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Special Issue: Diaspora Migration Original Articles and Reviews

Suicidal Ideation and Alcohol Use Among Ethiopian Adolescents in Israel The Relationship With Ethnic Identity and Parental Support Sophie D. Walsh,1 Arnon Edelstein,2 and Danbulu Vota1 1

Department of Criminology, Bar Ilan University, Bar Ilan, Israel, 2Kaye College, Béer Sheva, Israel

Abstract. Recent figures point to alarming rates of suicidal tendencies and risk behaviors among Ethiopian adolescents (first and second generation) in Israel. This study tries to understand this phenomenon through an examination of the relationship between ethnic identity (Israeli and Ethiopian) and parental support with suicidal ideation and alcohol use. Two hundred adolescents aged 15–18 years from the Ethiopian community in Israel completed questionnaires examining the degree to which they felt a sense of (positive) Israeli and Ethiopian identity and parental support as well as suicidal ideation, drinking behavior, and depression. Results showed significant correlations between both Israeli and Ethiopian identities and suicidal ideation and alcohol use and a significant relationship between suicidal ideation and parental support. Regression analysis highlighted the pivotal role of a strong and positive heritage (Ethiopian) identity in lower levels of suicidal ideation and alcohol use. Results suggest the important role of ethnic identity for well-being among immigrant and minority youth, in particular in the ability of minority youth to consolidate a coherent ethnic identity incorporating a positive connection to their heritage culture as providing a protective role against suicidal tendencies and risk behaviors. Keywords: Ethiopian immigrant adolescents, suicidal ideation, alcohol use, ethnic identity, parent support

Suicide rates among the Ethiopian community in Israel, in particular youth, have been growing in recent years at alarming rates. Between 2005 and 2007, suicide rates for Ethiopian adolescents (aged 15–24 years) were 12.7 times higher than rates for the rest of the Jewish population of Israel and 6.6 times higher than rates of suicide among immigrant adolescents from the Former Soviet Union (Suicide in Israel, 2010). In the same years 43% of suicides in the Ethiopian community were of adolescents aged 15–24 years. 2008 figures from the World Health Organization, European region placed Israel in fourth place for suicides among girls aged 15–29 years and fifth place for boys, from 26 countries. In addition, recent research shows that immigrant adolescents in Israel have been found to report significantly higher levels of alcohol drinking and smoking than Israeli-born adolescents, with Ethiopian adolescents showing significantly higher levels of binge drinking than both other immigrant groups and Israeli-born adolescents (Walsh, Harel-Fisch, & Fogel-Grinvald, 2010). The statistics highlight the distress of Ethiopian adolescents, attempting to ‘‘navigate’’ their way (Goldblatt & Rosenblum, 2007) in Israeli society facing constant struggles, with integration challenges, cultural gaps, and their dark skin color identified as major obstacles (Ben-David & Ben-Ari, 1997). The past decade has seen an increasing Ó 2012 Hogrefe Publishing

racialization in the discourse of young Ethiopians, characterized by increasing alienation and exclusion, together with poverty, social isolation, segregation, and limited opportunities (Offer, 2007). This study looks at suicidal ideation and alcohol use of 200 Ethiopian adolescents, aged 15–18 years and their relationship with ethnic identity (Israeli and Ethiopian) and parental support. The study asks whether it is a state of a diffused ethnic identity whereby young Ethiopian adolescents feel alienated and disconnected from both their Ethiopian heritage and Israeli culture (Edelstein, 2010) together with the decrease in parental support and involvement, due to acculturative dissonance (Portes, 1997) and immigration difficulties of adults in the Ethiopian community (Kaplan & Salamon, 1998) which are leading to the increased distress and marginalization of Ethiopian youth.

Immigrant Adolescents, Psychological Distress, and Parental Support Recent research in Israel and around the world has emphasized the vulnerability of immigrant adolescents in a range of psychological, social, and behavioral difficulties. Immigrant adolescents have been shown to have higher levels of anxiety, depression, withdrawal, somatic complaints, European Psychologist 2012; Vol. 17(2):131–142 DOI: 10.1027/1016-9040/a000115

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social problems, attention problems, delinquency, and aggressive behavior (Janssen et al., 2004; Stevens et al., 2003). While these findings are in contrast to other research showing the adaptability of first-generation immigrant adolescents (Berry, Phinney, Sam, & Vedder, 2006), suicide rates have been found to be consistently higher among immigrant adolescents in Israel (Edelstein, 2005, 2010; Ponizovsky & Ritsner, 1999; Shoval, Schoen, Vardi, & Zalsman, 2007) and among diverse populations around the world (Eshun, 2006; Hjern & Allebeck, 2002). Higher rates of alcohol and ecstasy use have also been found among immigrant adolescents in Israel (Isralowitz & Reznik, 2007). Research among adolescents from the Former Soviet Union (FSU) in Israel involving a comparison with youth in the FSU (Ponizovsky & Ritsner, 1999) has found that suicide rates of immigrant adolescents are also significantly higher than rates in their former country. Research shows the pivotal role of parental monitoring, involvement, and support at school as related to lower levels of risk behavior among immigrant adolescents (Murad, Joung, Verhulst, Mackenbach, & Crijnen, 2004; Stevens, Vollebergh, Pels, & Crijnen, 2007). High parental conflict and lack of familial closeness have been found to be related to suicidal behavior among minority and immigrant adolescents in the US (Groves, Stanley, & Sher, 2007; O’Donnell, O’Donnell, Wardlaw, & Stueve, 2004) and alcohol use in immigrant Latino families in the US (Marsiglia, Kulis, Parsai, Villar, & Garcia, 2009). The change in family dynamics and a lack of cultural knowledge and language following immigration can lead to immigrant parents being less able or less confident to fulfill roles of support, monitoring, or authority and to be less involved in the lives of their children (SuarezOrozco & Suarez-Orozco, 2001). In addition, for immigrant families with adolescents, the challenges of adolescence in Western cultures can drastically increase stressors. For many adolescents, there is an increased desire for autonomy and separation from parents and families (Blos, 1967). But, for immigrant families, this increased autonomy and separation may conflict with traditional values and norms as well as create difficulties, since parents rely on the adolescent for particular tasks needed by immigrant and acculturating families. In many families, adolescents and children acculturate at a faster rate than do their parents, in what has been termed ‘‘Dissonant acculturation’’ (Portes, 1997). Kwak (2003) suggests three general findings of the impact of immigration on parent/adolescent relationships. Firstly, immigrant adolescents, as part of a process of developing autonomy, may accept new cultural values and practices more easily than their parents (Portes, 1997). Secondly, adolescents and their parents undergo an extensive negotiation process in terms of the cultural transmission of their ethnic heritage culture. Thirdly, since construction of self is built from one’s enculturation context, immigrant adolescents may have a delayed or less consolidated self-concept. Their simultaneous experience of enculturation and acculturation may not be fully supported by parents, either psychologically or culturally (Meeus, Oosterwegel, & Vollebergh, 2002). Widening acculturation gaps in which the adolescent learns new cultural norms, language, and values faster can lead to adolescents taking parental roles (Walsh, Shulman, European Psychologist 2012; Vol. 17(2):131–142

Bar-On, & Tsur, 2006) or ‘‘language brokering’’ for their parents (Buriel, Perez, de Ment, Chavez, & Moran, 1998; Valdes, Chavez, & Angelelli, 2003). Parents also go through their own personal acculturation process (Berry, 1997) making it difficult for them to be available for their adolescent’s needs.

