Navigating Cultural and Psychological Barriers: Acculturative Stress, Sexual Harassment, and Suicidal Ideation Among Arab Female Students

Navigating Cultural and Psychological Barriers: Acculturative Stress, Sexual Harassment, and Suicidal Ideation Among Arab Female Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Navigating Cultural and Psychological Barriers: Acculturative Stress, Sexual Harassment, and Suicidal Ideation Among Arab Female Students Anat Bunimovich, Sami Hamdan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6149387/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Across the world, female students from minority groups face unique stressors, including acculturation stress and sexual harassment. These factors potentially increase their mental health risks. This study aims to investigate the direct and indirect effects of these risk factors, depressive and suicidal ideation among Arab female students in Israel. Methods A cross-sectional study was conducted with 1425 Arab female students aged 17–54 enrolled in academic institutions across Israel. Participants completed self-report questionnaires assessing suicidal ideation, depression, acculturative stress, and experiences of sexual harassment both in childhood and during university. Results Suicidal ideation was reported by 20.5% of participants. Higher levels of depression, acculturative stress, and experiences of childhood sexual harassment were significant predictors of suicidal ideation. Path analysis revealed that depression mediated the relationship between acculturative stress and suicidal ideation, as well as the indirect effects of childhood sexual harassment. Additionally, childhood sexual harassment demonstrated a direct impact on suicidal ideation. The study found a cumulative effect of sexual harassment across both childhood and university, which increased the risk of depressive symptoms and suicidal ideation. Conclusion This study highlights the complex interaction between sexual harassment, acculturation, and depression on the impact of suicidal ideation among Arab female students. Findings highlight the need for culturally sensitive campus mental health programs. Minority students Sexual harassment Suicidal ideation Minority students Depression Figures Figure 1 1. Introduction The academic environment, while offering opportunities for growth and development, can also present significant stressors that may contribute to mental health challenges (Hernández-Torrano et al., 2023 ). Minority students, particularly those from ethnic or religious backgrounds, face additional stressors in academic environments that exacerbate their mental health vulnerabilities. Among these groups, Arab female students in Israel experience a unique intersection of ethnic and gender-based stressors, increasing their vulnerability to mental health issues such as depression and suicidal ideation (Attrash-Najjar & Katz, 2023 ; Benatov et al., 2017 ; Geiger, 2013 ). Despite growing awareness of mental health disparities among minority populations, research on the combined effects of acculturative stress and sexual harassment on Arab students in Israel remains limited. Mental health concerns among college students are a global issue. Studies indicate that 22.3% of students report lifetime suicidal ideation, and approximately 30.6% experience depressive symptoms, rates significantly higher than in the general population (Ibrahim et al., 2013 ; Mortier et al., 2018 ). In Israel, research suggests that 40.4% of students experience some level of depression, while 15.1% report suicidal ideation (Klugman et al., 2024 ).These rates highlight the urgent need to explore the unique psychological stressors affecting Arab female students, who navigate the pressures of both academic demands and cultural expectations. Israel is a multicultural society where Arab students, as a minority, experience distinct sociopolitical and cultural pressures. While suicide rates among Jewish Israelis are generally higher than those among Arabs, suicides among Arab individuals tend to occur at younger ages, with 71% of cases involving individuals under 45 (Israel Ministry of Health, 2023 ). One explanation for this trend is the waning influence of traditional cultural and religious norms that historically discouraged suicidal behavior (Klomek et al., 2016 ; Sheleg Mi-Ami, 2010 ). As younger Arab students are increasingly exposed to Western cultural values, they may experience greater acculturative stress, which has been linked to various mental health difficulties, including depression and suicidal ideation. Acculturative stress arises when individuals struggle to balance the expectations of two distinct cultural frameworks (Berry, 2006 ). Arab female students in Israeli universities must navigate between traditional cultural values and the norms of a predominantly Western academic environment, often leading to identity conflicts, social isolation, and diminished self-esteem- key risk factors for mental health deterioration (Abu-Rayya & Abu-Rayya, 2009 ; Mana et al., 2021 ; Nakash et al., 2015 ; Torres, 2010 ). While acculturative stress has been widely studied in immigrant populations, its effects on indigenous minorities, such as Arab students in Israel, require further investigation. Beyond acculturative stress, sexual harassment is a pervasive issue that significantly impacts mental health. It encompasses a range of non-consensual sexual activities, both physical and verbal, and is linked to PTSD, depression, and suicidal ideation. (Bergen et al., 2003 ; Mullen et al., 1993 ). Childhood sexual harassment, in particular, has severe long-term effects, increasing the risk of depression, self-esteem issues, and interpersonal difficulties (Lindert et al., 2014 ). In Israel, nearly half of reported cases occur within families, and survivors are twice as likely to attempt suicide (Ministry of Welfare and Social Affairs, 2022 ). The impact of sexual harassment extends beyond childhood, as college students - particularly women - face elevated risks of harassment during their academic years. Studies show that 20–25% of female students experience sexual assault during college (Carey et al., 2015 ). However, due to social stigma, only a small fraction of victims report their experiences (State Comptroller of Israel, 2012 ). The cumulative impact of sexual trauma, particularly when experienced in both childhood and university, significantly increases the risk of developing psychiatric conditions such as depression, PTSD, and suicidal ideation (Campbell et al., 2009 ; Classen et al., 2005 ). The intersection of cultural identity, gender, and higher education creates a complex mental health landscape for Arab female students in Israel. As they navigate conflicting demands from their cultural background and academic environment, experiences of sexual harassment further exacerbate their vulnerability, contributing to severe psychological distress (Benatov et al., 2017 ). Additionally, cultural stigma often discourages Arab women from reporting sexual harassment, leaving victims without necessary support and increasing their sense of isolation (Attrash-Najjar & Katz, 2023 ). This study aims to explore the impact of acculturative stress and sexual harassment, both in childhood and during the university, on depression and suicidal ideation among Arab female students in Israel. Specifically, we investigate how these factors interact and contribute to suicidal ideation through direct and indirect pathways. Based on prior research, we hypothesize that (1) Higher levels of acculturative stress will be associated with increased depressive symptoms and more frequent suicidal ideation, (2) Sexual harassment (in childhood and during university) will be positively correlated with depressive symptoms, and suicidal ideation (3) depressive symptoms will mediate the relation between acculturative stress and suicidal ideation (4) the cumulative effect of sexual harassment (both in childhood and university) will increase the risk for depressive symptoms suicidal ideation. Furthermore, we anticipate that (5) sexual harassment in childhood will have indirect effects on suicidal ideation, mediated by depressive symptoms. 2. Method 2.1 Participants This study included 1,425 Arab female students (M = 23.1 years, SD = 4.17) enrolled in various academic institutions across Israel. Participants self-identified as either religious (85.4%) or secular (14.6%). The inclusion criteria required students to (1) self-identify as Arab female students and (2) be enrolled in an academic institution in Israel. Participants who did not meet these criteria were excluded. 2.2 Procedure Participants were recruited through social media advertisements on platforms such as Facebook and Instagram, face-to-face outreach in university common areas, and a snowball sampling method, where initial participants were encouraged to share the study link within their networks. All participants provided informed consent, and their responses remained anonymous and confidential. The study received ethical approval from the Institutional Review Board (IRB) at the Academic College of Tel-Aviv-Yaffo. To ensure participant well-being, links to mental health resources were provided in case of distress caused by the survey questions. 2.3 Measures Suicidal ideation (Columbia-Suicide Severity Rating Scale – C-SSRS) Suicidal ideation was assessed using a modified item from the Columbia-Suicide Severity Rating Scale (C-SSRS) (Posner et al., 2008 ). Participants responded (Yes/No) to the question: "Have you had any thoughts of killing yourself in the past month?". Patient Health Questionnaire-9 (PHQ-9) Depression severity was measured using the 9-item PHQ-9 (Kroenke et al., 2001 ). Participants rated symptoms on a 4-point Likert scale (0 = not at all, 3 = nearly every day). Scores ≥ 10 indicated clinically significant depression. The Arabic version of PHQ-9 was used, with α = .90 in this study. Acculturation Stress Scale – Revised (SAFE-R) The Social, Attitudinal, Familial and Environmental Acculturation Stress Scale (SAFE-R) (Mena et al., 1987 ) is a self-report questionnaire aimed to assess negative stressors experienced by both immigrant and later-generation individuals as they acculturate to the host culture (e.g., "I don't feel at home"). Participants rated 28 items on a 4-point scale (0 = no stress, 3 = extremely stressful), with higher scores indicating greater acculturative stress. A cut-off score of 56 was used, with α = .89 in this study. Sexual harassment questionnaire Sexual harassment was assessed using questions adapted from the AAU Campus Climate Survey on Sexual Assault and Sexual Misconduct (Cantor et al., 2015 ). Participants were asked to respond to two sets of questions: (1) harassment experienced during their time at the university and (2) harassment experienced during adolescence or childhood (before the age of 18). The items evaluated whether participants had experienced any form of sexual harassment, such as unwanted sexual comments, offensive sexual jokes, or inappropriate sexual advances. Responses were given on a yes/no basis, with any affirmative answer being classified as an experience of sexual harassment. Examples of the questions include: “ Since you have been a student at [University or College], has a student, or someone employed by or otherwise associated with [University] made sexual remarks that were insulting or offensive to you? ” or “ Since you have been a student at [University or college], has a student, or someone employed by or otherwise associated with [University or college] have sex even though you said, “No ”?. Similar questions were asked to assess experiences of harassment before attending the university. The Arabic-translated version was piloted for cultural appropriateness, with α = .75 in this study. Demographics Variables Demographic information about age, marital status, student and parents' residence, academic institution, academic year of study, religion, and religiosity were also obtained. 