Social support and psychological distress among ... - SAGE Journals

International Social Work 45(1): 83±97 Sage Publications: London, Thousand Oaks, CA and New Delhi 0020-8728[200201]45:1;83±97; 020321

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Social support and psychological distress among young immigrants from the former Soviet Union in Israel

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Julia Mirsky, Yehudit Baron-Draiman and Peri Kedem

Immigrant adolescents are walking a tightrope trying to keep their psychological balance between the jolts of adolescence, the pains of migration and the confusion of a cross-cultural transition. At times, a security net may be spread under their feet, the network of social support. The present work focuses on the structure and effects of such networks among immigrant university students from the former Soviet Union (FSU) in Israel. Psychological distress has been long recognized as a part of the experience of migration (Berry, 1992; Grinberg and Grinberg, 1989; Scott and Scott, 1989; Murphy, 1977). It is usually related to signi®cant losses that occur in migration, as well as to stresses, which are inherent to adjustment in an unfamiliar society. The modern approach to the study of migration views psychological distress as a normative temporary reaction to real life stress and focuses on the attempts to identify factors, which affect this reaction. The present research follows in this tradition. Time is the most intriguing and controversial of factors that operate in migration. The concepts of àdjustment', àcculturation' and `naturalization' all imply a process, which takes place over time, a gradual ìmprovement'. It has indeed been found that some aspects Julia Mirsky is a senior clinical psychologist with the Social Work Department of the Ben-Gurion University of the Negev, POB 653, Beer-Sheva, 84115 Israel. [email: [email protected]]. Yehudit Baron-Draiman and Peri Kedem are at Bar-Ilan University, Ramat-Gan, Israel.

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of adjustment in migration, such as language acquisition, social skills and subjective satisfaction, do improve over time (Scott and Scott, 1989). Findings for psychological distress are, however, mixed. Some studies illustrate that with time the psychological distress of immigrants diminishes (Lin et al., 1982; Kuo and Tsay, 1986; Beiser, 1988), others fail to demonstrate such improvement (Flaherty et al., 1988; Kohn et al., 1989; Orley, 1994). The effect of time on the psychological adjustment in migration is also studied in the present work. Social support received by immigrants in the new country is the focus of the present research. This is one of the most widely investigated factors in migration and it is generally agreed that social support mitigates psychological distress (Berry, 1992; Brody, 1994; Feinstein and Ward, 1990; Westermeyer, 1989; Scott and Scott, 1989). At times, however, the cultural gap between the immigrants and the receiving society prevents the giving and receiving of social support. In such cases, the ethnic community of immigrants from the same homeland may become the main source of social support in the new country (Furnham and Bochner, 1986; Hepperlin, 1991; Brody, 1990). The role of the family, a potential source of support, is complicated in migration (Scott and Scott, 1989). Family members differ in their reactions to immigration: in the extent of their attachment to the homeland, in their rhythm of adjustment to the new country, etc. This may create tensions and con¯icts in the family. In addition, changes that occur in immigrant families may limit the ability of the family to extend support to the children (Berry, 1992; Ekblad, 1993). Parents, having been uprooted from their habitual cultural environment, may lose con®dence in their parental role and skills (Erikson, 1964). Moreover, the young are typically faster to gain orientation in the new environment ± learning the new language and new skills ± and parents may grow to rely, even depend on them. And ®nally, the encounter with a new culture may undermine existing family patterns and create con¯icts and intergenerational gaps which in their turn may hamper the supportive role of the family (Hepperlin, 1991; Rosenthal, 1984; Arredondo, 1984). The immigrant family, therefore, may be a source of support for its individual members, but it also may become a cause of extra stress and distress (Scott and Scott, 1989). Additional complications arise in the case of immigrant adolescents. Side by side with their independence struggles, adolescents still need their parents. Therefore, adolescent±family relations are

