Common Mental Disorders among Arab-Israelis: Findings from the Israel National Health Survey
Levav, Itzhak, Al-Krenawi, Alean, Ifrah, Anneke, Geraisy, Nabil, Grinshpoon, Alexander, Khwaled, Razek, Levinson, Daphna, The Israel Journal of Psychiatry and Related Sciences
Abstract: Objectives: Psychiatric epidemiological data on Arab populations are generally scanty. This community-based survey, a component of the World Health Organization's 27-country study, explored the prevalence rates of anxiety and mood disorders, emotional distress and help-seeking practices among Arab-Israelis, and compared them with those found among Jewish-Israelis. Methods: Close to 5,000 non-institutionalized individuals were interviewed with the WHO/Composite International Diagnostic Interview (CIDI) to determine the prevalence rates of selected psychiatric diagnoses, and with the 12-item General Health Questionnaire (GHQ) to measure emotional distress. The schedule included other items, e.g., socio-demographic variables and help-seeking practices. Results: Arab-Israelis, in contrast to Jewish-Israelis, had higher mean GHQ-12 scores and lower self-appraisal of mental health. Twelve-month prevalence rates for any anxiety or affective disorder were not significantly higher among Arab-Israelis. Among respondents with diagnosed disorders, rates of help-seeking from specialized health services were lower among Arab-Israelis than among Jewish-Israelis. Intention to consult was elicited from both groups when the disorders were accompanied by higher distress scores. Conclusions: Despite major health gains, the social stresses impacting the Arab-Israeli minority may explain both the higher emotional distress and lower self-appraisal of mental health. However, no impact was observed of social causation factors on the rates of common mental disorders in the Arab-Israeli group. Cultural factors, including the definition of disorders and stigma and a lesser availability of culturally-tailored services, could account for the marked treatment gap.
At 19.1%, Arab-Israelis constitute a sizeable minority of the Israeli population. Yet, except for a few studies (1-3), psychiatric epidemiological research on the Arab population remains wanting. A similar situation is found in most Arab countries, where only a few community-based surveys have been conducted (4-6). In Lebanon, where epidemiological research thrives compared to other Arab countries, 500 community respondents were interviewed in the early 1990s with the Diagnostic Interview Schedule (DIS), version III. The lifetime rates for major depression were the highest of a group often countries that participated in an international study, overall, 19.0%; women, 23.1%; men, 14.7%. These relatively high rates were attributed to the effects of the civil war that had raged in that country (6). Additional psychiatric epidemiological surveys in Arab countries focused on selected, relatively small populations, typically, primary medical care visitors (7).
Lately, the World Mental Health Survey (WMHS), launched and coordinated by WHO and Harvard University in 27 countries (8), investigated the prevalence of several disorders as well as service-related factors, such as the use of services. This global effort included Israel and Lebanon; both sites open (Israel) and broaden (Lebanon) a still narrow psychiatric epidemiological window into Arab populations (4). The more recent and larger WMHSLebanese study yielded the following 12-month prevalence rates: anxiety, 11.2% (95% CI 8.9-13.5); and mood disorders, 6.6% (95% CI 4.9-8.2) (8).
Help-seeking practices. Authors have discussed the assumptive world (9) that orients some Arab groups regarding the etiology of mental disorders and the sources of care. In many Arab countries, the assumptive world has had limited interaction with western psychiatry, while in Israel, as a result of the higher supply of services, the interaction has been greater. However, the behavioral expression of such a set of concepts in the use of mental health services in Israel remains generally unknown, except for national data on psychiatric hospitalizations (1) for all Arab-Israelis, and anthropological data on the Bedouin population. …