Unraveling Trust Issues Towards Mental Health Professionals Among Bedouin-Arab Minority in Israel.

Trust in mental health professionals and services profoundly impacts health outcomes. However, understanding trust in mental health professionals, especially in ethnic minority contexts, is lacking. To explore this within the Bedouin-Arab minority, a qualitative study conducted semi-structured interviews with 25 Bedouins in southern Israel. Participants were primarily female (60%) married (60%), averaging 34.08 years old. Employing grounded theory, three themes emerged. Firstly, concerns about confidentiality were central, eroding trust due to societal repercussions. Secondly, factors influencing confidentiality concerns and distrust were tied to Bedouin-Arab social structures and cultural values rather than professional attributes. Lastly, the consequences of distrust included reduced help-seeking. This study enriches the understanding of trust in mental health professionals among non-Western ethnic minorities, highlighting how cultural factors shape perceptions of mental health services and distrust. Addressing confidentiality worries demands Bedouin mental health professionals to acknowledge hurdles, build community ties, and demonstrate expertise through personal connections and events.

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 (ß = .17, p < .05), psychological distress (ß = .18, p < .05), trust in formal sources of information (ß = .28, p < .001), and two MHL dimensions: knowledge of where to seek information (ß = .25, p < .01) and attitudes that promote recognition or appropriate help-seeking behavior (ß = .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.

Mental health literacy as a barrier and facilitator for service use: Qualitative inquiry among Palestinian Bedouins in Israel.

BACKGROUND: Mental health literacy (MHL) has been related to health behaviors and outcomes. However, studies examining MHL as a barrier and facilitator to service use are limited, especially among minority groups. AIMS: This study examined MHL as a barrier and facilitator to mental health service use among the Palestinian Bedouin minority in Israel. METHODS: Twenty-five Bedouins (15 women) from southern Israel participated in semi-structured, in-depth interviews. The participants were recruited by publishing an ad on social media about the study, then through a snowball technique. The data were analyzed thematically using ATLAS.ti.9, and the intercoder reliability was 92%. RESULTS: We identified four major themes in the interviews: (1) MHL as a barrier to service use, due to lack of knowledge about professionals in the field, mental health services, or reasons and risk factors for mental health problems; (2) traditional attitudes that acted as barriers to service use, including a preference for informal treatment, a lack of faith in mental health treatment, aversion to discussing private feelings, and the perception that mental health is a luxury; (3) MHL as a facilitator to service use by enabling accurate identification of mental distress and suggesting practical avenues for seeking help; and (4) ways to improve MHL that should be culturally sensitive and under the government agencies' responsibility. CONCLUSIONS: Interventions aimed at increasing the use of mental health services among Bedouins and reducing racial/ethnic disparities should increase knowledge in culturally adapted ways, especially regarding professionals and services, and change negative attitudes such as mental health treatment as ineffective or bonus.

A scoping review of studies examining mental health literacy among Arabs worldwide.

BACKGROUND: There is growing interest in Mental health literacy (MHL) worldwide, given its important role in overcoming barriers to service use and reducing mental health disparities. However, little is known about MHL among Arabs. AIM: We conducted a scoping review to examine MHL levels and correlates among Arabs in both Arab and non-Arab countries, based on Jorm's MHL framework. METHODS: We conducted a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using six electronic databases: PubMed, PsycINFO, CINAHL, Soc Index, Web of Science, and Scopus. Data were summarized and synthesized. RESULTS: Nine studies examining MHL among Arabs met our inclusion criteria. Seven of them used a quantitative cross-sectional design. Four studies were conducted in Arab, and five were in non-Arab countries. Five studies were conducted among university students. The studies included indicate moderate to high levels of MHL. Higher MHL was associated with female gender, personal experience of mental health illness, and with help-seeking behaviours. CONCLUSIONS: Our review shows a significant lack of empirical studies on Arabs' MHL. These findings should be considered as a call for action for public health researchers, mental health workers, and policymakers to prioritize research in this field.

Exploring the Bereavement Experience Due to COVID-19 Death Among Arabs in Israel.

This study examined the experience of bereavement because of COVID-19 among the Arab minority in Israel, based on the two-track model of grief, using a qualitative approach. The data was collected in an in-depth interview with 34 participants representing the three religions in the Arab population in Israel, approximately 1 year after the loss occurred. The findings revealed that most participants reported returning to their previous function almost completely, exclusively in the field of work. However, they reported decreased social functioning and feelings of loneliness and sadness, and some reported manifestations of active and traumatic grief. Some findings may create a false impression that the mourners have gone through the loss process and returned to normal. However, the current study's findings refute this conclusion, which requires appropriate treatment from health professionals.

