Alexander M. Ponizovsky
Mental Health Services, Ministry of Health, Jerusalem, Israel
Immigration and Mental Health: Stress, Psychiatric Disorders and Suicidal Behavior Among Immigrants and Refugees. Hauppauge, New York: Nova Science Publishers, 2010, 350 pages.
This chapter describes findings of the Israel National Health Survey (INHS), conducted in 2003-2004 in conjunction with the World Mental Health (WMH) survey initiative. The INHS was designed to estimate the prevalence rates of psychological distress and common mental disorders, and the use of health care services and psychotropic medication in the adult Israeli population. Personal interviews were held with 3,906 veteran Israelis and 952 immigrants from the former Soviet Union (FSU) and other countries, who had immigrated to Israel after 1989. In addition, we also review here preliminary findings from the Israeli Survey of Mental Health among Adolescents (ISMEHA), conducted in 2004-2005 by the Mental Health Services at the Israeli Ministry of Health on a representative nationwide sample of 957 adolescents aged 14-17 (131 immigrants and 826 Israel-born peers). Psychological distress was measured by the General Health Questionnaire-12 (GHQ-12). Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) disorders were assessed using a revised version of the Composite International Diagnostic Interview (CIDI), and the Development and Well-Being Assessment Inventory (DAWBA) was used for diagnosis assessment in adolescents. Respondents were asked to report any health service and psychotropic drug use during the previous 12 months. Adult immigrants were almost twice as likely to report both mild and severe psychological distress compared with veteran Israelis. Both populations were equally likely to have a common mental disorder and to have used health care services during the past 12 months. This was the case for adolescent immigrants as well. Among adult respondents who did not meet the DSM-IV criteria for a specific mental disorder, the immigrants reported markedly more use of psychotropic drugs than veteran Israelis, in particular more anxiolytics, mood stabilizers, and hypnotics. The results suggest that the common mental disorders and the use of mental health services are no higher among the immigrants than among their veteran counterparts. The higher use of psychotropic drugs by adult immigrants may be an indirect indicator of a higher level of psychological distress symptoms, such as anxiety, depression, and sleep disorders. The symptoms do not reach the threshold at which a specific mental disorder would be diagnosed ― possibly thanks to the medication. Family doctors as first gatekeeper, if properly trained in culturally sensitive care provision, may be able to detect and treat immigrants’ psychological symptoms with psychotropic drugs at an early stage, thus preventing the development of full-blown psychiatric disorders.