Mental illness severity and characteristics among holocaust survivor immigrants, Non-Holocaust immigrants, and native israelis: A historical prospective study

Introduction: Holocaust survivors were exposed to extreme trauma. More than half a million survivors immigrated to Israel over the years, as well as immigrants who didn’t suffer the atrocities of the holocaust. Trauma and immigration are both risk factors for mental disorders. Aim: To describe differences in hospitalization characteristics and to determine whether there are differences in illness severity between mentally ill Holocaust Survivor Immigrants (HSI), non-Holocaust immigrants (NHI), and Native Israelis (NI). Methods: An unidentified list of hospitalized psychiatric patients was extracted from the Israel psychiatric case registry according to the following criteria: Jewish patients who were born in Europe or Israel before 1944 and were admitted to a psychiatric ward between 1945 and 2010. 30,539 records were divided into three groups: Holocaust Survivor Immigrants, Native Israelis, and Non-Holocaust Immigrants. Results: The number of first hospitalizations after age 70 is significantly higher at the HSI and NHI compared to NI. A significantly higher rate of suicide attempts was observed among HSI (13.8%), compared with the NI (11.8%) and NHI (9.7%). The odds for severe mental illness were significantly higher among HSI and NHI compared to NI by 84% and 66% among patients with psychotic disorders, twofold higher, and higher by 37% among patients with affective disorders, and threefold and 2.5 times higher among patients with anxiety. Conclusions: Exposure to the Holocaust trauma has an effect on patterns of psychiatric hospitalizations and the severity of Holocaust survivors’ psychiatric illness. Immigration is an independent risk factor for severe mental illness, although its influence was less pronounced than direct Holocaust exposure. Exposure to severe trauma such as war during childhood has long-term effects on the course and severity of mental illnesses.