Inequalities in intimate partner violence screening and receiving information among diverse groups of women: an online survey during COVID-19 lockdowns.

BACKGROUND: Research shows violence against women likely increases during emergencies. COVID-19's emergence exacerbated intimate partner violence (IPV), suggesting that healthcare services (HCS) should have increased IPV screening efforts and referrals of victims to support services. However, little is known about the prevalence of IPV screening and information provision during COVID-19 lockdowns. METHODS: We examined prevalence of 'ever been screened' (ES) for IPV and 'receiving information about support services' (RI) in HCS during COVID-19 lockdowns and compared these among non-immigrant Jewish women, immigrant Jewish and other women, and Palestinian women citizens in Israel. We collected data during Israel's second and third COVID-19 lockdowns (October 2020-February 2021) using a structured, online, self-administrated Arabic-language and Hebrew-language questionnaire. Eligibility criteria included women ≥18 years old, citizens of Israel, in a current intimate relationship (permanent or occasional) who used social media or smartphones. In total, 519 women completed the survey: 73 Palestinian, 127 Jewish immigrants and others, and 319 non-immigrant Jewish. RESULTS: Overall, 37.2% of women reported any IPV, of whom just 26.9% reported ES, 39.4% reported RI and 13.5% reported both (ES&RI). Palestinian women reported higher IPV rates (49.3%) compared with non-immigrant Jewish (34.2%) and immigrant Jewish and other (37.8%) women; however, they reported lower ES (OR 0.64, 90% CI (0.34 to 1.86) and RI 0.29 (0.17 to 0.50). CONCLUSIONS: In a survey during COVID-19 lockdowns, only about one-quarter of women who reported IPV were ES for IPV, or RI about support services, suggesting strengthened IPV screening is needed in HCS during emergencies, particularly targeting minority women, who report higher IPV but receive fewer services.

Direct and indirect predictors of postpartum depression symptoms among indigenous Bedouin mothers in Israel.

Postpartum depression (PPD) is a common and complex phenomenon with negative outcomes for children, women and their families. This study set out to identify both direct and indirect predictors of PPD symptoms among indigenous Bedouin mothers in Israel. The study included 305 women, 18 to 45 years of age, who were interviewed while pregnant and again, 2 to 4 months postpartum. Interviews were conducted in Arabic and included the Edinburgh Postnatal Depression Scale, administered at both points of measurement. Using path analyses, we identified four significant, direct predictors of PPD symptoms. The strongest was depressive symptoms when pregnant, followed by low relative income, low hemoglobin, and number of prior miscarriages. The latter was significantly associated with consanguinity, meaning that women married to a first cousin experienced more miscarriages which, in turn, increased PPD risk. Low relative income was the only variable that had both a direct and indirect effect upon PPD symptoms (via symptoms of depression when pregnant and hemoglobin). Education and polygamy also emerged as indirect predictors of PPD via depressive symptoms reported during pregnancy. Results suggest a high rate of PPD in this perinatal sample of indigenous women. Our findings underscore the need for tailored interventions to reduce PPD, especially for low-income Bedouin women, faced with many barriers and insufficient access to healthcare services.

A Non-Randomized Controlled Trial for Reducing Postpartum Depression in Low-Income Minority Women at Community-Based Women's Health Clinics.

