Emotional distress among first-time patients attending outpatient mental health clinics in Israel: An Arab-Jewish comparative study

Background: Few studies have focused specifically on the role of ethnicity in emotional distress and symptoms among first-time psychiatric outpatients. Methods: 251 first-time patients, aged 18-72 years, attending three out-patient mental health clinics in Israel, were surveyed. Three methods of case detection were used: a GHQ-12 score (equal or >3), self-reported symptoms (using a checklist) and a psychiatrist's provisional ICD-10 diagnosis. In addition, self-efficacy and perceived social support were measured using standardized self-report questionnaires. Univariate and multivariate analyses compared the two ethnic groups: Israeli Arabs and Israeli Jews. Results: Compared to Jewish patients, Israeli Arab patients had a higher "distress caseness" rate based on GHQ-12 score (70.8% versus 41.2%) and a higher rate of psychiatrist-detected ICD-10 stress-related disorders (46.7% versus 23.3%), but a lower rate of self-reported emotional distress (36% versus 54.3%) and symptoms of mood disturbances (38.7% versus 64.7%). The Israeli Arabs also had lower mean scores on measures of self-efficacy (2.0 versus 2.4) and perceived social support from friends (12.2 versus 17.6) and significant others (16.7 versus 20.0). In a parsimonious regression model, the best predictors of emotional distress had low self-efficacy and social support from significant others, and, being Arab, these variables accounted for 27.1%, 7.2% and 8.8%, respectively, of the total variance in GHQ distress scores. Conclusion: The results suggest that the detection of emotional distress and symptoms varies markedly by patients' ethnic background. These variations can be predicted by a lower sense of self-efficacy and social support among Israeli Arabs as compared to Israeli Jews.