Mirsky et al.: Social support for young immigrants

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typically con¯ictual and tense. To resolve their ambivalence, adolescents commonly withdraw from the family into a group of peers. The peer group alleviates the painful process of emancipation from childhood dependencies. It provides the adolescent with the feeling of belonging and acceptance and often becomes a `surrogate family' (Blos, 1967; Erikson, 1968). The loss of the peer group in migration deprives adolescents of major sources of support and stability which they need in order to complete the process of psychologically separating from their parents (Arredondo, 1984). The support of family and peers is studied in the present research in a group of immigrant adolescents from the FSU in Israel. Speci®c cultural patterns, which may affect the relationships of adolescents with their families and peers, and thereby their psychological distress and their social support network, will be addressed in the discussion. Method Respondents The research was conducted in two stages: the original study and a follow-up study performed after two years. The respondents in the original study (Mirsky, 1995) were 892 university students (518 males and 374 females) who immigrated to Israel from the FSU during their late adolescence (ages 15±18) or early adulthood (ages 20±24). At the time of the study their average length of residence in Israel was 2 years and 10 months (ranging from 6 months to 4 years) and their average age was 20 years and 4 months. The respondents were sampled from the national register of immigrant students and approached in classes as well as through advertisements. Of the original respondents, 68 (30 males and 38 females) participated in the follow-up study (Baron-Draiman, 1998). The average length of residence of the follow-up respondents in the country was 4 years and 3 months, and their average age was 22 years and 2 months. The respondents were located through the mail and community networks. Instruments The research instruments included a personal background questionnaire, a Brief Symptom Inventory (BSI) (Derogatis and Spencer, 1982), a Social Support Network Inventory (Flaherty et al., 1983) and two additional instruments not addressed here (Mirsky, 1995). All instruments were self-report measures and were administered

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in Russian in a group setting in the original study and through the mail in the follow-up. The BSI is a screening instrument which measures common psychological symptoms (Derogatis and Melisavados, 1983; Derogatis and Spencer, 1982). Respondents are required to indicate to what extent (`not at all' to èxtremely') each of the 53 symptoms listed in the BSI have troubled them during the last month. The answers are summarized in three general indices, which express the number and severity of the symptoms, and in nine symptomatic categories, which are similar to the common clinical categories (anxiety, depression, etc.). The BSI was translated into Russian by back translation for the purposes of the present research. The Russian version has shown high internal validity (Cronbach Alpha: .53±.83). The Social Support Network Inventory (Flaherty et al., 1983) provides a description of the social support network and measures the subjective feeling of support, the feeling that in one's social environment there are people to whom one can turn in need. Respondents are required to indicate four people who are close to them. Then they are asked to mark to what extent each of these people gives them support in various areas of life. The total score indicates the level of reported support. The Russian version of this instrument was constructed and tested by the original authors. In the present research a question was added about the ethnic origin of the indicated `close people', whether they were new or veteran immigrants from the FSU or from other countries, or Israel-born. Results Two general indices of the BSI were used for the comparison between the original and the follow-up studies: a Global Severity Index (GSI), which indicates the average severity of symptoms and has shown the highest predictive validity (Derogatis and Melisavados, 1983); and a Positive Symptom Total (PST), which indicates the number of reported symptoms. Mean BSI scores in the follow-up sample did not signi®cantly differ from mean BSI scores in the original study (Table 1). Both scores at both times were higher than those normative for Israel-born adolescents and also higher than the American adolescent norms for the BSI (Mirsky, 1997). Although the follow-up sample is of a limited size, in the original study the BSI scores of this sub-sample did not differ from those of the whole sample. Therefore, with all due caution, generalization can be made from ®ndings based on the

Table 1 Mean BSI scores in the original and the follow-up studies Men N 30 Original study Whole sample

Follow-up sample

GSI

0.79 (0.48)

0.75 (0.43)

PST

25.29 (10.99)

24.10 (10.04)

Follow-up study

Original study

Follow-up study

p1

p2

Whole sample

Follow-up sample

p3

p4

p5

p6

0.67 (0.42)

NS

NS

1.04 (0.54)

1.14 (0.60)

1.02 (0.57)

NS

NS

**

**

23.53 (10.38)

NS

NS

29.74 (9.69)

31.55 (9.60)

