Monitoring and evaluating psychological health indicators is of utmost importance because of their potential short and long-term personal and social impact on individuals and their families, as well as the significant burden that they cause on communities and the global economy (Belek, 2000; Visla et al., 2016). A major indicator of mental health is psychological distress, i.e. the state of emotional suffering characterized by symptoms of mental health disorders, stress, loneliness, anxiety, sadness, and suicidal ideation, plans, or attempts, personality traits, functional disabilities, and behavioral problems (Drapeau et al., 2011). Psychological distress has been documented in diverse cultural contexts in connection with multiple life challenges such as medical and physical conditions (Karkhanis & Mathur, 2016), exposure to violence, immigration (Ferrajão & Elklit, 2020), discrimination (Schmitt et al., 2014) and unemployment (Kim & von dem Knesebeck, 2016).

Psychological Distress in Adolescence

One of the life stages most vulnerable to psychological distress is adolescence. The rapid and intense physical, cognitive, emotional and social developments, which characterize it require adjustment to changes in one’s self, family and peer group (Lerner & Galambos, 1998). This includes negotiating own identity, achievement and sexuality potentially contributing to elevated stress levels (Visla et al., 2016). Reported prevalence of adolescents’ psychological distress ranges from 8 to 57% depending on the methodological approach used, the definition of psychological distress, type of population studied, and the assessment measures employed, as well the cultural contexts of exposure to risk factors and manifestations of the distress (Myklestad et al., 2012).

Psychological distress in adolescents has significant short and long term consequences. It may have immediate negative impact on health, academic and social achievements and has been documented as a strong predictor for negative outcomes extending into adulthood (Kenny et al., 2013; Kessler et al., 2007; Kim-Cohen et al., 2003) including health-risk behaviors (Arbour-Nicitopoulos et al., 2012) and medical problems (Wirtz & von Känel, 2017). Data from the World Health Organization (2020) show that adolescence is a crucial period for determining mental well-being and that an estimated 10–20% of adolescents globally experience mental health conditions. These estimates were supported by a meta-analysis of community studies worldwide (Polanczyk et al., 2015). It is further estimated that 50% of all mental disorders are established by the age of 14 and 75% by the age of 18 (Keles et al., 2020). Manifestations and Correlates of Psychological Distress. One manifestation of psychological distress are sleep disorders. Research has shown that higher psychological distress was associated with sleeping difficulties (Jakobsson et al., 2019), specifically short sleep duration (Sampasa-Kanyinga et al., 2018), poor sleep quality (Zhou et al., 2015), fatigue and difficulties in sleep initiation (Matos et al., 2016). Sleep disorders in turn were associated with daytime sleepiness and poor functioning (Shochat et al., 2014), lower academic success, increased aggression, health and safety issues (Kamphuis et al., 2012; Krizan & Herlache, 2016), and this association was significantly stronger in those who reported feelings of social isolation (Cho et al., 2015).

Both intrinsic and environmental factors may contribute to psychological distress in general and among adolescents in particular. Intrinsic factors include demographic characteristics, personal history (Marsh et al., 2018), irrational beliefs (Visla et al., 2016), as well as metabolic and genetic factors, trauma, nutritional deficiencies, and physical health. Specific to adolescents, correlates of psychological distress were sociodemographic characteristics such as age and gender, low socioeconomic status, unhealthy behaviors (Arbour-Nicitopoulos et al., 2012; Jaisoorya et al., 2017; Keles et al., 2020; Marino et al., 2018), poor academic performance and being bullied at school (Myklestad et al., 2012), minority group affiliation (Roberts, 2018), and low self-compassion (Marsh et al., 2018).

Environmental factors contributing to psychological distress in adolescents include high risk context, which may detract from adolescents’ ability to resolve developmental challenges effectively and thus may have a lasting effect (Chiccetti & Toth, 1998). Disadvantaged family and societal circumstances may generate exposure to traumatic situations, especially traumas perpetrated by trusted individuals or within the family such as physical and emotional abuse, parental conflict and parents’ substance abuse and divorce (Gamache Martin et al., 2016; Myklestad et al., 2012; Shahinuzzaman et al., 2016). Poor social network and neighborhood violence exposure were also correlated with psychological distress (Goldman-mellor et al., 2016).

