers associated with undergoing vaccination, appears to contribute to vaccine scepticism among young people with an ethnic minority background. The authorities and healthcare personnel should provide young people with better vaccine information. Information should be provided by personnel they already trust, such as the school nurse.

Gambling and Migration - The Role of Culture and Family.

Problem gambling (PG) is a public health concern with severe repercussions for the individual, concerned significant others and the society. Foreign borns generally gamble less but are overrepresented among those with PG. Previous research has suggested that other factors, such as socio-economic status, might explain this, but also that cultural factors might play a role in the relationship to gambling and the development of PG. This qualitative study using content analysis investigates the experiences of and opinions about gambling and PG among 12 males living in Sweden with a migrant background in Afghanistan, the Middle East and North Africa. The results were show that the acculturation process could be a factor in developing PG, as well as a cultural values regarding money and wealth. PG was seen as more stigmatized in the origin country, and the family played a more important role in the rehabilitation of PG compared to the general population. The results of this study could be used to inform preventive and clinical programs to better reach people with a migrant background.

Disordered eating and emotional eating in Arab, middle eastern, and north African American women.

Arab, Middle Eastern, and North African (A-MENA) American women are often subject to intersectional discrimination, and they have also not been traditionally recognized as a distinct racial group in disordered eating literature. No study to date has provided descriptive information on disordered and emotional eating A-MENA American women, nor has examined perceptions of widely used measurements of eating pathology in this population. The current study generated descriptive information among A-MENA women on two widely used measures of eating pathology, the Eating Disorder Examination Questionnaire (EDE-Q) and the Emotional Eating Scale (EES). Participants (N = 244) were A-MENA adult women were recruited via social media and snowball sampling. Qualitative findings provide potential sociocultural predictors of disordered eating that should be further explored, such as bicultural identity and family pressures/comments toward appearance. Secondly, themes from the EES-R indicate adding emotion of shame and considering identity-related stress. The current study provides prevalence data and future directions of research on widely used eating pathology and appearance attitude measurements for A-MENA American women.

Depression, gender, and help-seeking among Arab/Middle Eastern North African (MENA) Americans: The role of enculturation.

The purpose of this study was to examine the ways in which depression severity, gender, acculturation, and enculturation are associated with help-seeking attitudes among Arab/Middle Eastern North African (MENA) Americans. A hierarchical linear regression was conducted with a sample of 296 Arab/MENA participants (154 women and 142 men). After controlling for pertinent demographic variables, depression severity was negatively associated with help-seeking. Further, there was a significant three-way interaction between depression severity, gender, and enculturation on help-seeking attitudes. For women with higher levels of depression symptoms, higher levels of enculturation were associated with less positive help-seeking attitudes; conversely, higher levels of enculturation for men were associated with more positive help-seeking attitudes. These results have significant implications for clinicians working with Arab/MENA American populations. Practitioners should be aware of acculturation and enculturation processes as well as the ways in which depression symptom severity may influence engagement in treatment differentially for Arab/MENA women and men. Future research is needed to examine the mechanisms underlying these relationships. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Enabling Better Nutrition for Adolescents from Middle Eastern Backgrounds: Semi-Structured Interviews with Parents.

The unyielding obesity epidemic in adolescents from Middle Eastern (ME) backgrounds warrants culturally-responsive and co-designed prevention measures. This study aimed to capture the opinions of ME parents residing in Australia on the crisis and their enablers and barriers to healthy eating interventions given their influence on adolescent eating behaviors. Twenty-six semi-structured interviews were conducted with ME mothers, aged 35-59 years, and most residing in low socioeconomic areas (n = 19). A reflexive thematic analysis using the Capability, Opportunity, Motivation-Behaviour model and Theoretical Domain Framework was conducted. Parents expressed confidence in knowledge of importance of healthy eating, but were reluctant to believe behaviours were engaged in outside of parental influence. Time management skills are needed to support working mothers and to minimize reliance on nearby fast-food outlets, which was heightened during COVID-19 with home-delivery. Time constraints also meant breakfast skipping was common. A culture of feeding in light of diet acculturation and intergenerational trauma in this diaspora was also acknowledged. Parents pleaded for upstream policy changes across government and school bodies to support parental efforts in the form of increased regulation of fast-food and subsidization of healthy products. Opportunities for weight-inclusive programs including parenting workshops underpinned by culturally-responsive pedagogy were recommended.

Enabling Better Nutrition and Physical Activity for Adolescents from Middle Eastern Backgrounds: Focus Groups.