OBJECTIVE: To analyze an intervention that delivered tailored clinic staff training on postpartum depression (PPD) followed by awareness raising and social support aimed at lowering PPD among low-income Bedouin women in southern Israel. METHODS: We conducted a non-randomized controlled trial at two women's health clinics. The study included 332 of the 384 eligible women recruited at baseline (intervention = 169, control = 163), who completed two face-to-face interviews, one at 26-38 weeks of pregnancy (Time 1) and one 2-4 months postpartum (Time 2). PPD was measured by the Edinburgh Postnatal Depression Scale (EPDS) and dichotomized using a ≥ 10 score cutoff. We calculated EPDS change (rate difference of dichotomous EPDS from Time 1 to Time 2) (no change, positive change, or negative change), and compared EPDS changes in a control clinic vs. an intervention clinic. RESULTS: The intervention group showed a greater decrease in dichotomous EPDS ≥ 10 between times 1 and 2 (38.5% to 17.2%) than the control group (31.9% to 29.4%, PV = 0.008). Multinomial logistic regression showed that high PPD awareness significantly contributed to positive EPDS change in the intervention group (PV = 0.003) and high social support significantly protected against negative EPDS change in both groups, intervention (PV = 0.001) and control (PV = 0.003). CONCLUSIONS: In low-income women, an intervention focusing on increasing PPD awareness and social support following staff training was associated with reduced EPDS and positive EPDS change following the intervention. Similar interventions should be implemented in women's clinics during pregnancy. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov NCT02862444.

Prediction of embryo implantation rate using a sole parameter of timing of starting blastulation.

A time-lapse monitoring system provides a complete picture of the dynamic embryonic development process and simultaneously supplies extensive morphokinetic data. The objective of this study was to investigate whether the use of the morphokinetic parameter of time of starting blastulation (tSB) can improve the implantation rate of day-5 transferred blastocyst selected based on morphological parameters. In this retrospective study we analyzed the morphokinetics of 196 day-5 transferred blastocysts, selected solely based on morphological parameters. The interval time from intracytoplasmic sperm injection (ICSI) to time of starting blastocyst formation (tSB) was calculated for each embryo. The overall implantation rate of transferred blastocyst, selected based only on morphological parameters, was 49.2%. Implantation rate, determined retrospectively, was significantly higher (58.8% versus 42.6%, P = 0.02) for embryos with a short interval time to tSB (78-95.9 h) compared with embryos with a longer timeframe (96-114 h). Time of expanded blastocyst (tEB) post-ICSI was also significantly associated with implantation; however, this parameter was not available for all the embryos at time of transfer. When we tested only high ranked KIDScore day-3 sub-group embryos, the implantation rate was significantly higher in short interval time embryos compared with longer interval time embryos (62.2% vs. 45.5%, respectively, P = 0.02).These observations emphasize the importance of the timing of starting blastulation over blastocyst morphological parameters and may provide a preferable criterion for good morphology day-5 blastocyst selection.

Residential segregation, neighborhood violence and disorder, and inequalities in anxiety among Jewish and Palestinian-Arab perinatal women in Israel.

BACKGROUND: Residential segregation can foster health inequality mechanisms by increasing stress related to neighborhood violence and disorder. AIMS: We studied the association between neighborhood violence and disorder and inequalities in anxiety between two groups of perinatal Israeli women (Jewish, Palestinian-Arab) living in ethno-nationally segregated neighborhoods, and explored the influence of neighborhood characteristics; social support and chronic stress to this inequality. METHODS: We linked survey data on neighborhood violence and disorder, neighborhood social characteristics (collective efficacy, social capital and social support) and aggregate discrimination to neighborhood SES census data. The survey data was obtained from the "Family Relations, Violence and Health" study (2014-2015) and included a stratified national sample of women (Palestinian-Arab = 436, Jewish = 965) residing in 63 segregated neighborhoods. We conducted multi-variable logistic regression analysis for anxiety (measured based on State-trait Anxiety Inventory) using generalized estimating equation (GEE) to estimate odds ratios of the association with neighborhood violence and disorder (total score for 10 problems) while considering neighborhood characteristics (SES; social characteristics; aggregate discrimination), social support and chronic stress in different models for the total sample, and separately for Palestinian-Arab and Jewish women. RESULTS: Palestinian-Arab women had higher anxiety (60.5% vs. 42.1%, respectively) and higher severity of neighborhood violence and disorder (49.5% vs. 16.2%, respectively) compared to Jewish women. After considering individual and neighborhood variables, adjusted odds ratio (AOR) and 95% confidence intervals (CI) = 1.63, 1.04-2.56. The association between neighborhood violence and disorder and anxiety was significant for low vs. no problems in the final model for the total sample (AOR, 95%CI = 1.28, 1.00-1.64). Similarly, significant association was found only for low severity vs. no problems for Jewish women (1.40, 1.07-1.86). While among Palestinian-Arab women the association between neighborhood violence and disorder and anxiety rendered insignificant in the final model. Neighborhood social cohesion and social support were protective factors from anxiety in both groups, high neighborhood SES was protective factor only among Jewish women, and neighborhood aggregate discrimination was a risk factor only in Palestinian-Arab women. CONCLUSIONS: Inequalities in anxiety related to neighborhood violence and disorder in ethno-national perinatal groups of women likely reflect residential segregation. Policies entrenching segregation might have affected neighborhood mechanisms (SES inequalities, aggregate discrimination and low social cohesion) that lead to higher stress and ethno-national inequalities in anxiety among perinatal women.

