Psychological Distress Among Ethiopian and Russian Jewish Immigrants To Israel: a Cross-Cultural Study

International Journal of Social Psychiatry http://isp.sagepub.com

Psychological Distress Among Ethiopian and Russian Jewish Immigrants To Israel: a Cross-Cultural Study A. Ponizovsky, Y. Ginath, R. Durst, B. Wondimeneh, S. Safro, S. Minuchin-Itzigson and M. Ritsner International Journal of Social Psychiatry 1998; 44; 35 DOI: 10.1177/002076409804400104 The online version of this article can be found at: http://isp.sagepub.com/cgi/content/abstract/44/1/35

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PSYCHOLOGICAL DISTRESS AMONG ETHIOPIAN AND RUSSIAN JEWISH IMMIGRANTS TO ISRAEL: A CROSS-CULTURAL STUDY

A. PONIZOVSKY, Y. GINATH, R. DURST, B. WONDIMENEH, S. SAFRO, S. MINUCHIN-ITZIGSON & M. RITSNER

SUMMARY conducted community survey examining the differences in levels of psychological distress and its symptomatology, comparing 110 Ethiopian-Jewish and 400 Russian-Jewish immigrants to Israel. Psychological distress was measured by the Talbieh Brief Distress Inventory. Russian immigrants were found to be more distressed than their Ethiopian counterparts and this between-group difference can be attributed to the greater relative number of females, older immigrants and those with longer duration of stay in Israel in the Russian sample. The highest levels of distress were observed for paranoid ideation in the Ethiopian sample and anxiety and hostility in the Russian sample. These symptoms were independent of gender and time since immigration. Russians with longer duration of stay demonstrated higher scores signifying adjustment difficulties than their Ethiopian counterparts. These results suggest that the differences in levels and symptom expression of psychological distress are determined, to a considerable extent, by demographic factors (sex, age) and the differing cultural backgrounds of the two immigrant groups. A

was

INTRODUCTION

Immigration, or the transition from a country of origin elsewhere is experienced by the immigrant as a stressful process that may evoke a crisis. This crisis embodies complex psychological processes, e.g., detachment from and mourning for the culture deserted, and an investment of energy in the acculturation process in an effort to integrate in the new land, society and culture. Each and every immigrant experiences strong feelings of loss, insecurity and disappointment with respect to the host society. The relationship between immigration and psychological reaction to it is strongly linked to three sets of dynamic factors: pre-migration factors, factors specific to the migration process, and post-migration factors related to the host society. Pre-migration factors refer to cultural background and the position which the immigrants occupied as an individual and as member of a group in the country of origin. All cultures have a ’cognitive map’ characterizing its members, which comprise a framework orientation of values, skills, beliefs and verbal and nonverbal language (Tolman, 1948). This may facilitate processes of reciprocity and mutual support and a feeling of security. The cultural framework is shared by the members of a community and enhances their communication and interaction through the generation of mutual assumptions which permit appropriate conduct.

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that the individual adjust to a new and unacquainted sociocultural This demands new modes of behavior and adjustment to cope with the new configuration. society. Following the classic work of Odegaard (1932) the core factor in the process of adjustment of an immigrant is his/her ability to preserve his/her personal identity despite the process of immigration which requires drastic change and adaptation. Post-migration factors comprise a host of factors which are associated with the interaction with and the attitude of the absorbing society. Israel is a country in which the constant flow of immigrants is a well-established norm (Shuval, 1993). Many Israclis identify with the newcomers as a result of their own past experience as immigrants. The nation is also committed to an ongoing process of immigration, as one of the founding principles of the state. This article aims to throw some light on the psychological distress of immigrants to Israel as moderated by differences in countries and cultures of origin. Accordingly, the psychological distress encountered by Ethiopian and Russian immigrants-the two more recent waves of immigration to Israel, will be analyzed and compared. These populations differ tremendously from one other, yet it is possible to find some features they hold in common. The two groups emigrated en masse and not as individuals, providing the individual immigrant with a meaningful familial network and a frame of reference. Both groups left countries in which the political and socioeconomic structures were repressive, for a Western democratic state with open opportunities (Lerner et ccl. 1992). Both encounter a wide gap between their native culture and the Israeli culture. Furthermore, the two groups encountered drastic political changes prior to their arrival to Israel. In the former USSR, the transition from a centralized communist political system to ’glasnost’ generated anxiety (as well as hope) regarding the unknown, and the necessity to internalize new and unfamiliar ideological elements of liberalism so different from the ideology which had dominated Soviet society for several generations. In Ethiopia, there was a movement of political change in the opposite direction, namely, the Marxist revolution in 1974. Both groups have enjoyed the advantage of meeting in Israel former immigrants from their country of origin who could act as cultural facilitators to help to bridge the gap. The Russian ’facilitators’ arrived in Israel during the 1970s and the former Ethiopians came to Israel in the early 1980s. Thus the absorption process began on a familiar and personal basis, using informal routes of acculturation, with aid provided by families and friends. The two groups of immigrants met with difficulties in findings solutions for the concrete problems of daily living. These were greater for the Ethiopian group, as a result of poor communication with the Israelis, financial problems, homesickness, mtrafamilial arguments, diminished status and loss of honor. All these were perceived by the Ethiopians as ’emotional distress’ (Youngman et al. 1995). The most important difference between the two groups was the following: while Ethiopians adhered strongly to the Jewish religion and had a strong Jewish identity, Soviet Jewry was cut off from Jewish heritage, and their Jewish identity was weaker. Historically, the first Jews appeared in Ethiopia 2500 years ago. The Ethiopian Jews, a remarkable and unique ethnic group, were cut off from the rest of the Jewish world (Waldman, 1985; Well, 1988), and developed specific indigenous customs of practicing Judaism, e.g., mourning rituals for dead. The Old Testament (the Bible) was their main source of religion and their dream of coming to the Holy Land remained vital over centuries. They lived in small villages (10 Jewish families in a typical village) usually working in agriculture or as artistans. Most of