2.4 Data Analysis Data were analyzed using IBM SPSS Statistics (Version 27.0) and AMOS software for path analysis. Descriptive statistics, including means, standard deviations, frequencies, and percentages, were computed to summarize the demographic and clinical characteristics of the sample. Differences between participants with and without suicidal ideation were examined using chi-square tests for categorical variables and t-tests for continuous variables. A hierarchical logistic regression model was conducted to assess the relationship between depression, acculturation stress, sexual harassment in childhood and during the university, and the likelihood of reporting suicidal ideation. In the first step, demographic variables (age, religiosity, marital status) were entered to control for potential confounding effects. In the second step, clinical predictors, including depression, acculturative stress, and experiences of sexual harassment, were added to the model. Odd Ratio (OR) with 95% confidence intervals (CIs) were reported to quantify the likelihood of participants reporting suicidal ideation for each variable. The Hosmer – Lemeshow goodness of fit test was used to ensure the overall fit of the regression model. To explore the indirect effects of acculturative stress and sexual harassment on suicidal ideation, a confirmatory path analysis was conducted using AMOS software. The model tested whether depression mediated these relationships. Model fit was assessed using the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Normed Fit Index (NFI), and Root Mean Square Error of Approximation (RMSEA), with good fit criteria set at CFI, TLI, and NFI ≥ .90 and RMSEA ≤ .08. To account for multiple comparisons, Bonferroni corrections were applied, and a significance level of p < .05 was used for all statistical tests. 3. Results Table 1 represents the characteristics of the study population, which included 1,425 participants aged 17–54 years. The sample included participants from different academic year levels: First years (N = 916, 64.3%) and Advanced years (N = 509, 35.7%), 85.5% are single (N = 1218), and 14.5% are married (N = 206). Table 1 Demographic characteristics of the sample Age ( M; SD ) 23.1 4.17 N % Academic year level First years 916 64.3 Advanced years 509 35.7 Marital status Single 1218 85.5 Married 206 14.5 Cohabitation status On their own 647 45.4 Parent or guardian's home 778 54.6 Parents’ settlement pattern homogeneous ethnicity 1319 92.6 Mixed ethnicity 106 7.4 Ethnicity Islam 1182 82.9 Christianity 144 10.1 Druze 82 5.8 Religiosity Secular 208 14.6 Religious 1217 85.4 Parents religiosity Secular 97 6.8 Religious 1328 93.2 Table 2 summarizes the clinical characteristics of the study sample. Suicidal ideation was reported by 20.5% of participants (N = 292). Depression and acculturative stress were prevalent, affecting 43.2% (N = 616) and 40.0% (N = 570) of the sample, respectively. Regarding sexual harassment, 27.9% of participants (N = 398) reported experiences during childhood, while 13% (N = 185) reported incidents during their university study. Table 2 Clinical characteristics of the sample N % Suicidal ideation* 292 20.5 Depression 616 43.2 Sexual harassment in childhood 398 27.9 Sexual harassment during university 185 13 Acculturative stress 570 40 * Suicidal ideation was measured during the preceding month Regarding demographic characteristics, students with suicidal ideation showed significantly higher proportions of secular individuals (χ² = 24.04, p < .001), single status (χ² = 12.89, p < .001), and enrollment in the first years of their degree programs (χ² = 8.51, p < .01) compared to those without suicidal ideation (Table 3 ). With respect to clinical characteristics, students with suicidal ideation were significantly younger (t = 1.86, p < .05) and exhibited significantly higher levels of depression (χ²=157.64, p < .001) and acculturative stress (χ²=50.79, p < .001) compared to those without suicidal ideation. Furthermore, the suicidal ideation group reported higher rates of sexual harassment both in childhood (χ²=54.45, p < .001) and during university (χ²=27.98, p < .001). Table 3 Demographic and clinical characteristics in terms of engagement in suicidal ideation Suicidal ideation (n = 292) No suicidal ideation (n = 1133) Test df P Effect size Demographic characteristics Age (M ± SD) 22.65 ± 3.66 23.16 ± 4.29 t = 1.86 1420 0.032 0.122 Academic year level % (N) First years 71.6% (209) 62.4% (707) χ 2 = 8.511 1 < 0.01 0.077 Advanced years 28.4% (83) 37.6% (426) Cohabitation status % (N) On their own 42.1% (123) 46.2% (524) χ 2 = 1.59 1 0.207 0.033 Parent or guardian's home 57.9% (169) 53.8% (609) Marital status % (N) Single 92.1% (269) 83.8% (949) χ 2 = 12.890 1 < 0.001 0.095 Married 7.9% (23) 16.2% (183) Parents’ settlement pattern % (N) homogeneous ethnicity 91.8% (268) 92.8% (1051) χ 2 = 0.325 1 0.569 0.015 Mixed ethnicity 8.2% (24) 7.2% (82) Ethnicity % (N) Islam 85% (238) 83.7% (944) χ 2 = 0.889 2 0.641 0.025 Christianity 10.4% (29) 10.2% (115) Druze 4.6% (13) 6.1% (69) Religiosity % (N) Secular 23.6% (69) 12.3% (139) χ 2 = 24.042 1 < 0.001 0.13 Religious 76.4% (223) 87.7% (994) Parents religiosity % (N) Secular 7.5% (22) 6.6% (75) χ 2 = 0.306 1 0.580 0.15 Religious 92.5% (270) 93.4% (1058) Clinical characteristics Depression % (N) 35.9% (221) 64.1% (395) χ 2 = 157.645 1 < 0.001 0.333 Sexual harassment in childhood % (N) 33.2% (132) 66.8% (266) χ 2 = 54.452 1 < 0.001 0.195 Sexual harassment during university % (N) 35.1% (65) 64.9% (120) χ 2 = 27.983 1 < 0.001 0.140 Acculturative stress % (N) 29.8% (170) 70.2% (400) χ 2 = 50.794 1 < 0.001 0.189 As shown in Table 4 , significant correlations were observed between suicidal ideation and acculturative stress (r = .189, p < .001), depression (r = .333, p < .001), and sexual harassment in childhood (r = .195, p < .001), and sexual harassment during university (r = .14, p < .001). Acculturative stress was significantly correlated with depression (r = .360, p < .001) and sexual harassment experienced both in childhood (r = .137, p < .001) and during university (r = .141, p < .001 Moreover, sexual harassment in childhood and during university were significantly correlated with each other (r = .178, p < .001) and with depression (r = .117, p < .001 and r = .164, p < .001, respectively). Table 4 Pearson correlation between variables 1 2 3 4 5 6 7 8 9 1. academic year level 1 2. Cohabitation status 0.036 1 3. Marital status .147 *** .251 *** 1 4. religiosity 0.014 .170 *** .097 *** 1 5. depression -0.030 0.008 − .093 *** -0.040 1 6. sexual harassment in childhood -0.007 0.034 .060 * − .062 * .117 *** 1 7. sexual harassment during university .056 * -0.046 − .052 * − .130 *** .164 *** .178 *** 1 8. acculturative stress 0.022 0.025 − .055 * − .056 * .360 *** .137 *** .141 *** 1 9. suicidal ideation − .077 ** 0.033 − .095 *** − .130 *** .333 *** .195 *** .140 *** .189 *** 1 Note: *p < .05, **p < .01, ***p < .001 The logistic regression analysis identified several significant associations between suicidal ideation and clinical variables among Arab female students. Higher levels of depression were strongly associated with suicidal ideation (B = 1.574, p < .001), with participants who reported depressive symptoms having 4.83 times higher odds of reporting suicidal ideation (OR = 4.83, 95% CI [3.51–6.63]). Acculturative stress was also significantly associated with suicidal ideation (B = 0.318, p = .03), with participants experiencing acculturative stress having 1.38 times higher odds of reporting suicidal ideation (OR = 1.38, 95% CI [1.02–1.85]). A history of childhood sexual harassment was strongly associated with suicidal ideation (B = 0.792, p < .001), with participants who experienced childhood sexual harassment having 2.21 times higher odds of reporting suicidal ideation (OR = 2.21, 95% CI [1.65–2.96]). While sexual harassment during university was positively associated with suicidal ideation (B = 0.37, p = .053, OR = 1.45, 95% CI [0.99–2.11]), this association approached but did not reach statistical significance, suggesting that university harassment may still play a role and requires further investigation. The Hosmer-Lemeshow test indicated a good fit for the model (Χ² (8) = 2.041, p = 0.98), suggesting that the model adequately describes the associations between the variables and suicidal ideation in this sample. (Table 5 ). Table 5 Logistic regression of correlates of suicidal ideation in the total sample B SE B Wald P OR (CI 95%) Academic year level 1 0.484 0.158 9.41 0.02 1.62 (1.19–2.21) Cohabitation status 2 0.274 0.149 3.384 0.06 1.32 (0.98–1.76) Religiosity 3 0.79 0.187 17.788 < 0.001 2.2 (1.53–3.18) Depression 4 1.574 0.162 94.406 < 0.001 4.83 (3.51–6.63) Acculturative stress 5 0.318 0.153 4.356 0.03 1.38 (1.02–1.85) Sexual harassment in childhood 6 0.792 0.15 27.924 < 0.001 2.21 (1.65–2.96) Sexual harassment during university 7 0.37 0.191 3.744 0.053 1.45 (0.99–2.11) Hosmer & Lemeshow Test of the goodness of fit: Χ 2 (8) = 2.041, p = 0.98 1 reference group – advanced years of university 2 reference group – living in parent or guardian's home 3 reference group – religious 4 reference group – no depression 5 reference group – without acculturative stress 6 reference group – no sexual harassment in childhood 7 reference group – no sexual harassment during university A confirmatory path analysis was conducted to identify both direct and indirect pathways leading to suicidal ideation. The model tested whether depression mediates the effects of acculturative stress and sexual harassment on suicidal ideation. The model demonstrated an acceptable fit to the data (CFI = 0.958, TLI = 0.894, NFI = 0.954, RMSEA = 0.082). Significant direct effects on suicidal ideation were observed for depression (β = 0.376, p < 0.001, SE = 0.002, 95%) and childhood sexual harassment (β = 0.156, p < 0.001, SE = 0.017, 95%). Furthermore, significant indirect effects were identified. Specifically, Sexual harassment experienced in childhood was associated with higher levels of acculturative stress (β = 0.16, p < 0.001), which in turn led to increased depressive symptoms (β = 0.49, p < 0.001), ultimately contributing to suicidal ideation (β = 0.38, p < 0.001). These findings suggest that acculturative stress acts as a significant mediator between childhood sexual harassment and later mental health outcomes. Furthermore, sexual harassment in childhood also had a significant indirect effect on suicidal ideation through its impact on sexual harassment during university (β = 0.25, p < 0.001), which was further linked to depression (β = 0.08, p < 0.001). This indicates a cumulative effect of sexual harassment, where earlier experiences of harassment increased the likelihood of being harassed again during university, which in turn intensified depressive symptoms and contributed to suicidal ideation. (Fig. 1 ). 