Recurrent implantation failure: which patients benefit from endometrial scratching prior to IVF?

PURPOSE: Endometrial scratching (ES) using a biopsy catheter prior to the IVF cycle in the repeated implantation failure (RIF) population has been suggested, but no convincing evidence of its benefit has been presented until now. METHODS: A retrospective mono-center study among 300 consecutive IVF-RIF cycles following evaluation of the ovarian reserve, hysterosalpingography or hysteroscopy, pelvic ultrasound, thrombophilia evaluation, karyotyping and assessment of male sperm parametrs. The findings within normal limits. All the patients offered ES, 78 consented and underwent ES prior to their next IVF cycle. RESULTS: A comparison of treatment outcomes between the post-ES cycles (n = 78) and the non-ES cycles (222) demonstrated the following: 34 (43.5%) versus 14 (6.3%) conceptions, respectively (p = 0.001) and 30 (38.4%) versus 2 (0.9%) clinical pregnancies, respectively (p < 0.001%), emphasizing an extremely high biochemical pregnancy rate among the non-ES cycles. Implantation rate was 19.7% versus 0.4%, respectively (p < 0.001) and live birth rate was 33.33% (26 newborns) versus 0.45% (1 newborn), respectively (p < 0.001). Since there were more embryos available for transfer and more top-quality embryos in the post-ES-IVF conception cycles, the role of ES became questionable. A multivariate analysis that included ES and the percentage of top-quality embryos demonstrated that ES was an independent factor highly correlated with conception in this particular RIF population. CONCLUSIONS: ES proved to be an efficient tool in a particular subgroup of RIF patients with fertility investigation results within normal limits, an optimal ovarian response to gonadotropins, and a high percentage of top-quality embryos. Nevertheless, the results should not be overestimated, since the study has limitations related to its retrospective model.

The association between sociodemographic characteristics and postpartum depression symptoms among Arab-Bedouin women in Southern Israel.

BACKGROUND: Prevalence rates of postpartum depression (PPD) are 10 to 20% among various populations. Little is known about the characteristics of PPD among populations experiencing cultural transition. This study aimed to assess PPD symptoms (PPDS) prevalence and to identify risk factors unique to Arab-Bedouin women in southern Israel. METHODS: The sample included 564 women who visited maternal and child health clinics. Sociodemographic characteristics were obtained using in-person interviews. PPDS were assessed using a validated Arabic translation of the Edinburgh Postnatal Depression Scale (EPDS). Prevalence of PPDS was estimated using the cut-off score of EPDS ≥10; a more stringent cut-off score of EPDS ≥13 was used to define women with moderate to severe PPDS. RESULTS: The prevalence of PPDS among women was 31%, of which 19.1% were assessed as having moderate to severe symptoms (EPDS ≥ 13). In a multivariate logistic regression, the variables associated with EPDS ≥10 were having an ill-infant odds ratio (OR) = 3.9, lack of husband's support (OR = 2.6), history of emotional problems (OR = 3.2), low income (OR = 1.6), low level of education (OR = 1.6), high marital conflicts (OR = 1.5), and an unplanned pregnancy (OR = 1.5). CONCLUSION: In the generally understudied population of Arab-Bedouin women living in southern Israel, we found a high prevalence of PPDS. The unique risk factors described in our research can inform health care professionals in designing interventions for early detection and prevention of PPD.

