Intention to seek mental health treatment among Ethiopian immigrants: the contribution of social-psychological and cultural factors

Immigration is a complex and sometimes traumatic event that requires coping and adapting to changes in different aspects of life and is a risk factor for the development of emotional distress. This risk exists for both first-generation and second-generation immigrants. Yet, although immigrants are a population with high rates of emotional distress, studies indicate that mental health care use rates among them and their children are low relatively to the general population. This disparity is particularly evident among immigrants who migrated from non-Western countries to Western countries, such as the Ethiopian population in Israel.

The emotional help seeking decision-making process (from trained mental health professionals) is a complex process that is influenced by various factors. Numerous studies in Israel and around the world have examined the intention to seek professional emotional help among various populations and in relation to different variables. However, no studies were found which examined factors associated with seeking professional emotional help among adults who immigrated to Israel from Ethiopia and among Israel-born Ethiopians.

Therefore, the objectives of the present study were: (A) To examine the differences in the intention to seek professional emotional help between Ethiopian immigrants (Israel-born Ethiopians and immigrants from Ethiopia) and Israelis. (B) To examine the attitudes, psychological-social factors, and cultural factors that may be associated with this intention. The study was based on the Emotional Health Help-Seeking Model of Vogel and colleagues (Vogel, Wester, and Wei Boysen, 2005), which suggests an association between various psychological variables, as well as personal attitudes toward seeking professional emotional help, and intention to seek professional emotional help. In addition, for the purpose of the present study, cultural variables, that were found related to the intention to seek help in the literature, were added to the model. Therefore, the variables that were examined in the study as associated with seeking professional emotional help were: social norm toward seeking professional help, social support, social stigma, attitudes towards seeking professional help, identification with the ethnic group and identification with the Absorbing society (i.e., Israeli society).

This cross-sectional study was conducted using self-report questionnaires filled out by 173 participants. The questionnaires were distributed manually or via a link on the Internet. The participants in the study were adults, aged 18-60, living in Israel. Among them were first generation Ethiopian immigrants, Israeli-born Ethiopians and Israeli born (non-Ethiopian).

Findings regarding the hypotheses that examined differences between the groups in the dependent variable and in some of the independent variables (attitudes, social norm and social stigma): According to the first hypothesis, differences in the intention to seek professional emotional help between the groups were found, such that Israel-born Ethiopian and Israelis had a significantly higher intention to seek professional emotional help than Ethiopian immigrants. However, contrary to the hypothesis, no difference was found between Israel-born Ethiopian and Israelis; According to the second hypothesis, attitudes toward seeking professional emotional help were more negative among Ethiopian immigrants than among Israelis, but contrary to the hypothesis, there was no difference in attitudes toward seeking professional emotional help among Israeli-born Ethiopian and Israelis. Contrary to the third hypothesis, no difference was found between the groups in their social norm toward seeking professional emotional help; and in line with the fourth hypothesis, the social stigma toward seeking professional emotional help among Ethiopian immigrants and Israeli-born Ethiopian was higher than the social stigma among Israelis.

Findings regarding the hypothesis dealing with the associations between the dependent variable and the independent variables: Consistent with the fifth hypothesis, the more positive the attitudes toward seeking professional emotional help were, the higher were participants’ intentions to seek professional emotional help. Contrary to the hypothesis, the higher the social stigma was, the higher the intention to seek professional emotional help. Also, no association was found between social norm, social support, identification with the ethnic group, identification with Israeli society, and the intention to seek professional emotional health help.

Findings regarding the mediation hypothesis: Consistent with the sixth hypothesis, attitudes toward seeking professional emotional help fully mediated the association between social norm and intention to seek professional emotional help. However, contrary to the hypothesis, these attitudes did not mediate the association between the other independent variables and intention to seek professional emotional help.

Findings regarding the moderation question: When identification with Israeli society is low, then identification with the ethnic group explains intention to seek professional emotional help; such that the higher the identification with the ethnic group, the lower the intention to seek professional emotional help. Conversely, if identification with Israeli society is high, then identification with the ethnic group does not explain the intention to seek professional emotional help.

In conclusion, the study’s findings indicate that there are differences in the intention to seek professional emotional help between the study groups, that first generation Ethiopian immigrants have lower intention to seek professional emotional help than Israel-born Ethiopians and Israelis; and that attitudes, stigma, social norms, identification with the ethnic group and identification with Israeli society group explain the intention to seek professional emotional help.

Due to the paucity of studies dealing with factors related to the intention to seek professional emotional help among Ethiopian immigrants, and in particular due to the paucity of research on this topic in  the context of intergenerational differences, this study adds to the literature that exists on the subject and can serve as a basis for further studies . On a practical level, findings stress the importance of developing intervention programs to improve attitudes toward seeking professional emotional help among Ethiopian immigrants; as well as the importance of promoting culturally sensitive mental health services, with the goal of raising mental health service use for those  in need.