Mental Health Underutilization by Palestinian-Arabs in Israel: Stigma-Related, Attitudinal, and Instrumental Barriers.

BACKGROUND: Many studies show that members of minority groups underutilize mental health services and report more barriers to such utilization than majority groups. However, very little is known about these barriers and their relation to mental health service use among the Palestinian-Arab minority in Israel. AIMS: This study examined barriers to mental health service use in this population based on the stigma-related, attitudinal, and instrumental barriers dimensions of the Barriers to Care Evaluation scale (BACE v3) and its correlates to mental health service use. METHODS: The participants were a convenience sample of 231 Palestinian Arabs. They completed measures of BACE v3, mental health service use, and sociodemographic characteristics. RESULTS: The findings showed that participants who reported using mental health services had lower levels of barriers in all dimensions compared to those who did not use such services. Attitudinal barriers were found to be the main determinants of mental health service use. CONCLUSIONS: This study underscored the role of attitudinal barriers to the utilization of mental health services. The findings indicated that interventions addressing such barriers might be helpful in increasing mental health service use among the Palestinian-Arab minority in Israel as well as other minorities in Israel and elsewhere, who might share similar backgrounds and perceptions.

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.

Theory of Planned Behavior: Exploring the Use of Digital Mental Health Interventions in Israel.

ABSTRACT: Based on the theory of planned behavior (TPB), this study aimed to examine factors influencing therapist uptake of digital mental health interventions in Israel. Two hundred twenty-nine mental health professionals recruited through a convenience sample completed a background and demographic questionnaire, as well as the TPB-based electronic-therapy attitudes and process questionnaire. Regressions were used to examine the contribution of attitudes, perceived behavioral control, subjective norms, and behavioral intentions. Intention to use and use of digital interventions were significantly predicted by attitudes, subjective norms, and perceived behavioral control, as suggested by the TPB. The use of cognitive behavioral therapy (CBT) and higher perceived behavioral control increased the likelihood of using digital interventions. Having a positive attitude, having expectations/social pressure from one's professional environment, and having a sense of control over the process were found to predict the intent to use, as well as the actual use of, digital interventions.

Cognitive illness representations among Israeli Arabs diagnosed with depression and their relationship with health-related quality of life.

BACKGROUND: The number of studies that have assessed cognitive illness representations among people diagnosed with depression, and their relationship to health outcomes, has clearly grown. Nevertheless, the relationship between cognitive illness representations and health-related quality of life (HRQoL) has received very little research attention. AIMS: This study examined cognitive illness representations, based on the self-regulation model (SRM), and the contribution of each dimension of these cognitive illness representations to health-related quality of life (HRQoL) among Israeli Arabs diagnosed with depression. METHODS: A convenience sample of 160 Israeli Arabs with depression completed measures of cognitive illness representations (identity, timeline, consequences, personal control, treatment control, and coherence), HRQoL, and sociodemographic and health characteristics. RESULTS: Participants reported high levels of negative perceptions in the identity, timeline, and consequences dimensions, and moderate levels in the dimensions of personal control, treatment control, and coherence. Also, participants reported low levels of HRQoL. Identity, consequences, and coherence were found to be the main determinants of HRQoL. CONCLUSION: This study underlines the crucial role of the identity, consequences, and coherence dimensions in the HRQoL of individuals diagnosed with depression. The findings indicate that clinical interventions targeting cognitive illness representations of individuals with depression, and in particular identity, consequences, and coherence, might be helpful in improving the HRQoL of this population.

Mental health literacy among Arab university students in Israel: A qualitative study.

BACKGROUND: There has been a noticeable increase in the number of studies concerned with mental health literacy (MHL), specifically among students. Still, very few studies have examined MHL among students of non-Western minority groups. AIMS: This study examined MHL among Arab students in Israel based on Jorm's conceptual framework. METHODS: Twenty-eight Arab students in Israel took part in semi-structured, in-depth interviews. Most were single and Muslim, in their second year of studies, and most reported low socioeconomic status. The data were analyzed thematically, guided by the Jorm's six MHL dimensions. RESULTS: Different levels of literacy were found in the various MHL dimensions. The participants identified severe mental disorders more easily than mood disorders; reported a variety of possible causes of mental disorders; were well aware of available professional help (apart for rehabilitative services); identified significant barriers to mental health help seeking, as Arabs; and reported the internet as a major source of information about mental health problems and their treatment. CONCLUSIONS: The participants' MHL appeared to be associated with their unique sociocultural characteristics. This study stresses the need to raise MHL among Arab students in Israel, and in particular to promote positive attitudes to seeking professional help. It also highlights the need to develop culturally adapted mental health interventions for the Arab population in Israel.