The obesity epidemic in adolescents from Middle Eastern (ME) backgrounds necessitates co-designed and culturally-responsive interventions. This study's objective was to gather the opinions, attitudes, capabilities, opportunities and motivations of ME adolescents residing in Australia on healthy eating and physical activity (PA) behaviours to inform a future prevention program. Five focus groups were conducted, with 32 ME participants, aged 13-18 years, recruited via purposive and snowball sampling. More participants were female (n = 19) and from lower socioeconomic areas (n = 25). A reflexive thematic analysis was performed using the Capability, Opportunity, Motivation-Behaviour (COM-B) model as the coding framework. Limited nutritional knowledge and cooking skills accompanied by a desire to make dietary changes were reported. Local and school facilities provided adolescents with PA opportunities, but participants declared safety concerns and limited opportunities for females and older grade students. Social support from family and friends were enablers for both healthy eating and PA. Cravings and desire for cultural foods influenced food choices. Individual and/or group approaches using social media and face-to-face format were recommended for future programs. To enable PA and dietary behaviour changes, interventions should be specifically tailored for ME adolescents to improve their nutrition literacy and skills, along with providing safe environments for sport in conjunction with social support.

Clinical Profile and Health Disparities in a Multiethnic Cohort of Patients With Hypertrophic Cardiomyopathy.

BACKGROUND: Clinical studies of hypertrophic cardiomyopathy are over-represented by individuals of European ethnicity, with less known about other ethnic groups. We investigated differences between patients in a multiethnic Australian hypertrophic cardiomyopathy population. METHODS: We performed a retrospective cohort study of 836 unrelated hypertrophic cardiomyopathy probands attending a specialized clinic between 2002 and 2020. Major ethnic groups were European (n=611), East Asian (n=75), South Asian (n=58), and Middle Eastern and North African (n=68). The minor ethnicity groups were Oceanian (n=9), People of the Americas (n=7), and African (n=8). One-way ANOVA with Dunnett post hoc test and Bonferroni adjustment were performed. RESULTS: Mean age of the major ethnic groups was 54.9±16.9 years, and 527 (65%) were male. Using the European group as the control, East Asian patients had a lower body mass index (29 versus 25 kg/m2, P<0.0001). South Asians had a lower prevalence of atrial fibrillation (10% versus 31%, P=0.024). East Asians were more likely to have apical hypertrophy (23% versus 6%, P<0.0001) and Middle Eastern and North African patients more likely to present with left ventricular outflow tract obstruction (46% versus 34%, P=0.0003). East Asians were less likely to undergo genetic testing (55% versus 85%, P<0.0001) or have an implantable cardioverter-defibrillator implanted (19% versus 36%, P=0.037). East Asians were more likely to have a causative variant in a gene other than MYBPC3 or MYH7, whereas Middle Eastern and North African and South Asians had the highest rates of variants of uncertain significance (27% and 21%, P<0.0001). CONCLUSIONS: There are few clinical differences based on ethnicity, but importantly, we identify health disparities relating to access to genetic testing and implantable cardioverter-defibrillator use. Unless addressed, these gaps will likely widen as we move towards precision-medicine-based care of individuals with hypertrophic cardiomyopathy.

Disparities in Coronavirus Disease 2019 Mortality by Country of Birth in Stockholm, Sweden: A Total-Population-Based Cohort Study.

Preliminary evidence points to higher morbidity and mortality from coronavirus disease 2019 (COVID-19) in certain racial and ethnic groups, but population-based studies using microlevel data are lacking so far. We used register-based cohort data including all adults living in Stockholm, Sweden, between January 31, 2020 (the date of the first confirmed case of COVID-19) and May 4, 2020 (n = 1,778,670) to conduct Poisson regression analyses with region/country of birth as the exposure and underlying cause of COVID-19 death as the outcome, estimating relative risks and 95% confidence intervals. Migrants from Middle Eastern countries (relative risk (RR) = 3.2, 95% confidence interval (CI): 2.6, 3.8), Africa (RR = 3.0, 95% CI: 2.2, 4.3), and non-Sweden Nordic countries (RR = 1.5, 95% CI: 1.2, 1.8) had higher mortality from COVID-19 than persons born in Sweden. Especially high mortality risks from COVID-19 were found among persons born in Somalia, Lebanon, Syria, Turkey, Iran, and Iraq. Socioeconomic status, number of working-age household members, and neighborhood population density attenuated up to half of the increased COVID-19 mortality risks among the foreign-born. Disadvantaged socioeconomic and living conditions may increase infection rates in migrants and contribute to their higher risk of COVID-19 mortality.

A greater awareness of children with glucose-6-phosphate dehydrogenase deficiency is imperative in western countries.

