Effect of implementation of mental health services within primary care on GP detection and treatment of mental disorders in Israel.

BACKGROUND: Psychiatric morbidity is frequent in primary care, but a substantial proportion of these psychiatric problems appear to be neither recognized nor adequately treated by GPs. There exists a number of models of introduction of mental health services (MHS) into primary care, but little data are available on their effect on GPs' detection or management of mental disorders. The study aimed to measure the effect of referring patients to a psychiatrist within primary care (Shifted OutPatient model-SOP) or consultation of psychiatrists by the GPs (Psychiatric Community Consultation Liaison-PCCL) on the detection and treatment of mental disorders by GPs. METHODS: In six primary care clinics in Israel (three "SOP clinics" and three "PCCL clinics"), GP detection of mental disorders and treatment of GP-detected cases were evaluated before and after provision of 1-year MHS, according to GP questionnaires on a sample of primary care consecutive attenders whose psychological distress was determined according to the GHQ12 and psychiatric disorders according to the Composite International Diagnostic Interview. RESULTS: After model implementation, a significant reduction in detection of mental disorders was found in SOP clinics, while no significant change was found in PCCL clinics. No significant change in detection of distress was found in any clinic. An increase in referrals to MHS for GP-diagnosed depression and anxiety cases, a reduction in GP counselling for GP-detected cases and those with diagnosed anxiety, an increased prescription of antidepressants and a reduced prescription of antipsychotics were found in SOP clinics. In PCCL clinics, no significant changes in GP management were observed except an increase in referral of GP-diagnosed depression cases to MHS. CONCLUSIONS: MHS models did not improve GP detection of mental disorders or distress, but possibly improved referral case mix. The SOP model might have a deskilling influence on GPs, resulting from less involvement in treatment, with decrease of detection and counselling. This should be taken into consideration when planning to increase referrals to a psychiatrist within primary care settings. Lack of positive effect of the PCCL model might be overcome by more intensive programs incorporating educational components.

Effects of individual differences, society, and culture on youth-rated problems and strengths in 38 societies.

BACKGROUND: Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry, 28, 1107) found that much more variance in 72,493 parents' ratings of their offspring's mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents' reports are essential for clinical assessment of their offspring, they reflect parents' perceptions of the offspring. Consequently, clinical assessment also requires self-reports from the offspring themselves. To test effects of individual differences, society, and culture on youths' self-ratings of their problems and strengths, we analyzed Youth Self-Report (YSR) scores for 39,849 11-17 year olds in 38 societies. METHODS: Indigenous researchers obtained YSR self-ratings from population samples of youths in 38 societies representing 10 culture cluster identified in the Global Leadership and Organizational Behavioral Effectiveness study. Hierarchical linear modeling of scores on 17 problem scales and one strengths scale estimated the percent of variance accounted for by individual differences (including measurement error), society, and culture cluster. ANOVAs tested age and gender effects. RESULTS: Averaged across the 17 problem scales, individual differences accounted for 92.5% of variance, societal differences 6.0%, and cultural differences 1.5%. For strengths, individual differences accounted for 83.4% of variance, societal differences 10.1%, and cultural differences 6.5%. Age and gender had very small effects. CONCLUSIONS: Like parents' ratings, youths' self-ratings of problems were affected much more by individual differences than societal/cultural differences. Most variance in self-rated strengths also reflected individual differences, but societal/cultural effects were larger than for problems, suggesting greater influence of social desirability. The clinical significance of individual differences in youths' self-reports should thus not be minimized by societal/cultural differences, which-while important-can be taken into account with appropriate norms, as can gender and age differences.

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

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

Testing Syndromes of Psychopathology in Parent and Youth Ratings Across Societies.