29.18 (11.50)

NS

NS

**

*

* p 0:05 ** p 0:01 NS GSI PST p1 p2 p3

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p4 p5 p6

Non-signi®cant Global Severity Index, mean symptomatic distress (the mean score of all BSI items) Positive Symptom Total, the number of reported symptoms The signi®cance of difference between mean scores of men in the whole sample and men in the follow-up sample at the time of the original study The signi®cance of difference between mean scores of men in the original study and men in the follow-up study The signi®cance of difference between mean scores of women in the whole sample and women in the follow-up sample at the time of the original study The signi®cance of difference between mean scores of women in the original study and women in the follow-up study The signi®cance of difference between mean scores of men and mean scores of women in the original study The signi®cance of difference between mean scores of men and mean scores of women in the follow-up study


BSI score

Women N 38

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follow-up. The social support network, which emerges in the study, consists mainly of immigrants from the FSU, 86 percent of all the close people indicated by male respondents and 84 percent by female respondents. This ®nding is related to the fact that about half of the sources of support were inside the family. Friends comprised the other half of the support network while formal systems were perceived as supportive only to a marginal extent (Figures 1 and 2). A closer look at the ®rst choice of the respondents (the person they have indicated as the ®rst source of support) (Figures 3 and 4) reveals an even higher weight for the family in the support network. Family members were mentioned in the ®rst place by a majority of the respondents (70 percent of males and 71 percent of females) and the mother by about half of the women (53 percent) and by a large proportion of men (38 percent). In order to examine the association between psychological distress and social support, Pearson correlation coef®cients were calculated between the GSI of the BSI and the social support score. A signi®cant inverse correlation between these two variables was found: a high level of social support was associated with a low level of psychological distress. This association appears to be stronger for men than for women. In the case of women, a signi®cant correlation between social support and distress was found only in the original study (r 0:13; p < 0:05). In the case of men, social support was highly correlated with psychological distress in both studies (the original study, r 0:16; p < 0:001; and the follow-up, r 0:29; p < 0:05). Moreover, social support measured at the time of the original study was highly and signi®cantly correlated with the psychological distress of men measured two years later (r 0:44; p < 0:001). Discussion Evidently, time as such does not cure the anguish of migration. Two years did not seem to bring about a change in the relatively high level of psychological distress among immigrant adolescents from the FSU in Israel. Social support, however, does appear to ameliorate their immediate as well as long-term psychological distress, especially that of men. The persistence of psychological distress into the fourth year since migration is inconsistent with the contentions about the decrease of psychological distress with time (Lin et al., 1982; Beiser, 1988). It is, however, congruous with evidence which is being accumulated in


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Figure 1 Distribution of the sources of support reported by men (% of all the sources reported)

Figure 2 Distribution of the sources of support reported by women (% of all the sources reported)

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Figure 3 Distribution of the sources of support reported in the ®rst place by men (% of all sources reported in the ®rst place)

Figure 4 Distribution of the sources of support reported in the ®rst place by women (% of all sources reported in the ®rst place)