Barriers to Adopting Healthy Lifestyle and Health Promotion among Ethnic Minority Bedouin Women in Southern Israel: A Qualitative Study.

BACKGROUND: A healthy lifestyle is a crucial step in disease prevention and management, as well as a significant predictor of health promotion. Yet, despite an increase in chronic morbidity among Bedouin women in southern Israel, little research has been conducted on their health behaviors. Therefore, the aim of this study is to examine barriers to adopting a healthy lifestyle and health promotion among ethnic minority Bedouin women in southern Israel. METHODS: This qualitative study was based on data collected through focus groups during June and July 2021. Participants included 44 Bedouin women aged 18-55. Focus groups were recorded and transcribed. Transcriptions were thematically analyzed and coded using the ecological model. RESULTS: We found multiple barriers at various levels that prevent Bedouin women from adopting a healthy lifestyle and health promotion. At the individual level, such factors included the impact of financial limitations on healthful nutrition, as well as a lack of awareness or knowledge regarding healthy lifestyle and health promotion. At the organizational level, barriers include a lack of clinics, accessibility, and availability of health services and cultural incompatibility of the health services. At the community level, impediments to a healthy lifestyle include inaccessibility to sports facilities and suppression of physical activity. At the public policy level, participants, especially those living in unrecognized villages, described difficult living conditions related to environmental and social neglect as affecting their health status and ability to maintain a healthy lifestyle. CONCLUSION: Study findings emphasize the need for policymaking and a systemic approach to address health disparities and ensure equal health promotion for the Bedouin population.

Promoting Positive Masculinities to Address Violence Against Women: A Multicountry Concept Mapping Study.

Interventions engaging men that challenge unequal gender norms have been shown to be effective in reducing violence against women (VAW). However, few studies have explored how to promote anti-VAW positive masculinity in young adults. This study aims to identify key multicountry strategies, as conceived by young adults and other stakeholders, for promoting positive masculinities to improve gender equity and prevent and target VAW. This study (2019-2021) involved young adults (aged 18-24 years) and stakeholders from Ireland, Israel, Spain, and Sweden. We applied concept mapping, a participatory mixed-method approach, in phases: (1) brainstorming, using semi-structured interviews with young adults (n = 105) and stakeholders (n = 60), plus focus group discussions (n = 88), to collect ideas for promoting anti-VAW positive masculinity; (2) development of an online questionnaire for sorting (n = 201) and rating ideas emerging from brainstorming by importance (n = 406) and applicability (n = 360); (3) based on sorting and rating data, creating rating maps for importance and applicability and clusters/strategies using multidimensional scaling and hierarchical cluster analysis with groupwisdom™ software; and (4) interpretation of results with multicountry stakeholders to reach agreement. The cluster map identified seven key strategies (41 actions) for promoting anti-VAW positive masculinities ranked from highest to lowest: Formal and informal education and training; Preventive education and activities in different settings/areas; Skills and knowledge; Empathy, reflection, and understanding; Media and public efforts; Policy, legislation, and the criminal justice system; and Organizational actions and interventions. Pattern matches indicated high agreement between young people and stakeholders in ranking importance (r = 0.96), but low agreement for applicability (r = 0.60). Agreement in the total sample on prioritizing statements by importance and applicability was also low (r = 0.20); only 14 actions were prioritized as both important and applicable. Young people and stakeholders suggested seven comprehensive, multidimensional, multi-setting strategies to facilitate promoting positive masculinity to reduce VAW. Discrepancy between importance and applicability might indicate policy and implementation obstacles.