Ethnic Identity as Related to Adolescent Immigrant Adaptation In this paper we are examining suicidal ideation and alcohol use as two indicators of adaptational difficulty as a consequence of social marginality, a perspective reinforced by recent literature showing that alcohol use and suicidal ideation are significantly related among immigrant and minority youth (Eaton et al., 2011; Reyes et al., 2011). Immigration theory and research (Vedder, van de Vijver, & Liebkind, 2006) emphasizes the pivotal role of the immigrants’ identity as related to social adjustment and psychological wellbeing following immigration (Chavous et al., 2003; Lee, 2003, 2005; Wong, Eccles, & Sameroff, 2003). The ability of immigrants to integrate internal representations of their country of origin and the receiving country and to form a harmonious self-concept has been found to be positively related to various forms of psychological and physical health (Berry, 1998). Developmental ethnic identity theory (Phinney, 1989) assumes that what is crucial for good adjustment of immigrant adolescents is not just a strong sense of ethnic belonging but rather ethnic identity achievement, that is, a positive attitude toward their ethnic group (Phinney & Ong, 2007). Research has shown that the ability to form a multifaceted identity which incorporates a connection to both identities (‘‘integration’’ – Berry, 1997) is linked to higher levels of both mental and physical health (Berry & Kim, 1988; Virta, Sam, & Westin, 2004). At the other end of the spectrum, ‘‘marginalization’’ (Berry, 1997) can result from failed attempts at assimilation (involving cultural loss) combined with failed attempts at participating in the larger society, due in part to discriminatory attitudes and practices of the dominant group. Many studies have found that a strong host country identity is associated with sociocultural adjustment, including school adjustment, and academic achievements (Oetting & Beauvais, 1991; Spencer, Noll, Stoltzfus, & Harpalani, 2001), while a strong country of origin identity of immigrant adolescents is related to psychological adjustment (Giang & Wittig, 2006; Umana-Taylor & Shin, 2007; Umana-Taylor & Updegraff, 2007; Vedder et al., 2006; Zamboanga, Schwartz, Jarvis, & Van Tyne, 2009). However, an overly large cultural gap between the heritage and receiving cultures may lead to considerable distress on the part of the individual who attempts to combine both in their identity and risks potential rejection from both cultures (Schwartz, Montgomery, & Briones, 2006). Vast cultural gaps between Ethiopian Jewish culture and Israeli culture and society (Weil, 1995) can leave adolescents confused and helpless in their attempt to develop a coherent identity. The confusion of identity formation in a new cultural milieu, together with family cultural conflicts, can be hypothesized to leave Ó 2012 Hogrefe Publishing

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immigrant adolescents in particular danger of distress and problem behavior. Few studies exist on the prevalence of suicidal ideation, planning, and attempts in specific cultural groups (Kennedy, Parhar, Samra, & Gorzalka, 2005) and even less on the relationship between ethnic identity and suicidal tendency (Zayas, 1987). Previous literature examining the relationship between suicidal ideation and behavior and risk and protective factors among diverse populations (Borowsky, Resnick, Ireland, & Blum, 1999; Pharris, Resnick, & Blum, 1997; Rew, Thomas, Horner, Resnick, & Beuhring, 2001) emphasizes a need to examine suicidal tendencies in different cultural realities. The very sparse research, which has been carried out, has shown a link between ethnic identity and psychological acculturation and suicidal ideation (Eshun, 2006; Kennedy et al., 2005). Interestingly, in contrast to theoretical expectations, identification with heritage culture among Chinese and Indo-Asian immigrants in Canada was found to predict suicidal ideation (Kennedy et al., 2005). In the area of acculturation, acculturative stress and lack of parental support have been found to be predictive of suicidal ideation among Korean immigrant adolescents in the US (Cho & Haslam, 2010) and Latino adolescents in the US (Hovey, 1998; Hovey & King, 1996). A recent review of 22 studies on immigrant youth and suicide from the 1990s onwards (Bursztein Lipsicas & Makinen, 2010) suggests that the relationship between immigration status and suicidal behaviors varies by ethnicity and country of settlement, although there appear to be similar stressors such as intergenerational conflict, particularly among girls, coming from traditional cultures to more individualistic ones and among Asian youth in the US (Handy, Chithiramohan, Ballard, & Silveira, 1991) which can increase suicidal ideation. A pilot study examining 62 Ethiopian adolescents in Israel (Edelstein, 2010) points to the role of intergenerational conflict between adolescents and their parents, difficulties that the youth had in turning to the parents for support and culture conflict (Sellin, 1938) in contributing to suicidal tendencies. However, research on suicidal behavior among immigrant adolescents is sorely lacking (Bursztein Lipsicas & Makinen, 2010) and almost no research has addressed issues of ethnic identity (host and heritage) and their relationship to suicidal tendencies. Recent research on the use of alcohol and illicit drugs among minority and immigrant adolescents shows a relationship connected to both immigrant generation and gender (Eitle, Wahl, & Aranda, 2009; Wahl & Eitle, 2010) and an inconsistent relationship to acculturation (Fosados et al., 2007; Hahm, Lahiff, & Guterman, 2004). In a study of 13,000 adolescents in Sweden, second-generation immigrant adolescents were found to be more likely to use alcohol and binge drink than first-generation or native Swedes (Svensson & Hagquist, 2010). However, low levels of alcohol use among Muslim adolescents in the Netherlands (van Tubergen & Poortman, 2010) and a lack of a relationship between cultural identification and alcohol use among African-American and Haiti-born American adolescents (Strunin & Demissie, 2001) suggest that alcohol use among immigrant adolescents is related to the particular cultural group from which the adolescents come and the social conÓ 2012 Hogrefe Publishing

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text in which they live. On a more general level suicidal behavior has been seen to be related to a variety of health and social behaviors such as sexual activity, drug, alcohol, and cigarette use, injuries, physical fighting, knife-carrying shoplifting, and gambling (Afifi, Cox, & Katz, 2007; King et al., 2001).

Ethiopian Adolescents in Israel Recent statistics place the Ethiopian community in Israel at a little over 1% of the population (110,700 in 2006, statistics from the Israeli Central Bureau of Statistics) of whom around 70% of the community are first-generation immigrants. The Ethiopian Jewish community, known as Beta Israel, has followed Jewish customs since at least the 12th century (Ben-Eliezer, 2004). Following 1973 recognition of their Jewish status (Ben-David & Ben-Ari, 1997) emigration of the Jewish community began, starting with dangerous, long, and arduous journeys through Sudan, involving extended periods of waiting, trauma (including illness and death of relatives), and physical hunger and deprivation (Ben-Ezer, 2002). Two major waves of immigration took place in 1984 (‘‘Operation Moses’’ – massive airlifts from refugee camps in Sudan) and in 1991 (‘‘Operation Solomon’’ in which 14,000 Ethiopian Jews were airlifted from Addis Ababa to Tel Aviv in only 33 hr). Since the mid1990s a second wave of immigration of the Falas Mura (Christian converts) has taken place (Offer, 2007). The transition from poor rural living to an urban society brought with it a plethora of absorption problems. Many adults are unable to participate in the labor force, live on welfare as a main source of livelihood, and reside in disadvantaged neighborhoods (Kaplan & Salamon, 1998). High concentrations of Ethiopians in certain neighborhoods are perceived to be a major barrier for successful integration of the younger generation (Offer, 2007). Difficulties in integration have resulted from deep cultural differences, including different communication systems, whereby Ethiopians rely more on nonverbal communication, indirect expression, silence, and soft-spokenness (Weil, 1995). Cultural transition has led to a breakdown of the traditional community framework and a decline in status of traditional institutions, such as the community elders (‘‘shmagaleh’’) and religious leaders (‘‘Kessim’’). A dramatic increase in rates of juvenile delinquency and school dropout among Ethiopian youth has been seen since the late 1990s (Kaplan & Salamon, 1998), together with high incidence of depression and suicide (Arieli, Gilat, & Aycheh, 1996). Parents’ limited Hebrew ability leaves them unable to support and help their children academically and socially (Lifshitz, Noam, & Habib, 1998). This study focuses on the experience of adolescents within the Ethiopian community in Israel. Research on adolescents and young adults (first and second generation) has identified specific difficulties for the younger generation, involving intergenerational conflicts with parents and an experience of ‘‘feeling different’’ (Ben-David & Ben-Ari, 1997) involving emotions of despair, sorrow, sadness, disappointment, and humiliation, feelings of disrespect and devaluation in their professional life, and feelings of inferiority, European Psychologist 2012; Vol. 17(2):131–142