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respect to immigrants from the Soviet Union and the FSU. The ®rst unanticipated report demonstrated that in elderly immigrants from the Soviet Union in the USA, psychological distress could persist for even 10 years (Flaherty et al., 1988; Kohn et al., 1989). In a later study, the persistence of psychological distress for ®ve years after immigration was demonstrated in a representative sample of immigrants from the former Soviet Union in Israel (Zilber et al., 1996). A similar tendency was observed in a comparison between cohorts of immigrant students with different lengths of stay in the country (Mirsky, 1995). An intriguing ®nding was obtained in a recent study, which compared immigrant high-school students from the FSU in Israel with their Israel-born peers whose parents had immigrated from the Soviet Union during the 1960s and 1970s. Both these groups reported a higher psychological distress than that reported by their Israel-born peers of non-Soviet (Russian) origin (Slonim-Nevo et al., 1999). Immigration-related psychological pain may become a creative driving force that may last for a lifetime, as was the case with Chopin, Nabokov, Bashevis Singer and Chagall, to name only a few. These talented immigrants and refugees succeeded in capturing and expressing in their creations some vital aspects of the experience of migration, as artists do with many human experiences. Such works of art then touch their listeners, readers or spectators, produce identi®cation and help the process of working through. Eva Hoffman emigrated to Canada from Poland when she was an adolescent. Over 30 years later she describes her distress as an immigrant and the experience stands out fresh and vivid: `Dear Basia', I write, Ì am standing at the window looking out on a garden in which there is a cherry tree, an apple tree and bushes of roses now in bloom. The roses are smaller and wilder here, but imagine! All this in the middle of a city. And tomorrow I am going to a party. There are parties here all the time, and my social life is, you might say, blooming.' I am repeating a ritual performed by countless immigrants who have sent letters back home meant to impress and convince their friends and relatives ± and probably even themselves ± that their lives have changed for the better. I am lying. But I am also trying to fend off my nostalgia. I couldn't repudiate the past even if I wanted to, but what can I do with it here, where it doesn't exist? After a while, I begin to push the images of memory down, away from consciousness, below emotion. Relegated to an internal darkness, they increase the area of darkness within me and they return in the dark, in my dreams . . . I can't afford to look back, and I can't ®gure out how to look forward. In both direction, I may see a Medusa, and I already feel the danger of being turned into stone. Betwixt and between, I am stuck in time and time is stuck in me. Time used to open out, serene, shimmering with promise. If I wanted to hold a moment still, it

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was because I wanted to expand it, to get its ®ll. Now time has no dimension, no extension backwards or forwards. I arrest the past and hold myself stif¯y against the future. I want to stop the ¯ow. As a punishment, I exist in the stasis of a perpetual present, that other side of `living the present', which is not eternity, but a prison. I can't throw the bridge between the present and the past, and therefore, I can't make time move. (Hoffman, 1991: 116±17)

Evidently, psychological distress is an inseparable part of the experience of all immigrants. However, a culturally-speci®c trait appears to be emerging from the results of the study: a relatively high and tenacious psychological distress seems to characterize immigrants with a Russian-Soviet cultural background. Is the experience of migration especially stressful to ex-Soviet immigrants, so stressful that their distress lasts for years and may be even transmitted to the second generation? If it is, what may be the reason for such vulnerability? At this stage, only tentative directions for explanation may be pointed out: the relatively low tolerance for threatening psychological experiences which seems to characterize this cultural group (Mirsky, 1997); their relatively limited ability for introspection (Goldstein, 1984); parent±child relationship patterns that do not encourage autonomy and individuation (Roer-Strier and Rivlis, 1998). These culturally-speci®c patterns may negatively affect the ability of immigrants to maintain a psychological balance while coping with the stresses of adjustment. Further research is needed, especially designed comparatively, in order to fully describe the phenomenon at hand and to test these and other speculative explanations. As to the social support network which was unveiled in this research, most of it consists of immigrants from the FSU. This apparent withdrawal into the community of immigrants from one homeland in search of support has a threefold derivation: immigration, adolescence and the Russian culture. Firstly, such a withdrawal is a natural stage of the psychological process of migration (Mirsky and Kaushinsky, 1989; Brody, 1990). Only in the company of those who share a common culture, a common past and a common language, can immigrants reconstruct their pre-immigration selves and rehabilitate their self-esteem. Secondly, close relationships with peers who share similar experiences are especially important in adolescence (Blos, 1967). And thirdly, the Russian and Soviet culture places a very high value in friendship. In a friend, people of Russian descent look for total partnership and commitment, for a soul-mate (Markowitz, 1993). It is evident, therefore, that at least in the initial stages of adjustment, support-providing relationships