Social Relationships and Adolescents’ Psychological Distress

A central environmental determinant of adolescents’ psychological distress is their social relationships. A sense of meaningful connection with peers is one of the strongest indicators of psychological health in adolescents because of the age-related increased need for social support from peers (Hall-Lande et al., 2007). As they move away from parental authority, adolescents increasingly turn to peers as a source of support and companionship (Kenny et al., 2013), are striving for greater social acceptance and hence, are highly sensitive to issues of belonging and social inclusion (Kapıkıran, 2013). Social relationships become very influential as youngsters redirect their emotional and sexual interests (Kapi et al., 2007).

Because of the importance of social relationships, sense of affiliation and peer validation in this developmental stage, the absence of social contacts, social isolation and exclusion may have considerable impact on adolescents’ physical and mental health and on their quality of life, including the levels of psychological distress (Adamczyk & Segrin, 2015; Safipour et al., 2011; Zhang et al., 2015).

Social Alienation. One form of social exclusion is social alienation, i.e. feelings of distance, estrangement and isolation from one’s community, society, or world, lack of identification with prevailing norms and common values (Rayce et al., 2018) and disconnection in the context of a desired relationship (Case, 2008). Alienation has been conceptualized as involving powerlessness, meaninglessness, normlessness, isolation and cultural estrangement (Seeman, 1959, 1971, 1975). Alienation can be interpersonal, i.e. social isolation and loneliness; political, i.e. estrangement from society’s institutional systems; and socio-economic, i.e. poverty, limited prospects of sustainable employment (Ifeagwazi et al., 2015). Specifically, minority alienation from mainstream society means that minority group members perceive not being a part of society at large, being discriminated against and that no matter what they do, they will never be integrated into society (Tsfati, 2007).

Alienation has been identified as an important concept in the study of adolescent behavior and health because the feelings of alienation may reflect a living situation that harms a healthy development during adolescence (Kaur & Singh, 2015; Rayce et al., 2018).

Social alienation is contextual and based on the circumstances surrounding an individual situation (Rayce et al., 2018). Thus, in persons from non-dominant ethnic/racial minority and socially or economically disadvantaged groups, feelings of social alienation can occur in response to discrimination, pressures to conform to the dominant group’s social norms and behaviors and social exclusion. These experiences may generate engaging in risk behaviors as a form of social resistance in response to the sense of social alienation (Factor et al., 2013a). Factor et al. (2011, 2013a, 2013b) identified social alienation as a key concept in their social resistance model. According to this model, institutional and everyday discrimination as well as individual demographic and socioeconomic variables may breed in non-dominant minorities’ lack of attachment to and alienation from society, perceived procedural injustice and anonymity. This alienation may produce resistance to norms and laws of the dominant group as an expression of dissatisfaction with economic, political and social exclusion and oppression, a collective identity different from the dominant majority, and demarcation of the limits of the dominant group’s power. Manifestations of the resistance in unhealthy behaviors opposed to those that are acceptable by the majority group may result in negative health outcomes. The model has been supported by empirical findings. For example, Nieri et al. (2020) found that the perceived discrimination was a significant problem among ethnic minority adolescents linked to negative outcomes.

Social Alienation and Psychological Distress. Exposure to alienation may exacerbate distress and impact negatively on mental health in general (Levula et al., 2016) and in adolescents in particular (Hall-Lande et al., 2007). Social alienation in adolescents has been found to be associated with emotional problems, anxiety, reduced self-esteem, depression, sense of meaninglessness and powerlessness, risk behaviors and suicide (Hall-Lande et al., 2007; Lacourse et al., 2003; O’donnell et al., 2006). Young adolescents and their parents who experienced discrimination or social inequality with lack of access to resources and services were at elevated risk for mental health problems (Schuster et al., 2012).

The relationship between alienation and distress may be moderated by multiple factors, including ethnic identity (Umaña-Taylor & Updegraff, 2007) and specifically ethnic pride and shame, which reflect a person’s attitude to their own ethnic group (Valk & Karu, 2001). Ethnic pride represents a sense of attachment, positive emotions and interest in own culture, history, and customs (Anderson, 2016). Ethnic shame refers to viewing negatively a “foreign” appearance, accent, name, food, language, cultural norms and values (Berger et al., 2019). That ethnic identity is correlated with wellbeing in general and in adolescents in particular has been supported by research (Upadhyayula et al., 2017). For example, a meta-analysis of 184 studies by Smith and Sylva (2011) synthesized research examining the relationship between ethnic identity and personal wellbeing among people of color residing in North America. The results supported previous conclusions that ethnic identity is positively related to wellbeing, especially in adolescents and young adults. A meta-analysis by Rivas-Drake et al. (2014) has shown that ethnic–racial perception was associated with social functioning, self‐esteem, well‐being, internalizing, externalizing, academic achievement, academic attitudes, and health risk outcomes. Wills et al. (2007) reported that ethnic pride was a protective factor against early involvement in substance use and sexual behavior and Kosic and Dimitrova (2017) found that multiple aspects of collective identities derived from familial, ethnic and religious identities were linked to the wellbeing of minority Slovene adolescents in Italy. Similarly, Roma youth representing the largest low-status minority group that is subjected to marked public intolerance and discrimination, reported lower levels of wellbeing than other Bulgarian youth (Dimitrova et al., 2013) and ethnic identity was significantly positively correlated with psychological wellbeing among mixed Arab-European adolescents in Israel (Abu, 2006).