Self-stigma formation process among younger and older Israeli Arabs diagnosed with depression.

OBJECTIVES: Self-stigma is common among persons with depression. Still, studies that examined the process of self-stigma concentrated mostly on younger adults (ages 18-65) with mental illness in general, with a limited number of studies examining older adults with depression. This study was aimed to examine and compare the self-stigma formation process and its relation to self-esteem among younger (ages 18-64) and older Israeli Arabs (age 65+) diagnosed with depression. The study was based on a self-stigma model which defines the self-stigma formation process as composed of three stages: stereotypes awareness, stereotype agreement, and self-concurrence. METHOD: A total of 160 younger and older Israeli Arabs with depression completed measures of self-stigma formation process, self-esteem, and socio-demographic and health characteristics. RESULTS: The self-stigma formation process was found as a multi-level and progressive model for both younger and older adults, despite that older adults reported significantly higher levels of self-stigma in all stages of the process. Low self-esteem was significantly associated with higher levels of stereotype agreement and self-concurrence in both age groups. CONCLUSION: The self-stigma formation process provides an adequate model for understanding depression self-stigma in both younger and older adults. Appropriate intervention programs aiming to reduce self-stigma should be developed, focusing on reducing the three stages of self-stigma.

Depression Illness Representations Among Arabs in Israel: a Qualitative Study Comparing Younger and Older Adults.

There has been a noticeable increase in the number of studies assessing perceptions regarding depression (illness representations) among people diagnosed with the disorder. However, these studies have examined mainly younger adults (ages 18 to 65), and very little is known about older adults. This study examined illness representations among younger and older Israeli Arabs with depression based on the Self-Regulation Model (SRM). A total of 12 Israeli Arabs (six younger adults aged 18-64 and six older adults aged 65+) diagnosed with depression took part in semi-structured, in-depth interviews. The majority of the participants in the younger group were female and married, compared to the older group which has a gender equal ratio, half of which are married. The data were analyzed thematically, guided by the SRM illness representations' dimensions (identity; timeline; cause; consequences; control/cure; cyclical and coherence; and emotional representations). Differences between younger and older adults were found in some of the illness representations. Older adults described depression as a chronic illness associated with somatic symptoms, and did not believe in psychological treatment. Younger adults did not perceive depression as chronic, reported cognitive and emotional symptoms, and believed in the efficacy of psychological treatment. Our findings indicated that participants' perceptions about depression appeared to be associated with their age, along with their unique cultural background as they are traditional but undergoing processes of modernization. This study stress the importance of illness representations in intervention programs tailored for different age groups, and considering their specific cultural needs.

Health-related quality of life among Israeli Arabs diagnosed with depression: the role of illness representations, self-stigma, self-esteem, and age.

BACKGROUND: Studies that examined health-related quality of life (HRQoL) and related factors among people diagnosed with depression, have only focused on sociodemographic and clinical factors. This study examined the contribution of illness representations (IRs), self-stigma, self-esteem, and age group (younger adults aged 18 to 64 and older adults aged 65+) to HRQoL among Israeli Arabs diagnosed with depression. METHODS: A convenience sample of 160 Israeli Arabs with depression completed measures of cognitive and emotional IRs, self-stigma, self-esteem, HRQoL, and sociodemographic and health characteristics. RESULTS: Participants reported low levels of HRQoL, with the older adults reporting significantly lower levels of HRQoL in comparison to those reported by the younger adults. Low levels of HRQoL were significantly associated with negative cognitive and emotional IRs, high levels of self-stigma, and low levels of self-esteem. Cognitive IRs, self-stigma, self-esteem, and age group were found to be the main determinants of HRQoL. LIMITATIONS: Limitations of the study include use of a cross-sectional design among culturally homogeneous sample. This limits the generalizability of our results and conclusions, and prevented us from determining causal relationships. CONCLUSIONS: This study emphasizes the role of cognitive IRs, self-stigma, and self-esteem, as well as age, in the HRQoL of individuals diagnosed with depression. Intervention programs should be mindful of these determinants in order to improve the HRQoL of individuals diagnosed with depression.