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with representatives of the general Israeli society are improbable. The cultural gap between immigrant youths from the FSU and their peers who grew up in Israel and do not share their experience of migration inevitably creates estrangement and prevents such relationships. However, it is not their peers but rather their families that immigrant youths from the FSU turn to for support. This is an unforeseen ®nding in the light of the numerous reports of the intensi®cation of intergenerational con¯icts in immigrant families (Arredondo, 1984; Hepperlin, 1991) and speci®cally in families of Soviet and FSU immigrants (Mastayeva, 1994; Zicht, 1993). It is startling also in the light of the normative expectation for greater emotional independence of adolescents from their parents (Blos, 1967). This, however, turns out to be a culturally-biased expectation. In Soviet culture, due to ideological and economic reasons, a greater and more prolonged dependency of adolescent and adult children on their parents was normative. The dependency of youths from the FSU is expressed in an intense emotional need for their parents as well as in a strong negative emotional attachment to them (Mirsky, 1995). This ambivalence was more intense than normatively expected from their peers in western society. Such a sort of ambivalence may absorb vast emotional energies and leave the adolescents depleted of strength for personal development and for creating signi®cant attachments outside the family. This is a possible explanation of the social support network which was depicted in this study. Another is that withdrawal into the family re¯ects regression. In the face of migration stresses, the major changes in their lives, the loss of a peer-group and the encounter with an unfamiliar, therefore threatening environment, these youths may regress into the protected space of the familial and parental support. Eva Hoffman again provides a germane illustration of the complex relationships between immigrant adolescents and their parents. Ìn Poland, I would have known how to bring you up, I would have known what to do,' my mother says wistfully, but here she has lost her sureness, her authority. She doesn't know how hard to scold Alinka, when she comes home at late hours; she can only worry over her daughter's vague evening activities. She has always been gentle with us, and she doesn't want, doesn't know how, to tighten the reins. But familial bonds seem so dangerously loose here! Truth to tell, I don't want the fabric of loyalty and affection, and even of obligation, to unravel either. I don't want my parents to lose us, I don't want to betray our common life. I want to defend our dignity because it is so fragile, so beleaguered. There is only a tiny cluster, the four of us to know, to preserve whatever fund of human experience we may represent . . .

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I adjure my sister to treat my parents well: I don't want her to challenge my mother's authority, because it is so easily challenged. It is they who seem more defenseless to me than Alinka, and I want her to protect them. (Hoffman, 1991: 145±6)

The support that immigrant adolescents experience mainly from their parents and to a lesser degree from their fellow immigrant friends appears to ease their psychological distress. The effect of social support in the present study was more consistent and stronger for men than for women. The level of psychological distress men experienced in the second and fourth year of migration was inversely and closely associated with the level of social support they were receiving at the time. Moreover, their level of distress in the fourth year of migration is in strong inverse relation with the support they have experienced during their second year in the country. In other words, social support was identi®ed as a possible long-term distress-mitigating factor in migration, especially for men. Universal gender differences may account for the different patterns found in this study among men and women. Men tend more than women do to express their psychological distress through externalization, behaviors directed at the external environment (Achenbach, 1991). Therefore, they may also be more affected than are women by environmental reactions towards them. Further research is obviously needed in order to clearly identify and explain gender-speci®c patterns in the psychological reactions to migration. Conclusion In conclusion, here are some implications for practice with immigrants. Findings about the persistence of psychological distress for a number of years may help counteract the tendency to regard only immigrants in their initial stages of adjustment as the target population for interventions. It is important to view migration as a potentially stressful long-term life event, one that may even affect the second generation of immigrants. Therefore, assets should be allocated and interventions planned for ongoing primary prevention and treatment of psychological distress in immigrant communities. Immigrants from the FSU may be in need of such interventions for longer than expected. The fact that immigrants establish effective support-providing relationships within their ethnic community should not be inter-