Our study focused on social alienation and psychological distress in Israeli Palestinian and Jewish adolescents. Palestinian Israelis are the largest minority group comprising about 20.9% of the total Israeli population (Israel Central Bureau of Statistics, 2018). This population is about 83% Muslims, 9% Christians and 8% Druze (Gharrah, 2018). The Palestinian Israeli population is young with about 45% of children and adolescents below the age of 19. The vast majority lives in exclusively Arab towns and villages and about 8% live in a minority in mixed cities (Gharrah, 2018). Palestinian Israeli families, including extended families (called “hamulas”), tend to live in the same village or town. While formally enjoying equality and basic civil liberties, Israeli Palestinians and the Jewish majority differ in ethnicity, religion, culture, and language. Israeli Palestinians are distant from the sociopolitical power centers, are personally and institutionally discriminated against in multiple domains of life, socially excluded in terms of residence, labor market participation, housing and political representation; they suffer from higher unemployment, higher levels of poverty, lower educational attainment and inferior municipal services (Tsfati, 2007; Youngmann & Kushnirovich, 2020). Previous research examined social alienation (Tsfati, 2007) and psychological distress in the Israeli Palestinian population separately (Ayer et al., 2017; Rabaia et al., 2018). Available studies concluded that Palestinians may be at particularly high risk of psychological distress as a result of the Israeli-Palestinian conflict (Ayer et al., 2017).

The association between social alienation and psychological distress was studied to a very limited degree (Tsfati, 2007) and no study could be identified that looked at this association in Israeli Jewish and Palestinians adolescents; nor any study that examined the moderating effect of ethnic pride and shame on this relationship.

The current study had two main goals: to address this gap and examine the relationship between social alienation and psychological distress and to test the moderating effect of ethnic pride and shame on this relationship. Better understanding of these associations can help inform policy makers, researchers, and practitioners in developing and employing effective measures to decrease psychological distress in socially alienated population groups.

Hypotheses

  1. 1.

    Manifestations of adolescents’ social alienation (i.e. disbelief in procedural justice, non-commitment to the law, preference of own ethnic group and alienation) are positively associated with their psychological distress and sleep problems.

  2. 2.

    Adolescents’ ethnic pride moderates the relationships between social alienation and psychological distress and sleep problems. Specifically, the relationships between the four aspects of social alienation and the outcome variables of psychological distress and sleep problems will be weaker at higher levels of ethnic pride.

  3. 3.

    Adolescents’ ethnic shame moderates the relationships between social alienation and psychological distress and sleep problems. Specifically, the relationships between the four aspects of social alienation and the outcome variables of psychological distress and sleep problems will be stronger at higher levels of ethnic shame.

Method

Sample and Sampling

A convenience sample of 1008 respondents was recruited from Israeli public high schools whose principles allowed access. The students’ ages ranged from 14 to 18 (M = 16.13, SD = 0.97). Almost two-thirds (63.9%) of the sample were girls; over half (57.4%) were Palestinian-Israelis; the rest were Jewish. The majority (68.6%) defined their family’s social economic status as “good” or “very good”, 24.1% as “average”, and the rest as “bad” or “very bad”.

Measures

Demographics background Participants reported their gender (girls, boys), age, national identity (Palestinian-Israelis, Jewish), and family social economic status on a five- point Likert scale (1 = very poor to 5 = very good).

Psychological Distress was assessed by the K-6 questionnaire (Kessler et al., 2003), which was developed as a measure sensitive to nonspecific distress and is capable of discriminating serious mental illness (SMI) from non-serious cases. It taps six indicators of anxiety and depression (e.g., restlessness, hopelessness). Respondents were asked to state how often they experienced each of the indicators in the past month, from 1 = not at all to 5 = all the time. Reliability was α = 0.86. Scores were calculated as the sum of responses to all six items. Higher scores indicate more severe psychological distress.

