Determinants of intentions to seek formal mental health help among Palestinian adolescents in Israel

BACKGROUND

Mental health challenges are widespread among adolescents undergoing significant physical, emotional, social, and academic changes. However, rates of formal help-seeking remain low, particularly among those from ethnic minorities.

AIMS

This study investigated the determinants of intentions to seek formal mental health help among Palestinian adolescents in Israel, focusing on mental health literacy (MHL) and trust in formal sources of information.

METHODS

A total of 178 adolescents (Mage = 16.24 ± 1.24 years, 61.8% female) completed measures assessing intention for formal help-seeking, psychological distress, MHL, trust in formal sources of information, sociodemographic, and clinical characteristics.

RESULTS

Findings revealed low levels of intention to seek formal help and psychological distress, alongside average or above-average levels on all MHL dimensions and trust in formal sources for information. Our analysis identified socioeconomic status (β = .17, p < .05), psychological distress (β = .18, p < .05), trust in formal sources of information (β = .28, p < .001), and two MHL dimensions: knowledge of where to seek information (β = .25, p < .01) and attitudes that promote recognition or appropriate help-seeking behavior (β = .16, p < .05) - as the main determinants of intention for formal help-seeking.

CONCLUSIONS

This study underscores the critical role of trust in formal sources of information and MHL in seeking formal help among adolescents from ethnic minorities. Interventions aiming to improve access to mental health-related information, address and enhance attitudes, and foster trust in formal professionals and institutions may contribute to an increased tendency for formal mental health help-seeking among this population and others.

Life and Health Under Israeli Military Occupation During COVID-19: Report from the West Bank, Occupied Palestinian Territory

This qualitative study explores lived experiences of Palestinians in the West Bank during the COVID-19 pandemic intersecting with life under Israeli military occupation, structural violence, and racism. Insight is provided into the pandemic's effect on daily life and health and into coping and support mechanisms employed under apartheid conditions. Forty-three semi-structured interviews were conducted among a stratified sample of Palestinian adults. Interviews were digitally recorded, transcribed, and analyzed using thematic analysis. During the pandemic, Palestinian social lives were interrupted, jobs were lost, and incomes declined. Families fell into social and financial crises, with strife, insecurity, uncertainty, and fear negatively affecting physical and mental health. Pandemic effects were compounded by the Palestinian Authority's shortcomings and policies not taking into account citizens' rights and social protection and by Israel's continued colonization of Palestinian land and violation of Palestinian human rights. Social solidarity was instrumental for coping during the pandemic just as it was during intensified political violence. One key feature that helped Palestinians survive promoting their cause for freedom, sovereignty, and self-determination is their social solidarity in times of strife. This has proven to be a crucial component in overcoming threats to the survival of a people during the twentieth century and into the twenty-first century.

Barriers to Mental Health Service Use among Palestinian-Arab Women in Israel: Psychological Distress as Moderator

BACKGROUND

Many studies indicate that ethnic minority women, including women from the disadvantaged Palestinian-Arab minority in Israel, experience higher rates of psychological distress but are less likely to use mental health services. This study examined psychological distress and its role as a moderator in the relationship between mental health service use and stigma-related, attitudinal, and instrumental barriers.

METHOD

Cross-sectional study of 146 Palestinian-Arab women who completed measures of psychological distress, mental health service use, the Barriers to Care Evaluation scale, and sociodemographic characteristics.

RESULTS

Participants who did not utilize mental health services reported higher levels of all barrier types compared to participants who reported previous use, but lower levels of psychological distress. Psychological distress was a significant moderator only in the relationship between attitudinal barriers and mental health service use.

CONCLUSIONS

This study highlights the role of psychological distress in the relationship between barriers to and utilization of mental health services, helping professionals and policymakers increase mental health service use among Palestinian-Arab women in Israel and other vulnerable women elsewhere.

