Depression stigma and treatment preferences among Orthodox and non-Orthodox Jews

Patterns of psychiatric hospitalizations of Arab and Jewish adults with chronic psychotic disorders, before and after national mental health reforms, Israel, 1991-2016

BACKGROUND

Members of the Arab minority in Israel are at increased risk of developing mental illness, although less likely to seek care and have accessible treatment. This study compares trends in psychiatric hospitalizations between Arabs and Jews with chronic psychotic disorders, before and after introduction of the Community Rehabilitation of Persons with Mental Disability Law in 2000, and governmental recognition of the need to allocate resources for patients with co-occurring substance use disorder and mental illness in 2010.

METHODS

The National Psychiatric Case Registry provided data on 18,684 adults with schizophrenia/schizoaffective disorder, hospitalized in 1991-2016 (at least once in 2010-2015). Repeated-measures ANOVA was used to measure the effect (and interactions) of population-group (Arabs and Jews), time-period (Period1: 1991-2000, Period2: 2001-2009, Period3: 2010-2016) and sex, on average length of stay (LOS), annual number of hospitalizations and hospitalization days.

RESULTS

The proportion of Arab patients hospitalized with a diagnosis of chronic psychotic disorder (14.4%) was significantly lower than their proportion in the general population (21%), and their average age at first hospitalization (28.4 years) was older than that of Jewish inpatients (27.0 years). The average number of hospitalization days and LOS of Jewish patients were double that of Arab patients in Period1. Following implementation of the Rehabilitation Law, hospitalization days increased among Arab patients and decreased slightly among Jewish patients, such that by Period3 the average number of hospitalization days was similar among Jewish (41) and Arab (37) patients. The increase in hospitalization days among Arab patients was limited to men with no change noted among women. The number of hospitalization days among Arab women was about half that of Jewish women (p < 0.0001).

CONCLUSIONS

The findings reveal a narrowing of disparities in psychiatric hospitalizations between Arab and Jewish patients in Israel over time. However, among Arab women the number of hospitalization days remains considerably lower than that of Jewish women, raising concerns that Arab women may be receiving insufficient care. Further study is needed to fully understand the underpinnings of these disparities, although increasing the number of Arabic-language mental health services and providing psycho-education, will help further close the gap.

Mental Health Public Stigma in US Jewish Communities

Stigma is a multifaceted barrier for individuals living with mental illness, contributing to negative stereotypes, prejudice, and discrimination, and is underinvestigated in minority ethnic groups. This study examines the stigma within the US Jewish communities, specifically the following: a) differences in public stigma dimensions based on mental illness ( e.g. , major depressive disorder, anxiety disorder, schizophrenia, or alcohol use disorder) and sex; and b) whether participant characteristics influence the public stigma. A community-based sample of 317 self-identified Jewish individuals participated in an experimental randomized vignette survey on stigma and help-seeking beliefs toward various mental illness. Findings indicate differences in stigma based on stigmatized individuals' sex and diagnosis as well as participants' demographics. Schizophrenia and alcohol use disorder were stigmatized similarly, with lower stigma for depression and the least stigma toward anxiety. Of interest, younger males have the most treatability and professional efficacy stigma, and tailored stigma-reducing interventions are recommended.

A comparative study of mental health diagnoses, symptoms, treatment, and medication use among Orthodox Jews

Historical clinical reports and media narratives suggest that Orthodox Jews are reticent to seek treatment for mental illness, present only with serious concerns, and hesitate to comply with treatment in general and psychopharmacology in particular. On the other hand, recent developments, and some limited research, suggest that Orthodox Jews may be likely to seek and comply with treatment. The current study compared the diagnostic, symptomatic, and treatment characteristics of 191 Orthodox Jews and 154 control patients all presenting to a large private mental health clinic with offices throughout greater New York. Results indicated that the groups were largely demographically similar, and that their diagnoses did not significantly differ. Orthodox Jews initially presented with lower levels of symptoms, terminated with similar symptom levels, attended a similar number of sessions, and were equally likely to use psychopharmacological interventions of similar types, compared to controls. This was equally true of ultra-Orthodox and modern Orthodox Jews. Clinicians providing mental health services to Orthodox Jews should be aware of these findings, which contrast with existing clinical and popular stereotypes. Further, excessive efforts to protect Orthodox Jewish patients against stigma may be unnecessary and counterproductive.

Depression-related stigma: comparing laypersons' stigmatic attributions towards younger and older persons

Objectives: A great amount of interest has been invested in the understanding of public stigma toward persons with depression. However, published studies were mostly restricted to the study of stigma toward a young person with depression. This study was aimed to compare public stigma towards a younger and an older person with depression among a sample of the Jewish adult population in Israel.Method: Computerized phone interviews were conducted with 393 participants (aged 18+) who were randomly presented with one of two vignettes describing a younger or an older person with depression.Results: Overall, the participants reported low levels of stigma towards a person with depression. With the exception of pity, the younger person elicited higher levels of stigmatic attributions in all dimensions (cognitive, emotional, and behavioral) in comparison to the older person. Regardless of the age of the person with depression, only emotional reactions - but not cognitive attributions-were associated with discriminatory attributions.Conclusion: Our findings stress the importance of paying attention to the age of the person with depression in anti-stigma campaigns and studies to better understand the meaning and consequences of depression-stigma.