4. Discussion This study examined how acculturative stress, sexual harassment, and depression contribute to suicidal ideation among Arab female students in Israel. Results showed that depression mediates the impact of acculturative stress and childhood sexual harassment on suicidal ideation. Our path analysis identified two key indirect pathways: one through acculturative stress and another through continued harassment during university. These findings align with research showing that cumulative trauma increases depression and suicidal ideation (Pérez-González & Pereda, 2015 ) and highlight the complex, interconnected nature of the risk factors for suicidal ideation in this population. Consistent with previous research, we found a direct connection between sexual harassment in childhood and suicidal ideation (Bedi et al., 2011 ; Yoon et al., 2018 ) likely due to its severe psychological impact, including low self-esteem, maladaptive coping, and depression (Tsur et al., 2022 ). Survivors often experience PTSD and guilt, which heighten suicidal risk (Decou & Lynch, 2019 ). Additionally, Arab female students face the challenge of balancing traditional cultural norms with Western academic expectations, which can lead to identity conflict, social isolation, and increased vulnerability to depression and suicidal ideation. Addressing these stressors requires culturally competent mental health support and stronger campus interventions. Addressing these cultural challenges requires culturally competent interventions that emphasize both mental health support and fostering a sense of community belonging on campus. Our findings also indicate that sexual harassment in childhood indirectly influences suicidal ideation through acculturative stress. When victims of childhood sexual harassment enter university life and encounter a different majority culture, they often experience heightened acculturative stress (Berry, 2006 ). This stress can intensify depressive symptoms, ultimately contributing to suicidal thoughts. Mangold et al. ( 2010 )demonstrated that both childhood trauma and acculturation independently alter cortisol responses in adults, with exposure to both factors having a worse effect than either alone. Sexual harassment during university also contributes to the relationship between childhood sexual harassment and suicidal ideation. Research consistently shows that women with a history of childhood sexual harassment face higher risks of sexual victimization in university (Campbell et al., 2009 ; Decker & Littleton, 2018 ; Krebs et al., 2007 ; Papalia et al., 2021 ; Ports et al., 2016 ). This heightened vulnerability may be due to various factors. Although the association between sexual harassment during university and suicidal ideation did not reach statistical significance (p = .053), this result was close to the significance threshold. This finding suggests that sexual harassment during university may still have an impact, particularly when considered alongside cumulative traumatic experiences from childhood. Protective factors such as resilience, coping strategies, or institutional support may help buffer the effect of harassment during university life. Future research should explore whether longer-term exposure or more severe harassment intensifies this relationship. Psychologically, childhood sexual harassment can lead to lower self-esteem, increased stress, maladaptive coping mechanisms and impaired risk perception. These effects may make survivors more susceptible to future victimization and less able to recognize or respond to threatening situations (Decker & Littleton, 2018 ). Societal stigma and taboos surrounding sexual harassment also play a significant role, particularly in Arab society, where open discussion of sexuality and sexual violence remains heavily restricted (Attrash-Najjar & Katz, 2023 ; Miller et al., 2011 ). Moreover, the lack of comprehensive sexual education and harassment prevention programs in many Arab societies leave abuse survivors ill-equipped to recognize, prevent, or cope with sexual harassment (Miller et al., 2011 ; Sinai & Shehade, 2019 ; Tahir, 2014 ). This pattern of revictimization can significantly increase the risk of depression and suicidal ideation among survivors. Studies show that individuals who experience multiple sexual assaults tend to exhibit more severe depressive symptoms and higher rates of suicidal thoughts compared to those with a single incident (Campbell et al., 2009 ). More research is needed to explore how universities can better support students with history of sexual harassment, particularly those from minority cultures, in order to prevent repeated victimization. It is notable that while sexual harassment during university was closely associated with suicidal ideation, it did not reach statistical significance. This could be due to the protective factors of certain coping factors developed during adulthood or the relatively shorter duration of exposure compared to childhood experiences. Future studies should explore if factors (personal resilience, campus support system) play roles in buffering the impact of sexual harassment during university on suicidal ideation. In alignment with our initial hypotheses and previous research, our study found a significant association between acculturative stress and suicidal ideation among Arab female students in Israel. This result persisted even when accounting for other risk factors, underscoring the psychological toll of navigating between traditional Arab culture and the predominantly Jewish-Israeli academic environment. The process of acculturation can lead to feelings of isolation, identity conflict, and reduced self-esteem, all of which contribute to increased risk for depression and, consequently, suicidal ideation (Abu-Rayya & Abu-Rayya, 2009 ; Mana et al., 2021 ; Meisler et al., 2023 ; Nakash et al., 2015 ; Torres, 2010 ). While our analysis suggests that the effect of acculturative stress on suicidal ideation is primarily mediated through depression, it's important to note that we did not test for other potential mediating factors. For instance, a sense of belonging, social support, cultural identity, and perceived discrimination may play a role in the relationship between acculturative stress and mental health outcomes (Baeza-Rivera et al., 2022 ; Berry, 2006 ; Kayama & Yamakawa, 2020 ; Nakash et al., 2012 ) were not included in our model. This omission may partially explain the complexity of the relationship between acculturative stress and suicidal ideation in our study. Further studies should examine these potential moderating variables for a more comprehensive understanding of how acculturative stress affects suicidal thoughts in Arab Israeli female students. 4.1 Clinical implications This study highlights the urgent need for culturally sensitive mental health interventions for Arab Israeli female students. Given the strong link between acculturative stress and mental health issues (Abu-Rayya & Abu-Rayya, 2009 ; Mana et al., 2021 ; Meisler et al., 2023 ; Nakash et al., 2015 ; Torres, 2010 ), universities should offer mentorship programs, cultural awareness workshops, and inclusivity initiatives to support students’ adaptation (Byars-Winston et al., 2018 ; Cisneros et al., 2023 ; Eden et al., 2024 ; Rodrigues et al., 2023 ). Sexual harassment, particularly in childhood, significantly increases mental health risks and the likelihood of revictimization. However, the Arab community faces barriers such as limited mental health resources and social taboos around sexual abuse (Elroy et al., 2017 ; Mansbach-Kleinfeld et al., 2010 ; Tahir, 2014 ). Interventions should include support groups, peer mentorship programs, and campus-based workshops that educate students on sexual harassment and coping strategies in a culturally appropriate manner. Moreover, as a very traditional culture, discussions about sex remain taboo, and childhood sexual harassment is frequently underreported and inadequately addressed (Attrash-Najjar & Katz, 2023 ). Universities should also ensure that students with a history of sexual harassment receive targeted mental health resources to prevent repeated victimization and reduce long-term psychological distress (Krebs et al., 2007 ). Lastly, there is a significant research gap regarding suicidal ideation among Arab students in Israel. More extensive data collection is needed to develop effective suicide prevention programs tailored to this population (Auerbach et al., 2018 ; Ibrahim et al., 2013 ; Mortier et al., 2018 ). 4.2 limitations This study has several limitations that should be considered. First, the cross-sectional nature of our study limits our ability to establish causal relationships. Longitudinal designs could help better understand the complex interplay of factors contributing to suicidal ideation. Second, the focus on Arab female students in Israel limits the generalizability of our findings to other minority populations, particularly in Western countries where Arabs are often immigrants rather than an indigenous minority. The unique sociopolitical context of Arabs in Israel may result in experiences of acculturation and discrimination that differ from those of Arab minorities elsewhere. Third, our reliance on self-reporting tools created potential biases, as participants may not always provide truthful responses, especially regarding sensitive topics like mental health and sexual experiences. This limitation is particularly salient given the cultural taboos surrounding sexuality in Arab society (Attrash-Najjar & Katz, 2023 ), which may have led to underreporting questions related to sexual harassment. Fourth, our recruitment process, which utilized a snowball sampling method, may have introduced selection bias, potentially overrepresenting individuals with similar characteristics or experiences. Finally, our assessment of sexual harassment experiences, both in childhood and during university, was based on only two self-reported questions from a validated questionnaire rather than the full instrument. This may have failed to capture the full complexity and nuance of participants' experiences. 4.3 Conclusion This study highlights the link between acculturative stress, sexual harassment, and suicidal ideation among Arab female students. Findings emphasize the need for culturally sensitive mental health interventions and sexual harassment prevention programs. Addressing these challenges can foster safer, more inclusive academic environments and reduce suicide risk among minority students. Declarations Author Contribution A.B. wrote the main manuscript text, and S.H. supervised the study and contributed to the analysis. Both authors reviewed and approved the final manuscript. References Abu-Rayya HM, Abu-Rayya MH (2009) Acculturation, religious identity, and psychological well-being among Palestinians in Israel. 