As societies become increasingly diverse, mental health professionals need instruments for assessing emotional, behavioral, and social problems in terms of constructs that are supported within and across societies. Building on decades of research findings, multisample alignment confirmatory factor analyses tested an empirically based 8-syndrome model on parent ratings across 30 societies and youth self-ratings across 19 societies. The Child Behavior Checklist for Ages 6-18 and Youth Self-Report for Ages 11-18 were used to measure syndromes descriptively designated as Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, and Aggressive Behavior. For both parent ratings (N = 61,703) and self-ratings (N = 29,486), results supported aggregation of problem items into 8 first-order syndromes for all societies (configural invariance), plus the invariance of item loadings (metric invariance) across the majority of societies. Supported across many societies in both parent and self-ratings, the 8 syndromes offer a parsimonious phenotypic taxonomy with clearly operationalized assessment criteria. Mental health professionals in many societies can use the 8 syndromes to assess children and youths for clinical, training, and scientific purposes.

Does Specializing in Family Medicine Improve the Detection and Diagnosis of Mental Health Problems?

BACKGROUND: Approximately half the patients seeking mental health (MH) treatment consult primary care practitioners (PCPs). Previous research indicates that patients often do not receive correct MH diagnoses or appropriate treatment from PCPs. The present study examines whether a specialization in family medicine compared to other or no PCP residency programs enhances physicians' ability to detect, diagnose and treat MH problems. METHODS: Face-to-face interviews with 49 physicans in eight clinics in Israel. Two case vignettes and questionnaires assess MH awareness and factors influencing treatment. RESULTS: Significantly more family practitioners (FPs) compared to others correctly diagnosed depression and anxiety vignettes were aware of patients' MH problems and prescribed psychotropic drugs. LIMITATIONS: Small sample size, indirect examination of PCPs' skills using vignettes and the absence of psychotherapy options. CONCLUSIONS: FPs are more likely than other PCPs to detect, diagnose and treat MH problems. To improve MH detection among a broad range of PCPs, an expanded MH curriculum should be encouraged. Additional MH training should be available for all PCPs.

Physicians' influence on primary care patients' reluctance to use mental health treatment.

OBJECTIVES: The study examined attitudes of primary care patients toward mental health treatment and whether ambivalent or negative attitudes change after patients receive recommendations from their primary care physicians to seek treatment from a mental health professional. METHODS: Data were collected in face-to-face interviews with 902 Jewish patients aged 25-75 in eight primary care clinics in Israel. Measures included validated mental health instruments and a vignette eliciting patients' readiness to consider treatment and potential influence of a physician's recommendation. RESULTS: Initially, almost half of patients were reluctant to consider specialized mental health treatment. The probability of having a more positive attitude after the physician's recommendation was significantly higher among patients with more severe clinical diagnoses. CONCLUSIONS: A major finding was the positive impact of primary care physicians' recommendations on reluctant patients. Encouraging physicians to discuss mental health issues would likely promote more positive attitudes and increase patients' willingness to access treatment.

Use of unconventional therapies by primary care patients--religious resources vs. complementary or alternative medicine services.

OBJECTIVES: The study examines the difference in characteristics between primary care patients who turn to "religious resources for medical purposes" (RRMP) and those who turn to "complementary or alternative medicine" (CAM) services to cope with a physical or mental health problem. DESIGN AND SETTING: Data were collected from eight primary care clinics in Israel and included 905 Jewish patients aged 25-75. MAIN OUTCOME MEASURE: A self-report questionnaire with a battery of validated mental health assessment instruments and two questionnaires regarding use of unconventional therapies (RRMP and CAM services) were administered to the participants. The association of various variables with type of 'service use' was examined through logistic regression analysis. RESULTS: Primary care patients suffering from emotional problems have a propensity to utilize unconventional therapies in addition to conventional medical treatment. However, differences exist between patients who turn to RRMP and to CAM. The risk factors for turning to RRMP are North African, Middle Eastern or Israeli origin, low SES, religious observance, and high use of primary care clinics. For using CAM services the risk factor is high SES. CONCLUSIONS: In the present study, a quarter of primary care patients also use additional resources for their medical problems. While all segments of the population use unconventional resources, our study reveals that two types of unconventional therapies - RRMP and CAM - tend to be used by two different population sectors. It is noteworthy that those suffering from mental health problems are more likely to utilize unconventional resources.