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hopelessness, and helplessness in their social lives. The process of immigration and the difficulties of absorption have impacted on parental ability to serve as an authority or guidance for their developing children. Parents’ difficulties in finding work, learning the language and culture norms together, and break-down of the traditional community structure can leave adolescent and emerging adult children in need of ‘‘navigating’’ their own way (Goldblatt & Rosenblum, 2007). Educational policy to encourage Ethiopian-born adolescents to live and study in boarding schools has enforced a loss in parental guidance, an everwidening gap between adolescents and their parents, and a break-down in family structure (Ben-Ezer, 2002). The theory of segmented assimilation (Portes & Zhou, 1993), which suggests that it is not acculturation per se but rather into which segment of society a particular group assimilates which dictates levels of adaptation, can be a useful theoretical prism through which to understand the experience of Ethiopian adolescents in Israel. Portes and Zhou (1993) suggest that there are three factors which can lead to downward mobility: color, location, and the absence of mobility ladders. Ethiopian immigrant adolescents who stand out for their black skin and are prone to segregation and lack of educational opportunities (Offer, 2007) can be seen to be vulnerable for a marginalized status leading to a variety of adaptational difficulties. Ben-Eliezer (2004) suggests that a new identity of ‘‘blackness’’ is being developed among young Ethiopian Jews as a result of the encounter with Israeli society and its mechanisms of exclusion, discrimination, and control. He adds that the Israeli experience of discrimination, exclusion, and cultural racism has metaphorically sent the young generation back to Africa, involving a reclaiming of their language (Amharic), names (many of which were changed on immigration), music (Shabtai, 2003), and culture.

Method Sample and Procedure The sample included 200 adolescents aged 15–18 years (96 boys, 104 girls) of whom 124 (62.9%) were born in Israel and the rest in Ethiopia.1 One hundred fifty-two were school students (community and boarding schools) while 47 (22.6%) were involved in external studies or programs related to the work ministry and had ‘‘dropped out’’ of formal schooling. Following permission being granted from the Israeli Education Ministry and the school head teachers, and ethical approval from the University Ethical Board, adolescents were sampled in high schools in four cities in Israel with high concentrations of Ethiopian students (Netanya, Kiryat Malachi, Rehovot, and Ashkelon). ‘‘Detached youth’’ were contacted through community centers and clubs. Letters of consent were sent home to parents in order to obtain permission. Adolescents were promised confidentiality and anonymity and no identifying details were taken for any of the participants. Questionnaires were filled in by schoolchildren at school, at the end of lessons. All Ethiopian students were invited to participate in the survey and close to 80% agreed to do so. Interestingly, more boys refused to participate than girls. The researcher (an Ethiopian female immigrant) explained to all the students what the research was and invited them to participate. Participation was voluntary and the students did not receive any compensation. Questionnaires were filled in in Hebrew although the researcher was there to explain in Amharic any lack of clarity.2

Measures The Current Study The current study aimed to explore the relationship between ethnic identity (Israeli and Ethiopian) and parental support with suicidal ideation and alcohol use. In keeping with previous literature and theories of ethnic identity, it was hypothesized that: (1) higher levels of parental support would be related to lower levels of suicidal ideation and alcohol use; (2) higher levels of both Ethiopian and Israeli identities would be related to lower levels of suicidal ideation and alcohol use. Due to the known relationship between depression and suicidal ideation among adolescents (Pace & Zappulla, 2010; Vitiello et al., 2009) and the interplay between depression, suicidal ideation, and alcohol use (Galaif, Sussman, Newcomb, & Locke, 2007), although not part of the study objectives, it was decided to include levels of depression into the study framework, in order to control for individual differences in psychological wellbeing. 1 2

(i) Suicidal ideation was measured through four items which examine the existence and frequency of suicidal thoughts, based on questionnaires of Wilburn and Smith (2005) and Roberts, Roberts, and Chen (1997). ‘‘I thought of committing suicide,’’ ‘‘I thought of how I would commit suicide,’’ ‘‘I thought of when I would commit suicide,’’ and ‘‘I thought that if I had the opportunity I would commit suicide.’’ All four items were measured on a 6-point scale (0 – I have never had that thought; 5 – I have that thought several times a week). Cronbach’s alpha for the scale was found to be .90. Fifty-one of the participants (25.5%) reported that they had suicidal thoughts at least once in the past year. In addition, students were asked whether they had ever attempted suicide (1 – never; 4 – in the past month). Sixteen participants (8.1%) reported having made an actual suicide attempt; however, due to the small numbers

Due to the fact that the large immigration waves from Ethiopia occurred in 1984 and 1991, it would be expected that the majority of the sample would be second-generation immigrants. Although some of the adolescents spoke Amharic and preferred explanations in Amharic, the questionnaires themselves were in Hebrew due to low levels of reading and writing in Amharic among adolescents in Israel.

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Table 1. Descriptive statistics: Mean (SD) of study variables according to gender, country of birth, and study framework Boys N = 96 Depression Parental support Israeli identity Ethiopian identity Suicidal ideation Drinking frequency

1.95 1.70 3.64 4.21 0.31 2.83

(.67) (.85) (1.04) (.56) (.82) (1.5)

Girls N = 104 1.93 1.69 4.14 4.37 0.29 2.05

(.55) (.86) (.78) (.46) (.62) (1.22)

T 0.19 0.02 3.81** 2.21* 0.19 4.07**

Born in Israel N = 124 1.99 1.74 4.02 4.28 0.26 2.37

(.63) (.87) (.84) (.53) (.78) (1.37)

Born in Ethiopia N = 73 1.83 1.57 3.72 4.28 0.32 2.76

(.54) (.79) (1.09) (53) (.62) (1.50)

T 1.54 1.22 2.05* 0.06 0.50 1.67

Schoolchildren N = 152 1.93 3.32 3.89 4.28 0.32 2.24

(.61) (.85) (.95) (.54) (.18) (1.32)

‘‘Dropout’’ N = 47 1.95 3.26 3.97 4.35 0.22 3.06

(.62) (.89) (.95) (.47) (.16) (1.54)

T 1.27 0.39 0.57 0.77 0.77 3.60**

Note. *p < .05. **p < .01.

(ii)

(iii)

(iv)

(v)

3 4

(which are, however, clearly significant on an individual level), it was decided to use suicidal ideation in the following analyses. Alcohol use was measured through ‘‘How often have you drunk alcohol in the past year?’’ The item was measured on a 5-point scale (1 – never; 5 – more than 10 times a month). Parental support was measured through three questions which were used in previous research among Ethiopian adolescents in Israel (Edelstein, 2005): ‘‘To what extent can you turn to your parents when you are dealing with something difficult?’’; ‘‘To what extent do your parents give you support when you are distressed or dealing with a problem?’’; ‘‘To what extent do you feel your parents can help you when you are having a hard time?’’. All questions were answered on a 5-point scale (1 – never; 5 – always). Cronbach’s alpha for the three items was .75. Ethnic identity (Ethiopian and Israeli) was measured by items from the acculturation scale (Shalom & Horenczyk, 2004) used previously with Ethiopian late adolescents in Israel. The scale included 11 items examining Ethiopian identity (e.g., ‘‘I feel connected to Amharic culture,’’ ‘‘I am pleased I come from Ethiopian heritage,’’ ‘‘I feel close to Ethiopians’’) and seven items measuring Israeli identity (e.g., ‘‘I am pleased to be Israeli,’’ ‘‘I feel I am part of Israeli culture,’’ ‘‘I feel close to Israelis’’). All items were measured on a 5-point scale (1 – very much disagree; 5 – very much agree). Cronbach’s alphas for the Ethiopian and Israeli identity scales were .76 and .82, respectively. Depression was measured through the Center for Epidemiologic Studies Depression Scale (Radloff, 1977). The scale includes 25 items such as ‘‘I feel hopeless about the future,’’ ‘‘I cry easily or feel like crying.’’ Items are measure on a 4-point scale (1 – never; 4 – every day). Cronbach’s alpha for the scale in this study was found to be .94.