The Comprehensive Communal Trauma Intervention Model (CCTIM), an Innovative Transdisciplinary Population-Level Model for Treating Trauma-Induced Illness and Mental Health in Global Vulnerable Communities: Palestine, a Case Study

This paper explores how Western medicine may not fully understand and address post-traumatic stress disorder (PTSD) and other trauma-induced illnesses in a culturally appropriate manner in marginalized communities and offers a theoretical framework to develop comprehensive, effective, and sustainable solutions that comprehensively address and treat the trauma on both a collective and individual level. Focused on Palestinians, this paper discusses the collective trauma Palestinians experienced and how it manifests in transgenerational effects on the body and mind that may be post-traumatic stress disorder (PTSD) or perhaps another distinct condition that is yet to be codified in the Western medical lexicon. It describes local alternatives to Western medical diagnostic tools like the "ease to disease" diagnostic scale and the sociopolitical context-in this case, the Palestinian fight for karamah, or dignity-from which such alternatives arise. Based on these findings, a novel theoretical framework, the comprehensive communal trauma intervention model (CCTIM), a truly transdisciplinary population-level model for treating mental health in vulnerable communities globally, is proposed. It articulates the need to address the root cause of collective trauma, make modifications to the healthcare system, and cultivate strategic equity-oriented and research-based partnerships.

Constraints to liberty of movement and attachment styles significantly account for well-being in three Palestinian samples

BACKGROUND

Political violence and constraints on liberty of movement can have consequences for health and well-being but affect individuals differently.

OBJECTIVE

In three Palestinian samples, we sought to examine the relationship between key environmental and psychological factors and general and mental health, including the previously unexplored roles of constraints to liberty of movement and attachment orientation.

METHOD

Participants (N = 519) in the Occupied Palestinian Territories and Jordan completed questionnaires on constraints to liberty of movement, attachment insecurity, resource loss, experience of political violence , demographics, general healthdepression, and anxiety. All measures were translated from English to Arabic and back-translated into English.

RESULTS

Findings from regression and mediation analyses indicated that (1) differences in general and mental health among Palestinians in the Occupied Palestinian Territories and the diaspora in Jordan can be explained by the assessed constructs; (2) constraints to liberty of movement, attachment avoidance, and resource loss significantly accounted for poor general health; (3) constraints to liberty of movement, attachment anxiety, and resource loss significantly explained general anxiety symptoms; and (4) attachment anxiety, resource loss, and experience of political violence significantly explained depression symptoms.

CONCLUSION

The findings have theory-building implications for psychological models of human flourishing and suffering, suggesting that they are incomplete without consideration of liberty as a context, as well as implications for policymakers and champions of global health initiatives, as they highlight the psychological effects of constraints to liberty of movement on health.

Is silence about trauma harmful for children? Transgenerational communication in Palestinian families

Style of family communication is considered important in the transgenerational transmission of trauma. This study had three aims: first, to identify the contents of family communication about past national trauma; second, to examine how parents' current war trauma is associated with transgenerational communication; and third, to analyze the associations between transgenerational communication and children's mental health, measured as posttraumatic stress disorder (PTSD), depression and psychological distress. The study sample consisted of 170 Palestinian families in Gaza Strip, in which both mothers (n = 170) and fathers (n = 170) participated, each with their 11-13-year-old child. Mothers and fathers responded separately to three questions: 1) what did their own parents tell them about the War of 1948, Nakba?; 2) what did they tell their own children about the Nakba?; and 3) What did they tell their own children about the 1967 Arab-Israeli War and military occupation? Current war trauma, as reported separately by mothers, fathers and their children, refers to the Gaza War 2008/09. Children reported their symptoms of PTSD, depression, and psychological distress. Results revealed seven communication content categories and one category indicating maintaining silence about the traumas. Fathers' high exposure to current war trauma was associated with a higher level of communicating facts, reasons, and meanings regarding the1948 and 1967 wars, and mothers' high exposure to current war trauma was associated with a lower level of maintaining silence. Family communication about facts, reasons, and meanings was significantly associated with children not showing PTSD and marginally with not showing psychological distress, while maintaining silence was not associated with children's mental health.

Society, individual, family, and school factors contributing to child mental health in war: The ecological-theory perspective

Mental health problems are common in war-affected areas, but children have different levels of vulnerability. Based on ecological theory (Bronfenbrenner, 2005), this study analyses how factors related to the child (cognitive capacity), their family (parental depression and parenting styles), and their school (teachers' practices and peer relations) mediate the association between traumatic stress (traumatic war experiences and stressful life-events) and child mental health (posttraumatic stress and psychological distress symptoms). The participants were 303 Palestinian children (51.2% girls) of 10-13 years (M = 10.94 ± 0.50) and their parents from the Gaza Strip. The children filled in questionnaires during school classes and the parents did so at their homes. The results of structural equation modeling substantiated the hypothesis that parental depression, poor parenting and low-quality peer relations mediated between traumatic stress and children's mental health problems. Contrary to the hypothesis, child-related factors did not mediate that association. To conclude, parents and peers provide important age-salient social resources for children in war conditions, and psychosocial interventions should therefore enhance their beneficial functions.