Sleep problems were assessed by a six-item questionnaire. Four items serve as a screening measure for sleep problems (, 2012; e.g., difficulties in falling asleep, waking up frequently during the night, waking up too early in the morning). The questionnaire also includes questions on headaches and anxiety, as both have been identified as indicators of sleep disorders. Several studies found that morning or nocturnal headaches are possible manifestations of a sleep disorder such as obstructive sleep apnea (Paiva et al., 1995; Singh & Sahota, 2013). Respondents were asked to state if they experienced each of the indicators in the past month (1 = no, 2 = yes). Reliability was α = 0.71. Scores were calculated as the means of responses to all six items. Higher scores indicate more sleep problems.

Social alienation was assessed by a questionnaire compiled by Factor et al., (2013a, 2013b). In this study we used four of the six subscales: alienation (three items, e.g., “The rich get richer and the poor remain poor”; alpha = 0.63); perceived procedural justice (five items, e.g., “Police and court decisions are generally fair”; alpha = 0.87); Non-commitment to the law (four items, e.g., “There is no need to obey laws that seem illogical to me”; alpha = 0.81); preference for one’s own ethnic group (five items, e.g., “Most of the time I prefer to be with people of own background/ethnic group”; alpha = 0.72).

Respondents were asked to indicate to what extent they agree on a 7-point Likert scale with each of these statements (1 = ”Very much disagree”, 7 = ”Very much agree”). Four scores were calculated, for each of the sub-scales, based on the mean of the items included in each. Higher scores in three of the sub-scales indicate a stronger sense of social alienation; higher score on the perceived procedural justice sub-scale indicate a weaker sense of alienation.

Ethnic Pride and shame were measured by seven items phrased on the basis of literature on ethnic identity (Phinney, 1996; Phinney & Ong, 2007). Participants were asked to indicate how proud (3 items, e.g., “I am happy that I am a member of the group I belong to”; alpha = 0.88), and how ashamed they are of their ethnicity (4 items, e.g., “I am ashamed of my ethnic group”; alpha = 0.78). Responses were rated on a 5-point Likert-type scale (1 = not at all, 5 = a great deal). Scores were calculated as the mean of the items comprising each of the scales; the higher the score, the prouder or more ashamed the respondents were.

Procedure

The study employed a cross-sectional survey design. After the study was approved by Israel’s Ministry of Education and by [Authors’ University] Ethics Committee, interviewers approached school principals to explain the purpose of the study and request permission to carry it out. The questioners were administered in schools where we were able to enlist cooperation.

Contact with administrators was followed by letters sent to the parents explaining the purpose of the study. Where parents refused permission for their children to participate in the study, they were asked to send a letter stating their objections. None of the parents refused to allow their adolescent children to participate. Next, an interviewer (from a team of MSW and PhD social work students, trained to administer the questionnaire) entered the homeroom classes, explained to the students that this study aimed to obtain a realistic picture of their lives, assured them anonymity, and told them that participation was voluntary and that they could decline to complete the questionnaires with absolutely no repercussions. All the adolescents who were present at school on that day agreed to complete the questionnaires. The questionnaires were administered in the adolescents’ native language: Hebrew or Arabic. Completion of the questionnaire set lasted between 35 and 45 min. The records were identified by sequential numbers recoded into SPSS software.

The students signed a consent form, prior to filling out the questionnaire. To assure anonymity, the consent form was separated from the questionnaire. After completion, the students were provided with a list of agencies and professionals prepared by the Ministry of Education in case they wanted to consult with someone.

Statistical Analyses

Descriptive statistics and initial univariate analyses were performed using SPSS software v.25. The research model was tested within a structural equation model using the Mplus 8.3 program (Muthén & Muthén, 1998–2017). There was a small amount of missing data in the variance–covariance matrix used in the analyses (minimal covariance coverage was 0.95). Therefore, we fit the models using full-information maximum likelihood (FIML) estimation with robust standard errors (Little & Rubin, 2003). Following recommendations of Hu and Bentler (1999), we report fit indices of two types: the Tucker–Lewis index (TLI) and the Comparative Fit Index (CFI), and two indices of misfit: Root Mean-Square Error of Approximation (RMSEA) and Standardized Root Mean-Square Residual (SRMR). NNFI and CFI close to or above 0.95, combined with RMSEA below 0.06 and SRMR below 0.08, are considered indicative of acceptable fit. We controlled for gender, ethnicity, and SES, which were specified as manifest variables. Gender was dummy-coded with 1 = girls, and 0 = boys; ethnicity was dummy-coded with 1 = Palestinian-Israeli, and 0 = Jewish. All content research constructs were modeled as latent variables. Alienation and ethnic pride and shame were indicated each with their three items. The other constructs were indicated by three indicators each, defined as random thirds of the scale items (the parceling technique, Bandalos, 2002).