Analysis Initial descriptive analysis of the study variables examined the levels of depression, parental support, Israeli identity, Ethiopian identity, suicidal ideation, and alcohol use according to gender, country of birth (Israel/Ethiopia), and school framework (schoolchildren/dropout). As can be seen from Table 1 no significant differences between either boys/girls or country of birth were found for suicidal ideation though boys were found to drink alcohol significantly more frequently than girls (t = 4.07, p < .001). Since no country of birth differences were found for either of the outcome variables, this factor was not included in the following analyses and gender was used only in the analysis of alcohol use. In addition, no significant difference was found between the schoolchildren and the ‘‘detached’’ adolescents in levels of almost all the study variables, although detached adolescents (M = 3.06, SD = 1.5) as compared with schoolchildren (M = 2.24, SD = 1.3) were shown to drink significantly more alcohol (t = 3.6, p < .001). As such, study framework (school/detached) was included in further analyses of alcohol use. Correlational analysis between the study variables was used for initial analysis of relationships between parental support, ethnic identity, and outcome variables of suicidal ideation and alcohol use (see Table 2), following which hierarchical regression was used to explore the relative contribution of the predictor variables.3 For suicidal ideation, in Step 1, depression and parental support were included. In Step 2, Ethiopian identity and Israeli identity were added (see Table 3). For alcohol use, in Step 1 gender and study framework were included; in Step 2, depression levels and parental support were added and in Step 3, Ethiopian and Israeli identities were added (see Table 4).4

Results (a) Gender and country of birth differences in study variables

While drinking frequency was positively correlated to suicidal ideation (.18), since the two variables were theoretically conceptualized as dependent variables it was decided not to include them as independent variables. A further step in the regression analysis included an interaction between Israeli and Ethiopian identity, in line with literature showing the independent nature of the two identities (Berry, 1997). However, since there was no significant R2 change with this step, it has been left out.

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Table 2. The relationship between alcohol frequency, suicidal ideation, depression, parental support, and ethnic identity Depression Ethiopian identity Israeli identity Parental support Drinking frequency Suicidal ideation

Ethiopian identity

.272** .151* .366** .214** .425**

.337** .171* .242** .269**

Israeli identity

.132 .204** .186**

Parental support

.138 .361**

Drinking frequency

.184**

Note. *p < .05. **p < .01.

Table 3. The relationship between suicidal ideation, parental support, depression, and ethnic identity Step 1 Depression Parental support R2 change F change Step 2 Depression Parental support Ethiopian identity Israeli identity R2 change F change

b

B

SE

0.431 0.217 0.23 29.27**

.086 .061

.338*** .237**

0.381 0.202 0.199 0.057 0.05 3.18*

.087 .061 .101 .054

.299*** .221** .166* .069

Note. *p < .05. **p < .01. ***p < .001.

Table 4. The relationship between alcohol frequency, parental support, depression, and ethnic identity Step 1 Sex School framework R2 change F change

b

B

SE

0.656 0.448 0.149 17.133***

.19 .113

.232** .266***

Step 2 Sex School framework Depression Parental support R2 change F change

0.661 0.418 0.363 0.13 0.04 4.7**

.187 .112 .162 .115

.234*** .248*** .157* .079

Step 2 Sex School framework Depression Parental support Ethiopian identity Israeli identity R2 change F change

0.52 0.451 0.252 0.097 0.403 0.131 0.033 4.06**

.192 .111 .164 .114 .192 .105

.184** .267*** .109 .059 .148* .088

Note. *p < .05. **p < .01. ***p < .001. European Psychologist 2012; Vol. 17(2):131–142

Interestingly, no gender differences were found for levels of depression, suicidal ideation, or parental support (see Table 1). However, girls reported higher levels of both Ethiopian identity and Israeli identity and lower levels of alcohol use. No country of birth differences were found for any of the study variables, other than Israeli identity in which Israeli-born Ethiopian adolescents showed higher levels of Israeli identity.

(b) Parental support and ethnic identity as related to suicidal ideation Suicidal ideation was found to be significantly correlated with all the study variables. As can be seen in Table 2, higher levels of suicidal ideation were related to lower levels of Ethiopian identity, Israeli identity, and parental support. Suicidal ideation was also associated with higher levels of depression. In addition, as can be seen in Table 2, suicidal ideation was significantly related to alcohol drinking. Regression analysis showed that in the final step while depression, parental support, and Ethiopian identity were significant predictors of levels of suicidal ideation, Israeli identity was not found to significantly explain suicidal ideation over and above the other variables (see Table 3). As can be seen in Table 3, the addition of ethnic identity gave an R2 change of .03 in Step 2 (adjusted R2 value for Step 1 with depression and parental support = .22).

(c) Parental support and ethnic identity as related to alcohol use Levels of alcohol use were found to be significantly correlated with depression, Ethiopian identity, and Israeli identity. As can be seen in Table 2, higher levels of alcohol use were related to lower levels of Ethiopian identity and Israeli identity and higher levels of depression. Regression analysis showed that in addition to gender and study framework, once all the other study variables were included in the regression analysis, only levels of Ethiopian identity were found to significantly explain levels of alcohol use (see Table 4). As can be seen in Table 4, the addition of ethnic identity gave an R2 change of .03 in Step 3 (adjusted R2 value for Step 1 with sex and school framework = .12 and for Step 2 with depression and parental support added = .16). Ó 2012 Hogrefe Publishing

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Discussion The current study explored the role of parental support and ethnic identity (Israeli and Ethiopian) in predicting suicidal ideation and alcohol use among 200 Ethiopian adolescents in Israel. It explored whether the recent alarming growth in suicidal ideation and alcohol use among Ethiopian youth in Israel may be understood as related to difficulties in forming a cohesive and positive ethnic identity and parental difficulties following immigration in providing support to their adolescent children. As hypothesized, correlational analysis showed a negative relationship between suicidal ideation and parental support, and both Israeli and Ethiopian identities. Alcohol use was negatively related to both Israeli and Ethiopian identities. Suicidal ideation and alcohol consumption were also positively correlated. However, regression analysis showed that Israeli identity did not play a significant role in predicting either suicidal ideation or alcohol use over and above Ethiopian identity (though correlational analysis showed a clear positive relationship between Israeli and Ethiopian identity). The results suggest that suicidal tendencies and alcohol use may be reflecting psychological distress as a consequence of difficulties in forming a consolidated and positive ethnic identity. While results do suggest the relevance of feeling connected to Israel, they highlight the pivotal and essential role of feeling a strong and positive connection to the heritage culture, both for those born in Israel and for those who emigrated with families from Ethiopia. The results support a developmental theory of ethnic identity of ethnic minorities (Phinney, 1992), which assumes that ethnic pride and affirmation help immigrant adolescents to overcome hardships of immigration. The results of the present study are also in line with those of previous studies which have demonstrated that ethnic pride and positive regard are related to measures of psychosocial adjustment in ethnic minorities (Greene, Way, & Pahl, 2006; Mossakowski, 2003). The importance of ethnic identity in suicidal ideation and alcohol use raises the possibility of groups of Ethiopian youth feeling alienated, disconnected from their heritage culture, and struggling to form a coherent and cohesive sense of identity. As adolescents, in the throes of a normative process of identity formation (Erickson, 1968), of which ethnic identity is a central part (Phinney, 2006), it may be that a combination of a large culture gap (Schwartz et al., 2006), experiences of discrimination and alienation, intergenerational conflict, and acculturation difficulties is leading to a diffused sense of identity and belonging. The work of Malka Shabtai (Shabtai, 1995, 2003) looking at the embracing of reggae music and a black African-American identity among Ethiopian youth in Israel enforces the idea that Ethiopian youth, failing to feel a strong, positive heritage identity, are turning to replacement identities in order to feel a sense of belonging. The study suggests that it may be this sense of identity confusion which may help to explain the dramatic figures of suicidal tendencies and risk behaviors among Ethiopian youth in Israel.