Migration requires

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them remained illiterate. They lived in closely-knit, traditional communities. Their behavioral codes enhanced the significance of the extended family. Iznmigration and transculturation forced Ethiopian Jews to disregard their culturally-ingrained mores, thus submitting them to shame and guilt when they found themselves not fulfilling their moral and social obligations to family and society (Youngman, 1992). Unlike the Russian immigrants who are dispersed all over Israel, assimilating within the absorbing society, Ethiopian immigrants continue to live in isolated locations amongst their own people. Russian immigrants came from an industrialized country where bureaucracy was the rule. They know its ins and outs and are well-versed in handling and manipulating bureaucracy. Many were acquainted with others who immigrated during the seventies that can be used as ’facilitators’. The Ethiopians knew little of the bureaucratic norms and mechanisms of Western industrialized society, and their ability to make various transactions was limited. Immigrants can learn about sociocultural norms through negotiation with the new society and its appointed authorities. When and where this ability is lacking, the ability to cope with daily situations and problems will be impaired. In an attempt to differentiate and identify stress reactions and coping styles in crosscultural adaptation, it was found that Western immigrants give priority to individual coping and progress, while Asiatic immigrants are more oriented to their group of reference (Cross, 1995). This situation can be viewed as analogous to that of two groups of immigrants to Israel: the Russians are more concerned with individual progress and achievements, while the

Ethiopians are more group-oriented. It is important to note that the process of transculturation began prior to the arrival in Israel in both groups, and pre-migration and post-migration factors combine with the stresses of migration. The passage of Ethiopians to Israel was exceedingly difficult but motivation was high. The King Solomon Operation was an airlift of 14,200 Ethiopian Jews that lasted 30 hours and aimed to save them from a civil war and from poverty. While the Ethiopians underwent a stage of being refugees, the Russians, who enjoyed a free choice in emigrating to Israel, developed high expectations concerning professional and/or economic standards and opportunities in the new country. Thus, Ethiopian Jewish immigrants were involved in a bitter process of loss and mourning that involved the entire community (Oberg, 1960). This collective loss was aggravated by individual losses, as there is hardly a family which did not lose one or more of its members on their trek to Israel. The cultural clash and lack of understanding between the Ethiopians and the absorbing society aroused feelings of anger and humiliation in the immigrant population, which will be categorized in this paper within the context of psychological distress. Finally, the influence of a specific factor such as black skin color, as opposed to the predominantly light skin color of the local citizenry and all other immigrants, cannot be ignored. Until now, there has been no actual community-based research comparing between these two immigrant populations in regard to the stress associated with immigration and its symptomatic structure and the studies which have been published regarding this topic tend to be descriptive rather than quantitative (Arieli & Ayche, 1993). The purposes of the current study were (i) to measure and compare levels and symptoms of psychological distress experienced by Ethiopian and Russian Jewish immigrants to Israel as well as (ii) to attempt to identify factors affecting differences in levels and symptoms of distress in these two populations.

