Research Interests: Psychology, Child Development, Public Health, Medicine, Israel, and 14 moreCommunity Medicine, Humans, Child, Infant, Birth Order, Newborn Infant, Public health systems and services research, Guidance and Counseling Intervention Programs, Disadvantaged, Preventive Health Services, Child Health Services, Socioeconomic Factors, Child preschool, and Mother child relations
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The incidence of amyotrophic lateral sclerosis (ALS) in Israel was determined for the period 1959 through 1974. A total of 246 patients with ALS was ascertained. The male-female ratio was 1.62:1. The average annual age-adjusted incidence... more
The incidence of amyotrophic lateral sclerosis (ALS) in Israel was determined for the period 1959 through 1974. A total of 246 patients with ALS was ascertained. The male-female ratio was 1.62:1. The average annual age-adjusted incidence per 100,000 persons increased during this period by 41%. The increase was almost entirely due to a higher rate in persons more than 60 years of age and was greater in women than in men. This led to a decrease in the male-female ratio. The mean age of onset increased from 52.8 to 58.6 years during the same period. The increment in incidence could not be explained by better case ascertainment or increased life expectancy, but greater precision in diagnosis of ALS in the aged may have partially contributed to the increase.
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Research Interests: Medicine, Humans, Mutation, Female, Disease, and 10 moreMale, Clinical Sciences, Aged, Middle Aged, Prions, Adult, Annals, Neurosciences, PRNP, and Creutzfeldt-Jakob disease
The relation between birth order and risk of multiple sclerosis (MS) was studied among MS patients in Israel. The evaluation was both by case-control study and comparison of expected and observed birth order in Israel-born patients.... more
The relation between birth order and risk of multiple sclerosis (MS) was studied among MS patients in Israel. The evaluation was both by case-control study and comparison of expected and observed birth order in Israel-born patients. Results showed an excess of first-born and a low birth order among MS patients. Conversely, in MS patients born abroad but who developed the disease in Israel, MS was connected with an excess of last-born and high birth order. These contradictory results could not be explained by bias of case selection, difference in age, or changes in family size with time, and could indicate that different etiological factors are responsible for MS in distinct populations.
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BACKGROUND Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent... more
BACKGROUND Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry, 28, 1107) found that much more variance in 72,493 parents' ratings of their offspring's mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents' reports are essential for clinical assessment of their offspring, they reflect parents' perceptions of the offspring. Consequently, clinical assessment also requires self-reports from the offspring themselves. To test effects of individual differences, society, and culture on youths' self-ratings of their problems and strengths, we analyzed Youth Self-Report (YSR) scores for 39,849 11-17 year olds in 38 societies. METHODS Indigenous researchers obtained YSR self-ratings from population samples of youths in 38 socie...
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As a basis for theories of psychopathology, clinical psychology and related disciplines need sound taxonomies that are generalizable across diverse populations. To test the generalizability of a statistically derived 8-syndrome taxonomic... more
As a basis for theories of psychopathology, clinical psychology and related disciplines need sound taxonomies that are generalizable across diverse populations. To test the generalizability of a statistically derived 8-syndrome taxonomic model for youth psychopathology, confirmatory factor analyses (CFAs) were performed on the Youth Self-Report (T. M. Achenbach & L. A. Rescorla, 2001) completed by 30,243 youths 11–18 years old from 23 societies. The 8-syndrome taxonomic model met criteria for good fit to the data from each society. This was consistent with findings for the parent-completed Child
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In 2001, the Rehabilitation of the Mentally Disabled Law was implemented, defining a basket of rehabilitation services to which people with mental disabilities are entitled. To describe change over time in the characteristics of... more
In 2001, the Rehabilitation of the Mentally Disabled Law was implemented, defining a basket of rehabilitation services to which people with mental disabilities are entitled. To describe change over time in the characteristics of applicants to rehabilitation committees, types of referral agencies, and the proportion of those referred who were admitted. To identify factors affecting implementation of decisions to admit people with mental disabilities into different rehabilitation services and predictors of the length of time they remain in the services. The study population consisted of all applicants to rehabilitation committees during 2001-2008. Rehabilitation services included hostels, supported housing, and vocational services. Data were extracted from Ministry of Health rehabilitation and psychiatric hospitalization case registers. Findings were analyzed using descriptive statistics, Kaplan-Meier survival analyses, and Cox regressions. There was a trend over time for more patient...