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Omega-Journal Death Dying. https://doi.org/10.1177/00302228241252531 Krebs CP, Lindquist CH, Warner TD, Fisher BS, Martin SL (2007) The campus sexual assault (CSA) study: Final report. Washington, DC: National Institute of Justice, US Department of Justice . https://www.ncjrs.gov/pdffiles1/nij/grants/221153.pdf Kroenke K, Spitzer RL, Williams JBW (2001) The PHQ-9. J Gen Intern Med 16(9):606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x Lindert J, von Ehrenstein OS, Grashow R, Gal G, Braehler E, Weisskopf MG (2014) Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis. Int J Public Health 59(2):359–372. https://doi.org/10.1007/s00038-013-0519-5 Mana A, Srour A, Sagy S (2021) Sense of Community Coherence, Perceptions of Collective Narratives, and Identity Strategies in Intra- and Interreligious Group Conflicts. Peace Conflict-Journal Peace Psychol 27(4):669–673. https://doi.org/10.1037/pac0000538 Mangold D, Wand G, Javors M, Mintz J (2010) Acculturation, childhood trauma and the cortisol awakening response in Mexican-American adults. Horm Behav 58(4):637–646. https://doi.org/10.1016/j.yhbeh.2010.06.010 Mansbach-Kleinfeld I, Farbstein I, Levinson D, Apter A, Erhard R, Palti H, Geraisy N, Brent DA, Ponizovsky AM, Levav I (2010) Service Use for Mental Disorders and Unmet Need: Results From the Israel Survey on Mental Health Among Adolescents. Psychiatric Serv 61(3):241–249 ://WOS:000275056500007 Meisler S, Sleman S, Orgler M, Tossman I, Hamdan S (2023) Examining the relationship between non-suicidal self-injury and mental health among female Arab minority students: the role of identity conflict and acculturation stress. Front Psychiatry 14:1247175. https://doi.org/10.3389/fpsyt.2023.1247175 Mena FJ, Padilla AM, Maldonado M (1987) Acculturative Stress and Specific Coping Strategies among Immigrant and Later Generation College Students. Hispanic J Behav Sci 9(2):207–225. https://doi.org/10.1177/07399863870092006 Miller AK, Canales EJ, Amacker AM, Backstrom TL, Gidycz CA (2011) Stigma-Threat Motivated Nondisclosure of Sexual Assault and Sexual Revictimization: A Prospective Analysis. Psychol Women Q 35(1):119–128. https://doi.org/10.1177/0361684310384104 Ministry of Welfare and Social Affairs (2022) 9% increase in the number of children treated in centers for child and youth victims of sexual assault in 2022 . Government of Israel. https://www.gov.il/he/pages/molsa-news-violence-and-delinquency-violence-and-sexual-assault-29062023 Mortier P, Cuijpers P, Kiekens G, Auerbach RP, Demyttenaere K, Green JG, Kessler RC, Nock MK, Bruffaerts R (2018) The prevalence of suicidal thoughts and behaviours among college students: a meta-analysis. Psychol Med 48(4):554–565. https://doi.org/10.1017/s0033291717002215 Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP (1993) Childhood Sexual Abuse and Mental Health in Adult Life. Br J Psychiatry 163(6):721–732. https://doi.org/10.1192/bjp.163.6.721 Nakash O, Nagar M, Shoshani A, Lurie I (2015) The Association Between Acculturation Patterns and Mental Health Symptoms Among Eritrean and Sudanese Asylum Seekers in Israel. Cult Divers Ethn Minor Psychol 21(3):468–476. https://doi.org/10.1037/a0037534 Nakash O, Nagar M, Shoshani A, Zubida H, Harper RA (2012) The Effect of Acculturation and Discrimination on Mental Health Symptoms and Risk Behaviors Among Adolescent Migrants in Israel. Cult Divers Ethn Minor Psychol 18(3):228–238. https://doi.org/10.1037/a0027659 Papalia N, Mann E, Ogloff JRP (2021) Child Sexual Abuse and Risk of Revictimization: Impact of Child Demographics, Sexual Abuse Characteristics, and Psychiatric Disorders. Child Maltreat 26(1):74–86 Article 1077559520932665. https://doi.org/10.1177/1077559520932665 Pérez-González A, Pereda N (2015) Systematic review of the prevalence of suicidal ideation and behavior in minors who have been sexually abused. Actas Esp De Psiquiatria 43(4):149–158 ://WOS:000358339500004 Ports KA, Ford DC, Merrick MT (2016) Adverse childhood experiences and sexual victimization in adulthood. Child Abuse Negl 51:313–322. https://doi.org/10.1016/j.chiabu.2015.08.017 Posner K, Brent D, Lucas C, Gould M, Stanley B, Brown G, Fisher P, Zelazny J, Burke A, Oquendo M (2008) Columbia-suicide severity rating scale (C-SSRS). New York, NY: Columbia University Medical Center , 10 , 2008 Rodrigues RB, Donald J, Seniuk Cicek J, Miller-Koran F, Kia J, Y., Donald S (2023) June 18–21, 2023). Engineering Leadership and Cultural Awareness Development Through a Student-Led Workshop Canadian Engineering Education Association-Association canadienne de l'éducation en génie (CEEA-ACÉG23), Okanagan College & UBC-Okanagan. https://ceea.ca/conference/conference-2023/ Sheleg Mi-Ami N (2010) Suicides in Israel by sector: Jews and Arabs . The Knesset Research and Information Center. https://fs.knesset.gov.il/globaldocs/MMM/12bf8d55-f7f7-e411-80c8-00155d010977/2_12bf8d55-f7f7-e411-80c8-00155d010977_11_6914.pdf Sinai M, Shehade FM (2019) Let’s (Not) Talk about Sex: Challenges in Integrating Sex Education in Traditional Arabic Society in Israel. Int J Advancement Counselling 41(3):361–375. https://doi.org/10.1007/s10447-018-9355-x State Comptroller of Israel (2012) The handling of Sexual Harassment Cases by Higher Education Institutions . https://www.mevaker.gov.il/sites/DigitalLibrary/Documents/63c/2013-63c-302-hatrada.pdf Tahir Z (2014) Sex education in the Middle East: Promising or punishing? An insight to perceptions and reality. Georgetown University. http://www.academia.edu/9891766/Sex_education_in_the_Middle_East Torres L (2010) Predicting Levels of Latino Depression: Acculturation, Acculturative Stress, and Coping. Cult Divers Ethn Minor Psychol 16(2):256–263. https://doi.org/10.1037/a0017357 Tsur N, Najjar AA, Katz C (2022) Explode into small pieces: Suicidal ideation among child sexual abuse survivors. Child Abuse Negl., 131, Article 105780 https://doi.org/10.1016/j.chiabu.2022.105780 Yoon Y, Cederbaum JA, Schwartz A (2018) Childhood sexual abuse and current suicidal ideation among adolescents: Problem-focused and emotion-focused coping skills. J Adolesc 67:120–128. https://doi.org/10.1016/j.adolescence.2018.06.009 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6149387","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":424967040,"identity":"f042b9d2-a90b-46cc-8f5a-30af9b2ab46b","order_by":0,"name":"Anat Bunimovich","email":"","orcid":"","institution":"Academic College of Tel Aviv-Yafo","correspondingAuthor":false,"prefix":"","firstName":"Anat","middleName":"","lastName":"Bunimovich","suffix":""},{"id":424967041,"identity":"e0255d67-554c-4beb-812a-8bb60a5083a4","order_by":1,"name":"Sami Hamdan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYJCCw0DM2A/jsbETq2VmAzNUCzMRWkBqGDccYEbi4gPy7acTDxfUbJPdfO38wQ8MNXYMfIS0GJzJ3XB4xrHbxttuJzNLMBxLJuwwAwagFh6224lALQwSDGwHCGuR738L1PLvduLm2cnMPxj+EaGF4QbQFt6224kbpJPZJBjbiNBicANoC2/fbeMZt5PNLBL7knmIcFju5s88327L9s9OfHzjwzc7Ofn2BkIuQwYJDAw8pKgfBaNgFIyCUYADAADddUIpl8k2zwAAAABJRU5ErkJggg==","orcid":"","institution":"Academic College of Tel Aviv-Yafo","correspondingAuthor":true,"prefix":"","firstName":"Sami","middleName":"","lastName":"Hamdan","suffix":""}],"badges":[],"createdAt":"2025-03-03 22:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6149387/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6149387/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78237212,"identity":"cc405e26-f157-454b-804a-e3371d7139a6","added_by":"auto","created_at":"2025-03-11 08:36:37","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":169837,"visible":true,"origin":"","legend":"\u003cp\u003ePath Analysis of associations among sexual harassment, acculturative stress, depression, and suicidal ideation\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote. *p \u0026lt; .05, **p \u0026lt; .01, ***p \u0026lt; .001\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6149387/v1/efb8417073abf529ddcf9b81.jpeg"},{"id":79053741,"identity":"c3068ef5-f06a-4c97-9499-773a55751d29","added_by":"auto","created_at":"2025-03-23 19:31:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1118436,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6149387/v1/6c99c2cb-b14f-43a3-9528-c013dca80dad.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Navigating Cultural and Psychological Barriers: Acculturative Stress, Sexual Harassment, and Suicidal Ideation Among Arab Female Students","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe academic environment, while offering opportunities for growth and development, can also present significant stressors that may contribute to mental health challenges (Hern\u0026aacute;ndez-Torrano et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Minority students, particularly those from ethnic or religious backgrounds, face additional stressors in academic environments that exacerbate their mental health vulnerabilities. Among these groups, Arab female students in Israel experience a unique intersection of ethnic and gender-based stressors, increasing their vulnerability to mental health issues such as depression and suicidal ideation (Attrash-Najjar \u0026amp; Katz, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Benatov et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Geiger, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Despite growing awareness of mental health disparities among minority populations, research on the combined effects of acculturative stress and sexual harassment on Arab students in Israel remains limited.\u003c/p\u003e \u003cp\u003eMental health concerns among college students are a global issue. Studies indicate that 22.3% of students report lifetime suicidal ideation, and approximately 30.6% experience depressive symptoms, rates significantly higher than in the general population (Ibrahim et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Mortier et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In Israel, research suggests that 40.4% of students experience some level of depression, while 15.1% report suicidal ideation (Klugman et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).These rates highlight the urgent need to explore the unique psychological stressors affecting Arab female students, who navigate the pressures of both academic demands and cultural expectations.\u003c/p\u003e \u003cp\u003eIsrael is a multicultural society where Arab students, as a minority, experience distinct sociopolitical and cultural pressures. While suicide rates among Jewish Israelis are generally higher than those among Arabs, suicides among Arab individuals tend to occur at younger ages, with 71% of cases involving individuals under 45 (Israel Ministry of Health, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). One explanation for this trend is the waning influence of traditional cultural and religious norms that historically discouraged suicidal behavior (Klomek et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Sheleg Mi-Ami, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). As younger Arab students are increasingly exposed to Western cultural values, they may experience greater acculturative stress, which has been linked to various mental health difficulties, including depression and suicidal ideation.\u003c/p\u003e \u003cp\u003eAcculturative stress arises when individuals struggle to balance the expectations of two distinct cultural frameworks (Berry, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Arab female students in Israeli universities must navigate between traditional cultural values and the norms of a predominantly Western academic environment, often leading to identity conflicts, social isolation, and diminished self-esteem- key risk factors for mental health deterioration (Abu-Rayya \u0026amp; Abu-Rayya, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Mana et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Nakash et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Torres, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). While acculturative stress has been widely studied in immigrant populations, its effects on indigenous minorities, such as Arab students in Israel, require further investigation.