A cross-country study on the impact of governmental responses to the COVID-19 pandemic on perinatal mental health.

This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries' Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period-with an infant aged up to 6 months-who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19.

Elevated Perinatal Depression during the COVID-19 Pandemic: A National Study among Jewish and Arab Women in Israel.

This study assessed prevalence of perinatal depression symptoms (PNDS) during the COVID-19 pandemic among Arab and Jewish women in Israel and identified COVID-19-related risk factors for PNDS, while comparing Arab and Jewish women. Sample included 730 perinatal women (604 Jewish and 126 Arab) aged 19-45 years, who filled out an online self-report questionnaire. The questionnaire assessed several areas: perinatal experiences and exposure to COVID-19, social support, and financial and emotional impact. PNDS was measured by the Edinburgh Postnatal Depression Scale (EPDS). Prevalence of PNDS (EPDS ≥ 10) in the entire study population was 40.0%. Prevalence among Arab women was significantly higher compared to Jewish women (58% vs. 36%, PV < 0.001). Higher PNDS were significantly associated with anxiety symptoms (GAD ≥ 10) (PV < 0.001), stress related to COVID-19 (PV < 0.001), adverse change in delivery of healthcare services (PV = 0.025), and unemployment (PV = 0.002). PNDS has elevated more than twofold during COVID-19 in Israel. Such high rates of PNDS may potentially negatively impact women, and fetal and child health development. This situation requires special attention from public health services and policy makers to provide support and mitigation strategies for pregnant and postpartum women in times of health crises.

The Role of Organizational Factors in Nurses' Perceived Preparedness to Screen, Intervene and Refer in Cases of Suspected Postpartum Depression.

Routine screening for postpartum depression (PPD) is widespread, yet little attention has been given to the perceived preparedness of health providers to perform screening procedures, or to the role of organizational factors in their preparedness, although these are crucial elements for optimal implementation. The aim of this study was to examine organizational factors associated with public health nurses' (PHNs) perceived preparedness to screen women for PPD, intervene, and refer them in cases of suspected PPD. Two hundred and nineteen PHNs completed a self-report survey regarding their perceived preparedness to carry out a screening program (including screening, intervening, and referring women), and their perceived organizational support, supervisor's support, colleagues' support, and colleagues' preparedness. A path analysis model was used to analyze the data. The results showed that perceived colleagues' preparedness was significantly associated with the three perceived preparedness constructs (screen, intervene, and refer). Perceived supervisor's support was positively associated with perceived preparedness to screen, and perceived organizational support was positively associated with perceived preparedness to intervene. This paper highlights the manner in which formal and informal organizational factors play an important role in the perceived preparedness of PHNs to carry out a PPD screening program, and how these factors impact the three different aspects of the screening program. Organizations implementing PPD screening should support PHNs in all aspects of the implementation process, provide guidance, and enhance peer-group continued learning through which PHNs could share knowledge, discuss barriers, and foster professional development.

Temporal Stability of Responses to the Edinburgh Postpartum Depression Scale by Bedouin Mothers in Southern Israel.

The detection and treatment of mental illness during pregnancy and postpartum are essential for the well-being of both mother and child. For this study, we set out to estimate the prevalence of perinatal depression among Bedouin mothers in southern Israel and determine if the latent structure of responses to the Edinburgh Postpartum Depression Scale (EPDS)-including depression, anxiety, and anhedonia-previously reported also applies to this population. A total of 332 women completed the EPDS during pregnancy (26-38 weeks) and again 2-4 months postpartum. Confirmatory factor analyses were performed to determine if first-order factors were correlated, or instead measure a second- or higher-order latent construct. We next performed temporal invariance analyses to compare the latent structure of EPDS responses over time. When pregnant, 35% of women provided EPDS responses suggestive of elevated depressive symptomology; this decreased to 23% postpartum. At both points, each EPDS factor significantly measures a higher-order, latent construct. The EPDS appears to measure three factors, labeled sadness, anxiety, and anhedonia. This latent structure appears stable (i.e., during pregnancy and postpartum). Further research is needed to validate EPDS responses versus structured clinical interviews. The construct validity of EPDS factors should be examined across other at-risk groups and over time.

