Petah Tikva, Israel
Petah Tikva, Israel

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Farbstein I.,Ziv Hospital | Mansbach-Kleinfeld I.,Mental Health Services | Levinson D.,Mental Health Services | Goodman R.,King's College London | And 6 more authors.
Journal of Child Psychology and Psychiatry and Allied Disciplines | Year: 2010

Background: The development of epidemiological instruments has enabled the assessment of mental disorders in youth in countries that plan policy according to evidence-based principles. The Israel Survey of Mental Health among Adolescents (ISMEHA) was conducted in 2004-2005 in a representative sample of 957 adolescents aged 14-17 and their mothers. Methods: The aims of this study were to estimate prevalence rates of internalizing and externalizing mental disorders and their socio-demographic and health correlates. Disorders were ascertained with the Development and Well-Being Assessment inventory and verified by child psychiatrists. Results: The prevalence rates were 11.7%, 8.1% and 4.8% for any disorder, internalizing disorders and externalizing disorders, respectively. Distinct risk factors were associated with the different types of disorders: internalizing disorders were associated with female gender, chronic medical conditions and being cared for by a welfare agency. Risk factors for externalizing disorders were male gender, having divorced or single parents, being an only child or having only one sibling. Learning disability was associated with both types of disorders. Conclusions: The risk and protective factors related to internalizing and externalizing disorders are interpreted within the framework of family composition in this multicultural society. © 2009 Association for Child and Adolescent Mental Health.


Klomek A.B.,The Interdisciplinary Center | Klomek A.B.,Columbia University | Klomek A.B.,Feinberg Child Study Center | Sourander A.,Columbia University | And 3 more authors.
Canadian Journal of Psychiatry | Year: 2010

To review the research addressing the association of suicide and bullying, from childhood to young adulthood, including cross-sectional and longitudinal research findings. Method: Relevant publications were identified via electronic searches of PsycNet and MEDLINE without date specification, in addition to perusing the reference lists of relevant articles. Results: Cross-sectional findings indicate that there is an increased risk of suicidal ideation and (or) suicide attempts associated with bullying behaviour and cyberbullying. The few longitudinal findings available indicate that bullying and peer victimization lead to suicidality but that this association varies by sex. Discrepancies between the studies available may be due to differences in the studies' participants and methods. Conclusions: Bullying and peer victimization constitute more than correlates of suicidality. Future research with long-term follow-up should continue to identify specific causal paths between bullying and suicide.


Horesh N.,Bar - Ilan University | Levi Y.,Ruppin Academic Center | Levi Y.,Feinberg Child Study Center | Apter A.,Feinberg Child Study Center
Journal of Affective Disorders | Year: 2012

Background: The study of near-fatal suicide attempts may provide insight into the minds of suicidal subjects. The aim of the study was to investigate the relationship of intent and lethality in medically serious and medically non-serious suicide attempts and to examine relationship of specific psychological and clinical variables with the subjective and objective components of suicide intent. Methods: The study group included 102 participants, 35 consecutive subjects hospitalized for a medically serious suicide attempt and 67 subjects who presented to the same tertiary medical center after a medically non-serious suicide attempt. All were interviewed with the SCID-I and completed the Suicide Intent Scale (SIS), the Lethality Rating Scale, and instruments measuring mental pain and communication difficulties. Results: Patients who made medically serious suicide attempts had higher total SIS score and higher objective and subjective subscale scores. The objective component of the SIS was highly correlated with the lethality of the suicide attempt and communication difficulties; the subjective component was associated with mental pain variables. The interaction of mental pain and communication difficulties was predictive of the severity of the objective suicide intent. Limitations: Relatively small number of patients with medically serious suicide attempt and the relatively large number of questionnaires which may to some extent have diminished informant reliability. Conclusions: Suicidal individuals with depression and hopelessness who cannot signal their pain to others are at high risk of committing a medically serious suicide attempts. © 2011 Elsevier B.V. All rights reserved.


Lipsicas C.B.,Feinberg Child Study Center | Lipsicas C.B.,National Health Research Institute | Makinen I.H.,National Health Research Institute | Makinen I.H.,University of Stockholm
Canadian Journal of Psychiatry | Year: 2010