\u003c/p\u003e \u003cp\u003eBeyond acculturative stress, \u003cb\u003esexual harassment\u003c/b\u003e is a pervasive issue that significantly impacts mental health. It encompasses a range of non-consensual sexual activities, both physical and verbal, and is linked to PTSD, depression, and suicidal ideation. (Bergen et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Mullen et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e1993\u003c/span\u003e). Childhood sexual harassment, in particular, has severe long-term effects, increasing the risk of depression, self-esteem issues, and interpersonal difficulties (Lindert et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). In Israel, nearly half of reported cases occur within families, and survivors are twice as likely to attempt suicide (Ministry of Welfare and Social Affairs, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe impact of sexual harassment extends beyond childhood, as college students - particularly women - face elevated risks of harassment during their academic years. Studies show that 20\u0026ndash;25% of female students experience sexual assault during college (Carey et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). However, due to social stigma, only a small fraction of victims report their experiences (State Comptroller of Israel, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The cumulative impact of sexual trauma, particularly when experienced in both childhood and university, significantly increases the risk of developing psychiatric conditions such as depression, PTSD, and suicidal ideation (Campbell et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Classen et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe intersection of cultural identity, gender, and higher education creates a complex mental health landscape for Arab female students in Israel. As they navigate conflicting demands from their cultural background and academic environment, experiences of sexual harassment further exacerbate their vulnerability, contributing to severe psychological distress (Benatov et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Additionally, cultural stigma often discourages Arab women from reporting sexual harassment, leaving victims without necessary support and increasing their sense of isolation (Attrash-Najjar \u0026amp; Katz, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study aims to explore the impact of acculturative stress and sexual harassment, both in childhood and during the university, on depression and suicidal ideation among Arab female students in Israel. Specifically, we investigate how these factors interact and contribute to suicidal ideation through direct and indirect pathways. Based on prior research, we hypothesize that (1) Higher levels of acculturative stress will be associated with increased depressive symptoms and more frequent suicidal ideation, (2) Sexual harassment (in childhood and during university) will be positively correlated with depressive symptoms, and suicidal ideation (3) depressive symptoms will mediate the relation between acculturative stress and suicidal ideation (4) the cumulative effect of sexual harassment (both in childhood and university) will increase the risk for depressive symptoms suicidal ideation. Furthermore, we anticipate that (5) sexual harassment in childhood will have indirect effects on suicidal ideation, mediated by depressive symptoms.\u003c/p\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants\u003c/h2\u003e \u003cp\u003eThis study included 1,425 Arab female students (M\u0026thinsp;=\u0026thinsp;23.1 years, SD\u0026thinsp;=\u0026thinsp;4.17) enrolled in various academic institutions across Israel. Participants self-identified as either religious (85.4%) or secular (14.6%). The inclusion criteria required students to (1) self-identify as Arab female students and (2) be enrolled in an academic institution in Israel. Participants who did not meet these criteria were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Procedure\u003c/h2\u003e \u003cp\u003eParticipants were recruited through social media advertisements on platforms such as Facebook and Instagram, face-to-face outreach in university common areas, and a snowball sampling method, where initial participants were encouraged to share the study link within their networks. All participants provided informed consent, and their responses remained anonymous and confidential. The study received ethical approval from the Institutional Review Board (IRB) at the Academic College of Tel-Aviv-Yaffo. To ensure participant well-being, links to mental health resources were provided in case of distress caused by the survey questions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Measures\u003c/h2\u003e \u003cp\u003e \u003cem\u003eSuicidal ideation (Columbia-Suicide Severity Rating Scale \u0026ndash; C-SSRS)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSuicidal ideation was assessed using a modified item from the Columbia-Suicide Severity Rating Scale (C-SSRS) (Posner et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Participants responded (Yes/No) to the question: \u003cem\u003e\"Have you had any thoughts of killing yourself in the past month?\".\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003ePatient Health Questionnaire-9 (PHQ-9)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eDepression severity was measured using the 9-item PHQ-9 (Kroenke et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). Participants rated symptoms on a 4-point Likert scale (0\u0026thinsp;=\u0026thinsp;not at all, 3\u0026thinsp;=\u0026thinsp;nearly every day). Scores\u0026thinsp;\u0026ge;\u0026thinsp;10 indicated clinically significant depression. The Arabic version of PHQ-9 was used, with α\u0026thinsp;=\u0026thinsp;.90 in this study.\u003c/p\u003e \u003cp\u003e \u003cem\u003eAcculturation Stress Scale \u0026ndash; Revised (SAFE-R)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe Social, Attitudinal, Familial and Environmental Acculturation Stress Scale (SAFE-R) (Mena et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e1987\u003c/span\u003e) is a self-report questionnaire aimed to assess negative stressors experienced by both immigrant and later-generation individuals as they acculturate to the host culture (e.g., \"I don't feel at home\"). Participants rated 28 items on a 4-point scale (0\u0026thinsp;=\u0026thinsp;no stress, 3\u0026thinsp;=\u0026thinsp;extremely stressful), with higher scores indicating greater acculturative stress. A cut-off score of 56 was used, with α\u0026thinsp;=\u0026thinsp;.89 in this study.\u003c/p\u003e \u003cp\u003e \u003cem\u003eSexual harassment questionnaire\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSexual harassment was assessed using questions adapted from the AAU Campus Climate Survey on Sexual Assault and Sexual Misconduct (Cantor et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Participants were asked to respond to two sets of questions: (1) harassment experienced during their time at the university and (2) harassment experienced during adolescence or childhood (before the age of 18). The items evaluated whether participants had experienced any form of sexual harassment, such as unwanted sexual comments, offensive sexual jokes, or inappropriate sexual advances. Responses were given on a yes/no basis, with any affirmative answer being classified as an experience of sexual harassment. Examples of the questions include: \u0026ldquo;\u003cem\u003eSince you have been a student at [University or College], has a student, or someone employed by or otherwise associated with [University] made sexual remarks that were insulting or offensive to you?\u003c/em\u003e\u0026rdquo; or \u0026ldquo;\u003cem\u003eSince you have been a student at [University or college], has a student, or someone employed by or otherwise associated with [University or college] have sex even though you said, \u0026ldquo;No\u003c/em\u003e\u0026rdquo;?. Similar questions were asked to assess experiences of harassment before attending the university. The Arabic-translated version was piloted for cultural appropriateness, with α\u0026thinsp;=\u0026thinsp;.75 in this study.\u003c/p\u003e \u003cp\u003e \u003cem\u003eDemographics Variables\u003c/em\u003e \u003c/p\u003e \u003cp\u003eDemographic information about age, marital status, student and parents' residence, academic institution, academic year of study, religion, and religiosity were also obtained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using IBM SPSS Statistics (Version 27.0) and AMOS software for path analysis. Descriptive statistics, including means, standard deviations, frequencies, and percentages, were computed to summarize the demographic and clinical characteristics of the sample. Differences between participants with and without suicidal ideation were examined using chi-square tests for categorical variables and t-tests for continuous variables.\u003c/p\u003e \u003cp\u003eA hierarchical logistic regression model was conducted to assess the relationship between depression, acculturation stress, sexual harassment in childhood and during the university, and the likelihood of reporting suicidal ideation. In the first step, demographic variables (age, religiosity, marital status) were entered to control for potential confounding effects. In the second step, clinical predictors, including depression, acculturative stress, and experiences of sexual harassment, were added to the model. Odd Ratio (OR) with 95% confidence intervals (CIs) were reported to quantify the likelihood of participants reporting suicidal ideation for each variable. The Hosmer \u0026ndash; Lemeshow goodness of fit test was used to ensure the overall fit of the regression model.\u003c/p\u003e \u003cp\u003eTo explore the indirect effects of acculturative stress and sexual harassment on suicidal ideation, a confirmatory path analysis was conducted using AMOS software. The model tested whether depression mediated these relationships. Model fit was assessed using the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Normed Fit Index (NFI), and Root Mean Square Error of Approximation (RMSEA), with good fit criteria set at CFI, TLI, and NFI\u0026thinsp;\u0026ge;\u0026thinsp;.90 and RMSEA\u0026thinsp;\u0026le;\u0026thinsp;.08. To account for multiple comparisons, Bonferroni corrections were applied, and a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;.05 was used for all statistical tests.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e represents the characteristics of the study population, which included 1,425 participants aged 17\u0026ndash;54 years. The sample included participants from different academic year levels: First years (N\u0026thinsp;=\u0026thinsp;916, 64.3%) and Advanced years (N\u0026thinsp;=\u0026thinsp;509, 35.7%), 85.5% are single (N\u0026thinsp;=\u0026thinsp;1218), and 14.5% are married (N\u0026thinsp;=\u0026thinsp;206).