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In addition, the fact that no significant differences were found between first- and second-generation immigrants in any of the study variables suggests that we are looking at minority adolescents feeling socially marginalized as highlighted in a theory of segmented assimilation (Portes & Zhou, 1993) and not just a phenomenon related to immigration per se. The correlation between alcohol use and suicidal ideation could also point to them being two manifestations of an experience of social marginalization but further research is needed to entangle the relationship between these two outcome measures. In addition, while this study looked at alcohol use and suicidal ideation as outcome measures, there are various additional outcomes, such as delinquency and school failure, which should also be studied as potential outcomes of identity confusion and social marginality. Acculturation theory has emphasized the importance of ‘‘integration’’ as related to psychological and physical well-being (Berry, 1998). The results of this study are in line with this but highlight the crucial role of a positive heritage identity. It is possible that the country of origin becomes of particular relevance for immigrants’ adjustment in cases of discrimination and prejudice (Berry, Kim, Minde, & Mok, 1987; Winter-Ebmer, 1994). The Ethiopian community in Israel stands out for its dark skin color and has encountered many cases of both collective (Ben-Eliezer, 2004) and individual discrimination (Walsh & Tuval-Mashiach, 2012). Previous research suggests that a strong ethnic identity may serve as a buffer against experiences of discrimination and racism (Galliher, Jones, & Dahl, 2011; Rivas-Drake, Hughes, & Way, 2008). As hypothesized, parental support was related to and predicted suicidal ideation. These results are in line with general developmental psychological theories showing the importance of parental support as related to adolescent psychological well-being. Parental support has been consistently found to be inversely related to internalizing behaviors such as anxiety and depression (Laible, Carlo, & Raffaelli, 2000; Vazsonyi & Belliston, 2006) and to suicidal behavior in particular (Brausch & Gutierrez, 2010; Peltzer, 2008). As suggested above, the change in family dynamics following immigration and a lack of cultural knowledge and language can lead to immigrant parents being less able or less confident to fulfill roles of support, monitoring, or authority and to be less involved in the lives of their children (Suarez-Orozco & Suarez-Orozco, 2001). Previous research has shown lowered levels of parental support among Ethiopian youth in Israel (Walsh et al., 2010) which may explain the difficulties that Ethiopian parents may have in filling meaningful support roles for their children. Interestingly, in this study the relationship between parental support and alcohol use was not found to be significant. Elevated parental monitoring has been found to be negatively related to various forms of risk behavior, including substance abuse, smoking, and alcohol (Barnes, Reifman, Farrell, & Dintcheff, 2000; Dick et al., 2007) and it may be that an examination of parental monitoring (in addition to parental support) would have shown a relationship with alcohol use.

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The significant correlation between heritage identity and parental support found in the study suggests that there are adolescents who feel a sense of closeness to their parents and their parents’ heritage, providing them with a sense of identification and sense of belonging, important in the developmental process of identity formation. The important role of parental support in decreasing levels of suicidal ideation, found in this study, needs to be noted in light of parental difficulties and lowered levels of support among Ethiopian families in Israel. Another interesting (non-) finding was the lack of gender differences in suicidal ideation and depression. Although caution should be used in interpreting non-results, this lack of gender differences is in contrast to widespread research showing that women and adolescent girls report higher levels of depression and suicidal ideation (Essau, Lewinsohn, Seeley, & Sasagawa, 2010; Weissman & Klerman, 1977). Suicidal ideation and tendency have also been found to be higher among females in four ethnic minority groups in the US (Langhinrichsen-Rohling, Friend, & Powell, 2009). Further research is needed to explore the relationship between gender and suicidal ideation among Ethiopian adolescents, but we would like to hypothesize that the results may reflect particular identity difficulties that Ethiopian adolescent boys may be experiencing. The move from a patriarchal non-Western society to Israel has led to particular difficulties for Ethiopian men (Itzhaky & Levy, 2002), which may leave adolescent boys lacking positive role models for internalization. Alcohol use was significantly higher among adolescents who had dropped out of the formal system. The relationship between alcohol use and school failure has been documented in diverse populations (Galambos & Silbereisen, 1987; Lopez-Frias et al., 2001), though due to the study’s cross-sectional nature, the directionality of the relationship is not assessable. It is possible that alcohol use may be a result of young people lacking a formal framework, needing to ‘‘fill’’ their time but we would like to suggest that both alcohol use and school failure are reflections of underlying adaptational difficulties of these young people. Problem Behavior Theory (Jessor, 1998; Jessor & Jessor, 1977) holds a covariate perspective in which risk behaviors exist in an organized constellation and are interrelated and strongly correlated. Empirical evidence for a problem behavior perspective (Donovan, Jessor, & Costa, 1993) has suggested that covariance of risk behaviors is particularly evident with problem risk behaviors (e.g., alcohol, delinquency, and sexual precocity). Results of the current study suggest that there is a group of Ethiopian adolescents particularly vulnerable to a range of risk behaviors and negative adaptational outcomes. There are various social, clinical, and policy implications to the results. Study results emphasize the importance of the role of ethnic identity, in particular heritage identity, and parental support as acting as a buffer against suicidal ideation and alcohol use among Ethiopian adolescents in Israel. As such, intervention programs helping Ethiopian youth connect to their Ethiopian culture (music, culture, food, history) or those working with parents to enable them to play stronger, more influential roles with their children could European Psychologist 2012; Vol. 17(2):131–142

be helpful in lowering levels of distress among Ethiopian youth. In addition, an understanding of the importance of a connection to a heritage identity is essential for all those working with Ethiopian youth (clinicians, social workers, youth workers, teachers). On a policy level, Israel has often been considered as encouraging assimilation among its immigrants (Ben-Eliezer, 2004; Jasinskaja-Lahti, Liebkind, Horenczyk, & Schmitz, 2003) and results suggest potentially harmful results to such policies among minority youth.

Limitations of the Current Study The last 20 years of research on immigration have demonstrated that all immigration is unique (Kwak, 2003); therefore, further research among other immigrant groups is needed in order to generalize results. As noted above, Israel has been characterized by its assimilationist social policies. It may be that when there is pressure to assimilate, together with a large immigrant community, both parts of the immigrants’ identity (national and ethnic) become salient, and positive confirmation of both parts of one’s identity becomes crucial for the immigrants’ feelings of self-worth and social competence. Similar results were obtained by Verkuyten (2009, 2010) in his studies of Turkish-Dutch students in Holland but results should be explored in different host environments. In particular in this study, there was a fairly heterogeneous sample, involving both first- and second-generation immigrants and adolescents in school frameworks and those who had dropped out of the formal system. Although there were no significant differences between firstand second-generation immigrants and only differences in alcohol use between the school pupils and those who had dropped out, the heterogeneity of the sample could be seen as a limitation. In addition, the study was based on adolescent self-report at a single time point and further research over time and involving multiple evaluations (e.g., parents, teachers, etc.) would be valuable. As noted, there was a lower participation rate among adolescent boys. This may be due to the fact that the research was carried out by a woman but also due to particular feelings of alienation that adolescent boys may be feeling, which may deter them from wanting to be part of a research project connected to a national university. We also do not know if those adolescents who did not participate (close to 20%) are similar to those who did take part in terms of the study variables. The sample included adolescents from 15 to 18 years. Adolescence is a period of fast, dramatic changes and future research should examine the impact of developmental changes throughout adolescence on suicidal ideation. However, research on suicidal tendencies is a sensitive and difficult area to research and longitudinal research demands collecting personal information in order to track participants, which has its own complexities and ethnical issues. Suicidal ideation and alcohol use were outcome measures of the current study, though results showed a significant correlation between them (Eaton et al., 2011; Reyes et al., 2011). The results leave open the question of the relationship between the two measures: Does marginality Ó 2012 Hogrefe Publishing

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equally promote alcohol use and suicidal ideation? Are both outcomes parallel symptoms according to a problem behavior perspective (Jessor, 1998; Jessor & Jessor, 1977)? Why do some teenagers choose to drink alcohol and some attempt suicide? Is one behavior a predictor or a precursor of the other? Further research is needed to tease apart the relationship between suicidal ideation and alcohol use, as well as other risk behaviors. Another issue was the inclusion of depression as a study variable. It was important to control for the impact of individual psychopathology as a predictor of suicidal ideation before looking at social and familial factors. However, there are many causes of depression and as a variable depression may also include factors relevant to the immigration process and in itself be a measure of acculturation-related stress (Berry, 1997), conflict, and alienation. Further research into the elements involved in depression among minority youth could unravel personal, social, and cultural components. However, despite the limitations, the study is examining a severely under-researched area, suicidal ideation among immigrant and minority youth. Almost no research to date has explored the relationship between suicidal ideation and ethnic identity and this study plays a role in filling part of this gap.