Little research has focused on the relation of immigration and suicidal behaviour in youth. Nevertheless, the impact of migration on the mental health of youth is an issue of increasing societal importance. This review aimed to present studies on the prevalence of suicidal behaviour in immigrant youth in various countries and to provide possible explanations for suicidal behaviour in immigrant youth, especially regarding acculturation. Methods: The review included a literature search to locate articles on the subject of suicidal behaviour in immigrant youth in the context of acculturation. Results: Studies on suicidal behaviour in culturally diverse youth are few and most of the existing research does not differentiate ethnic minorities from immigrants. Studies on epidemiology and on specific risk factors were found regarding various immigrant youth including Hispanics in the United States, Asians in North America and Europe, as well as comparative studies between different immigrant groups in specific countries. Conclusions: The relation between immigration status and suicidal behaviours in youth appears to vary by ethnicity and country of settlement. Time spent in the new country as well as intergenerational communication and conflicts with parents have, in many of the studies, been related to suicidality in immigrant youth. Summing up, there is a clear and urgent need to further pursue the work in this field, to develop targeted public health interventions as well as psychosocial treatment for preventing suicide in these youth.


Shechner T.,Tel Aviv University | Shechner T.,Feinberg Child Study Center
Israel Journal of Psychiatry and Related Sciences | Year: 2010

The present paper reviews the theoretical and empirical literature on children and adolescents with gender variant behaviors. The organizational framework underlying this review is one that presents gender behavior in children and adolescents as a continuum rather than as a dichotomy of normal versus abnormal categories. Seven domains are reviewed in relation to gender variant behavior in general, and to Gender Identity Disorder (GID) in particular: theories of normative gender development, phenomenology prevalence, assessment, developmental trajectories, comorbidity and treatment.


Horesh N.,Bar - Ilan University | Apter A.,Feinberg Child Study Center | Apter A.,Bar - Ilan University | Apter A.,Tel Aviv University | And 2 more authors.
Journal of Affective Disorders | Year: 2011

Background: A large body of evidence supports the importance of genetic risk factors in bipolar disorder (BPD), but less is known about the role of stressful life events (SLE). This study assessed the role of SLE in childhood, adulthood and one year prior to first episodes of both depression and mania in BPD. Methods: Three groups of 50 matched subjects each were assessed: patients with BPD, with borderline personality disorder (BLPD) and healthy controls. Structured clinical interviews were used for diagnoses. The Coddington Life Events Schedule and the Israel Psychiatric Epidemiology Research Interview Life Event Scale measured life events and were confirmed with a semi-structured interview for subjective experience for each SLE. Results: In BPD, the total number of SLE was lower during childhood and higher in the year preceding the first depression compared to controls and the proportion of loss-related events in childhood was higher. In the year preceding the first depressive episode, BPD subjects had more total, negative uncontrolled and independent but not positive SLE. In the year preceding the first episode of mania, the total number of uncontrolled, negative SLE were higher in BPD, whereas positive and separation-related SLE were not. After the first episode, BPD subjects had less SLE than controls. Conclusions: Negative and loss-related SLE are common in BPD subjects, occur in the year preceding the first episodes of depression and mania and are less common in childhood or after the onset of the disorder. © 2011 Elsevier B.V. All rights reserved.


Barzilay S.,Feinberg Child Study Center | Barzilay S.,Tel Aviv University | Apter A.,Feinberg Child Study Center | Apter A.,Tel Aviv University
Archives of Suicide Research | Year: 2014

Suicidal behavior is highly complex and multifaceted. Consequent to the pioneering work of Durkheim and Freud, theoreticians have attempted to explain the biological, social, and psychological nature of suicide. The present work presents an overview and critical discussion of the most influential theoretical models of the psychological mechanisms underlying the development of suicidal behavior. All have been tested to varying degrees and have important implications for the development of therapeutic and preventive interventions. Broader and more in-depth approaches are still needed to further our understanding of suicidal phenomena. © 2014, Copyright International Academy for Suicide Research.


Gvion Y.,Bar - Ilan University | Apter A.,Feinberg Child Study Center | Apter A.,Tel Aviv University
Public Health Reviews | Year: 2012

Suicidal behavior is a major public health problem. As it has for decades, suicide remains one of the leading causes of death in the western world. This paper reviews the literature and the latest developments on the research and knowledge of suicide behavior and death from suicide. The keywords: suicide, psychopathology, mental pain, impulsivity, aggression and communication difficulties were entered into databases: PubMed, PsychLit and ProQuest. Significant articles were scrutinized for relevant information. According to WHO estimates for the year 2020, approximately 1.53 million people will die from suicide, and ten to 20 times more people will attempt suicide worldwide. These estimates represent on average one death every 20 seconds and one attempt every one to two seconds. Although of low predictive value, the presence of psychopathology is probably the single most important predictor of suicide. Accordingly, approximately 90 percent of suicide cases meet criteria for a psychiatric disorder, particularly major depression, substance use disorders, cluster B personality disorders and schizophrenia. Other more transient factors that reflect an imminent risk of suicide crisis and therefore require immediate intervention include unbearable mental pain and related experiences of depression and hopelessness. Problems with help-seeking, social communication and self-disclosure also pose a suicide risk, as do personality traits of aggression and impulsivity. All these factors are highly correlated with suicidal behavior across psychiatric samples and nosological borders. Although suicidal behavior has been well studied, empirically and clinically, the definition of the different subtypes and phenotypes of suicidal behaviors and mechanisms underlying some of the risk factors (such as aggression, impulsivity, suicide intent) remain unclear. Reducing the increasing trend of suicide rates among the most vulnerable populations will require further research. Hopefully this review will contribute to the understanding of this phenomenon and to the development of preventive initiatives.


