Mental illness stigma in the Israeli context: deliberations and suggestions

Screening for Emotional Problems in Pediatric Hospital Outpatient Clinics: Psychometric Traits of the Pediatric Symptom Checklist (Hebrew Version)

This study assessed feasibility and psychometric properties of the Hebrew parent version of the Pediatric Symptom Checklist (PSC-17), aiming to improve treatment access for children and adolescents with behavioral and mental needs through early screening. The PSC-17 and the Strengths and Difficulties Questionnaire (SDQ) were filled in the waiting room, at three ambulatory clinics in a tertiary pediatric center, by 274 parents using a tablet or their cellphone. Demographic and clinical data were retrieved from patients' files. PSC results were compared to SDQ results and assessed vis-a-vis a psychiatric diagnosis, determined previously and independently by trained pediatric psychiatrists for 78 pediatric patients who attended these clinics. Construct and discriminant validity of the PSC-17 Hebrew version were good. Sensitivity, specificity, and positive and negative predictive values are presented. The PSC-17 (Hebrew version) was found to be a feasible tool for mental health screening at pediatric ambulatory care clinics.

Effect of national cultural dimensions and consumption rates on stigma toward alcohol and substance use disorders

BACKGROUND

Despite the notion of stigma as a socio-cultural process with the concept rooted in social space rather than in individual space, global studies examining impact of cultural differences on stigma toward substance use disorders are lacking.

AIM

In this study, we aim to study the influence of national culture differences on stigma toward alcohol and substance use disorders.

METHODS

We analyzed individual-level data from 68,041 respondents from 49 countries on stigma toward alcohol and substance use disorders. We examined the effect of the national culture dimensions and national alcohol and substance consumption rates on stigma toward alcohol and substance use disorders using hierarchical linear modeling.

RESULTS

Our hierarchical linear modeling results indicate that cultural dimensions and consumption rates significantly influence stigma. We found significant positive associations between stigma toward AUD and institutional collectivism and assertiveness, but a negative association with future orientation dimension. Like AUD, stigma toward SUD was also positively associated with institutional collectivism and assertiveness, but negatively associated with power distance.

CONCLUSIONS

The study findings have immense implications for national interventions to decrease stigma and influence policy making.

Epidemiology of treatment resistant depression among major depressive disorder patients in Israel

INTRODUCTION

Major depressive disorder (MDD) is one of the most common mental disorders worldwide, estimated to affect 10-15% of the population per year. Treatment resistant depression (TRD) is estimated to affect a third of these patients who show difficulties in social and occupational function, decline of physical health, suicidal thoughts and increased health care utilization. We describe the prevalence of MDD, TRD and associated healthcare resource utilization in Maccabi Healthcare Services (MHS), a 2.5 million-member state-mandated health service in Israel.

METHODS

All MHS members with an MDD diagnosis were identified within the years 2017-2018 and prevalence assessed by age, sex and TRD. To assess the incidence of MDD, members aged 18-65 years at the start of any MDD episode were identified between 1^st January 2016 and 31^st May 2018 with at least one systemic first-line antidepressant treatment within three months before or after the initial episode. Treatment patterns, time on first-line treatment, and healthcare resource utilization were compared by TRD.

RESULTS

A total of 4960 eligible MDD patients were identified (median age = 51 years, 65% female), representing a period prevalence of 0.218%, and of those, a high proportion of patients received drug treatment (92%). Among incident MDD cases (n = 2553), 24.4% had TRD. Factors associated with TRD included increasing age and personality disorder. Median time on treatment was 3.7 months (longer for those without TRD than those with) and 81.9% of patients purchased more than one month's supply of therapy. In the year after index, patients with TRD had a significant increased number of visits to primary care physicians, psychiatrists, emergency room visits, general hospitalizations, and psychiatric hospitalizations.

CONCLUSION

Our study shows that prevalence of MDD in Israel is low compared to other countries, however once diagnosed, patients' are likely to receive drug treatment. Among patients diagnosed with MDD, the proportion of TRD is similar to other countries, increases with age and is associated with increased healthcare utilization, therefore should be a focus of continued research for finding effective long term treatment options.