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Research Interests: Psychology, Cognitive Science, Mental Health, Adolescent, Israel, and 15 moreHumans, Social Psychiatry, Mental Disorders, Incidence, Clinical Sciences, Aged, Middle Aged, Public Service, Adult, Cross Sectional Studies, Community Based Mental Health Services, Life tables, Psychiatric disorder, Service Utilization, and Referral and consultation
In 2001 the Rehabilitation of the Mentally Disabled in the Community Law was implemented in Israel, defining a basket of rehabilitation services to which the mentally disabled are entitled. The objectives of the present study were to... more
In 2001 the Rehabilitation of the Mentally Disabled in the Community Law was implemented in Israel, defining a basket of rehabilitation services to which the mentally disabled are entitled. The objectives of the present study were to examine the effect of being placed in a rehabilitation program after discharge from a psychiatric hospitalization on the probability of rehospitalization and on the length of the following hospitalization if it occurred. Anonymized data were extracted from two registers of the Ministry of Health: the Rehabilitation Register and the Israeli Psychiatric Case Register, whose data were merged. The study population consisted of all the discharges from a psychiatric hospital during 2001-8. There were three study groups (those admitted to hostels, supportive housing, and vocational rehabilitation) and two control groups (those referred to rehabilitation and did not implement the referral and a matched control group of potential candidates for rehabilitation). Kaplan-Meyer survival and Cox analysis were performed on the data. The results showed that the probability to stay in the community after discharge was higher in all the study groups compared to those who were referred but did not reach the rehabilitation system and to the matched control group of potential candidates. Moreover, if the patients were rehospitalized, the probability of a short duration of the next inpatient episode was higher among all the study groups compared to the control groups. The results emphasize the beneficial effect on the pattern of psychiatric hospitalization of the legislation regarding national rehabilitation services for the mentally disabled.
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ABSTRACT
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Numerous national surveys have shown that the rate of use of mental health services in a population lags behind the prevalence rate of psychiatric disorder. The preparations to provide universal coverage in Israel require estimates of the... more
Numerous national surveys have shown that the rate of use of mental health services in a population lags behind the prevalence rate of psychiatric disorder. The preparations to provide universal coverage in Israel require estimates of the utilization levels likely to be reached once mental health care becomes a legal right of each resident. This paper aims to provide an estimate of the size of the population which not only will be eligible for specialty mental health care, but which will also demand ambulatory mental health specialty care from public providers Data for this study were extracted from a national survey conducted during 2003-2004 in Israel as part of the WMH2000 initiative. Use and perceived need to use services among eligible respondents was used to estimate likely levels of demand. The estimates for future demands on public mental health clinics ranged between 1.2%--the size of the population that is eligible by law and is currently using public mental health service...
Research Interests: Business, Psychology, Anxiety Disorders, Community-Based Mental Health Services, Employment, and 14 moreMedicine, Applied Economics, Israel, Humans, Female, Male, Young Adult, Mood Disorders, Middle Aged, Adult, Public health systems and services research, Community Based Mental Health Services, Logistic Models, and Health Care Surveys
Research Interests: Clinical Psychology, Mental Health, Consulting, Adolescent, Generalization, and 15 moreFactor analysis, Humans, Child, Models, Age, Evaluation methods, Female, Confirmatory factor analysis, Classification, Male, Age Groups, Child Behavior Checklist, Child behavior disorders, Affective symptoms, and Confirmatory factor analyses
Inconsistent results have been published on variables affecting readmission to psychiatric hospitals, in particular length of hospitalization before discharge. The objective of the present study was to develop a predictive model for 30... more
Inconsistent results have been published on variables affecting readmission to psychiatric hospitals, in particular length of hospitalization before discharge. The objective of the present study was to develop a predictive model for 30 days readmission after discharge, as the latter is one of the performance indicators in the pending mental health reform in Israel. The data were extracted from the Israeli national psychiatric case register. They concerned all patients discharged from psychiatric hospitals in Israel during a six month period (January 1,-June 30, 2004). A follow-up since the first discharge during this period (discharge from index hospitalization) until November 30, 2005 was performed for each patient. A Cox regression allowed constructing a multi factorial prediction model for readmission within 30 days from discharge. The readmission rate within 30 days was 13 percent. The variables predicting early readmission were age up to 45, history of prior hospitalization, sh...
