A comparative study of Arab and Jewish patients admitted for psychiatric hospitalization in Jerusalem: the demographic, psychopathologic aspects, and the drug abuse comorbidity

Abstract

Background

The influence of ethnicity on different aspects of psychiatric hospitalization is far from clear.

The Aim of the Study

The main aim of the study was to compare the Arab and the Jewish inpatients, at the time of admission, for the demographic factors, severity of psychotic, and affective psychopathology and comorbid drug abuse rate.

Population, Method, and Tools

Among 250 consecutively admitted patients in the Jerusalem Mental Health Center-Kfar Shaul Hospital, 202 Jews and 42 Arabs (aged 18-65 years) were examined within 48 hours after admission. The psychiatric diagnoses were made according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. For the differential measurement of psychopathologic severity, the following rating scales were used: 21-item Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale (PANSS), and Young Mania Rating Scale. Urine tests for Δ9-tetrahydrocannabinol (THC), cocaine, opiates, amphetamines, and methamphetamine were performed using the Sure Step TM kits (Applied Biotech, Inc, San Diego, CA, USA). The Structured Clinical Interview Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for drug abuse were applied based on self-report and results of urine analysis.

Results

The comparison of the 2 population showed that among the Arab inpatients, there were more males (81% vs 67.4%; P < .005). No significant difference in psychiatric diagnosis was observed. The overall severity of positive symptoms (PANSS positive) in Arab group was higher, but only slightly so (P = .05). No significant difference was observed for total rates of PANSS negative subscale. The rates of PANSS-general were also similar. The Arab patients were significantly less depressive according to 21-item Hamilton Depression Rating Scale (P = .032), and the total score of Hamilton Anxiety Rating Scale for the Jewish group was significantly higher (P = .001). No significant difference in general severity of manic symptoms for 2 groups was detected according to Young Mania Rating Scale. The rate of comorbid drug abuse for Jewish inpatients was borderline higher (P = .068).

Conclusions

The issue of referral to psychiatric hospitalization could be culturally influenced; it may be the result of disparities in demographic, psychopathologic, and drug abuse comorbid presenting symptoms, which are demonstrated upon admission by patients of different ethnic origins.

Introduction

Ethnicity is one of the important factors for understanding the different aspects of mental disorders [1], [2]. In recent years, there has been an effort to compare the frequency of different mental problems among the Arab and Jewish populations in Israel. In the study of Gelkopf et al [3], the Arab minority and the Jewish majority were compared on measures of exposure to terrorism, posttraumatic stress symptoms, feeling depressed, coping, sense of safety, future orientation, and previous traumatic experiences. 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 3-fold, posttraumatic symptoms doubled, and resiliency almost disappeared. Tracy et al [4] sought to assess the predictors of depressive symptoms in a population-based cohort exposed to ongoing and widespread terrorism. They interviewed a representative sample of adults living in Israel, including both Jews and Arabs. In multivariable models, Israeli Arab ethnicity, lower household income, lower social support, experiencing economic loss from terrorism, experiencing higher levels of psychosocial resource loss, and meeting criteria for posttraumatic stress disorder were significantly associated with increased severity of depressive symptoms. Palmieri et al [5] used nationally representative samples to examine the impact of war on civilians, after the Israel-Hezbollah War (July to August 2006). The aims of this study were to document probable posttraumatic stress disorder (PTSD), determined by the PTSD symptom scale and self-reported functional impairment, in Jewish and Arab residents of Israel immediately after the Israel-Hezbollah War and to assess potential risk and resilience factors. The rate of probable PTSD was 7.2%. Higher risk of probable PTSD was associated with being a woman, recent trauma exposure, economic loss, and higher psychosocial resource loss in both ethnical groups. The level of psychologic distress seems to differ for Jewish Israelis and Arab Israelis in various conditions. Ponizovsky et al [6] reported results of an Arab-Jewish comparative study of emotional distress among first-time patients attending outpatient mental health clinics in Israel. Compared with Jewish patients, Israeli Arab patients had a higher “distress caseness” rate based on 12-item General Health Questionnaire score and a higher rate of psychiatrist-detected International Statistical Classification of Diseases, 10th Revision, stress-related disorders but a lower rate of self-reported emotional distress and symptoms of mood disturbances. The information regarding different aspects of psychiatric hospitalization for both ethnic groups is rather scarce. Jerusalem, in spite of its known political and religious problems, is the unique place for the research of cultural and ethnic factors of psychiatric morbidity. The Jerusalem Mental Health Center–Kfar Shaul Hospital has a multinational team that provides psychiatric hospitalization treatment for both Jewish and Arab populations in Jerusalem, which provides an opportunity for comparative transcultural research of inpatients.