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (\u003cem\u003eM; SD\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.17\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcademic year level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e916\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvanced years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCohabitation status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn their own\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParent or guardian's home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParents\u0026rsquo; settlement pattern\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehomogeneous ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDruze\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligiosity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParents religiosity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the clinical characteristics of the study sample. Suicidal ideation was reported by 20.5% of participants (N\u0026thinsp;=\u0026thinsp;292). Depression and acculturative stress were prevalent, affecting 43.2% (N\u0026thinsp;=\u0026thinsp;616) and 40.0% (N\u0026thinsp;=\u0026thinsp;570) of the sample, respectively. Regarding sexual harassment, 27.9% of participants (N\u0026thinsp;=\u0026thinsp;398) reported experiences during childhood, while 13% (N\u0026thinsp;=\u0026thinsp;185) reported incidents during their university study.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of the sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuicidal ideation*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual harassment in childhood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual harassment during university\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcculturative stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*\u003cem\u003eSuicidal ideation was measured during the preceding month\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding demographic characteristics, students with suicidal ideation showed significantly higher proportions of secular individuals (χ\u0026sup2; = 24.04, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), single status (χ\u0026sup2; = 12.89, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), and enrollment in the first years of their degree programs (χ\u0026sup2; = 8.51, p\u0026thinsp;\u0026lt;\u0026thinsp;.01) compared to those without suicidal ideation (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWith respect to clinical characteristics, students with suicidal ideation were significantly younger (t\u0026thinsp;=\u0026thinsp;1.86, p\u0026thinsp;\u0026lt;\u0026thinsp;.05) and exhibited significantly higher levels of depression (χ\u0026sup2;=157.64, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and acculturative stress (χ\u0026sup2;=50.79, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) compared to those without suicidal ideation. Furthermore, the suicidal ideation group reported higher rates of sexual harassment both in childhood (χ\u0026sup2;=54.45, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and during university (χ\u0026sup2;=27.98, p\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and clinical characteristics in terms of engagement in suicidal ideation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuicidal ideation (n\u0026thinsp;=\u0026thinsp;292)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo suicidal ideation (n\u0026thinsp;=\u0026thinsp;1133)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEffect size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDemographic characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.65\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic year level % (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.6% (209)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.4% (707)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;8.511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvanced years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.4% (83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.6% (426)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCohabitation status % (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn their own\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.1% (123)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.2% (524)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParent or guardian's home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.9% (169)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.8% (609)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status % (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92.1% (269)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.8% (949)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;12.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.9% (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.2% (183)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents\u0026rsquo; settlement pattern % (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehomogeneous ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.8% (268)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.8% (1051)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.2% (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.2% (82)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity % (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85% (238)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.7% (944)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristianity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.4% (29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.2% (115)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDruze\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.6% (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.1% (69)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligiosity % (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.6% (69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.3% (139)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;24.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76.4% (223)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.7% (994)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents religiosity % (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.5% (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.6% (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92.5% (270)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.4% (1058)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression % (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.9% (221)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.1% (395)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;157.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual harassment in childhood % (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.2% (132)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.8% (266)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;54.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual harassment during university % (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.1% (65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.9% (120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;27.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcculturative stress % (N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.8% (170)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.2% (400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;50.794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, significant correlations were observed between suicidal ideation and acculturative stress (r\u0026thinsp;=\u0026thinsp;.189, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), depression (r\u0026thinsp;=\u0026thinsp;.333, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), and sexual harassment in childhood (r\u0026thinsp;=\u0026thinsp;.195, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), and sexual harassment during university (r\u0026thinsp;=\u0026thinsp;.14, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Acculturative stress was significantly correlated with depression (r\u0026thinsp;=\u0026thinsp;.360, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and sexual harassment experienced both in childhood (r\u0026thinsp;=\u0026thinsp;.137, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and during university (r\u0026thinsp;=\u0026thinsp;.141, p\u0026thinsp;\u0026lt;\u0026thinsp;.001 Moreover, sexual harassment in childhood and during university were significantly correlated with each other (r\u0026thinsp;=\u0026thinsp;.178, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and with depression (r\u0026thinsp;=\u0026thinsp;.117, p\u0026thinsp;\u0026lt;\u0026thinsp;.001 and r\u0026thinsp;=\u0026thinsp;.164, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, respectively).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson correlation between variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. academic year level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Cohabitation status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Marital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.147\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.251\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. religiosity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.170\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.097\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.093\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. sexual harassment in childhood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.060\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.062\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.117\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. sexual harassment during university\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.056\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.052\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.130\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.164\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.178\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. acculturative stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.055\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.056\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.360\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.137\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.141\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. suicidal ideation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.077\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.095\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.130\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.333\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.195\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.140\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.189\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eNote: *p\u0026thinsp;\u0026lt;\u0026thinsp;.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;.01, ***p\u0026thinsp;\u0026lt;\u0026thinsp;.