Depression among Arabs and Jews in Israel: a population-based study

Introduction  

Depression is the second most common chronic disorder seen by primary care physicians. Risk factors associated with depression include medical and psychosocial factors. While in Israel, the rate and risk factors for depression are considered similar to those in other Western countries, population-based data are limited. The present study aims to estimate the prevalence of depression among Jews and Muslim Arabs, and to consider possible associations with demographic, socioeconomic, and health factors.     

The mental health impact of terrorism in Israel: a repeat cross-sectional study of Arabs and Jews

Objective: Since September 2000 Israeli society has been subjected to numerous deadly terror attacks. Few studies have studied the comparative mental health vulnerability of minorities and majorities to continuous terror attacks. Method: Two telephone surveys (N = 512 and 501) on two distinct representative samples of the Israeli population after 19 months and after 44 months of terror. The Arab minority and Jewish majority were compared on measures of exposure to terrorism, posttraumatic stress symptomatology, feeling depressed, coping, sense of safety, future orientation, and previous traumatic experiences. Results: After 19 months of terrorist attacks Arab Israelis and Jewish Israelis reacted roughly similarly to the situation, however after 44 months of terror, posttraumatic symptom disorder in the Arab population increased three‐fold, posttraumatic symptomatology doubled and resiliency almost disappeared. Conclusion: We suggest that certain conditions inherent to political conflict situations may potentially put minorities at risk and may only be observable as terrorism‐related stressors become chronic.     

Daily hassles, uplifts, and time use in individuals with bipolar disorder in remission

Although life stress has been shown to trigger relapse in bipolar disorder, little is known about how bipolar patients perceive daily hassles or their positive counterparts, uplifts. We used the experience sampling method to investigate the daily experience of hassles and uplifts in 38 patients with remitted bipolar disorder and 38 healthy controls. Largely because of current unemployment, patients were more often alone and at home and spent less time working and more time in passive leisure activities. Contrary to expectations, the groups did not differ in total frequencies or appraisals of events. Within the patient group, however, those patients with current depressive symptoms and more previous depressive episodes experienced negative events as more stressful. These findings are consistent with hypothesized processes linking depressive symptoms to the generation of stressful conditions or to the reactivation of negative cognitive schemas.     

Alternative Modalities of Help Within Socio-Political and Ethnic Minorities: Self-Help Among Arabs Living in Israel

The present paper deals with alternative modalities of help within socio-political and ethnic minorities. It explores the phenomenon of self-help as one modality of help within the Arab population living in Israel. The analysis is based on four research studies, which incorporate the perspectives of lay people, professionals, self-help group members, and students in the helping professions, regarding definitional issues associated with the concept of self-help and attitudes toward such a modality of help. Findings obtained from the four studies reported here suggest that a natural fit exists between the Arab culture and such a helping modality as self-help organizations. Based on the findings, practical recommendations are outlined for use in the area of social work with socio-political and ethnic minorities.     

In search of the saddiq: visitational dreams among Moroccan Jews in Israel

Folk veneration of saints (hagiolatry) plays a major role in the lives of many Moroccan Jews living in Israel and constitutes a basic ingredient of their distinctive ethnic identity. In this context, pilgrimages to the saint's tomb and visitational dreams, in which he appears in person or in some symbolic guise, are related phenomena through which the linkage to the saint is maintained and his blessing is granted to his adherents. This paper is concerned with visitational dreams collected among Moroccan Jews in a major pilgrimage center in northern Israel. An attempt is made to show how personal concerns of the dreamers are mediated through the culturally shared idiom of the saint. We discuss the basic structure of visitational dreams, the major life problems conveyed by them (drawing on illustrations from the dream collection), their therapeutic qualities and their significance in the framework of the pilgrimage to the saint's sanctuary.     

Plasma homocysteine, vitamin B12 and folate in Alzheimer's patients and healthy Arabs in Israel

High plasma homocysteine (tHcy) is a risk factor for cardiovascular disease and stroke and Alzheimer's disease (AD). An inverse relationship has been reported between tHcy and plasma B12 and folate levels. Seventy-nine AD patients and 156 controls from three Arab villages in northern Israel participated. Plasma tHcy, B12 and folate levels were determined. Data were analyzed using univariate statistical tests and logistical regression with confounders. tHcy was significantly higher in AD patients (20.6+/-8.7 micromol/l) than in controls (16.4+/-6.5 micromol/l) (p=0.03) after correction for year of birth, gender and smoking status. Plasma B12 (322.9+/-136.0/350.5+/-175.3 pmol/l) and plasma folate (4.5+/-3.8/4.9+/-2.6 nmol/l) levels did not differ significantly between AD patients and controls. Subjects in the highest tHcy tertile or in the lowest B12 and folate tertiles did not have greater risk to develop AD. In this population residing in Arab villages in northern Israel, tHcy levels were significantly higher among AD patients than in controls. Plasma B12 and folate levels were lower among cases but were not significant. There was not a significant association between plasma tHcy, B12 and folate levels in controls or AD patients. High levels of tHcy may suggest the need for folate and vitamin B12 supplementation in this population.     