References Arieli, A., Gilat, I., & Aycheh, S. (1996). Suicide among Ethiopian Jews: A survey conducted by means of a psychological autopsy. The Journal of Nervous and Mental Disease, 184, 317–319. Afifi, T. O., Cox, B. J., & Katz, L. Y. (2007). The associations between health risk behaviours and suicidal ideation and attempts in a nationally representative sample of young adolescents. Canadian Journal of Psychiatry, 52, 666– 674. Barnes, G. M., Reifman, A. S., Farrell, M. P., & Dintcheff, B. A. (2000). The effects of parenting on the development of adolescent alcohol misuse: A six-wave latent growth model. Journal of Marriage and Family, 62, 175–186. Ben-David, A., & Ben-Ari, A. T. (1997). The experience of being different: Black Jews in Israel. Journal of Black Studies, 27, 510–527. Ben-Eliezer, U. (2004). Becoming a black Jew: Cultural racism and anti-racism in contemporary Israel. Social Identities, 10, 245–266. Ben-Ezer, G. (2002). The Ethiopian Jewish Exodus: Narratives of the migration journey to Israel 1977–1985. London, UK: Routledge. Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology, 46, 5–34. Berry, J. W. (1998). Acculturation and health: Theory and research. In S. S. Kazarian & D. R. Evans (Eds.), Cultural clinical psychology: Theory, research, and practice (pp. 39–57). Oxford, UK: Oxford University Press. Berry, J. W., & Kim, U. (1988). Acculturation and mental health. In R. P. Dasen, J. W. Berry, & N. Sartorius (Eds.), Health and cross-cultural psychology: Toward applications (pp. 207–236). Thousand Oaks, CA: Sage. Berry, J. W., & Kim, U. (1988). Acculturation and mental health. Health and Cross-Cultural psychology, 10.

Ó 2012 Hogrefe Publishing

139

Berry, J. W., Kim, U., Minde, T., & Mok, D. (1987). Comparative studies of acculturative stress. International Migration Review, 21, 491–511. Berry, J. W., Phinney, J., Sam, D. L., & Vedder, P. (2006). Immigrant youth in cultural transition: Acculturation, identity, and adaptation across national contexts. Mahwah, NJ: Erlbaum. Blos, P. (1967). The second individuation process of adolescence. Psychoanalytic Study of the Child, 22, 162–186. Borowsky, I. W., Resnick, M. D., Ireland, M., & Blum, R. W. (1999). Suicide attempts among American Indian and Alaska Native youth: Risk and protective factors. Archives of Pediatrics and Adolescent Medicine, 153, 573. Brausch, A. M., & Gutierrez, P. M. (2010). Differences in nonsuicidal self-injury and suicide attempts in adolescents. Journal of Youth and Adolescence, 39, 233–242. Buriel, R., Perez, W., de Ment, T. L., Chavez, D. V., & Moran, V. R. (1998). The relationship of language brokering to academic performance, biculturalism, and self-efficacy among Latino adolescents. Hispanic Journal of Behavioral Sciences, 20, 283. Bursztein Lipsicas, C., & Makinen, H. (2010). Immigration and suicidality in the young. Canadian Journal of Psychiatry, 55, 274–281. Chavous, T. M., Bernat, D. H., Schmeelk-Cone, K., Caldwell, C. H., Kohn-Wood, L., & Zimmerman, M. A. (2003). Racial identity and academic attainment among African American adolescents. Child Development, 74, 1076–1090. Cho, Y. B., & Haslam, N. (2010). Suicidal ideation and distress among immigrant adolescents: The role of acculturation, life stress, and social support. Journal of Youth and Adolescence, 39, 370–379. Dick, D. M., Viken, R., Purcell, S., Kaprio, J., Pulkkinen, L., & Rose, R. J. (2007). Parental monitoring moderates the importance of genetic and environmental influences on adolescent smoking. Journal of Abnormal Psychology, 116, 213–218. Donovan, J. E., Jessor, R., & Costa, F. M. (1993). Structure of health-enhancing behavior in adolescence: A latent-variable approach. Journal of Health and Social Behavior, 34, 346– 362. Eaton, D. K., Foti, K., Brener, N. D., Crosby, A. E., Flores, G., & Kann, L. (2011). Associations between risk behaviors and suicidal ideation and suicide attempts: Do racial/ethnic variations in associations account for increased risk of suicidal behaviors among Hispanic/Latina 9th-to 12th-grade female students? Archives of Suicide Research, 15, 113–126. Edelstein, A. (2005). Suicidal behavior among Ethiopian youth – a case study [in Hebrew]. From Exclusion to Inclusion, 14, 1–19. Edelstein, A. (2010). Culture conflict and suicidal behaviors among Ethiopian youth in Israel. In C. N. Phellas (Ed.), Sociological Perspectives of Health and Illness (pp. 41–58). Newcastle, UK: Cambridge Scholars. Eitle, T. M. N., Wahl, A. M. G., & Aranda, E. (2009). Immigrant generation, selective acculturation, and alcohol use among Latina/o adolescents. Social Science Research, 38, 732–742. Erickson, E. H. (1968). Identity: Youth and crisis. New York, NY: Norton. Eshun, S. (2006). Acculturation and suicide attitudes: A study of perceptions about suicide among a sample of Ghanaian immigrants in the United States. Psychological Reports, 99, 295. Essau, C. A., Lewinsohn, P. M., Seeley, J. R., & Sasagawa, S. (2010). Gender differences in the developmental course of depression. Journal of Affective Disorders, 127, 185–190.

European Psychologist 2012; Vol. 17(2):131–142

140

S. D. Walsh et al.: Suicidal Ideation and Alcohol Use Among Adolescent Ethiopians in Israel

Fosados, R., McClain, A., Ritt-Olson, A., Sussman, S., Soto, D., Baezconde-Garbanati, L., & Unger, J. B. (2007). The influence of acculturation on drug and alcohol use in a sample of adolescents. Addictive Behaviors, 32, 2990–3004. Galaif, E. R., Sussman, S., Newcomb, M. D., & Locke, T. F. (2007). Suicidality, depression, and alcohol use among adolescents: A review of empirical findings. International Journal of Adolescent Medicine and Health, 19, 27–35. Galambos, N. L., & Silbereisen, R. K. (1987). Substance use in West German youth: A longitudinal study of adolescents’ use of alcohol and tobacco. Journal of Adolescent Research, 2, 161. Galliher, R. V., Jones, M. D., & Dahl, A. (2011). Concurrent and longitudinal effects of ethnic identity and experiences of discrimination on psychosocial adjustment of Navajo adolescents. Developmental Psychology, 47, 509–526. Giang, M. T., & Wittig, M. A. (2006). Implications of adolescents’ acculturation strategies for personal and collective selfesteem. Cultural Diversity and Ethnic Minority Psychology, 12, 725–739. Goldblatt, H., & Rosenblum, S. (2007). Navigating among worlds: The experience of Ethiopian adolescents in Israel. Journal of Adolescent Research, 22, 585. Greene, M. L., Way, N., & Pahl, K. (2006). Trajectories of perceived adult and peer discrimination among Black, Latino, and Asian American adolescents: Patterns and psychological correlates. Developmental Psychology, 42, 218–235. Groves, S. A., Stanley, B. H., & Sher, L. (2007). Ethnicity and the relationship between adolescent alcohol use and suicidal behavior. International Journal of Adolescent Mental Health, 19, 19–25. Hahm, H. C., Lahiff, M., & Guterman, N. B. (2004). Asian American adolescents’ acculturation, binge drinking, and alcohol and tobacco using peers. Journal of Community Psychology, 32, 295–308. Handy, S., Chithiramohan, R. N., Ballard, C. G., & Silveira, W. R. (1991). Ethnic differences in adolescent self-poisoning: A comparison of Asian and Caucasian groups. Journal of Adolescence, 14, 157–162. Hjern, A., & Allebeck, P. (2002). Suicide in first- and secondgeneration immigrants in Sweden: A comparative study. Social Psychiatry and Psychiatric Epidemiology, 37, 423– 429. Hovey, J. D. (1998). Acculturative stress, depression, and suicidal ideation among Mexican-American adolescents: Implications for the development of suicide prevention programs in schools. Psychological Reports, 83, 249–250. Hovey, J. D., & King, C. A. (1996). Acculturative stress, depression, and suicidal ideation among immigrant and second-generation Latino adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1183–1192. Isralowitz, R. E., & Reznik, A. (2007). Former Soviet Union immigrant and native-born adolescents in Israel: Substance use and related problem behavior. Journal of Ethnicity in Substance Abuse, 6, 8. Itzhaky, H., & Levy, D. (2002). Contributions of self-esteem and gender to the adaptation of immigrant youth from Ethiopia: Differences between two mass immigrations. Journal of Social Work Research and Evaluation, 3, 33–46. Janssen, M., Verhulst, F., Bengi-Arslan, L., Erol, N., Salter, C., & Crijnen, A. (2004). Comparison of self-reported emotional and behavioral problems in Turkish immigrant, Dutch and Turkish adolescents. Social Psychiatry and Psychiatric Epidemiology, 39, 133–140. Jasinskaja-Lahti, I., Liebkind, K., Horenczyk, G., & Schmitz, P. (2003). The interactive nature of acculturation: Perceived

