1. DEPRESSION AND SOMATIC SYMPTOMS AMONG BEDOUIN ARAB AND JEWISH STUDENTS IN ISRAEL: TESTING THREE THEORETICAL MODELS Sarah Abu-Kaf, PhD, Golan Shahar, PhD, and Beatriz Priel, PhD Conflict Management and Resolution Program & Department of Psychology Ben-Gurion University of the Negev, Israel E-mail: aks@bgu.ac.il

2. Depression  Definition/ The symptoms of depression include sadness, diminished pleasure in daily life, weight change, disturbed sleep patterns, fatigue, feelings of worthlessness and self- blame (American Psychiatric Association, 2000).  Prevalence/ Over the past 15 years, the incidence of depression has doubled among the college/university student population (American College Health Association 2012).  Depression affects academic Performance and academic adaptation.  Cultural differences/ Depression scores of Bedouin Arab students exceed the cut-off point of 16, indicating a risk for clinical depression (Abu-Kaf and Braun-Lewensohn 2015). Somatic complaints\Somatization  Definition/Somatization is the translation of emotional distress into physical symptoms that have no identifiable physical cause.  Prevalence / The prevalence of somatic complaints among college students ranges from 15–60% (El Ansari et al. 2014).  Cultural differences/ The tendency for individuals to somaticize distress is commonly observed in countries with non- Western individualistic cultures, such as Arab countries (Hamdi et al. 1997; Kleinman 2004). Depression–Somatization Comorbidity: Testing Three Theoretical Models  Depressive symptoms and somatization are strongly associated with one another (Kroenke 2003).  The functional model/ This model suggests that somatic complaints may precede depression (Banks and Kerns 1996).  The affect-dysregulation model. This model suggests the reverse relationship, that is, that depression may precede somatization (Lépine and Briley 2004).  The sociocultural model suggests that cultural context affect the strength of the relationship between these mental health problems. INTRODUCTION: DEPRESSION AND SOMATIC COMPLAINTS

3. Methods  Design / We designed a two-wave longitudinal study to test the predictions of the three models.  Subjects/ 190 individuals took part in the study, including 89 Bedouin Arab freshmen students and 101 Jewish freshmen students.  Measures / The Center for Epidemiological Studies Depression Scale (CES-D). The 15-item Somatic Symptom Severity Scale (PHQ-15), and Demographics.  Procedure/ During the first month of the students' first year of university/ college(T1), the students completed the self-report questionnaires in their native language. Twelve to fourteen months later (T2), the same students completed the self- reports once again. Results  Regression analyses addressing longitudinal associations provided support for the functional model among the Bedouin Arab males, whereby somatic complaints prospectively predicted depression in these males.  No support for the affect- dysregulation and the sociocultural models.  Ethnic Differences /Bedouin Arabs had higher levels of depression (Time 1 and Time 2) and somatization (only Time 1) than Jews. Approximately 50% of the surveyed Bedouin Arab students (males and females) scored above the stricter diagnostic cut-off point of 23, indicating severe levels of depressive symptoms  Gender differences / Females reported higher levels of somatization and depression than males. Discussion  The possibility that somatic complaints strongly affect the functional level and the quality of life of Bedouin Arab males (masculine stress) more than that of Jewish males or females from either of the two cultural-ethnic groups.  The possibility that the onset of somatic complaints is a result of accumulated exposure to depression over several years (Larson et al. 2004).  Bedouin Arab students, as members of the minority Arab group within Israeli society, are faced with additional difficulties. They are generally less prepared academically than their Jewish peers and also experience a variety of nonacademic stresses: personal, social, financial, and cultural (Ben-Ari, 2004).  Previous research found that females reported significantly higher levels of symptoms of somatization and depression, as compared to males(Houghton et al. 2012). METHODS, RESULTS, AND DISCUSSION

4. CONCLUSIONS: The longitudinal associations between depression and somatization might change as a function of ethnicity. Somatization might proceed, or lead to, depression in Bedouin Arab males. Further research is needed to test potential pathways between somatic complaints and depressive symptoms among Bedouin Arab male students. βB (SE)t (df = 181) Bedouin Arab Men.78 1.82[.35] 5.20*** Bedouin Arab Women.08.19[.23].82 Jewish Men.17.40[.38]1.06 Jewish Women.03.08[.30].29