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MATERIALS AND METHODS

Study populations The study population

consisted of immigrants living in Jerusalem and in Ashkelon. The administered by the Psychiatric Epidemiology Research Unit (PERU) of the surveys Talbieh Mental Health Center. During a period of six months in 1995, structured interviews were conducted with adult immigrants (18 and over). One member was selected from each household for interviewing by means of available lists of immigrants’ addresses in several neighborhoods of these cities. Interviews were conducted privately at the interviewers’ homes, in their native language, by two Ethiopian and four Russian interviewers trained in the use of the study instrument in PERU. The reliability coefficients of the instrument will be quoted below in the measures section. The Russian sample consisted of 400 Russian-born Jewish immigrants, 175 males and 225 females, aged 18-80 (mean = 43.3; SD = 14.9). Their mean duration of residence in Israel was 42 months (SD 15.3; range = 6-66). In terms of sex and age structure, the sample was of the total Russian immigrant population from which it was drawn, i.e., of all representative adult immigrants who arrived in Israel from the former USSR between 1989 and 1992 were

=

(N = 280,637). The Ethiopian sample included 110 randomly selected, Ethiopian-born Jewish respondents, of which 69 were males and 41 females, aged 18--80 (mean 35.0; SD = 15.5). Their mean duration of residence in Israel was 49 months (SD = 3.8; range 24-60). In terms of sex and of the the age, sample was representative Ethiopian immigrant population from which it was drawn (N = 14,200), i.e. of all adult immigrants who arrived in Israel by The King Solomon Operation in 1991 (Table 1). =

=

Measures distress was assessed by the Talbieh Brief Distress Inventory (TBDI). This instrument was especially developed to measure levels and symptoms of psychological distress among immigrants (Ritsner et al. 1995). It includes 24 items with 5-grade scales. A TBDI general index, and six symptom scales (obsessiveness, hostility, sensitivity, depression, anxiety and paranoid ideation) are computed. The higher the TBDI general index and dimensions, the higher is the level of psychological distress. The cut off points for psychopathological caseness is TBDI index sc®r~ - 1.15 for males and =1.39 for females. For the Russian sample, the reliability coefficients (Cronbach’s alpha) of the TBDI scales and general index ranged from .75 to .94 (except for the paranoid ideation scale which had a reliability of .45). For the Ethiopian sample, four scales had reliability coefficients of at least .62, indicating a satisfactory degree of internal consistency, and the two other scales (sensitivity and paranoid ideation) at least .41. The TBDI index had a reliability coefficient of .85. All respondents were asked to rate the extent to which adjustment stresses contributed to their experienced distress on a five-point scale, ranging from 0 (not at all) to 4 (extremely).

Psychological

Demographic variables included gender, age, occupation and duration of stay in Israel.

marital status,

family composition, education,

Procedure The TBDI and demographic items

were

translated from English into Russian and Amharic

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by

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assistant. A blind back-translation into English was then performed by another ensure semantic equivalence. The Russian version of the questionnaire was employed previously (Ritsner et ail. 1996). A pilot study involving ten Ethiopian subjects was conducted to test the use of the Amharic version of the instrument. Subjects completed the questionnaires anonymously and on a voluntary basis. The no-response rates were 15% for Ethiopian immigrants and 8% for the Russians. No difference was found in sociodemographic characteristics between refusals and participants. Compared to Russian respondents, the main difficulties in interviewing Ethiopian participants were the following: a) unwillingness to participate in the interview; b) suspiciousness towards figures of authority; c) slower understanding of the questions (the average length of interview was three hours). This is related to the fact that more than half of the Ethiopian participants were illiterate. Results were analyzed using chi-square and t statistic tests. Reliability of scales was examined using Cronbach’s Alpha. Number Cruncher Statistical System (NCSS 6.0) software package was used for statistic analysis (Hintze, 1995). a

bilingual

assistant to

RESULTS

Sociodemographic characteristics. Table 1 compares the basic sociodemographic variables of the Ethiopian and Russian samples. Significant differences in sex, age, family composition, education and occupational status were found between the two samples. In comparison with the Russian immigrants, the Ethiopian sample had a lower percentage of females and people age 31 and over, but a higher percentage of never married, non-educated housewives and retired subjects. Psychological distress. Table 2 compares TBDI mean scores between the two samples by demographic variables. Overall, the level of psychological distress was higher in the Russian sample than that in the Ethiopian sample. However, since there were significant differences in sex, age and time elapsed since immigration to Israel, the effects of these factors on levels and symptoms of distress were taken into account in further analyses. These analyses indicated that levels of distress in Ethiopian and Russian men were similar, whereas significant differences were found between women of both groups, older immigrants and those who had spent more time in Israel. Thus the parameters of length of stay, being a woman and older age contribute to a higher psychological distress among the Russian immigrants than among Ethiopians. Distress symptoms. Table 3 compares the values of the symptoms of psychological distress between the two samples. This comparison indicates that levels of obsessiveness, sensitivity, and depression were similar in both groups, but there was significantly higher hostility and anxiety among the Russian immigrants and higher paranoid ideation among the Ethiopian

immigrants. Tables 4-6, respectively, show that significant differences in these symptom patterns between groups remains, even if sex, age and duration of stay in the country are controlled. However, in these analyses, some additional differences in the symptomatology of distress between the groups were established. Thus, the Russian females reported higher sensitivity than the Ethiopian females. While the level of paranoid ideation in older immigrants of both

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Demographic

* p < 0.®Ol;

**p