Healthcare Utilization and Prevalence of Symptoms in Women with Menopause: A Real-World Analysis

Objective

Self-reported studies estimated that as many as 50-75% of women experience symptoms during menopause; however, limited real-world clinical data are available to support this observation. The electronic databases of Maccabi Healthcare Services were used to describe the prevalence of menopause symptoms in Israel and to characterize patients with regard to socioeconomic status, comorbidities and use of healthcare services.

Methods

Females aged 45-54 years diagnosed with menopausal symptoms (N=17,046, cumulative incidence of 8% during the study period) were identified from the Maccabi Healthcare Services electronic database and matched to female members without menopause symptoms, one-to-one on birth year and enumeration area.

Results

Symptomatic peri- and post-menopausal women, and particularly those under 52 years, were more likely to have a higher prevalence of comorbid conditions such as depression, anxiety, osteoporosis and insomnia in the year following index. Correspondingly, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors and hypnotic drug use were significantly higher in symptomatic women as was healthcare utilization including hospitalization (OR=1.10; 95% CI=1.00-1.20), primary care visits (1.90; 1.73-2.08), gynecologist visits (24.84; 22.36-27.59) and hysterectomy procedures (2.26; 1.63-3.14).

Conclusion

Medically documented menopausal symptoms are associated with increased burden of disease (particularly among women diagnosed with menopausal symptoms prior to age 52 years), healthcare utilization and greater likelihood of undergoing hysterectomy within one year of diagnosis. This burden is expected to rise further as awareness and social acceptance of peri- and post-menopausal symptoms increase.

Etiological Beliefs, Treatments, Stigmatizing Attitudes toward Schizophrenia. What Do Italians and Israelis Think?

Background: Although scientific research on the etiology of mental disorders has improved the knowledge of biogenetic and psychosocial aspects related to the onset of mental illness, stigmatizing attitudes and behaviors are still very prevalent and pose a significant social problem. Aim: The aim of this study was to deepen the knowledge of how attitudes toward people with mental illness are affected by specific personal beliefs and characteristics, such as culture and religion of the perceiver. More precisely, the main purpose is the definition of a structure of variables, namely perceived dangerousness, social closeness, and avoidance of the ill person, together with the beliefs about the best treatment to be undertaken and the sick person' gender, capable of describing the complexity of the stigma construct in particular as far as schizophrenia is concerned. Method: The study involved 305 university students, 183 from the University of Padua, Italy, and 122 from the University of Haifa, Israel. For the analyses, a latent class analysis (LCA) approach was chosen to identify a latent categorical structure accounting for the covariance between the observed variables. Such a latent structure was expected to be moderated by cultural background (Italy versus Israel) and religious beliefs, whereas causal beliefs, recommended treatment, dangerousness, social closeness, and public avoidance were the manifest variables, namely the observed indicators of the latent variable. Results: Two sets of results were obtained. First, the relevance of the manifest variables as indicators of the hypothesized latent variable was highlighted. Second, a two-latent-class categorical dimension represented by prejudicial attitudes, causal beliefs, and treatments concerning schizophrenia was found. Specifically, the differential effects of the two cultures and the religious beliefs on the latent structure and their relations highlighted the relevance of the observed variables as indicators of the expected latent variable. Conclusion: The present study contributes to the improvement of the understanding of how attitudes toward people with mental illness are affected by specific personal beliefs and characteristics of the perceiver. The definition of a structure of variables capable of describing the complexity of the stigma construct in particular as far as schizophrenia is concerned was achieved from a cross-cultural perspective.

The role of secure attachment, empathic self-efficacy, and stress perception in causal beliefs related to mental illness - a cross-cultural study: Italy versus Israel

Background

Research suggests that “mental illness etiological beliefs” and attitudes toward mentally ill people are significantly related; it has also been demonstrated that adult attachment style and empathic self-efficacy affect such attitudes. Moreover, community or regional culture has a significant impact on etiology beliefs and attitudes toward the mentally sick.