Mental disorders in primary care in Israel: prevalence and risk factors.

OBJECTIVE: Psychiatric morbidity is common among patients in primary care services and leads to disability and increased use of medical services. Comparison of primary care and community prevalence data is of interest in relation to the health services planning for mental disorders. The aim of the present study was to measure prevalence of mental disorders in six primary care clinics in Israel and to assess risk factors for these disorders. METHOD: Prevalence of mental disorders was measured in a sample of 2,948 primary care consecutive attendees, using two-stage stratified sampling with the General Health Questionnaire 12 (GHQ-12) and the Composite International Diagnostic Interview (CIDI). RESULTS: A high rate (46.3%) of current mental disorders was found, with rates of current depressive episode, generalized anxiety disorder, somatization disorder, and neurasthenia being relatively high in comparison with rates in other countries. Low education was a risk factor for all categories of disorders, unemployment a risk factor for depressive disorders, and parenthood was protective for most categories of disorders. CONCLUSIONS: High rates of mental disorders were found in this Israeli primary care sample as compared to other countries, while in the community the rates were midrange as compared to other countries, pointing to a relatively higher use of primary care services by patients with mental disorders in Israel than in other countries.

Trends in the use of rehabilitation services in the community by people with mental disabilities in Israel; the factors involved.

BACKGROUND: In 2001, the Rehabilitation of the Mentally Disabled Law was implemented, defining a basket of rehabilitation services to which people with mental disabilities are entitled. OBJECTIVES: To describe change over time in the characteristics of applicants to rehabilitation committees, types of referral agencies, and the proportion of those referred who were admitted. To identify factors affecting implementation of decisions to admit people with mental disabilities into different rehabilitation services and predictors of the length of time they remain in the services. METHODS: The study population consisted of all applicants to rehabilitation committees during 2001-2008. Rehabilitation services included hostels, supported housing, and vocational services. Data were extracted from Ministry of Health rehabilitation and psychiatric hospitalization case registers. Findings were analyzed using descriptive statistics, Kaplan-Meier survival analyses, and Cox regressions. RESULTS: There was a trend over time for more patients with shorter or no psychiatric hospitalization histories to be referred to rehabilitation services. Moreover, there was an increase in the proportion of referrals from the community, although the majority of referrals still came from psychiatric hospitals. Less than half of those recommended for a rehabilitation program were admitted and remained in a rehabilitation facility for one year or more. One factor predicting participants' longer stays in rehabilitation services after hospitalization was the proximity of the committees' decisions to the hospitalization. Another factor was the patient receiving vocational services while in residential care. CONCLUSION: Although over time the new law has resulted in a broader spectrum of people with mental disabilities receiving rehabilitation services, additional efforts are needed to enable them to remain in the system for a sufficient amount of time. Programs addressing specific needs should be developed accordingly.

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

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

[Impairment status and related predictors for adults hospitalized as children in a psychiatric ward in Israel].

BACKGROUND: The few studies that exist on long term outcome of psychiatric hospitalization of children show poor prognosis. OBJECTIVES: To study the level of functioning of adults who were hospitalized as children in a psychiatric ward in Israel and to identify prognosis predictors. METHODS: The study population consisted of all 1654 people who had been hospitalized in a psychiatric hospital in Israel and whose age at the time of the study was 21 years and above. For each subject, demographic and clinical data were extracted from a national case registry and data on disability benefits were retrieved from another file in the Ministry of Health. RESULTS: Only 8% of the study subjects were married, 8.3% died (3.5 times more in men compared to the general population), and 21% received disability benefits. More than half of the people who were hospitalized as children were rehospitalized during the follow-up (43% as adults). Younger age at first hospitalization was associated with a longer cumulative duration of hospitalization, while an older age was associated with a greater number of hospitalizations and a higher rate of eligibility for disability benefits. Diagnosis at first hospitalization was associated with all measures of functioning in adulthood. Diagnosis of an "organic" or severe psychiatric disorder was associated with poor prognosis. Longer duration of first hospitalization was associated with a higher rate of death and eligibility for disability benefits. CONCLUSIONS: This study shows poor prognosis for adults who were hospitalized in child psychiatry wards and calls for long-term prospective and controlled studies.