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe logistic regression analysis identified several significant associations between suicidal ideation and clinical variables among Arab female students. Higher levels of depression were strongly associated with suicidal ideation (B\u0026thinsp;=\u0026thinsp;1.574, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), with participants who reported depressive symptoms having 4.83 times higher odds of reporting suicidal ideation (OR\u0026thinsp;=\u0026thinsp;4.83, 95% CI [3.51\u0026ndash;6.63]). Acculturative stress was also significantly associated with suicidal ideation (B\u0026thinsp;=\u0026thinsp;0.318, p\u0026thinsp;=\u0026thinsp;.03), with participants experiencing acculturative stress having 1.38 times higher odds of reporting suicidal ideation (OR\u0026thinsp;=\u0026thinsp;1.38, 95% CI [1.02\u0026ndash;1.85]). A history of childhood sexual harassment was strongly associated with suicidal ideation (B\u0026thinsp;=\u0026thinsp;0.792, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), with participants who experienced childhood sexual harassment having 2.21 times higher odds of reporting suicidal ideation (OR\u0026thinsp;=\u0026thinsp;2.21, 95% CI [1.65\u0026ndash;2.96]). While sexual harassment during university was positively associated with suicidal ideation (B\u0026thinsp;=\u0026thinsp;0.37, p\u0026thinsp;=\u0026thinsp;.053, OR\u0026thinsp;=\u0026thinsp;1.45, 95% CI [0.99\u0026ndash;2.11]), this association approached but did not reach statistical significance, suggesting that university harassment may still play a role and requires further investigation. The Hosmer-Lemeshow test indicated a good fit for the model (Χ\u0026sup2; (8)\u0026thinsp;=\u0026thinsp;2.041, p\u0026thinsp;=\u0026thinsp;0.98), suggesting that the model adequately describes the associations between the variables and suicidal ideation in this sample. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression of correlates of suicidal ideation in the total sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003csub\u003eB\u003c/sub\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWald\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (CI 95%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcademic year level\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.62 (1.19\u0026ndash;2.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCohabitation status\u003c/b\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.32 (0.98\u0026ndash;1.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligiosity\u003c/b\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.2 (1.53\u0026ndash;3.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepression\u003c/b\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.83 (3.51\u0026ndash;6.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcculturative stress\u003c/b\u003e\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.38 (1.02\u0026ndash;1.85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual harassment in childhood\u003c/b\u003e\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.21 (1.65\u0026ndash;2.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual harassment during university\u003c/b\u003e\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.744\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.45 (0.99\u0026ndash;2.11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eHosmer \u0026amp; Lemeshow Test of the goodness of fit: Χ\u003csup\u003e2\u003c/sup\u003e (8)\u0026thinsp;=\u0026thinsp;2.041, p\u0026thinsp;=\u0026thinsp;0.98\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e1\u003c/sup\u003e reference group \u0026ndash; advanced years of university\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e2\u003c/sup\u003e reference group \u0026ndash; living in parent or guardian's home\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e3\u003c/sup\u003e reference group \u0026ndash; religious\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e4\u003c/sup\u003e reference group \u0026ndash; no depression\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e5\u003c/sup\u003e reference group \u0026ndash; without acculturative stress\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e6\u003c/sup\u003e reference group \u0026ndash; no sexual harassment in childhood\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e7\u003c/sup\u003e reference group \u0026ndash; no sexual harassment during university\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA confirmatory path analysis was conducted to identify both direct and indirect pathways leading to suicidal ideation. The model tested whether depression mediates the effects of acculturative stress and sexual harassment on suicidal ideation. The model demonstrated an acceptable fit to the data (CFI\u0026thinsp;=\u0026thinsp;0.958, TLI\u0026thinsp;=\u0026thinsp;0.894, NFI\u0026thinsp;=\u0026thinsp;0.954, RMSEA\u0026thinsp;=\u0026thinsp;0.082). Significant direct effects on suicidal ideation were observed for depression (β\u0026thinsp;=\u0026thinsp;0.376, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, SE\u0026thinsp;=\u0026thinsp;0.002, 95%) and childhood sexual harassment (β\u0026thinsp;=\u0026thinsp;0.156, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, SE\u0026thinsp;=\u0026thinsp;0.017, 95%). Furthermore, significant indirect effects were identified. Specifically, Sexual harassment experienced in childhood was associated with higher levels of acculturative stress (β\u0026thinsp;=\u0026thinsp;0.16, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), which in turn led to increased depressive symptoms (β\u0026thinsp;=\u0026thinsp;0.49, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ultimately contributing to suicidal ideation (β\u0026thinsp;=\u0026thinsp;0.38, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings suggest that \u003cb\u003eacculturative stress\u003c/b\u003e acts as a significant mediator between childhood sexual harassment and later mental health outcomes. Furthermore, sexual harassment in childhood also had a significant indirect effect on suicidal ideation through its impact on sexual harassment during university (β\u0026thinsp;=\u0026thinsp;0.25, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), which was further linked to depression (β\u0026thinsp;=\u0026thinsp;0.08, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This indicates a \u003cb\u003ecumulative effect\u003c/b\u003e of sexual harassment, where earlier experiences of harassment increased the likelihood of being harassed again during university, which in turn intensified depressive symptoms and contributed to suicidal ideation. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e "},{"header":"4. Discussion","content":"\u003cp\u003eThis study examined how acculturative stress, sexual harassment, and depression contribute to suicidal ideation among Arab female students in Israel. Results showed that depression mediates the impact of acculturative stress and childhood sexual harassment on suicidal ideation. Our path analysis identified two key indirect pathways: one through acculturative stress and another through continued harassment during university. These findings align with research showing that cumulative trauma increases depression and suicidal ideation (P\u0026eacute;rez-Gonz\u0026aacute;lez \u0026amp; Pereda, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and highlight the complex, interconnected nature of the risk factors for suicidal ideation in this population.\u003c/p\u003e \u003cp\u003eConsistent with previous research, we found a direct connection between sexual harassment in childhood and suicidal ideation (Bedi et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Yoon et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) likely due to its severe psychological impact, including low self-esteem, maladaptive coping, and depression (Tsur et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Survivors often experience PTSD and guilt, which heighten suicidal risk (Decou \u0026amp; Lynch, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Additionally, Arab female students face the challenge of balancing traditional cultural norms with Western academic expectations, which can lead to identity conflict, social isolation, and increased vulnerability to depression and suicidal ideation. Addressing these stressors requires culturally competent mental health support and stronger campus interventions. Addressing these cultural challenges requires culturally competent interventions that emphasize both mental health support and fostering a sense of community belonging on campus.\u003c/p\u003e \u003cp\u003eOur findings also indicate that sexual harassment in childhood indirectly influences suicidal ideation through acculturative stress. When victims of childhood sexual harassment enter university life and encounter a different majority culture, they often experience heightened acculturative stress (Berry, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). This stress can intensify depressive symptoms, ultimately contributing to suicidal thoughts. Mangold et al. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2010\u003c/span\u003e)demonstrated that both childhood trauma and acculturation independently alter cortisol responses in adults, with exposure to both factors having a worse effect than either alone.\u003c/p\u003e \u003cp\u003eSexual harassment during university also contributes to the relationship between childhood sexual harassment and suicidal ideation. Research consistently shows that women with a history of childhood sexual harassment face higher risks of sexual victimization in university (Campbell et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Decker \u0026amp; Littleton, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Krebs et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Papalia et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Ports et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This heightened vulnerability may be due to various factors. Although the association between sexual harassment during university and suicidal ideation did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;.053), this result was close to the significance threshold. This finding suggests that sexual harassment during university may still have an impact, particularly when considered alongside cumulative traumatic experiences from childhood. Protective factors such as resilience, coping strategies, or institutional support may help buffer the effect of harassment during university life. Future research should explore whether longer-term exposure or more severe harassment intensifies this relationship. Psychologically, childhood sexual harassment can lead to lower self-esteem, increased stress, maladaptive coping mechanisms and impaired risk perception. These effects may make survivors more susceptible to future victimization and less able to recognize or respond to threatening situations (Decker \u0026amp; Littleton, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Societal stigma and taboos surrounding sexual harassment also play a significant role, particularly in Arab society, where open discussion of sexuality and sexual violence remains heavily restricted (Attrash-Najjar \u0026amp; Katz, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Miller et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Moreover, the lack of comprehensive sexual education and harassment prevention programs in many Arab societies leave abuse survivors ill-equipped to recognize, prevent, or cope with sexual harassment (Miller et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Sinai \u0026amp; Shehade, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Tahir, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). This pattern of revictimization can significantly increase the risk of depression and suicidal ideation among survivors. Studies show that individuals who experience multiple sexual assaults tend to exhibit more severe depressive symptoms and higher rates of suicidal thoughts compared to those with a single incident (Campbell et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). More research is needed to explore how universities can better support students with history of sexual harassment, particularly those from minority cultures, in order to prevent repeated victimization. It is notable that while sexual harassment during university was closely associated with suicidal ideation, it did not reach statistical significance. This could be due to the protective factors of certain coping factors developed during adulthood or the relatively shorter duration of exposure compared to childhood experiences. Future studies should explore if factors (personal resilience, campus support system) play roles in buffering the impact of sexual harassment during university on suicidal ideation.