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preted as an indication of separatism, but rather as an adaptive use of natural assets. Therefore, this tendency should be respected and encouraged and the immigrant community should be empowered. The need to empower immigrant parents is another important implication of the present ®ndings. It appears that parental support is a distress-mitigating factor even when it is being given and received in a context of parent±child relationships which are unusual in western society but are accepted in the homeland culture. A culturally-sensitive approach, as called for here, would remind the practitioners to respect child-rearing practices and values from various cultures. It should be granted, until proved differently, that immigrant parents have adequately performed their parental role in their homeland and that as a result of migration they are going through a crisis. It should be also assumed that it is in their children's interests that they reassume this role and that they may be able to do so if they are offered some orientation about the new society and taught some new parental skills and tools. Such assumptions would lead to interventions and attitudes which would help to restore immigrant parents to their parental roles rather than write them off as obsolete and as a `desert generation'. Acknowledgements The original research was supported by the following funds at the Hebrew University: Martin and Vivian Levine Center for the Normal and Pathological Development of Children and Adolescents; Levy Eshkol Institute for the Study of the Economy, Society and Policy in Israel; the Shein Center for Research in Social Sciences; and also by the Falk Institute for Mental Health and Behavioral Studies, the American Joint Distribution Committee-Israel and the Ministry of Immigrant Absorption. The follow-up study was supported by the Ministry of Health, Grant No. 3696. References Achenbach, T. (1991) Manual for the Child Behavior Checklist/4±18 and 1991 Pro®le. Burlington, VT: University of Vermont, Department of Psychiatry. Arredondo, P. (1984) Ìdentity Themes for Immigrant Young Women', Adolescence 19(76): 978±93. Baron-Draiman, Y. (1998) À Follow-up on the Adjustment of Immigrant Students from the Former Soviet Union ± Individual Aspects'. Unpublished masters thesis, Bar-Ilan University, Ramat-Gan, Israel (in Hebrew).

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Beiser, M. (1988) In¯uence of Time, Ethnicity and Attachment on Depression in Southeast Asian Refugees', American Journal of Psychiatry 145(1): 45±51. Berry, J. (1992) Àcculturation and Adaptation in a New Society', International Migration Quarterly Review 30: 69±85. Blos, P. (1967) `The Second Individuation Process in Adolescence', Psychoanalytic Study of the Child 22: 162±78. Brody, E. (1990) `Mental Health and World Citizenship: Sociocultural Bases for Advocacy', in W. Holtzman and T. Bornemann (eds) Mental Health of Immigrants and Refugees, pp. 299±328. Austin, TX: Hogg Foundation for Mental Health and University of Texas. Brody, E. (1994) `The Mental Health and Wellbeing of Refugees: Issues and Directions', in F. Marsella, T. Bornemann, S. Ekblad and J. Orley (eds) Amidst Peril and Pain: The Mental Health and Wellbeing of the World's Refugees, pp. 57±68. Washington, DC: American Psychological Association. Derogatis, L. and N. Melisavados (1983) `The Brief Symptom Inventory, an Introductory Report', Psychological Medicine 13: 595±605. Derogatis, L. and P. Spencer (1982) The Brief Symptom Inventory. Administration, Scoring and Procedures, Manual I. Chevy Chase, MD: Johns Hopkins University School of Medicine. Ekblad, S. (1993) `Psychosocial Adaptation of Children While Housed in Swedish Refugee Camps: Aftermath of a Collapse of Yugoslavia', Stress Medicine 9: 159±66. Erikson, E. (1964) Insight and Responsibility. New York: Norton. Erikson, E. (1968) Identity: Youth and Crisis. New York: Norton. Feinstein, B. and C. Ward (1990) `Loneliness and Psychological Adjustment of Sojourners: New Perspectives on Culture Shock', in D. Keats, D. Munro and L. Mann (eds) Heterogeneity in Cross-cultural Psychology, pp. 98±132. Lisse, Netherlands: Swets and Zeitlinger. Flaherty, J., M. Gaviria and D. Pthak (1983) `The Measurement of Social Support: The Social Support Network Inventory', Comprehensive Psychiatry 24: 521±9. Flaherty, J., R. Kohn, I. Levav and S. Birz (1988) `Demoralization in Soviet-Jewish Immigrants to the United States and Israel', Comprehensive Psychiatry 29(6): 588±97. Furnham, A. and S. Bochner (1986) Culture Shock: Psychological Reactions to Unfamiliar Environments. London: Methuen. Goldstein, E. (1984) ` ``Homo Sovieticus'' in Transition: Psychoanalysis and Problems of Social Adjustment', Journal of the American Academy of Psychoanalysis 12(1): 115±26. Grinberg, L. and R. Grinberg (1989) Psychoanalytic Perspectives of Migration and Exile. New Haven, CT: Yale University Press. Hepperlin, C. (1991) Ìmmigrant Adolescents in Crisis: A Model for Care', in B. Ferguson and E. Browne (eds) Health Care of Immigrants, pp. 122±45. Sydney, Australia: McLeannon and Petty. Hoffman, E. (1991) Lost in Translation. London: Minerva. Kohn, R., J. Flaherty and I. Levav (1989) `Somatic Symptoms Among Older Soviet Immigrants: An Exploratory Study', International Journal of Social Psychiatry 35: 350±60. Kuo, W. and Y. Tsay (1986) `Social Networking, Hardiness and Immigrants' Mental Health', Journal of Health and Social Behavior 27(2): 133±49.


