A comparative study of Arab and Jewish patients admitted for psychiatric hospitalization in Jerusalem: the demographic, psychopathologic aspects, and the drug abuse comorbidity
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.
Section snippets
The aim of the study
The main aim of the study was to compare the Arab and the Jewish admitted inpatients for demographic factors and severity of psychotic and mood psychopathology. The rate of comorbid drug abuse was also evaluated separately for both groups.
Population, method, and tools
Of 250 patients consecutively admitted 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 in psychotic and affective patients (38 Arabs and 179 Jews), the following rating scales were used: 21-item
Statistical analysis
χ2 Test was used to analyze statistically significant relationships in the distribution of categorical values. The t test on the contingency tables was used to compare rates of PANSS, YMRS, HAM-D-21, and HAM-A scales and subscales for the Arab and Jewish inpatients groups. P < .05 was considered statistically significant.
Results
Some demographic differences between 2 groups were detected: among the Arab inpatients, there were more males (81% vs 67.4%; P < .005). The average educational level in the Jewish group was higher (11.5 ± 3.0 vs 8.6 ± 4.1 years; P < .005); the age range was rather similar (36.1 ± 11.1 for the Jewish inpatients vs 35.0 ± 12.4 for the Arabs). No significant difference in psychiatric diagnosis was observed (Table 1).
Discussion
The results of our study suggest that there are some differences in admission criteria for psychiatric hospitalization between the Arab and the Jewish patients regarding demographic, psychopathologic aspects, and drug abuse comorbidity. In our sample, most admitted Arab patients were males. In general Arab population, females are aware of the stigma associated with seeking psychiatric services and the risk of jeopardizing both their honor and marital prospects [7].
As for psychopathologic
Limitations
The study had some obvious limitations—the Arab group was relatively small, most interviews in this group were performed with translation (although made by professional staff members). The Arab population of Jerusalem has some cultural and political differences from other Arab groups in Israel. The Jewish group included the ultraorthodox religious patients with their known special cultural background. The demographic differences between the Arab and the Jewish group made the comparison of
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Supported by a grant of the Israel Anti-Drug Authority.