AIM: This national retrospective Danish study described the characteristics of children diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency, an inherited X-linked recessive disorder that often affects children of Middle Eastern descent. METHODS: We studied children born between 1 January 2000 and 31 December 2017 and diagnosed with G6PD deficiency. They were identified from the Danish National Hospital Discharge Register and the Danish Database of Extreme Neonatal Hyperbilirubinaemia. RESULTS: There were 113 children diagnosed with G6PD deficiency, 67% were of Middle Eastern descent and they were frequently diagnosed before the onset of symptoms, based on known heredity. Of the 67 infants born in Denmark, 10% had extreme neonatal hyperbilirubinaemia and one developed kernicterus spectrum disorder, as did one child born in the Middle East. Most (61%) of the 33 children with jaundice received phototherapy, 12% had exchange transfusions and 18% received whole blood transfusions. After the neonatal period, 23% of the cohort had blood transfusions and 4% needed intensive care for acute haemolytic anaemia. The incidence of G6PD deficiency appeared to be severely underestimated. CONCLUSION: Many families from countries where G6PD deficiency is endemic move to Denmark and other Western countries. Greater awareness is essential to avoid chronic and potentially lethal, consequences.

Depression, Anxiety, and Coping During the COVID-19 Pandemic Among Indian Expats in the Middle East: A Survey Study.

OBJECTIVE: There are multiple studies indicating that the Indian expat population working in the Middle East is at a significantly high risk for developing anxiety, depression, and suicidal thoughts. The coronavirus disease 2019 (COVID-19) pandemic can precipitate or exacerbate psychological distress among the expat population. The objective of this study was to evaluate psychological distress and coping mechanisms among Indian expats working in the Middle East during the COVID-19 pandemic. METHODS: An online survey was conducted with a semistructured questionnaire using a nonprobability snowball sampling technique. In addition to demographic data, a list of COVID-19 pandemic-related questions, the Brief COPE, the 9-item Patient Health Questionnaire (PHQ-9), and the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) were also utilized. RESULTS: A total of 94 responses were received. Of the respondents, 52% reported clinically significant anxiety levels, and 41% reported clinically significant depression levels. Both the PHQ-9 and GAD-7 scores were significantly associated with the level of concern with air traffic restriction (P < .05). CONCLUSIONS: Our findings show that governments of both Indian and Middle Eastern countries should pay more attention to the mental health of the expat population while combating COVID-19.

Mortality in first- and second-generation immigrants to Sweden diagnosed with type 2 diabetes: a 10 year nationwide cohort study.

AIMS/HYPOTHESIS: Non-Western immigrants to Europe are at high risk for type 2 diabetes. In this nationwide study including incident cases of type 2 diabetes, the aim was to compare all-cause mortality (ACM) and cause-specific mortality (CSM) rates in first- and second-generation immigrants with native Swedes. METHODS: People living in Sweden diagnosed with new-onset pharmacologically treated type 2 diabetes between 2006 and 2012 were identified through the Swedish Prescribed Drug Register. They were followed until 31 December 2016 for ACM and until 31 December 2012 for CSM. Analyses were adjusted for age at diagnosis, sex, socioeconomic status, education, treatment and region. Associations were assessed using Cox regression analysis. RESULTS: In total, 138,085 individuals were diagnosed with type 2 diabetes between 2006 and 2012 and fulfilled inclusion criteria. Of these, 102,163 (74.0%) were native Swedes, 28,819 (20.9%) were first-generation immigrants and 7103 (5.1%) were second-generation immigrants with either one or both parents born outside Sweden. First-generation immigrants had lower ACM rate (HR 0.80 [95% CI 0.76, 0.84]) compared with native Swedes. The mortality rates were particularly low in people born in non-Western regions (0.46 [0.42, 0.50]; the Middle East, 0.41 [0.36, 0.47]; Asia, 0.53 [0.43, 0.66]; Africa, 0.47 [0.38, 0.59]; and Latin America, 0.53 [0.42, 0.68]). ACM rates decreased with older age at migration and shorter stay in Sweden. Compared with native Swedes, first-generation immigrants with ≤ 24 years in Sweden (0.55 [0.51, 0.60]) displayed lower ACM rates than those spending >24 years in Sweden (0.92 [0.87, 0.97]). Second-generation immigrants did not have better survival rates than native Swedes but rather displayed higher ACM rates for people with both parents born abroad (1.28 [1.05, 1.56]). CONCLUSIONS/INTERPRETATION: In people with type 2 diabetes, the lower mortality rate in first-generation non-Western immigrants compared with native Swedes was reduced over time and was equalised in second-generation immigrants. These findings suggest that acculturation to Western culture may impact ACM and CSM in immigrants with type 2 diabetes but further investigation is needed. Graphical abstract.