Predictors of early psychiatric rehospitalization: a national case register study.

BACKGROUND: Inconsistent results have been published on variables affecting readmission to psychiatric hospitals, in particular length of hospitalization before discharge. The objective of the present study was to develop a predictive model for 30 days readmission after discharge, as the latter is one of the performance indicators in the pending mental health reform in Israel. METHOD: The data were extracted from the Israeli national psychiatric case register. They concerned all patients discharged from psychiatric hospitals in Israel during a six month period (January 1,-June 30, 2004). A follow-up since the first discharge during this period (discharge from index hospitalization) until November 30, 2005 was performed for each patient. A Cox regression allowed constructing a multi factorial prediction model for readmission within 30 days from discharge. RESULTS: The readmission rate within 30 days was 13 percent. The variables predicting early readmission were age up to 45, history of prior hospitalization, short time between index and prior hospitalization and being discharged from a hospital in the Tel Aviv Center district. Length of hospitalization was not a predictor of early readmission, except for the very short ones (up to eight days) which predicted earlier readmission. CONCLUSION: The policy of shortening hospitalizations, which potentially could lead to premature discharge,was not found to be associated with early readmission,except for extremely short hospitalizations.

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

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

Post-discharge contact with mental health clinics and psychiatric readmission: a 6-month follow-up study.

BACKGROUND: Continuity of mental health care is a major topic in the post deinstitutionalization era, especially concerning its possible importance as a contributing factor in preventing rehospitalization. OBJECTIVES: To examine a) the association between continuing care and time to rehospitalization; and b) the predictors of time to first outpatient contact after discharge from psychiatric hospital. METHODS: Hospitalization records of all patients discharged from the Tirat Carmel psychiatric hospital in Israel, between January 1, 2006, and December 31, 2006, the National Register of Psychiatric Hospitalizations database and administrative databases of all psychiatric outpatient clinics in this catchment area were used to monitor continuing care and rehospitalization within 180 days from discharge. Predictors of time to rehospitalization and outpatient visits were examined using a Cox proportional hazards regression model. RESULTS: Out of the 908 discharged inpatients, 29% were rehospitalized and 59% visited an outpatient clinic during the study period. Of those who visited a clinic, 22% were rehospitalized compared with 40% of those who did not visit. Not making aftercare contact with a mental health clinic during the study period and/ or having a history of more than four hospitalizations were significant predictors of earlier psychiatric readmission. Males and patients diagnosed with schizophrenia or affective disorders made contact with outpatient clinics significantly earlier. Patients who were discharged from the hospital after a daycare period contacted outpatient clinics significantly later than those who were not in daycare. CONCLUSIONS: The findings suggest that psychiatric rehospitalization is associated with discontinuity of contact with psychiatric services but not with diagnosis. Patients with schizophrenia or affective disorders were found to adhere to a greater degree to clinical aftercare, which may explain why they are not rehospitalized earlier than less severe patients.

Predictors of cumulative length of psychiatric inpatient stay over one year: a national case register study.

BACKGROUND: Prior studies have shown inconsistent results regarding predictors of length of stay (LOS) and of readmission in psychiatric hospitals. "Cumulative LOS" over a given period, which reflects both LOS and readmission, has not been examined so far in a systematic way. The Israel Psychiatric Case Register in Israel made it possible to examine predictors of Cumulative LOS in a nationwide, representative sample. METHOD: All hospitalization admissions during a six-month period in Israel were recorded and followed-up for one year. The variables predicting Cumulative LOS over one year were identified through a Cox regression. RESULTS: The median Cumulative LOS during one year was 43.0 days, and only 1.7% of the patients remained hospitalized for more than one year after admission. The variables significantly predicting longer Cumulative LOS were: Jewish ethnicity, a diagnosis of schizophrenia or other functional psychosis, prior hospitalization, compulsory admission and Northern and Jerusalem districts of hospitalization (which have a lower admission rate). LIMITATIONS: Lack of information on severity of pathology and type of treatment. CONCLUSION: Cumulative LOS, which reflects both the length of each inpatient episode and the rate of readmission, is affected not only by clinical factors,but also by the cultural background of the patient population and by administrative factors such as bed pressure.