Brand-Gothelf A.,Feinberg Child Study Center | Leor S.,Ben - Gurion University of the Negev | Apter A.,Feinberg Child Study Center | Fennig S.,Feinberg Child Study Center
Journal of Nervous and Mental Disease | Year: 2014

We examined the impact of comorbid depression and anxiety disorders on the severity of anorexia nervosa (AN) in adolescent girls. Adolescent girls with AN (N = 88) were divided into one group with and another group without comorbid disorders, and selected subjective and objective measures of illness severity were compared between the two groups. The comorbid group had significantly higher scores than the noncomorbid group for all four subscales and total scores of the Eating Disorders Examination as well as for all Eating Disorders Inventory-2 subscales, except for bulimia. The comorbid group also had significantly more suicide attempts and hospitalizations compared with the noncomorbid group. There were no significant group differences for the lowest ever body mass index, duration of AN symptoms, and age at AN onset. Our findings suggest that AN with comorbid depression and anxiety disorder is a more severe clinical variant of the disorder, especially with respect to severity of psychological symptoms and suicide risk. Copyright © 2014 by Lippincott Williams & Wilkins.


Steinberg T.,Feinberg Child Study Center | Shmuel-Baruch S.,Feinberg Child Study Center | Shmuel-Baruch S.,Bar - Ilan University | Horesh N.,Bar - Ilan University | Apter A.,Feinberg Child Study Center
Comprehensive Psychiatry | Year: 2013

Introduction Tourette syndrome (TS) is a neuropsychiatric developmental disorder characterized by the presence of multiple motor tics and one or more vocal tics. Although TS is primarily biological in origin, stress-diatheses interactions most probably play a role in the course of the illness. The precise influence of the environment on this basically biological disorder is difficult to ascertain, particularly when TS is complicated by comorbidities. Among the many questions that remain unresolved are the differential impact of positive and negative events and specific subtypes of events, and the importance of major crucial events relative to minor daily ones to tic severity. Objectives To examine the relationships between life events, tic severity and comorbid disorders in Tourette Syndrome (TS), including OCD, ADHD, anxiety, depression and rage attacks. Life events were classified by quantity, quality (positive or negative) and classification types of events (family, friends etc.). Subjects Sixty patients aged 7-17 years with Tourette syndrome or a chronic tic disorder were recruited from Psychological Medicine Clinic in Schneider Children's Medical Center of Israel. Instruments Yale Global Tic Severity Scale; Children's Yale Brown Obsessive Compulsive Scale; Life Experiences Survey; Brief Adolescent Life Events Scale; Screen for Child Anxiety Related Emotional Disorders; Child Depression Inventory/Beck Depression Inventory; ADHD Rating Scale IV; Overt Aggression Scale. Results Regarding tics and minor life events, there was a weak but significant correlation between severity of motor tics and the quantity of negative events. No significant correlation was found between tic severity and quantity of positive events. Analysis of the BALES categories yielded a significant direct correlation between severity of vocal tics and quantity of negative events involving friends. Regarding comorbidities and minor life events, highly significant correlations were found with depression and anxiety. Regarding tics and major life events, significant correlation was found between the quantity of major life events and the severity of motor tics, but not vocal tics. Regarding comorbidities and major life events, significant correlation was found between the severity of compulsions, ADHD, and aggression and the subjects' personal evaluation of the effect of negative major life events on their lives. Conclusions Minor life events appear to be correlated with tic severity and comorbidities in children and adolescents with Tourette syndrome. The lack of an association between major life events and tic severity further emphasizes the salient impact of minor life events that occur in temporal proximity to the assessment of tic severity. Clinically, the results match our impression from patient narratives wherein they "blamed" the exacerbations in tics on social interactions. The high correlation between negative life events and depression, anxiety and compulsions symptoms, were reported also in previous studies. In conclusion, These findings may have clinical implications for planning supportive psychotherapy or cognitive behavioral therapy for this patient population. © 2013 Elsevier Inc.

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