Cross-national study of attitudes towards seeking professional help: Jordan, United Arab Emirates (UAE) and Arabs in Israel

BACKGROUND: Help-seeking processes provide critical links between the onset of mental health problems and the provision of professional care. But little is known about these processes in the Arab world, and still less in transnational, comparative terms. This is the first study to compare help-seeking processes among Muslim Arab female students in Jordan, the United Arab Emirates and Israel. AIMS: The present study compares the attitudes of Arab Muslim female students from Israel, Jordan and the United Arab Emirates (UAE) towards mental health treatment. METHOD: A convenience sample of 262 female Muslim-Arab undergraduate university students from Jordan, United Arab Emirates (UAE) and Arab students in Israel completed a modified Orientation for Seeking Professional Help (OSPH) Questionnaire. RESULTS: Data revealed that nationality was not statistically significant as a variable in a positive attitude towards seeking professional help; year of study, marital status and age were found to be significant predictors of a positive attitude towards seeking help. High proportions of respondents among the nationalities referred to God through prayer during times of psychological distress. CONCLUSIONS: The discussion considers implications for professional service delivery and programme development. Future research could extrapolate findings to other Arab countries and to Arab peoples living in the non-Arab world.     

Compliance with home rehabilitation therapy by parents of children with disabilities in Jews and Bedouin in Israel

Among key points in making progress and succeeding with a therapeutic programme for children with disabilities is parental compliance with the regime for their child. The purpose of this study was to evaluate factors influencing compliance with home therapy in the Jewish and Bedouin populations. Data were collected by structured questionnaires. A total of 193 families participated (84% response rate) with children who ranged in age from 6 months to 6 years (mean age at first visit to the centre was 9.5 years in Jews and 16.1 years in Bedouin). Compliance was significantly lower among the Bedouin. Multivariate regression analysis showed that the strongest contributory factor in lack of compliance was being Bedouin. The second factor was intensity of questioning destiny, indicating that parents with these feelings may be less likely to comply with therapeutic regimes. Other factors which were associated with compliance were parents' education and socioeconomic status: lower levels on these dimensions corresponded with lower parental compliance. These results were illuminated by a trial intervention programme for Bedouin families which involved telephone contact, translation facilities, and detailed explanations during visits to the centre. Intervention increased the compliance rate of the Bedouin appointments with specialists to 76% (91 of 120 appointments) thereby reaching similar levels to those of the Jewish group. These preliminary results indicate that the strong association between non-compliance and being Bedouin may be due to factors of communication, and that the Bedouin are receptive to therapeutic interventions when communicated in their own language.     

Muscle tension of patients with tension headaches during and between episodes of pain

The relationship between muscle activity and subjective pain in tension headache has been studied by comparing frontal EMG activity during and between headache episodes. Fifteen patients suffering from chronic tension headache were assessed during the course and outside headache episodes. These results suggest that there is no direct and constant relationship between muscle tension and pain in tension headache.     

The income of psychiatrists: adaptation during difficult economic times

The earnings of psychiatrists are substantially lower than the earnings of physicians in procedurally oriented and surgical specialties of medicine. The authors offer evidence, however, that when it is compared to other cognitive medical specialties, such as pediatrics and internal medicine, psychiatry is the highest paid specialty on an hourly basis. In recent years, psychiatrists' income has improved, largely because of enhanced productivity and efficiency, diversification of treatments, work in multiple settings, the expansion of group practice, and subspecialization. The authors provide an optimistic perspective on the future of psychiatry as a medical specialty.     

Associations of caregiver stressors and uplifts with subjective well-being and depressive mood: a meta-analytic comparison

The present meta-analytic study gives a systematic review of research on depression and the subjective well-being of caregivers. We integrate results from 60 studies on informal caregivers' subjective well-being (e.g., positive affect, life-satisfaction) and contrast them with the result of studies on caregiver depression. Analyses were based on a two-factor model of subjective well-being that distinguishes between positive and negative dimensions of well-being (e.g., happiness and depression). The strongest effects were domain-specific: uplifts of caregiving were associated with subjective well-being and caregiving stressors were associated with depression. In addition, weaker effects that crossed domains were present: uplifts were weakly associated with depressive symptoms. In addition, lower levels of caregivers' subjective well-being were weakly related to care receivers' physical and cognitive impairments, as well as behaviour problems, but not to the amount of caregiving. Type of care recipients' illness and the measure of well-being moderated, in part, the association between stressors/uplifts and subjective well-being.     