Perspectives on Social Suffering in Interviews and Drawings of Palestinian Adults Crossing the Qalandia Checkpoint: A Qualitative Phenomenological Study

The current study examined the psychological experience of Palestinians who daily cross an Israel Defense Forces (IDF) checkpoint to reach their schools or places of employment. The study employed an interpretative phenomenological analysis of semi-structured interviews and drawings to capture a depth insight regarding the psychological meaning of crossing the Qalandia checkpoint on a daily basis among 20 adult participants (10 males, 10 females). Three themes emerged. The first theme described deep feelings of distress and desperation and included the categories of humiliation and dehumanization, non-existence, rage, and pessimism and helplessness. The second theme concentrated on the participants’ coping strategies of avoidance and dissociation, which usually characterize maladaptive trauma coping style, as well as exhibited aggressiveness toward their fellow community members, while the third theme described the social fragmentation of the Palestinians’ solidarity. Furthermore, three pictorial phenomena emerged from the participants’ drawings: squared restricted drawings, the use of multiple black tiny objects, and the use of split drawings. These phenomena supported and validated participants’ verbal expressions. We suggest understanding these findings in light of the term “social suffering.”

Coping strategies used by parents of children with traumatic brain injury: A cross-sectional study of Palestinians and Israelis

This study examined the use and helpfulness of coping strategies and patterns among parents of children with traumatic brain injury (TBI). Participants were 122 Arab-Israeli, Jewish-Israeli, and Palestinian parents of 65 children with TBI following their discharge from pediatric rehabilitation hospital. Family-focused strategies were highly prevalent and most helpful among both mothers and fathers. Jewish mothers reported that support coping pattern (but not medical or family) was more helpful than did Arab-Israeli and Palestinian mothers. The findings highlight the need to promote effective coping among mothers of children with TBI with low levels of income and education and underscore the need for continuous long-term professional support to parents of children with TBI after hospital discharge.

From a Death Sentence to a Disrupted Life: Palestinian Women's Experiences and Coping With Breast Cancer

This study explores women's experiences of breast cancer in the occupied Palestinian territory. We use an inductive qualitative design with a thematic analytical approach for conducting and analyzing 35 semi-structured interviews with breast cancer patients. The interviews focused on diagnosis, experiences and coping with breast cancer, social support and care needs, and the impact of illness on their families and social relationships. Three themes emerged: (a) the transition from initial shock to the daily struggles with disruptions caused by illness, (b) the role of social support in helping women cope with the burden of disease, and the importance of (c) faith and reliance on God (tawakkul). In the Palestinian context, women's narratives highlighted the disruptive nature of breast cancer. Our findings underline the importance of social support provided by extended family members. Finally, faith is an important overarching theme that influences how women make sense of and cope with breast cancer.

"On the Sidelines": Access to Autism-Related Services in the West Bank

We examined access to autism-related services among Palestinians (N = 24) raising children with autism spectrum disorder (ASD) in the West Bank. Using qualitative methods, we identified five primary interview themes. Poor screening, diagnostic, and psychoeducational practices were prevalent, as parents reported service providers minimized parental concerns and communicated ineffectively with the caregivers regarding treatment options. Geographic barriers and financial burdens prevented many families from seeking or maintaining services. Limited service availability was a dominant barrier: parents reported limited or denied access to education, community-based services, and ASD-specific interventions. Consequently, several families noted their children did not receive any services whatsoever. Research, practices and policies to address the shortage of services for children with ASD are urgently needed in the West Bank.