European Psychologist 2012; Vol. 17(2):131–142

discrimination, acculturation attitudes and stress among young ethnic repatriates in Finland, Israel and Germany. International Journal of Intercultural Relations, 27, 79–97. Jessor, R. (1998). New perspectives on adolescent risk behavior. Cambridge, UK: Cambridge University Press. Jessor, R., & Jessor, S. L. (1977). Problem behavior and psychosocial development: A longitudinal study of youth. New York, NY: Academic Press. Kaplan, S., & Salamon, H. (1998). Ethiopian immigrants in Israel: Experience and prospects. London, UK: Institute for Jewish Policy Research. Kennedy, M. A., Parhar, K. K., Samra, J., & Gorzalka, B. (2005). Suicide ideation in different generations of immigrants. Canadian Journal of Psychiatry, 50, 353–356. King, R. A., Schwab-Stone, M., Flisher, A. J., Greenwald, S., Kramer, R. A., Goodman, S. H., . . . Gould, M. S. (2001). Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 837–846. Kwak, K. (2003). Adolescents and their parents: A review of intergenerational family relations for immigrant and nonimmigrant families. Human Development, 46, 115–136. Laible, D. J., Carlo, G., & Raffaelli, M. (2000). The differential relations of parent and peer attachment to adolescent adjustment. Journal of Youth and Adolescence, 29, 45–59. Langhinrichsen-Rohling, J., Friend, J., & Powell, A. (2009). Adolescent suicide, gender, and culture: A rate and risk factor analysis. Aggression and Violent Behavior, 14, 402–414. Lee, R. M. (2003). Do ethnic identity and other-group orientation protect against discrimination for Asian Americans? Journal of Counseling Psychology, 50, 133–141. Lee, R. M. (2005). Resilience against discrimination: Ethnic identity and other-group orientation as protective factors for Korean Americans. Journal of Counseling Psychology, 52, 36–44. Lifshitz, C., Noam, G., & Habib, J. (1998). The absorption of Ethiopian immigrant youth, a multi-dimensional perspective, The Ministry of Education and Culture, The Ministry of Absorption, and SDC Israel [in Hebrew]. Lopez-Frias, M., Fernandez, M. D. L. F., Planells, E., Miranda, M. T., Mataix, J., & Llopis, J. (2001). Alcohol consumption and academic performance in a population of Spanish high school students. Journal of Studies on Alcohol, 62, 741–744. Marsiglia, F. F., Kulis, S., Parsai, M., Villar, P., & Garcia, C. (2009). Cohesion and conflict: Family influences on adolescent alcohol use in immigrant Latino families. Journal of Ethnicity in Substance Abuse, 8, 400–412. Meeus, W., Oosterwegel, A., & Vollebergh, W. (2002). Parental and peer attachment and identity development in adolescence. Journal of Adolescence, 25, 93–106. Mossakowski, K. N. (2003). Coping with perceived discrimination: Does ethnic identity protect mental health? Journal of Health and Social Behavior, 44, 318–331. Murad, S., Joung, I., Verhulst, F., Mackenbach, J., & Crijnen, A. (2004). Determinants of self-reported emotional and behavioral problems in Turkish immigrant adolescents aged 1118. Social Psychiatry and Psychiatric Epidemiology, 39, 196–207. O’Donnell, L., O’Donnell, C., Wardlaw, D. M., & Stueve, A. (2004). Risk and resiliency factors influencing suicidality among urban African American and Latino youth. American Journal of Community Psychology, 33, 37–49. Oetting, E. R., & Beauvais, F. (1991). Orthogonal cultural identification theory: The cultural identification of minority adolescents. Substance Use & Misuse, 25, 655–685. Offer, S. (2007). The Ethiopian community in Israel: Segregation and the creation of a racial cleavage. Ethnic and Racial Studies, 30, 461–480.

Ó 2012 Hogrefe Publishing

S. D. Walsh et al.: Suicidal Ideation and Alcohol Use Among Adolescent Ethiopians in Israel

Pace, U., & Zappulla, C. (2010). Relations between suicidal ideation, depression, and emotional autonomy from parents in adolescence. Journal of Child and Family Studies, 19, 747–756. Peltzer, K. (2008). Social support and suicide risk among secondary school students in Cape Town, South Africa. Psychological Reports, 103, 653–660. Pharris, M. D., Resnick, M. D., & Blum, R. W. (1997). Protecting against hopelessness and suicidality in sexually abused American Indian adolescents. Journal of Adolescent Health, 21, 400–406. Phinney, J. S. (1989). Stages of ethnic identity development in minority group adolescents. Journal of Early Adolescence, 9, 34. Phinney, J. S. (1992). The multigroup ethnic identity measure: A new scale for use with diverse groups. Journal of Adolescent Research, 7, 156–176. Phinney, J. S. (2006). Ethnic Identity Exploration in Emerging Adulthood. In J. Arnett & J. L. Tanner (Eds.), Emerging adults in America: Coming of age in the 21st century (pp. 117–134). Washington, DC: American Psychological Association. Phinney, J. S., & Ong, A. D. (2007). Conceptualization and measurement of ethnic identity: Current status and future directions. Journal of Counseling Psychology, 54, 271–281. Ponizovsky, A. M., & Ritsner, M. S. (1999). Suicide ideation among recent immigrants to Israel from the former Soviet Union: An epidemiological survey of prevalence and risk factors. Suicide and Life-Threatening Behavior, 29, 376– 392. Portes, A. (1997). Immigration theory for a new century: Some problems and opportunities. International Migration Review, 31, 799–825. Portes, A., & Zhou, M. (1993). The new second generation: Segmented assimilation and its variants. The Annals of the American Academy of Political and Social Science, 530, 74–96. Radloff, L. S. (1977). The CES-D Scale: A Self-Report Depression Scale for research in the general population. Applied Psychological Measurement, 1, 385–401. Rew, L., Thomas, N., Horner, S. D., Resnick, M. D., & Beuhring, T. (2001). Correlates of recent suicide attempts in a triethnic group of adolescents. Journal of Nursing Scholarship, 33, 361–367. Reyes, J. C., Robles, R. R., Colo´n, H. M., Negro´n, J. L., Matos, T. D., & Caldero´n, J. M. (2011). Polydrug use and attempted suicide among hispanic adolescents in Puerto Rico. Archives of Suicide Research, 15, 151–159. Rivas-Drake, D., Hughes, D., & Way, N. (2008). A closer look at peer discrimination, ethnic identity, and psychological wellbeing among urban Chinese American sixth graders. Journal of Youth and Adolescence, 37, 12–21. Roberts, R. E., Roberts, C. R., & Chen, Y. R. (1997). Ethnocultural differences in prevalence of adolescent depression. American Journal of Community Psychology, 25, 95–110. Schwartz, S. J., Montgomery, M. J., & Briones, E. (2006). The role of identity in acculturation among immigrant people: Theoretical propositions, empirical questions, and applied recommendations. Human Development, 49, 1–30. Sellin, T. (1938). Culture conflict and crime. American Journal of Sociology, 44, 97–103. Shabtai, M (1995). The experience of Ethiopian Jewish soldiers in the Israeli army: The process of identity formation within the military context. Israel Social Science Research, 10, 69–80. Shabtai, M (2003). ‘RaGap’: Music and identity among young Ethiopians in Israel. Critical Arts, 17, 93–105. Shalom, U. B., & Horenczyk, G. (2004). Cultural identity and adaptation in an assimilative setting: Immigrant soldiers from the former Soviet Union in Israel. International Journal of Intercultural Relations, 28, 461–479. Ó 2012 Hogrefe Publishing