Materials and methods

We carried out this study in Italy and Israel among psychology students to compare two cultures in regards to causal beliefs of mental disorders and the roles that specific variables, such as secure attachment, empathic self-efficacy, and stress, play in etiological beliefs. The participants (N=305) were students who belonged to two universities: Padua (N=183) and Haifa (N=122). The Many Facet Rasch Model (MFRM) was applied in a cross-cultural perspective to analyze the differential functioning of specific etiological beliefs in relation to the above mentioned variables; the effect of gender and religious beliefs was also entered in the MFRM.

Results

The two cultures reacted differently to the biogenetic and psychosocial causal explanations of mental disorders: Israeli students endorsed the biogenetic causal beliefs model more frequently than the Italians. Among other findings, concerning the biogenetic model, the Italian students were predominantly males, who declared to be religious and reported lower levels of secure attachment than Israelis. On the other hand, the Israeli students who manifested a preference toward the biogenetic explanation were mostly females, who declared not to be religious and who manifested higher levels of secure attachment than the Italians.

Conclusion

This article is expected to contribute to the improvement of the understanding of general public’s etiological beliefs of mental illness. Similarities and differences between the two cultures, Israel and Italy, have been highlighted on the basis of the MFRM analysis. The effect that interpersonal relations, such as attachment style, perceived empathy, and stress, have on etiological beliefs was also investigated.

Predictors of mental health care stigma and its association with the therapeutic alliance during the initial intake session

OBJECTIVE

We investigated the association between socio-demographic and clinical variables with mental health care stigma, and the impact of the latter on the quality of the therapeutic alliance measured at intake.

METHOD

Consecutive clients (N = 236) filled questionnaires upon accessing services for a new episode of care. Immediately following the intake, a randomly selected sample of clients and their corresponding therapists (n = 102) completed the Working Alliance Inventory - Bond Scale.

RESULTS

Lower mean years of education and higher emotional distress (both partial r = .17) were significantly associated with higher stigma. Higher care stigma negatively correlated with therapists' ratings of the therapeutic alliance during the intake (partial r = -.22), but not with those of clients.

CONCLUSIONS

Care stigma is present among service-users and may affect outcomes of the intake.

Are cervical cancer screening rates different for women with schizophrenia? A Manitoba population-based study

CONTEXT

Barriers to cervical cancer screening (Pap tests) may exist for women experiencing schizophrenia.

DESIGN

This study analyzed healthcare records of all women in the province of Manitoba, Canada to: (a) compare cervical cancer screening rates of women with and without schizophrenia; and (b) determine factors associated with screening uptake.

SETTING

This study took place in Manitoba, Canada, utilizing anonymized universal administrative data in the Population Health Research Data Repository at the Manitoba Centre for Health Policy.

PARTICIPANTS

All females aged 18-69 living in Manitoba December 31, 2002, excluding those diagnosed with invasive or in situ cervical cancer in the study period or previous 5 years.

MAIN OUTCOME

To determine factors associated with Papanicolaou (Pap) test uptake (1+ Pap test in 3 years, 2001/02-2003/04), logistic regression modeling included: diagnosis of schizophrenia, age, region, average household income, continuity of care (COC), presence of major physical comorbidity. Good COC was defined as at least 50% of ambulatory physician visits from the same general/family practitioner within two years.

RESULTS

Women with schizophrenia (n=3220) were less likely to have a Pap test (58.8% vs. 67.8%, p<.0001) compared to all other women (n=335 294). In the logistic regression, a diagnosis of schizophrenia (aOR=0.70, 95% CI 0.65-0.75); aged 50+, and living in a low-income area or the North decreased likelihood; good continuity of care (aOR 1.88, 95% CI 1.85-1.91) and greater physical comorbidity (1.21, 95% CI 1.04-1.41) increased likelihood.

CONCLUSION

Women with schizophrenia are less likely to receive appropriate cervical cancer screening. Since good continuity of care by primary care physicians may mitigate this, psychiatrists should consider assisting in ensuring screening uptake.