COVID-19 and Mental Health of Minority Arab Higher-Education Students in Israel: Social, Economic, and Academic Factors.

The mental health and well-being of higher-education students is a topic of growing interest. COVID-19 impacted higher education in many ways and the challenges were especially pronounced for minority students. This study examines the impact of COVID-19 on the mental health of Arab minority students in Israel in relation to social, academic, and financial factors. We recruited 420 Arab higher-education students enrolled in academic colleges or universities in Israel who completed a battery of online questionnaires. Mental health status was measured by the Depression, Anxiety, and Stress Scale 21 (DASS-21). Moderate to severe symptoms of depression, anxiety, and stress were reported by 49.3%, 45.2%, and 54% of Arab students, respectively. Analyses indicate that low quality of online learning, academic difficulties, and negative economic effects of COVID-19 predicted stress, anxiety, and depression. Women reported higher levels of depression and stress; job loss predicted depression and anxiety; low income predicted depression; and COVID-19-related health concerns predicted anxiety. This study highlights the unique and multiple challenges faced by minority students from disadvantaged backgrounds. Campus programs are needed to address the emotional needs of students. Longitudinal research is needed to more fully understand the impact of COVID-19 on higher-education students.

Differential impacts of COVID-19 and associated responses on the health, social well-being and food security of users of supportive social and health programs during the COVID-19 pandemic: A qualitative study.

The effects of the coronavirus disease-2019 (COVID-19) pandemic on the lives of underserved populations are underexplored. This study aimed to identify the impacts of the COVID-19 pandemic and associated public health responses on the health and social well-being, and food security of users of Housing First (HF) services in Toronto (Canada) during the first wave of the COVID-19 pandemic. This qualitative descriptive study was conducted from July to October 2020 in a subsample of 20 adults with a history of homelessness and serious mental disorders who were receiving HF services in Toronto. A semi-structured interview guide was used to collect narrative data regarding health and social well-being, food security and access to health, social and preventive services. A thematic analysis framework guided analyses and interpretation of the data. The COVID-19 pandemic and response measures had a variable impact on the health, social well-being and food security of participants. Around 40% of participants were minimally impacted by the COVID-19 pandemic. Conversely, among the remaining participants (impacted group), some experienced onset of new mental health problems (anxiety, stress, paranoia) or exacerbation of pre-existing mental disorders (depression, post-traumatic stress disorder and obsessive-compulsive disorder). They also struggled with isolation and loneliness and had limited leisure activities and access to food goods. The pandemic also contributed to disparities in accessing and receiving healthcare services and treatment continuity for non-COVID-19 health issues for the negatively impacted participants. Overall, most participants were able to adhere to COVID-19 public health measures and get reliable information on COVID-19 preventive measures facilitated by having access to the phone, internet and media devices and services. In conclusion, the COVID-19 pandemic and associated response measures impacted the health, social well-being, leisure and food security of people with experiences of homelessness and mental disorders who use supportive social and housing services in diverse ways.

Direct and indirect determinants of prenatal depression among Arab-Bedouin women in Israel: The role of stressful life events and social support.

