Ora Nakash

Comorbidity of common mental disorders with cancer and their treatment gap: findings from the World Mental Health Surveys

This study aimed to study the comorbidity of common mental disorders (CMDs) and cancer, and the mental health treatment gap among community residents with active cancer, cancer survivors and cancer‐free respondents in 13 high‐income and 11 low‐middle‐income countries.

The Effect of Acculturation and Discrimination on Mental Health Symptoms and Risk Behaviors Among Adolescent Migrants in Israel

This study examines the role of acculturation, perceived discrimination, and self-esteem in predicting the mental health symptoms and risk behaviors among 1.5 and second generation non-Jewish adolescents born to migrant families compared with native-born Jewish Israeli adolescents in Israel. Participants included n = 65 1.5 migrant adolescents, n = 60 second generation migrant adolescents, and n = 146 age, gender, and socioeconomic matched sample of native-born Jewish Israelis. Participants completed measures of acculturation pattern, perceived discrimination, and self-esteem as well as measures of mental health symptoms and risk behaviors. Results show that migrant adolescents across generations reported worse mental health symptoms compared with native-born Jewish Israelis. However, only the 1.5 generation migrants reported higher engagement in risk behaviors compared with second generation migrants and native-born Jewish Israelis. Our findings further showed that acculturation plays an important role in predicting the mental health status of migrant youth, with those characterized with integrated acculturative pattern reporting lower mental health symptoms compared with assimilated acculturation pattern. Importantly, contextual factors, such as higher perception of discrimination in the receiving culture as well as individual factors such as lower self-esteem and female gender were strongly associated with worse mental health symptoms. The findings manifest the complex relationship between contextual factors and individual level variables in the acculturative process of migrants as well as the importance of examining the effect of migration generation on mental health outcomes.

Examination of the Role of Implicit Clinical Judgments During the Mental Health Intake

We examined the characteristics of therapists’ implicit clinical judgments during the mental health intake. Following the intake sessions with new clients, we conducted 129 semistructured interviews with 47 therapists. We found that 82% of therapists and 75% of interviews included reference to implicit clinical judgments. Therapists referred to these judgments as a cognitive process that relied on knowledge acquired through past clinical experiences and was primarily based on nonverbal cues and affective communication. Therapists used implicit processes when evaluating how to facilitate a good working alliance, what diagnostic information to collect, and how to decide on a diagnosis. The majority of therapists described elements of good rapport, such as being listened to, as central for a positive outcome of the intake. We concluded that implicit clinical judgments were vital to allow therapists to integrate the plethora of information from different channels of communication they collect during the intake.

Common mental disorders in immigrant and second-generation respondents: Results from the Israel-based World Mental Health Survey:

Background: The contrasting social status of ethnic groups differentially impacts the mental health of their members. This may be the case in Israel despite its egalitarian ideology. However, studies are a few and limited in scope. Aim: To study mental health disparities between immigrant and second-generation disadvantaged and advantaged Jewish groups. Methods: Data were extracted from the Israel World Mental Health Survey. This included the Composite International Diagnostic Interview and the General Health Questionnaire. We compared 547 first-generation immigrants born in North Africa/Asia and 708 born in Europe/America; and 707 second-generation immigrants of North African/Asian origin and 449 of European/American origin. Results: The prevalence rate of common mental disorders in the preceding year was approximately double for respondents of North African/Asian origin compared with their European/American counterparts following adjustment for socio-demographic confounders. Inmigrants: North African/Asian 12.4%, SE = 1.5; European/American 6.4%, SE = 1.0 (AOR = 2.1, 95% CI 1.4–3.4). Second generation: North African/Asian 10.1%, SE = 1.2; European/American 5.4%, SE = 1.1 (AOR = 1.7, 95% CI 1.1–3.2). Significant differences in emotional distress mean scores were observed only among second-generation respondents: North African/Asian respondents reported higher emotional distress (M = 18.7, SE = 0.5) compared with European/American (M = 17.3, SE = 0.4) (Wald F = 13.31, p < .001). Conclusions: Results showed disparities in the mental health measures in both generations. It is likely that social causation factors, such as restricted opportunities in the context of higher aspirations, partially account for the findings.

The association between acculturation patterns and mental health symptoms among Eritrean and Sudanese asylum seekers in Israel.

Past research has documented the role acculturation plays in the process of adjustment to new cultures among migrants. Yet little attention has been paid thus far to the role of acculturation in the context of forced migration. In this study we examined the association between acculturation patterns and mental health symptoms among a convenience sample of Eritrean and Sudanese asylum seekers (n = 118) who accessed health services at the Physicians for Human Rights Open-Clinic in Israel. Participants completed measures on sociodemographic information as well as detention history, mental health symptoms, exposure to traumatic events, and acculturation pattern, in their native language upon accessing services. Consistent with our predictions, findings showed that acculturation predicted depressive symptoms among asylum seekers beyond the effect of history of detention and reports of experiences of traumatic events. Assimilated compared with integrated asylum seekers reported higher depressive symptoms. Findings draw attention to the paradox of assimilation, and the mental health risks it poses among those wishing to integrate into the new culture at the expanse of their original culture. Asylum seekers may be particularly vulnerable to the risks of assimilation in the restrictive policies that characterize many industrial countries in recent years.