Results

Descriptive

Distribution and inter-correlations of the study’s variables are presented in Table 1. The findings show that the significant relationships are in the expected directions. Specifically, positive relationships were found between psychological distress and non-commitment to the law, preference for one’s own ethnic group and alienation, and negative relationships with perceived procedural justice. Furthermore, psychological distress was negatively associated with ethnic pride and positively associated with ethnic shame. Although not identical, a similar pattern was found for sleep problems. As for the relationships between the social alienation subscales and the moderators, the findings indicate positive relationships between ethnic pride and perceived procedural justice and preference to one’s own ethnic group, and negative relationships with psychological distress; ethnic shame was negatively associated with perceived procedural justice and positively associated with non-commitment to the law and alienation.

Table 1 Distribution and intercorrelations of research variables (N = 1008)
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Hypotheses Testing

The research hypotheses were tested within a structural model. At the first stage of the main analyses, we tested the measurement model. It yielded acceptable results: χ2 (224, N = 1008) = 578.66, p < 0.0001, TLI = 0.96, CFI = 0.97, SRMR = 0.04, RMSEA = 0.040 (90%CI = 0.036; 0.044). We proceeded to test the hypothesized structural model. The model was tested with the three background variables (gender, ethnicity, and SES) affecting each of the content variables. The data fitted this model fairly well, with χ2 (280, N = 1008) = 824.40, p < 0.0001, TLI = 0.94, CFI = 0.95, SRMR = 0.05, RMSEA = 0.044 (90% CI = 0.040; 0.047). The standardized path coefficients appear in Fig. 1. Omitted from the Figure are the paths emanating from the background variables, which are presented in Table 2.

Fig. 1
figure 1

Structural equation model Results with standardized coefficients. The solid lines indicate paths statistically significant at p < .05. The dotted lines indicate non-significant paths. χ2 (280, N = 1008) = 824.40, p < .0001, TLI = .94, CFI = .95, SRMR = .05, RMSEA = .044 (90% CI = .040; .047)

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Table 2 Standardized coefficients of paths relating background and research variables (N = 1008)
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The findings in Table 2 show no statistical differences between girls and boys on the social alienation sub-scales. Findings also show that compared to boys, girls are prouder and less shameful in their ethnic identity. However, they are more psychologically distressed and report more sleep problems. Regarding ethnicity, compared to Jewish adolescents, Palestinian-Israeli have less trust in the fairness of the justice system, and they are less committed to the law. Findings also show that they prefer their own ethnic group, yet, they are more ashamed of it. Finally, they are more psychologically distressed and report more sleep problems, compared to their Jewish counterparts. With regard to socio-economic status, the findings show that better SES is associated with more trust in procedural justice and with less alienation. No statistical differences were found in the relationships between SES and the other two sub-scales of social alienation. Findings also show that that adolescents from better SES background have more pride and less shame in their ethnic groups. Finally, their well-being—indicated by less psychological distress and sleep problems—is better than adolescents from less affluent families.

Figure 1 presents the structural equation model results with standardized coefficients. The solid lines indicate paths statistically significant at p < 0.05. The dotted lines indicate non-significant paths.

In the first hypothesis we argued that positive associations will be found between the four sub-scales of social alienation and the two measures of psychological distress. As seen in Fig. 1, this hypothesis received full support for the dependent variable sleep problem and partial support for psychological distress. Adolescents who have more trust in procedural justice (β = − 0.12, p < 0.004) and prefer their own ethnic group (β = − 0.14, p < 0.014) report less sleep problems. Adolescents who are less committed to the law (β = 0.14, p < 0.007) and more alienated (β = 0.12, p < 0.024) report more sleep problems. Regarding psychological distress, the findings show negative association with believing in procedural justice (β = − 0.17, p < 0.001) and positive association with alienation (β = 0.21, p < 0.001).