141

Shoval, G., Schoen, G., Vardi, N., & Zalsman, G. (2007). Suicide in Ethiopian immigrants in Israel: A case for study of the genetic-environmental relation in suicide. Archives of Suicide Research, 11, 247–253. Spencer, M. B., Noll, E., Stoltzfus, J., & Harpalani, V. (2001). Identity and school adjustment: Revisiting the ‘‘acting White’’ assumption. Educational Psychologist, 36, 21–30. Stevens, G., Pels, T., Bengi-Arslan, L., Verhulst, F. C., Vollebergh, W. A. M., & Crijnen, A. A. M. (2003). Parent, teacher and self-reported problem behavior in The Netherlands: Comparing Moroccan immigrant with Dutch and with Turkish immigrant children and adolescents. Social Psychiatry and Psychiatric Epidemiology, 38, 576–585. Stevens, G., Vollebergh, W. A. M., Pels, T. V. M., & Crijnen, A. A. M. (2007). Parenting and internalizing and externalizing problems in Moroccan immigrant youth in the Netherlands. Journal of Youth and Adolescence, 36, 11. Strunin, L., & Demissie, S. (2001). Cultural identification and alcohol use among ‘‘Black’’ adolescents. Substance Use & Misuse, 36, 2025–2041. Suarez-Orozco, C., & Suarez-Orozco, M. (2001). Children of immigrants. Cambridge, MA: Harvard University Press. Suicide in Israel: Suicides 1981–2007 and attempted suicides 1999–2009. (2010). [Israeli Parliamentary Paper] Jerusalem, Israel: Israeli Ministry of Health. Svensson, M., & Hagquist, C. (2010). Adolescent alcohol and illicit drug use among first- and second-generation immigrants in Sweden. Scandinavian Journal of Public Health, 38, 184–191. Umana-Taylor, A. J., & Shin, N. (2007). An examination of ethnic identity and self-esteem with diverse populations: Exploring variation by ethnicity and geography. Cultural Diversity and Ethnic Minority Psychology, 13, 178–186. Umana-Taylor, A. J., & Updegraff, K. A. (2007). Latino adolescents’ mental health: Exploring the interrelations among discrimination, ethnic identity, cultural orientation, selfesteem, and depressive symptoms. Journal of Adolescence, 30, 549–567. Valdes, G., Chavez, C., & Angelelli, C. (2003). Young interpreters and their parents. In G. Valdes (Ed.), Expanding definitions of giftedness. Mahwah, NJ: Erlbaum. van Tubergen, F., & Poortman, A. R. (2010). Adolescent alcohol use in the Netherlands: The role of ethnicity, ethnic intermarriage, and ethnic school composition. Ethnicity & Health, 15, 1–13. Vazsonyi, A. T., & Belliston, L. M. (2006). The cultural and developmental significance of parenting processes in adolescent anxiety and depression symptoms. Journal of Youth and Adolescence, 35, 15. Vedder, P., van de Vijver, F. J. R., & Liebkind, K. (2006). Predicting immigrant youths’ adaptation across countries and ethnocultural groups. In J. W. Berry, J. S. Phinney, D. Sam, & P. Vedder (Eds.), Immigrant youth in cultural transition: Acculturation, identity, and adaptation across national contexts (pp. 143–165). Mahwah, NJ: Ehrlbaum. Verkuyten, M. (2009). Self-esteem and multiculturalism: An examination among ethnic minority and majority groups in the Netherlands. Journal of Research in Personality, 43, 419–427. Verkuyten, M. (2010). Assimilation ideology and situational well-being among ethnic minority members. Journal of Experimental Social Psychology, 46, 269–275. Virta, E., Sam, D. L., & Westin, C. (2004). Adolescents with Turkish background in Norway and Sweden: A comparative study of their psychological adaptation. Scandinavian Journal of Psychology, 45, 15–25. Vitiello, B., Silva, S., Rohde, P., Kratochvil, C., Kennard, B., Reinecke, M., . . . March, J. S. (2009). Suicidal events in the Treatment for Adolescents with Depression Study (TADS). Journal of Clinical Psychiatry, 70, 741. European Psychologist 2012; Vol. 17(2):131–142

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S. D. Walsh et al.: Suicidal Ideation and Alcohol Use Among Adolescent Ethiopians in Israel

Wahl, A. M. G., & Eitle, T. M. N. (2010). Gender, Acculturation and alcohol use among Latina/o Adolescents: A multi-ethnic comparison. Journal of Immigrant and Minority Health, 12, 153–165. Walsh, S. D., Harel-Fisch, Y., & Fogel-Grinvald, H. (2010). Parents, teachers and peer relations as predictors of risk behaviors and mental well-being among immigrant and Israeli born adolescents. Social Science & Medicine, 70, 976–984. Walsh, S. D., Shulman, S., Bar-On, Z., & Tsur, A. (2006). The role of parentification and family climate in adaptation among immigrant adolescents in Israel. Journal of Research on Adolescence, 16, 321–349. Walsh, S. D., & Tuval-Mashiach, R. (2012). Ethiopian emerging adult immigrants in Israel: Coping with discrimination and racism. Youth and Society, 44, 49–75. Weil, S. (1995). ‘‘It is Futile to Trust in Man’’: Methodological difficulties in studying non-mainstream populations with reference to Ethiopian Jews in Israel. Human Organization, 54, 1–9. Weissman, M. M., & Klerman, G. L. (1977). Sex differences and the epidemiology of depression. Archives of General Psychiatry, 34, 98–111. Wilburn, V. R., & Smith, D. E. (2005). Stress, self-esteem, and suicidal ideation in late adolescents. Adolescence, 40, 33–45. Winter-Ebmer, R. (1994). Motivation for migration and economic success. Journal of Economic Psychology, 15, 269–284. Wong, C. A., Eccles, J. S., & Sameroff, A. (2003). The influence of ethnic discrimination and ethnic identification on African American adolescents’ school and socioemotional adjustment. Journal of Personality, 71, 1197–1232. Zamboanga, B. L., Schwartz, S. J., Jarvis, L. H., & Van Tyne, K. (2009). Acculturation and substance use among Hispanic early adolescents: Investigating the mediating roles of acculturative stress and self-esteem. Journal of Primary Prevention, 30, 315–333. Zayas, L. H. (1987). Toward an understanding of suicide risks in young Hispanic females. Journal of Adolescent Research, 2, 1–11.

European Psychologist 2012; Vol. 17(2):131–142

Received February 25, 2011 Accepted December 7, 2011

About the authors Dr. Sophie D. Walsh is a clinical psychologist and a lecturer in the Criminology Department at Bar Ilan University. Her research interests include the impact of immigration on internal processes and identity, with a particular emphasis on developmental processes in immigrant adolescents and young adults as they navigate parallel processes of immigration and developmental transition, and on the use of alcohol as well as drugs and suicidal behavior among immigrant adolescents. Professor Arnon Edelstein, Kaye College, Be´er Sheva, Israel, is a criminologist who has studied Ethiopian immigrants during the past 14 years. He has published many articles and research on antisocial behavior among Ethiopian youth. In addition, he is concerned about multiple victims’ murder and has published three books. The last book concerns intimate partner homicide against women in Israel, where he addresses the phenomenon among women of Ethiopian and Russian origin. Danbulu Vota, MA, Bar Ilan University, Israel, is a clinical criminologist who, in recent years, has worked in the police force and in informal educational frameworks with youth at risk, in particular in the Ethiopian community. Sophie D. Walsh Department of Criminology Bar Ilan University Ramat Gan 59200 Israel Tel. +972 522877609 E-mail [email protected]

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