\u003c/p\u003e \u003cp\u003eIn alignment with our initial hypotheses and previous research, our study found a significant association between acculturative stress and suicidal ideation among Arab female students in Israel. This result persisted even when accounting for other risk factors, underscoring the psychological toll of navigating between traditional Arab culture and the predominantly Jewish-Israeli academic environment. The process of acculturation can lead to feelings of isolation, identity conflict, and reduced self-esteem, all of which contribute to increased risk for depression and, consequently, suicidal ideation (Abu-Rayya \u0026amp; Abu-Rayya, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Mana et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Meisler et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Nakash et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Torres, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). While our analysis suggests that the effect of acculturative stress on suicidal ideation is primarily mediated through depression, it's important to note that we did not test for other potential mediating factors. For instance, a sense of belonging, social support, cultural identity, and perceived discrimination may play a role in the relationship between acculturative stress and mental health outcomes (Baeza-Rivera et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Berry, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Kayama \u0026amp; Yamakawa, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Nakash et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) were not included in our model. This omission may partially explain the complexity of the relationship between acculturative stress and suicidal ideation in our study. Further studies should examine these potential moderating variables for a more comprehensive understanding of how acculturative stress affects suicidal thoughts in Arab Israeli female students.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Clinical implications\u003c/h2\u003e \u003cp\u003eThis study highlights the urgent need for culturally sensitive mental health interventions for Arab Israeli female students. Given the strong link between acculturative stress and mental health issues (Abu-Rayya \u0026amp; Abu-Rayya, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Mana et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Meisler et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Nakash et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Torres, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), universities should offer mentorship programs, cultural awareness workshops, and inclusivity initiatives to support students\u0026rsquo; adaptation (Byars-Winston et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Cisneros et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Eden et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Rodrigues et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSexual harassment, particularly in childhood, significantly increases mental health risks and the likelihood of revictimization. However, the Arab community faces barriers such as limited mental health resources and social taboos around sexual abuse (Elroy et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Mansbach-Kleinfeld et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Tahir, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Interventions should include support groups, peer mentorship programs, and campus-based workshops that educate students on sexual harassment and coping strategies in a culturally appropriate manner. Moreover, as a very traditional culture, discussions about sex remain taboo, and childhood sexual harassment is frequently underreported and inadequately addressed (Attrash-Najjar \u0026amp; Katz, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Universities should also ensure that students with a history of sexual harassment receive targeted mental health resources to prevent repeated victimization and reduce long-term psychological distress (Krebs et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLastly, there is a significant research gap regarding suicidal ideation among Arab students in Israel. More extensive data collection is needed to develop effective suicide prevention programs tailored to this population (Auerbach et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Ibrahim et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Mortier et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.2 limitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations that should be considered. First, the cross-sectional nature of our study limits our ability to establish causal relationships. Longitudinal designs could help better understand the complex interplay of factors contributing to suicidal ideation. Second, the focus on Arab female students in Israel limits the generalizability of our findings to other minority populations, particularly in Western countries where Arabs are often immigrants rather than an indigenous minority. The unique sociopolitical context of Arabs in Israel may result in experiences of acculturation and discrimination that differ from those of Arab minorities elsewhere. Third, our reliance on self-reporting tools created potential biases, as participants may not always provide truthful responses, especially regarding sensitive topics like mental health and sexual experiences. This limitation is particularly salient given the cultural taboos surrounding sexuality in Arab society (Attrash-Najjar \u0026amp; Katz, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), which may have led to underreporting questions related to sexual harassment. Fourth, our recruitment process, which utilized a snowball sampling method, may have introduced selection bias, potentially overrepresenting individuals with similar characteristics or experiences. Finally, our assessment of sexual harassment experiences, both in childhood and during university, was based on only two self-reported questions from a validated questionnaire rather than the full instrument. This may have failed to capture the full complexity and nuance of participants' experiences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Conclusion\u003c/h2\u003e \u003cp\u003eThis study highlights the link between acculturative stress, sexual harassment, and suicidal ideation among Arab female students. Findings emphasize the need for culturally sensitive mental health interventions and sexual harassment prevention programs. Addressing these challenges can foster safer, more inclusive academic environments and reduce suicide risk among minority students.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.B. wrote the main manuscript text, and S.H. supervised the study and contributed to the analysis. Both authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbu-Rayya HM, Abu-Rayya MH (2009) Acculturation, religious identity, and psychological well-being among Palestinians in Israel. 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J Adolesc 67:120\u0026ndash;128. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.adolescence.2018.06.009\u003c/span\u003e\u003cspan address=\"10.1016/j.adolescence.2018.06.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Minority students, Sexual harassment, Suicidal ideation, Minority students, Depression","lastPublishedDoi":"10.21203/rs.3.rs-6149387/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6149387/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAcross the world, female students from minority groups face unique stressors, including acculturation stress and sexual harassment. These factors potentially increase their mental health risks. This study aims to investigate the direct and indirect effects of these risk factors, depressive and suicidal ideation among Arab female students in Israel.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional study was conducted with 1425 Arab female students aged 17\u0026ndash;54 enrolled in academic institutions across Israel. Participants completed self-report questionnaires assessing suicidal ideation, depression, acculturative stress, and experiences of sexual harassment both in childhood and during university.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSuicidal ideation was reported by 20.5% of participants. Higher levels of depression, acculturative stress, and experiences of childhood sexual harassment were significant predictors of suicidal ideation. Path analysis revealed that depression mediated the relationship between acculturative stress and suicidal ideation, as well as the indirect effects of childhood sexual harassment. Additionally, childhood sexual harassment demonstrated a direct impact on suicidal ideation. The study found a cumulative effect of sexual harassment across both childhood and university, which increased the risk of depressive symptoms and suicidal ideation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study highlights the complex interaction between sexual harassment, acculturation, and depression on the impact of suicidal ideation among Arab female students. Findings highlight the need for culturally sensitive campus mental health programs.\u003c/p\u003e","manuscriptTitle":"Navigating Cultural and Psychological Barriers: Acculturative Stress, Sexual Harassment, and Suicidal Ideation Among Arab Female Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-11 08:36:32","doi":"10.21203/rs.3.rs-6149387/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fda15db8-1d2f-438f-a985-3654d80d78f7","owner":[],"postedDate":"March 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-23T19:23:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-11 08:36:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6149387","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6149387","identity":"rs-6149387","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}