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Recognising inter-cultural differences in the way people experience and express emotional problems and the difficulties that consequently may arise in properly diagnosing mental health problems this study seeks to develop and validate a... more
Recognising inter-cultural differences in the way people experience and express emotional problems and the difficulties that consequently may arise in properly diagnosing mental health problems this study seeks to develop and validate a tool for screening psychiatric disorders in Ethiopian populations. The study was carried out in Ethiopia as well as among Ethiopian Jews in Israel among groups at different levels of exposure to western medicine. It was a collaborative effort between researchers from Israel Ethiopia and the Netherlands. NIRP aims to encourage development-related research focused on socioeconomic and cultural change. Being policy-oriented in nature NIRP aims to make the results of research accessible to anyone interested in solving the problems investigated. The target groups for such knowledge include policy makers representatives of non-governmental and donor organisations and the scientific community. With this aim in mind the Publication Board has launched the NIR...
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BACKGROUND Ethiopian immigrants in Israel (EI) have limited familiarity with western psychiatric care and, reciprocally, their culture is hardly known by mental health professionals. OBJECTIVE to compare utilization patterns of ambulatory... more
BACKGROUND Ethiopian immigrants in Israel (EI) have limited familiarity with western psychiatric care and, reciprocally, their culture is hardly known by mental health professionals. OBJECTIVE to compare utilization patterns of ambulatory psychiatric services in Israel by EI and other population groups. METHODS EI, former Soviet Union immigrants and Israel-born users of the 64 psychiatric governmental clinics and of the nationwide psychiatric rehabilitation services were compared on demographic and clinical data. Data were obtained from the Ministry of Health for the years 1997-2003. RESULTS Among the EI cared in psychiatric clinics, there was a greater proportion of users with psychotic disorders; a lesser proportion was referred by self, family or friends; a greater proportion was prescribed psychotropic medications; and a lesser proportion received individual psychotherapy. EI used more protected housing facilities and less social and leisure services. DISCUSSION Patterns of util...
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BACKGROUND Studies have demonstrated that a large percentage of patients in primary care clinics suffer from emotional problems. Many of the patients who suffer from these problems are not diagnosed properly, and do not receive... more
BACKGROUND Studies have demonstrated that a large percentage of patients in primary care clinics suffer from emotional problems. Many of the patients who suffer from these problems are not diagnosed properly, and do not receive appropriate treatment by the medical staff. The problem is especially severe for patients who immigrated to Israel from Ethiopia. This is mainly due to the difference between the medical belief system familiar to the Ethiopian immigrants and that of the non-Ethiopian doctors. It is also the result of the use of culturally typical idioms of distress by the Ethiopians that are not clearly understood by the doctors. The WHO developed the SRQ--Self-Reporting Questionnaire, a psychiatric screening instrument to assess populations in developing countries. Although this instrument has been widely used both in developing and developed countries, it has been found to be problematic in certain cultures. The difficulties stem partly from differences between the spontane...
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Objective: To estimate the 12-month and lifetime prevalence rates of mood and anxiety disorders in Israel and their socio-demographic correlates. Method: A representative sample of respondents extracted from the National Population... more
Objective: To estimate the 12-month and lifetime prevalence rates of mood and anxiety disorders in Israel and their socio-demographic correlates. Method: A representative sample of respondents extracted from the National Population Register of non-institutionalized residents, aged 21 or older, were interviewed at home between May, 2003, and April, 2004. DSM-IV disorders were assessed using a revised version of the Composite International Diagnostic Interview. Results: Seventeen percent of the sampled adult population reported a lifetime occurrence of a mood or anxiety disorder, while nearly one in 10 (9.7%) reported a mood or anxiety disorder occurring during the previous 12 months. Mood disorders were twice as common as anxiety disorders. Conclusion: Contrary to expectations born out of Israel’s unique life circumstances, the prevalence of mood or anxiety disorders fall within the range of other western countries. However, given the current age structure and the age of onset of the...