Rethinking the social history in the era of biolegitimacy: global health and medical education in the care of Palestinian and Syrian refugees in Beirut, Lebanon

The critiques leveled towards medical humanitarianism by the social sciences have yet to be felt in medical education. The elevation of biological suffering, at the detriment of sociopolitical contextualization, has been shown to clearly impact both acute and long-term care of individuals and communities. With many medical students spending a portion of their educational time in global learning experiences, exposure to humanitarianism and its consequences becomes a unique component of biomedical education. How does the medical field reconcile global health education with the critiques of humanitarianism? This paper argues that the medical response to humanitarian reason should begin at the level of a social history. Using experiential data culled from fieldwork with Palestinian and Syrian refugees in Lebanon, the authors argue that an expanded social history, combined with knowledge derived from the social sciences, can have significant clinical implications. The ability to contextualize an individual's disease and life within a complex sociopolitical framework means that students must draw on disciplines as varied as anthropology, sociology, and political history to further their knowledge base. Moreover, situating these educational goals within the framework of physician advocacy can build a strong base in medical education from both a biomedical and activist perspective.

Low protective PON1 lactonase activity in an Arab population with high rates of coronary heart disease and diabetes

BACKGROUND

Recent studies showing that high density lipoproteins (HDL) can effect plaque regression indicate that recent trial failures do not exclude an atheroprotective role of HDL. Instead, they highlight differences between HDL function and measured HDL-cholesterol (HDL-C). PON1 is one key functional activity of HDL. Urban Palestinians have lower HDL-C and a higher incidence and mortality of coronary heart disease than those of Israelis. We hypothesized that the cardioprotective PON1 lactonase and arylesterase activities and PON1 functional genotype may differ between Palestinians and Israelis.

METHODS

We measured PON1 activities in a cross-sectional population-based study of Palestinian (n=960) and Israeli (n=694) residents in Jerusalem, 1654 participants in all.

RESULTS

Palestinians had high prevalences of obesity and diabetes and low mean concentrations of HDL-cholesterol (0.97 mmol/l in men and 1.19 mmol/l in women). Lactonase and arylesterase activities were lower by 10.8% (p=1.2∗10(-14)) and 2.7% (p<0.0005), respectively, in Palestinians as compared to Israelis. The functional genotype distribution, demonstrated by plotting paraoxonase vs lactonase activities, showed a modest between-group difference (p=0.024), with 12.1% RR in Palestinian Arabs vs 8.4% in Israeli Jews, but no overall difference in allele frequencies. Lactonase correlated inversely with age (Spearman's rho=-.156), weakly with BMI (-.059), positively with HDL-C (.173) and non-HDL-C (.103), but was not associated with triglycerides or fasting glucose. Palestinians showed consistently lower lactonase activity in logistic regression models adjusted for multiple covariates and for functional genotype (odds ratios of 1.81 and 1.98, respectively, for the lower fifth vs the upper 4 fifths of lactonase activity p<0.0001).

CONCLUSION

We showed a lower physiologically-significant lactonase PON1 activity in an Arab population, a finding consistent with the high cardiovascular and diabetes risk of Palestinians.

Leukocyte telomere length and coronary artery calcification in Palestinians

OBJECTIVE

Shorter leukocyte telomere length (LTL) is associated with higher incidence of coronary heart disease (CHD) and increased mortality. We examined the association of LTL with coronary artery calcification (CAC), which reflects the cumulative burden of coronary atherosclerosis, in an urban Arab sample of Palestinians, a population at high risk of CHD.

METHODS

Using a cross-sectional design, a random sample of East Jerusalem residents, comprising 250 men aged 45-77 and women aged 55-76 and free of CHD or past stroke, was drawn from the Israel national population register. LTL was measured by Southern blots. CAC was determined by 16-slice multidetector helical CT scanning using Agatston scoring. We applied multivariable logistic modeling to examine the association between sex-specific tertiles of LTL and CAC (comparing scores >100 vs. <100, and the upper third vs. the lower 2 thirds), controlling for age, sex, education and coronary risk factors.

RESULTS

CAC, evident in 65% of men and 52% of women, was strongly associated with age (sex-adjusted Spearman's rho 0.495). The multivariable-adjusted odds ratios for CAC >100 (found in 30% of men and 29% of women) were 2.92 (95% CI 1.28-6.68) and 2.29 (0.99-5.30) for the lower and mid-tertiles of LTL vs. the upper tertile, respectively (Ptrend = 0.008). Findings were similar for CAC scores in the upper tertile (Ptrend = 0.006), and persisted after the exclusion of patients with diabetes or receiving statins.

CONCLUSIONS

Shorter LTL was associated with a greater prevalence of asymptomatic coronary atherosclerosis in an urban Arab population-based sample. Mechanisms underlying this association should be sought.