We further hypothesized that ethnic pride and ethnic shame moderate the relationships between social alienation and the two outcome variables: psychological distress and sleep problems, such that the relationships will be weaker at higher levels of ethnic pride, and stronger at higher levels of ethnic shame. Out of sixteen such effects tested, only ethnic pride reached statistical significance (p = 0.002) and was found to moderate the effect of alienation on sleep problems. Figure 2 illustrates the moderation pattern. At a high level of ethnic pride, the effect of alienation on sleep problems is milder than at the low level of ethnic pride, i.e., ethnic pride buffers the negative effect of alienation on sleep quality.

Fig. 2
figure 2

The moderation effect of ethnic pride

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Discussion

This paper reports findings from a study that examined (a) the relationships among sense of social alienation and psychological distress and sleep problems in Israeli adolescents; and (b) the moderating effects of ethnic pride and shame on these relationships. The findings supported the hypotheses partially.

Associations Between Predictors and Outcome Variables

The findings fully supported the hypotheses relative to sleep problems and partially supported the hypotheses relative to psychological distress. Sleep problems were positively related to three aspects of social alienation, i.e. non-commitment to the law, preference for one’s own ethnic group and alienation whereas it was negatively associated with belief in procedural justice. A similar pattern emerged for the relationships between belief in procedural justice, alienation and psychological distress.

These findings point to the dire consequences of social alienation for the wellbeing of adolescents. They are consistent with previous research, which has shown that discrimination, social exclusion and stigma (which are aspects of social alienation as measured in this study) are important psychosocial stressors that can lead to adverse changes in health (e.g., Everett et al., 2016). Factor et al. (2011, 2013a, 2013b) framework of social resistance offers a plausible explanation for these findings. According to this framework, power relations in society trigger negative stereotypes and discrimination, are pathogenic, affect the health of non-dominant populations adversely and foster health-damaging psychological responses (Williams & Mohammed, 2013). Further, the authors posit that exposure to environments governed by non-egalitarian policies cause members of marginalized groups to feel lack of attachment to and alienation from the larger society. Consequently, such persons engage in practices of resistance against the norms of the majority group and develop a collective identity with opposition to that of the dominant group as its core. This opposition can be manifested in risky health behaviors, which in turn generate negative health outcomes. Psychological distress and sleep problems may be such negative health outcomes in the alienated youth who were studied.

While a rich literature discusses the implications of exposure to social stressors for adolescents’ psychological distress, there are fewer attempts to relate to the trajectory of exposure to social stressors and sleep problems. Considering the negative ramifications of sleep problems on adolescents, it is important to understand the predictors and mechanisms that may generate such problems. Previous studies have shown that loneliness and social isolation are associated with poor sleep quality (Hawkley & Cacioppo, 2010; Matthews et al., 2017; Richardson et al., 2019). One possible explanation for these associations was offered by Cacioppo et al. (2006), who posit that the feeling of being lonely triggers a sense of vulnerability. Since it is impossible to remain alert while sleeping, the unsafe feelings of loneliness and vulnerability mitigate against restful sleep (Matthews et al., 2017). Furthermore, in their meta-analysis, Holt-Lunstad et al. (2015) found that social isolation, loneliness, and living alone corresponded to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. Findings have also shown that insufficient sleep by adolescents was associated with their decreased flourishing, school performance and physical and mental health (Ben Simon & Walker, 2018; Kansagra, 2020; Tsao et al., 2019). It is thus possible that adolescents in the current study experienced sleep problems generated by the absence of a sense of belonging due to social alienation. These findings underscore the importance of early interventions to mitigate potential negative long-term impact of social isolation and alienation on sleep deprivation and consequently on adolescents’ wellbeing and behaviors.

Moderating Effects

The findings indicated significant associations between the study’s outcome variables and the moderators. As expected, psychological distress was negatively associated with ethnic pride and positively associated with ethnic shame. A similar pattern was found for sleep problems. These findings are consistent with those of previous studies reporting positive associations between strong ethnic identity and psychological well‐being (Balidemaj & Small, 2018; Keyes, 2006; Phinney & Ong, 2007; Wills et al., 2007).