Continuity of mental health care is a major topic in the post deinstitutionalization era, especially concerning its possible importance as a contributing factor in preventing rehospitalization. To examine a) the association between... more
Continuity of mental health care is a major topic in the post deinstitutionalization era, especially concerning its possible importance as a contributing factor in preventing rehospitalization. To examine a) the association between continuing care and time to rehospitalization; and b) the predictors of time to first outpatient contact after discharge from psychiatric hospital. Hospitalization records of all patients discharged from the Tirat Carmel psychiatric hospital in Israel, between January 1, 2006, and December 31, 2006, the National Register of Psychiatric Hospitalizations database and administrative databases of all psychiatric outpatient clinics in this catchment area were used to monitor continuing care and rehospitalization within 180 days from discharge. Predictors of time to rehospitalization and outpatient visits were examined using a Cox proportional hazards regression model. Out of the 908 discharged inpatients, 29% were rehospitalized and 59% visited an outpatient c...
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BACKGROUND Continuity of mental health care is a major topic in the post deinstitutionalization era, especially concerning its possible importance as a contributing factor in preventing rehospitalization. OBJECTIVES To examine a) the... more
BACKGROUND Continuity of mental health care is a major topic in the post deinstitutionalization era, especially concerning its possible importance as a contributing factor in preventing rehospitalization. OBJECTIVES To examine a) the association between continuing care and time to rehospitalization; and b) the predictors of time to first outpatient contact after discharge from psychiatric hospital. METHODS Hospitalization records of all patients discharged from the Tirat Carmel psychiatric hospital in Israel, between January 1, 2006, and December 31, 2006, the National Register of Psychiatric Hospitalizations database and administrative databases of all psychiatric outpatient clinics in this catchment area were used to monitor continuing care and rehospitalization within 180 days from discharge. Predictors of time to rehospitalization and outpatient visits were examined using a Cox proportional hazards regression model. RESULTS Out of the 908 discharged inpatients, 29% were rehospit...
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Expose du probleme, etat de la rechercheL'augmentation des frais de sante primaire menace l'equilibre financier des organismes qui en assurent la prise en charge ou le remboursement. A cet egard, le probleme des « utilisateurs... more
Expose du probleme, etat de la rechercheL'augmentation des frais de sante primaire menace l'equilibre financier des organismes qui en assurent la prise en charge ou le remboursement. A cet egard, le probleme des « utilisateurs frequents des services de medecine generale », c’est-a-dire des malades qui ont recours de maniere repetee aux visites et consultations de generalistes, constitue un probleme preoccupant dans le champ des politiques de sante. Ce probleme concerne au premier chef la popu...
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Background Suicide rates among Ethiopian immigrants to Israel (EI) are relatively high. This study sought to identify suicide-risk factors in this population in order to suggest some potentially preventive measures to mental health... more
Background Suicide rates among Ethiopian immigrants to Israel (EI) are relatively high. This study sought to identify suicide-risk factors in this population in order to suggest some potentially preventive measures to mental health policymakers who are struggling to prevent suicide among EI. Method Nationwide age-adjusted suicide rates were calculated for EI, Former Soviet Union immigrants (FSUI) and Israeli-born (IB) Jews by age, gender, and year of death and, for EI, by marital status and immigration period in the years 1985–2017 (1990–2017 for FSUI). Results Age-adjusted suicide rates for the period 1990–2017 confirmed the significantly higher rate among EI––3.1 times higher than for FSUI and 4.1 times higher than for IB. Similar rates were obtained for both genders, within each age group, and in all study years. Comparable male/female rate ratios were found among EI and IB (3.3, 3.6, respectively). Over the years of the study, only among the Ethiopian immigrants were there large...