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

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

Estimating the changes in demand for public mental health services following changes in eligibility: analysis of national survey data.

BACKGROUND: Numerous national surveys have shown that the rate of use of mental health services in a population lags behind the prevalence rate of psychiatric disorder. The preparations to provide universal coverage in Israel require estimates of the utilization levels likely to be reached once mental health care becomes a legal right of each resident. AIMS: This paper aims to provide an estimate of the size of the population which not only will be eligible for specialty mental health care, but which will also demand ambulatory mental health specialty care from public providers METHODS: Data for this study were extracted from a national survey conducted during 2003-2004 in Israel as part of the WMH2000 initiative. Use and perceived need to use services among eligible respondents was used to estimate likely levels of demand. RESULTS: The estimates for future demands on public mental health clinics ranged between 1.2%--the size of the population that is eligible by law and is currently using public mental health services to 5.5%--the size of the eligible population that is currently using some type of service or perceives the need for care in mental health. DISCUSSION: The estimate of the expected use falls in the range of other universal access systems. CONCLUSIONS AND IMPLICATIONS FOR POLICY: The present study provides estimates that are much higher than the estimated size of the population currently using public mental health services, yet the upper limit of the range of estimates is close to those on which the new legislation is based.

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

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

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

OBJECTIVE: Prevalence rates of mental health problems in primary care vary according to population and the type of measure used. This study examined the prevalence of a full range of mental health problems, including sub-threshold diagnoses, and the socio-demographic risk factors for psychiatric disorders among a population with low out-of-pocket expenditures for medical care. METHOD: Four validated mental health assessment instruments, including the CIDI-SF, were administered to a sample of 976 users of primary care in Israel between the ages of 25-75 in eight clinics throughout the country. Prevalence estimates were obtained for seven psychiatric diagnoses, two "other mental health disorders" (somatization and disordered eating) and five sub-threshold conditions. RESULTS: The most common types of morbidity were depression and disordered eating (20.6% and 15.0%, respectively), followed by somatization (11.8%) and general anxiety (11.2%). Among respondents, 31.1% had at least one psychiatric diagnosis, 24.3% had 'other mental disorders' and 15.5% had sub-threshold conditions. Panic attack, disordered eating and somatization, as well as a global measure of any psychiatric diagnosis were significantly more prevalent among women than men. Psychiatric diagnoses were also more common among those in the age group 45-64, with less education and insufficient income, the never married and separated/divorced and those not working. No significant differences were found between recent immigrants, veteran immigrants and Israeli-born, between Arab and Jewish Israelis or between secular or religious sectors of the population. CONCLUSIONS: This study establishes the prevalence of the most common disorders in primary care including PTSD, somatization and disordered eating behaviors. The additional of other mental disorders suggests that a more accurate picture of mental disorders in primary care requires an expanded assessment procedure.

Prevalence of mood and anxiety disorders in the community: results from the Israel National Health Survey.

OBJECTIVE: To estimate the 12-month and lifetime prevalence rates of mood and anxiety disorders in Israel and their socio-demographic correlates. METHOD: A representative sample of respondents extracted from the National Population Register of non-institutionalized residents, aged 21 or older, were interviewed at home between May, 2003, and April, 2004. DSM-IV disorders were assessed using a revised version of the Composite International Diagnostic Interview. RESULTS: Seventeen percent of the sampled adult population reported a lifetime occurrence of a mood or anxiety disorder, while nearly one in 10 (9.7%) reported a mood or anxiety disorder occurring during the previous 12 months. Mood disorders were twice as common as anxiety disorders. CONCLUSION: Contrary to expectations born out of Israel's unique life circumstances, the prevalence of mood or anxiety disorders fall within the range of other western countries. However, given the current age structure and the age of onset of these disorders, their total burden in the near future is likely to increase.