Exposure to threat of war and terror, political attitudes, stress, and life satisfaction among teenagers in Israel

The study examines the pattern of relations between level of threat, political attitude (willingness for political compromise), and well-being (level of stress and life satisfaction) among Israeli teenagers in reaction to Israel's withdrawal from Lebanon. Participants were 419 teenagers from two residential areas: the Northern area (close to the Israeli-Lebanese border) and the Central area (distant from the border). The results show: (a) significant differences between the two groups on: political attitude (Center scored higher), on level of stress (North scored higher), and on life satisfaction (North scored lower); (b) a significant negative correlation between exposure to threat and political attitude; (c) significant negative correlations between political attitude and measures of stress, and a significant positive correlation with life satisfaction; (d) political attitude mediates between level of threat and well-being. Political and educational implications, and mental health policy are discussed.     

Epidemiology of multiple sclerosis in Arabs in Kuwait: A comparative study between Kuwaitis and Palestinians

On December 31, 1988 there were 201 registered multiple sclerosis patients in Kuwait, an overall prevalence rate (PR) of 10.2 per 100000; among them were 186 Arabs, of whom 72 were Palestinians and 51 Kuwaitis. Comparison of these two subgroups, who had a similar age distribution revealed that the disease was2 1/2 times more frequent among Palestinians (PR 23.8/100 000) than among Kuwaitis (PR 9.5/100 000). Palestinians also showed significant differences from Kuwaitis in eye color, blood group distribution and HLA-DR and HLA-DQW epitopes frequency. This suggests that genetic rather than environmental factors might be the underlying cause for the high susceptibility to develop MS among Arabs originating from the Eastern Mediterranean basin.     

Dystonia in Ashkenazi Jews: Clinical characterization of a founder mutation

A gene (DYT1) for idiopathic torsion dystonia maps to chromosome 9q34 in Ashkenazi Jewish families with early onset of symptoms. Further, there is linkage disequilibrium between DYT1 and a particular haplotype of alleles at 9q34 loci in this population. This implies that a large proportion of early-onset idiopathic torsion dystonia in Ashkenazi Jews is due to a founder mutation in DYT1. To characterize the phenotypic range of this mutation, we studied 174 Ashkenazi Jewish individuals affected with idiopathic torsion dystonia. We used GT(n) markers on chromosome 9q34 (D9S62, D9S63, and ASS) and classified individuals as having (“carriers”), not having (“noncarriers”), or being ambiguous with respect to a DYT1-associated haplotype. We assessed clinical features and found marked clinical differences between haplotype carriers and noncarriers. There were 90 carriers, 70 noncarriers, and 14 ambiguous individuals. The mean age at onset of symptoms was significantly lower in carriers than in noncarriers (12.5 ± 8.2 vs 36.5 ± 16.4 years). In 94% of carriers, symptoms began in a limb (arm or leg equally); rarely the disorder started in the neck (3.3%) or larynx (2.2%). In contrast, the neck, larynx, and other cranial muscles were the sites of onset in 79% of noncarriers; onset in the arms occurred in 21% and onset in the legs never occurred. Limb onset, leg involvement in the course of disease, and age at onset distinguished haplotype carriers from noncarriers with 90% accuracy. In conclusion, there are clinical differences between Ashkenazi Jewish individuals with idiopathic torsion dystonia who do or do not have a unique DYT1 mutation, as determined by a DYT1-associated haplotype of 9q34 alleles. These differences suggest that early, limb-onset idiopathic torsion dystonia and late, cervical cranial–onset idiopathic torsion dystonia are genetically distinct entities.     

Trauma and traumatized populations in Israel: the Israel Journal of Psychiatry and Related Sciences, 1963-2002

In Europe and the U.S., awareness of interpersonal traumatization has disappeared and reappeared, seemingly connected to socio-historical conditions. The authors wanted to explore this phenomenon in Israel, a complex, multicultural, society that has yet to know peace. Content analysis of a professional journal, the Israel Journal of Psychiatry, was the method of choice. This journal has existed since the fifteenth year of Israel's existence and, because it is published in English, is in active dialogue with the rest of the world. Striking parallels were found between the timing and focus on traumas in the published articles and the socio-cultural context.