BACKGROUND The few studies that exist on long term outcome of psychiatric hospitalization of children show poor prognosis. OBJECTIVES To study the level of functioning of adults who were hospitalized as children in a psychiatric ward in... more
BACKGROUND The few studies that exist on long term outcome of psychiatric hospitalization of children show poor prognosis. OBJECTIVES To study the level of functioning of adults who were hospitalized as children in a psychiatric ward in Israel and to identify prognosis predictors. METHODS The study population consisted of all 1654 people who had been hospitalized in a psychiatric hospital in Israel and whose age at the time of the study was 21 years and above. For each subject, demographic and clinical data were extracted from a national case registry and data on disability benefits were retrieved from another file in the Ministry of Health. RESULTS Only 8% of the study subjects were married, 8.3% died (3.5 times more in men compared to the general population), and 21% received disability benefits. More than half of the people who were hospitalized as children were rehospitalized during the follow-up (43% as adults). Younger age at first hospitalization was associated with a longer ...
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Approximately half the patients seeking mental health (MH) treatment consult primary care practitioners (PCPs). Previous research indicates that patients often do not receive correct MH diagnoses or appropriate treatment from PCPs. The... more
Approximately half the patients seeking mental health (MH) treatment consult primary care practitioners (PCPs). Previous research indicates that patients often do not receive correct MH diagnoses or appropriate treatment from PCPs. The present study examines whether a specialization in family medicine compared to other or no PCP residency programs enhances physicians' ability to detect, diagnose and treat MH problems. Face-to-face interviews with 49 physicans in eight clinics in Israel. Two case vignettes and questionnaires assess MH awareness and factors influencing treatment. Significantly more family practitioners (FPs) compared to others correctly diagnosed depression and anxiety vignettes were aware of patients' MH problems and prescribed psychotropic drugs. Small sample size, indirect examination of PCPs' skills using vignettes and the absence of psychotherapy options. FPs are more likely than other PCPs to detect, diagnose and treat MH problems. To improve MH dete...
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Objective: To measure the 12-month utilization rates for mental health reasons in all types of services. Method: A representative sample extracted from the National Population Register of non-institutionalized residents aged 21 or older... more
Objective: To measure the 12-month utilization rates for mental health reasons in all types of services. Method: A representative sample extracted from the National Population Register of non-institutionalized residents aged 21 or older were interviewed at their homes between May 2003 and April 2004. DSM-IV disorders were assessed using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). Results: About 10% of the adult population receives some type of treatment for emotional or mental health problems within a single year. More than half of service consumers were not classified as suffering from mood or anxiety disorders. Of those diagnosed with mood or anxiety disorders in the past 12 months only about 50% used any type of service for mental health problems. Conclusion: There is only a partial overlap between those who utilize the services and those who meet the criteria for a clinical diagnosis of mental disorder.
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Ethiopian immigrants in Israel (EI) have limited familiarity with western psychiatric care and, reciprocally, their culture is hardly known by mental health professionals. to compare utilization patterns of ambulatory psychiatric services... more
Ethiopian immigrants in Israel (EI) have limited familiarity with western psychiatric care and, reciprocally, their culture is hardly known by mental health professionals. to compare utilization patterns of ambulatory psychiatric services in Israel by EI and other population groups. EI, former Soviet Union immigrants and Israel-born users of the 64 psychiatric governmental clinics and of the nationwide psychiatric rehabilitation services were compared on demographic and clinical data. Data were obtained from the Ministry of Health for the years 1997-2003. Among the EI cared in psychiatric clinics, there was a greater proportion of users with psychotic disorders; a lesser proportion was referred by self, family or friends; a greater proportion was prescribed psychotropic medications; and a lesser proportion received individual psychotherapy. EI used more protected housing facilities and less social and leisure services. Patterns of utilization of both types of services were found to be different among EI, suggesting a need to develop culturally-sensitive programs for both the Ethiopian immigrants and the mental health professionals.