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Lin, K., M. Masuda and L. Tazuma (1982) Àdaptational Problems of Vietnamese Refugees: III Case Studies in Clinic and Field ± Adaptive and Maladaptive', Psychiatric Journal of the University of Ottawa 7: 173±83. Markowitz, F. (1993) Community in Spite of Itself. Washington, DC: Smithsonian Institution Press. Mastayeva, Y. (1994) `Soviet Jewish Adolescents ± Impact of Immigration on Development Issues: A Cultural Perspective', in Immigration and Resettlement Issues Facing Jewish EmigreÂs from the Former Soviet Union, pp. 111±22. New York: Refugee Mental Health Training Institute of the Jewish Board of Family and Child Services. Mirsky, J. (1995) `Psychological Adjustment of Immigrant Students from the Former Soviet Union in Israel: Psychodynamic Perspective'. Unpublished doctoral dissertation, The Hebrew University in Jerusalem, Israel (in Hebrew). Mirsky, J. (1997) `Psychological Distress among Immigrant Adolescents: Culturespeci®c Factors in the Case of Immigrant Adolescents from the Former Soviet Union', International Journal of Psychology 34(4): 221±30. Mirsky, J. and F. Kaushinsky (1989) `Migration and Growth: Separation Individuation Processes in Immigrant Students in Israel', Adolescence 24(95): 725±40. Murphy, H. (1977) `Migration, Culture and Mental Health', Psychological Medicine 7: 677±84. Orley, J. (1994) `Psychological Disorders Among Refugees: Some Clinical and Epidemiological Considerations', in F. Marsella, T. Bornemann, S. Ekblad and J. Orley (eds) Amidst Peril and Pain: The Mental Health and Wellbeing of the World's Refugees, pp. 193±206. Washington, DC: American Psychological Association. Roer-Strier, D. and M. Rivlis (1998) `Timetable of Psychological and Behavioral Autonomy Expectations among Parents from Israel and the Former Soviet Union', International Journal of Psychology 33: 123±7. Rosenthal, D. (1984) Ìntergenerational Con¯icts and Culture: A Study of Immigrant and Non-immigrant Adolescents and Their Parents', Genetic Psychology Monographs 109(1): 53±75. Scott, W. and R. Scott (1989) Adaptation of Immigrants: Individual Differences and Determinants. Sydney, Australia: Pergamon Press. Slonim-Nevo, V., Y. Sheraga and A. Abdalgani (1999) `Social and Psychological Adjustment of Immigrant and Israeli-born Adolescents of Russian Origin', Society and Welfare 19(1): 81±97 (in Hebrew). Westermeyer, J. (1989) Psychiatric Care of Immigrants: A Clinical Guide. Washington, DC: American Psychiatric Press. Zicht, G. (1993) `The Effects of Emigration on Soviet Children: Latency to Adolescence', Journal of Jewish Communal Service 71(2): 57±63. Zilber, N., Y. Lerner and J. Kertes (1996) Comparative Study of Immigrants from the Former Soviet Union, One and Five Years after Their Immigration to Israel. Psychological Status; Risk Factors for Psychological Distress. Jerusalem, Israel: Falk Institute for Mental Health and Behavioral Studies.