OBJECTIVE: Prenatal depression (PND) negatively affects the health and well-being of both mother and child. The aim of this study was to identify the direct and indirect determinants of prenatal depression symptoms (PNDS) among Arab-Bedouin women in southern Israel. DESIGN: Data collection was conducted in two women's health centers from October 2017 to February 2018. SETTING: Participants were recruited during visits to women's health centers in southern Israel. PARTICIPANTS: We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. All women were 18+ years of age and 26-38 weeks of gestational age. MEASUREMENTS: PNDS were measured by an Arabic version of the Edinburgh Postnatal Depression Scale. We computed path analyses to identify direct and indirect determinants of PND and estimated the contribution of stressful life events and social support. RESULTS: Positive direct associations emerged between stressful life events, history of depression and gestational age, and PNDS; direct inverse associations were found between social support, PND awareness, and education, and PNDS. History of depression was the single strongest direct predictor of PNDS yet when considering combined direct and indirect effects, the contribution of stressful life events is greater. Stressful life events (via history of depression and PND awareness) and education (via PND awareness) had both direct and indirect effects on PNDS. Age of the mother indirectly affects PNDS via education and PND awareness. Polygamy emerged as neither a direct nor indirect predictor of PNDS. CONCLUSIONS: PNDS in the underserved and understudied Bedouin women has serval direct and indirect predictors. Interventions aiming at reducing stress and increasing social support, via PND awareness might be successful in reducing PND and possibly future postpartum depression.

Barriers to postpartum depression treatment among Indigenous Bedouin women in Israel: A focus group study.

Postpartum depression (PPD), a common mental health problem among mothers worldwide, is higher among minority women. However, little is known about barriers faced by minority women when accessing mental health care services (MHCS) for PPD treatment. Drawing on McLeroy et al (Health Education Quartely 15: 351, 1988) ecological model, the current study explores barriers to mental health services among pregnant and postpartum minority Bedouin women in southern Israel. We conducted eight focus groups (FGs) in Arabic with 75 Bedouin women recruited using snowball sampling. Participants completed a socio-demographic questionnaire at each FG. Discussions were recorded and transcribed verbatim. Next, we conducted simultaneous thematic analysis and coded transcripts into conceptual categories based on the ecological model. We found multiple barriers that manifest at different levels (individual, family, organisational, economic, and public policy) and interact to limit Bedouin women's access to PPD treatment. At the individual level, factors included: women's negative attitudes toward PPD, women's societal status, grand multipara, gender, and limited knowledge about PPD; at the family level: low awareness among husbands and other family members regarding PPD symptoms and treatment, and lack of social support; at the organisational level: lack of culturally appropriate (health care services) HCSs, lack of PPD screening, and lack of PPD detection by family physicians; at the community level: economic barriers and poverty, stigmatisation of mental health problems, polygamy, and multiple births; finally, at the public policy level: residence in unrecognised villages lacking basic infrastructure. Our study thus sheds light on multilevel barriers impacting PPD prevention and treatment among Bedouin women. Policies and intervention programmes should seek to remove these barriers and protect Bedouin women and their children from the consequences of PPD.

Barriers to Health Care Services Among Palestinian Women Denied Family Unification in Israel.

Family unification received public and political attention following recent global immigration crises, though less within health research. In Israel, under the Family Reunification Order, about 20,000 Palestinian women from the Occupied Palestinian Territories are denied residency and the right to universal health care services (HSC) after marrying Palestinian citizens and moving to Israel. To better understand the relationship between lacking residency and barriers to accessing HCS, we conducted in-depth interviews with 21 Palestinian women (ages 22-59) denied family unification. Our findings revealed that in addition to hindering access to HCS, lacking residency intersects with other political, social, and economic determinants of these women's health and disrupts normal family life. Lacking residency intensifies poverty (via private health insurance and legal fees, permit extensions) and leads to family separations and risky crossings at military checkpoints into the West Bank for medical treatment. Restrictions on freedom of movement engender fear of deportation and precarity. Denial of residency also exacerbates gender inequality (increased dependence on husbands) and can endanger child custody when mothers' lack of residency passes to children, violating children's basic rights. Allowing family unification to Palestinian women would remove barriers to HCS access, allow normal family life, and permit social integration.