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A population study aimed at evaluating the influence of education on the prevalence of dementia was carried out in Ashkelon, a rural city in Israel. The whole population aged over 75 years was screened, with a very low refusal rate.... more
A population study aimed at evaluating the influence of education on the prevalence of dementia was carried out in Ashkelon, a rural city in Israel. The whole population aged over 75 years was screened, with a very low refusal rate. Altogether, 1501 people were examined, using DSM III-R criteria for dementia. The prevalence of dementia increased with age and was higher among females and immigrants to Israel from Africa and Asia. The most significant correlation was with a low level of education, which completely explained the ethnic differences and partially the female predominance in the frequency of dementia. Our study confirms that schooling appears to be an important protective factor against the development of dementia.
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In line with the worldwide trend of deinstitutionalization and development of community facilities, a rehabilitation legislation was passed in Israel in 2000. Its aim was to establish an infrastructure for the chronic mentally ill. The... more
In line with the worldwide trend of deinstitutionalization and development of community facilities, a rehabilitation legislation was passed in Israel in 2000. Its aim was to establish an infrastructure for the chronic mentally ill. The objective of the present study was to evaluate the impact of this legislation on the re-hospitalization of schizophrenic patients. Re-hospitalization rates within 3 years of discharge were compared for two cohorts of first-in-life hospitalized schizophrenics, those discharged in 1990-1991 and those discharged in 2000-2001, after the passing of the law. Possible confounding variables were controlled for by logistic regression analyses. The same analysis was done for patients with affective disorders who are not generally beneficiaries of this legislation. In 2000-2001, the re-hospitalization rate was significantly lower than in 1990-1991 for schizophrenic patients with an in-patient stay longer than 6 months (chronic patients) but not for short-stay schizophrenics or for affective patients. The study suggests that the expanding of the rehabilitation facilities in the community by legislation leads to increase in the survival in the community of schizophrenic patients.
Research Interests: Cognitive Science, Demography, Adolescent, Comparative Study, Israel, and 15 moreHumans, Child, Discharge, Chronic Disease, Female, Cohort Study, Incidence, Clinical Sciences, Aged, Adult, Deinstitutionalization, Community Care, Community Based Mental Health Services, Affective Disorder, and Cohort Studies
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Research Interests: Psychiatry, Social Work, Israel, Humans, Female, and 3 moreMale, Clinical Sciences, and Socioeconomic Factors
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To measure the 12-month utilization rates for mental health reasons in all types of services. A representative sample extracted from the National Population Register of non-institutionalized residents aged 21 or older were interviewed at... more
To measure the 12-month utilization rates for mental health reasons in all types of services. A representative sample extracted from the National Population Register of non-institutionalized residents aged 21 or older were interviewed at their homes between May 2003 and April 2004. DSM-IV disorders were assessed using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). About 10% of the adult population receives some type of treatment for emotional or mental health problems within a single year. More than half of service consumers were not classified as suffering from mood or anxiety disorders. Of those diagnosed with mood or anxiety disorders in the past 12 months only about 50% used any type of service for mental health problems. There is only a partial overlap between those who utilize the services and those who meet the criteria for a clinical diagnosis of mental disorder.
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To estimate the 12-month and lifetime prevalence rates of mood and anxiety disorders in Israel and their socio-demographic correlates. A representative sample of respondents extracted from the National Population Register of... more
To estimate the 12-month and lifetime prevalence rates of mood and anxiety disorders in Israel and their socio-demographic correlates. A representative sample of respondents extracted from the National Population Register of non-institutionalized residents, aged 21 or older, were interviewed at home between May, 2003, and April, 2004. DSM-IV disorders were assessed using a revised version of the Composite International Diagnostic Interview. Seventeen percent of the sampled adult population reported a lifetime occurrence of a mood or anxiety disorder, while nearly one in 10 (9.7%) reported a mood or anxiety disorder occurring during the previous 12 months. Mood disorders were twice as common as anxiety disorders. Contrary to expectations born out of Israel's unique life circumstances, the prevalence of mood or anxiety disorders fall within the range of other western countries. However, given the current age structure and the age of onset of these disorders, their total burden in ...