Based on theories of ethnic and racial identities (Phinney, 1989, 1996; Phinney et al., 2001; Sellers et al., 2003) and previous studies (e.g., Choi et al., 2016; Wills et al., 2007; Yoo & Lee, 2005), we hypothesized that (a) adolescents with higher ethnic pride would be protected from the harmful effects of social alienation and (b) adolescents with higher ethnic shame would be more vulnerable to the detrimental effects of social alienation. Findings show that only one of the interactions tested in the study reached a statistical significance—ethnic pride buffers the negative effect of alienation on sleep quality. This finding is consistent with previous findings, which indicated that ethnic identity affirmation moderated the association between perceived discrimination and flourishing by buffering the negative effect of perceived discrimination among Arab Americans (Atari & Han, 2018), Mexican Americans (Romero & Roberts, 2003) and African American youth (Wong et al., 2003). However, the mechanism by which ethnic identity moderates the negative impact of discrimination in general and alienation in particular remains to be explored and clarified in future studies.

All other hypothesized interactions were ruled out. Previous studies on the buffering effect of ethnic identity generated mixed findings. While some studies found that ethnic identity moderated the relationships between social stressors and wellbeing (Atari & Han, 2018; Romero & Roberts, 2003; Wong et al., 2003) others did not (e.g., Krysia et al., 2019; Atari & Han, 2018) and yet others (Choi et al., 2020; Yoo & Lee, 2008) reported that contrary to expectations Asian immigrants with higher ethnic identity were more likely to experience higher psychological distress when exposed to discrimination.

Several plausible explanations can be offered for the aforementioned inconsistencies. First, it is possible that a more crystalized ethnic identity may emphasize the experience of “otherness” from the hegemonies group, potentially leading to a stronger feeling of social alienation and to exacerbation of psychological distress (Choi et al., 2020; Krysia et al., 2019). Alternatively, the inconsistencies may result from the aspects of ethnic identity studied. Ethnic identity is a complex multi-faceted concept with mental health outcomes possibly related to some but not all of its dimensions. Different studies may have investigated various aspects of ethnic identity consequently generating incongruent conclusions (Brittian et al., 2015). Finally, employment of different methodological strategies, including the use of different measures to study ethnic identity, social stressors, and wellbeing may explain the inconsistent results. Future research should examine in more depth the interplay among the multiple dimensions of ethnic identity and mental health outcomes to inform the development of a more nuanced understanding of these relationships.

Associations Between Sociodemographic Features and the Outcome Variables

Findings show that gender, ethnicity and SES were partially linked to both outcomes variables such that—psychological distress and sleep problems were associated with female gender, Palestinian-Israeli ethnic affiliation and low SES.

That girls reported more psychological distress and sleep problems than boys are consistent with previous findings (e.g. Drapeau et al., 2011; Joiner & Blalock, 1995). Research suggests that adolescent girls report a greater severity of psychological problems, specifically higher levels of interpersonal stressors, emotional reactivity, and depressive symptomology (Alloy et al., 2016). Two mechanisms may explain the findings. First, Mendle et al. (2020) posit that the physiological, psychological and emotional developmental changes associated with adolescence put girls in a heightened risk for diverse manifestations of psychological distress because girls are more likely than boys to perceive the adolescent transition as unsettling and difficult and thus may be at particular risk during this transition. Alternatively, Koch et al. (2020) suggest that because girls perceive more difficulty at school, place more importance on peers, and clash more often with parents, they may experience more adolescence-related role disruption and thus manifest more psychological distress.

The findings that Palestinian ethnicity was associated with more psychological distress and sleep disorders can be explained by the discriminated minority status of Palestinians in Israel (Tsfati, 2007; Youngmann & Kushnirovich, 2020). It has been documented extensively that discrimination, structural and institutional racism against minorities can affect negatively mental health (Williams, 2019). Developing attitudes and acts of defiance in reaction to the negative social attitudes they receive from the dominant society in turn may generate negative health outcomes. Specifically, Palestinian-Israelis respond to being socially discriminated by rejecting the law, mistrusting the justice system and minimizing the relationships with the dominant society, all of which they feel treat them unjustly. The toll of employing these mechanisms for coping is increased psychological distress. This interpretation is in agreement with previous studies. For example, Youngmann and Kushnirovich (2020) showed that perceived unfairness and discrimination in public institutions threatens the emotional wellbeing of Palestinians-Israelis regardless of whether they themselves were targets of discrimination.

