Download What are the needs? Psychiatric Epidemiology

Mental Illness in the Orthodox
Jewish Community
Nachas Ruach
14 November 2010
Kate Miriam Loewenthal
Topics
• Needs – psychiatric illnesses and minor
disorders
- stress
• Barriers to help-seeking
• What types of support are likely to be sought?
• Conclusions and questions
What are the needs? Psychiatric
Epidemiology
Prevalences of psychiatric disorders(where
known) correspond roughly to prevalence in
the general urban population. Where they
differ, this can usually be related to life-style
factors.
For example:
Childhood disorders may be relatively low
among young children, with stable families as
a likely contributory factor (98% living with
both parents) (Lindsey et al, 2003).
Hyperactivity and attention disorders may be
raised among adolescent boys, possibly due to
poor sports facilities in the (very underresourced) charedi schools ) and possibly
traditional teaching styles(Frosh et al, 2005)
Unipolar depression:
Relatively low prevalence compared with other
urban populations. Protective factors include
religious factors, stable families, good community
support (Loewenthal et al, 1995, 2000).
Depression (MDD) may be as prevalent among
men as among women (unusual!) partly due to
low use of alcohol by orthodox Jews for coping
(Ball & Clare, 1990; Loewenthal et al, 2003)
Anxiety:
GAD: subclinical GAD (Generalised Anxiety Disorder)
may be high among women probably due to
eventfulness of life caring for large family
(Loewenthal et al, 1997).
OCD: Uncertain whether OCD more prevalent among
Jews than among other groups. Zohar et al (1992).
High prevalence among Israeli adolescents: app
4% compared to <2% general population.
Bernstein (1997) suggests OCD may be overdiagnosed among SOJs due to misinterpretation of
religious behaviour as “symptoms”.
Religious factors are thought not to be causal,
but do influence the shaping of symptoms
(Greenberg & Witztum, 2001)
PTSD: Many survivors of holocaust and other antisemitic persecutions: PTSD and other symptoms
among survivors (Yehuda et al, 1998), but not their
descendants (Levav, 2010). No epidemiological
studies in the UK
Psychosis & other
Bipolar disorder: there is still uncertainty about
whether this is more prevalent among
(Ashkenazi) Jews than among other groups (Fallin
et al, 2003).
Schizophrenia: probably similar prevalence as in
other groups, though possible genetic
susceptibility is under investigation.
Some cultural effects on symptoms (Littlewood &
Lipsedge, 1997)
Personality disorders: little/no clear information.
Needs for psychiatric and clinical psychological
services are at least as great as in other groups.
Statutory service providers would be helped by
knowledge of cultural and religious factors.
Presentation may have culture-specific features.
Stress
(339 interviews, approximately equal numbers of women and men,
traditionally and strictly orthodox: Loewenthal et al 1994).
% of difficulties requiring actual or potential social service support (over 90% were
using statutory or voluntary services; about 20% of these were judged to require
specialised appropriate cultural/religious knowledge)
Barriers against seeking
psychotherapeutic help
These are chiefly:
• Stigma
• Fear of violating religious laws
• Rabbinic attitudes
• Doubts about efficacy
% strictly orthodox Jews saying they would use the
following forms of support for health, relationship or
other difficulties, if appropriate (n=210)
Religious coping beliefs may be helpful or
unhelpful e.g. “Red flag” beliefs
e.g. “I am being punished for things I have done
wrong”
“G-d is angry with me” (Pargament, 2002).
Also, poorer mental health goes with
– Imposed religion.
– Religious beliefs and behaviour that have not been
examined, poorly integrated,
– Tenuous relationship with G-d and the world.
Religious activity, cognitions and affect: a model
involving some components of religious faith (items of
belief) (Loewenthal et al 2000)
Religious activity
All for
the best
Raises
positive affect
G-d
control
Spiritual (religious)
support
Lowers distress
Conclusions and questions
• Stress and psychiatric illness are about as prevalent in
the orthodox Jewish community as in other
communities, though patterns may be slightly different
• Reluctance to seek professional help has several
sources
• When and how does one decide to refer e.g. for social
services, community services, psychiatrist?
• How to overcome barriers e.g. stigma?
• What if any religious or spiritual resources might be
used in counselling?
• How might these be introduced?