Ethnic disparities in mental health treatment gap in a community-based survey and in access to care in psychiatric clinics

Background: Contrasting social status of ethnic groups differentially impacts the use of psychiatric services, including in Israel, despite its universal health system. However, relevant studies are limited. Aims: To examine ethnic differences in mental health treatment gap and in access to specialized care. Methods: Data were gathered from two sources. Study I included Mizrahi (Jews of North African/Asian origin, socially disadvantaged, n = 136) and Ashkenazi (Jews of European American origin, socially advantaged, n = 69) who were diagnosed with common mental disorders in the preceding 12 months in the Israeli component of the World Mental Health Survey. Study II included Mizrahi (n = 133) and Ashkenazi (n = 96) service users entering ambulatory mental health care. Results: Study I showed that the treatment gap was larger among Mizrahi compared with Ashkenazi respondents (28% standard error (SE) = 4.1 and 45% SE = 6.2, respectively, sought services) following adjustment for sociodemographic confounders (adjusted odds ratio (AOR) = 2.28, 95% confidence interval (CI) = 1.1–4.8). Study II showed that the access to specialized care lagged over a year among 40% of service users of both ethnic groups. No significant ethnic differences emerged in variables related to delay in accessing care. Conclusions: Treatment gap was larger among ethnically disadvantaged compared with the advantaged group. However, once in treatment, service users of both ethnic groups report similar barriers to care.

Interpersonal Complementarity in the Mental Health Intake: A Mixed-Methods Study.

The study examined which socio-demographic differences between clients and providers influenced interpersonal complementarity during an initial intake session; that is, behaviors that facilitate harmonious interactions between client and provider. Complementarity was assessed using blinded ratings of 114 videotaped intake sessions by trained observers. Hierarchical linear models were used to examine how match between client and provider in race/ethnicity, sex, and age were associated with levels of complementarity. A qualitative analysis investigated potential mechanisms that accounted for overall complementarity beyond match by examining client-provider dyads in the top and bottom quartiles of the complementarity measure. Results indicated significant interactions between clients race/ethnicity (Black) and providers race/ethnicity (Latino) (p = .036) and clients age and providers age (p = .044) on the Affiliation axis. The qualitative investigation revealed that client-provider interactions in the upper quartile of complementarity were characterized by consistent descriptions between the client and provider of concerns and expectations as well as depictions of what was important during the meeting. Results suggest that differences in social identities, although important, may be overcome by interpersonal variables early in the therapeutic relationship. Implications for both clinical practice and future research are discussed, as are factors relevant to working across cultures.

Women and health in Israel

Introduction WHO defines health as “a complete state of physical, mental and social wellbeing, and not merely the absence of disease or infirmity”. This broad definition includes physical and mental health, but also socioeconomic standing and access to resources such as health care and safety. In this Viewpoint, we present a holistic picture of women’s health within the Israeli societal and cultural context, taking these factors into account. Because of its volatile and insecure geographical position, direct and indirect exposure to violence is common in Israel, with most adult men and women participating in mandatory army service. This political context affects health outcomes for women and the resources available for health care. Around US

Cancer and common mental disorders in the community: Results of the Israel-World Mental Health Survey

23 billion— or nearly 8% of the total gross domestic product (GDP)—is allocated to the Ministry of Defence. Governments that spend a high proportion of their GDP on security do so at the expense of social welfare provisions. This allocation of funds affects the resources that are available for health in general, and for women’s health in particular. Israel’s health expenditure per person is one of the lowest of all Organisation for Economic Co-operation and Development (OECD) countries, and quite a small proportion of the GDP (7%) is spent on health. Israeli women are socialised within a pro-natal, familyoriented culture and a national ethos that emphasises and encourages family life. As such, women have an average of three children (although Muslims [average 3·35 children per woman] and orthodox Jews [6·5] have more children)—a high number compared with other OECD states (in which the average number of children per woman is 1·7). Women’s health information resources are available online, in academic centres, or in clinics that focus mainly on fertility and motherhood (appendix pp 1–3).

Social identities of clients and therapists during the mental health intake predict diagnostic accuracy.

Background and Objectives: To study common mental disorders (CMD) and other mental health-related variables among community residents with active cancer, cancer survivors and cancer-free respondents. Methods: Data were extracted from the Israeli component of the 28-country World Mental Health Survey. The sample included 165 respondents who reported ever having cancer and 2,282 cancer-free respondents, all aged 39 years and older. The WHO/Com- posite International Diagnostic Interview (CIDI) was used to determine the prevalence rate of CMD. Emotional distress (ED) was ascertained with the GHQ-12. Also, respon- dents were asked about sleep disturbances and mental health service utilization. Results: Respondents with active cancer were more likely to endorse CMD in the past year than cancer-free respondents, 22.1% SE = 6.1 and 7.2% SE = 2.5, respectively (ad- justed odds ratio = 2.6, 95% CI 1.2-5.6); to have higher ED scores, M = 27.1 SE = 1.3 and M = 19.8 SE = 0.3, respectively (Wald F = 16.7, p < 0.001); and higher prevalence rates of sleep disturbances, 64.7% SE = 6.5% and 31.5% SE = 4.6%, respectively (adjusted odds ratio = 2.1, 95% CI 1.1-3.9). Cancer survivors did not significantly differ from cancer-free respondents on the study variables. Despite the emotional toll, there were no differences in mental health service utilization among the three cancer groups. Conclusions: Respondents with active cancer residing in the community show en- hanced psychopathology. Study findings highlight a double need: to adequately assess mental health problems in persons with cancer and to bridge the treatment gap.