The finding that adolescents from better SES reported less psychological distress and better well-being than their counterparts from less affluent families agrees with multiple studies that have shown that low socioeconomic status is a predictor of numerous negative mental health reactions. For example, a systematic review showed that 52 of 55 studies indicated an inverse relationship between SES and mental health problems in children and adolescents (Reiss, 2013), including PTSD (El-Khodary et al., 2020). Furthermore “Across diverse populations and contexts, lower socioeconomic status (SES) predicts almost every measure of mental health including measures of self-reported distress” (Bridger & Daly, 2019 p. 1545). That is why low family socioeconomic status is recognized as a risk factor for adolescent mental health problems throughout cultural contexts (Kachi et al., 2017).

Several explanations have been offered for the relationships among SES and mental health outcomes. Among them, Sweeting and Hunt (2014) suggested that coming from a low SES leads to adolescents’ developing a stigmatized identity, which may impact negatively on their well-being. Kachi et al. (2017) attributed adverse effects of low family SES on adolescent mental health to disadvantaged life conditions such as material hardship, family dysfunction, ineffective parenting and parental psychopathology; however, they indicated the need for further research to establish the mechanisms underlying the association between SES and mental health problems among adolescents. Specific to sleep disorders, the findings of this study agree with previous studies that documented socioeconomic disparities in sleep, such that adolescents from lower socioeconomic status families are disproportionately likely to experience more sleep-related problems in duration, efficiency and sleep–wake problems (El-Sheikh et al., 2020). However, Poulain et al. (2019) failed to find associations between sleep-related problems and SES. This inconsistency may point to the need for more nuanced investigation of specific aspects of the SES and particular types of sleep problems. Similar to psychological distress in general, sleep disorders among adolescents from low SES have been attributed to parental stress and insufficient family financial or social resources, which can undermine parenting and parent-adolescent relationship quality and eventually contribute to adolescent’s sleep problems (El-Sheikh et al., 2020).

Study Limitations, Suggested Future Research, and Contributions

The main limitation of the study is the non-representative nature of the sample. As mentioned in the Method section, data were collected from schools whose principals were willing to cooperate. This yielded a sample that was biased in relation to gender, socio-economic status, and ethnicity. The proportion of girls, students who perceive their family economic status as above average and Palestinian-Israelis is higher in the sample than their proportion in the Israeli population. Thus, our conclusions should be taken with caution.

Moreover, the study’s design—a cross-sectional self-report survey design with one source of knowledge—does not allow causal conclusions. This means that we cannot determine the causal paths between the predictors and the outcomes. Finally, this study did not examine additional factors such as illnesses not amenable to social functioning that may contribute to sleep disorders. Questions to this effect may be explored in future research.

Its limitations notwithstanding, the findings offer implications for theory, research, and practice. In terms of theory, the findings confirm the role of perceived social alienation as an explanatory mechanism of psychological wellbeing among adolescents. In terms of research, to our best knowledge, this is the first study to test the moderating effect of ethnic pride and shame on the relationships between social alienation and psychological wellbeing among Israeli Jewish and Palestinian adolescents. Further studies are needed, to better understand the complex relationships among these variables and causality trajectories among them. It is thus recommended to replicate the study with a representative sample, in Israel and elsewhere, and to include adolescents who dropped out and those who study outside of the state high-school system. Additionally, studies should seek to gain more nuanced understanding of the protective role of ethnic and racial identity. Finally, studies with longitudinal design are recommended for determining causal relationships and conclusions.

The findings offer several implications for practice; specifically, the need to target he alienation and develop practices for minimizing it as well as offer help to curb its negative effects. The finding regarding the damaging effects of alienation on youth points to the need to develop and implement both micro and macro interventions. On the micro level intervention strategies are needed to decrease the feelings of alienation and of ethnic shame and to foster a sense of ethnic pride among adolescents. Previous research has shown that parents play an important role in the process of identity development of their children and can promote ethnic pride in youth (Hernández et al., 2014). Thus, professionals should focus on cultivating programs for parents’ education designed to guide and support minority groups parents in fostering ethnic pride in their children. On the macro level, somewhat similar to the current emphasis on promoting social justice and acknowledging and fighting against institutional racism, programs designed to raise public awareness of alienation and minimize it combined with policies that facilitates integration of alienated adolescents in society as well as providing social support are called for. It is critical for the helping professions to develop strategies with the potential to minimize social isolation among adolescents eventually leading to decrease in psychological distress and improvement of sleep patterns. This recommendation agrees with studies that suggested focusing on communication, public education, training and campaigns in relevant communities to address social conditions such as alienation that generate negative mental health outcomes (e.g. Murney et al., 2020). Social workers, educators, and other helping professionals can and should lead and have a role in promoting these interventions and policies.