*1.1. Acculturative Stress*

Redfield, Linton, and Herskovits [1] defined acculturation as a "phenomenon which results when groups of individuals having different cultures come into continuous first-hand contact with subsequent changes in the original cultural patterns of each other or both groups" (p. 149). The acculturation process can be positive, improving one's life chances in the new culture. However, it also imposes stress on the individual due to the challenging nature of change and adaptation to new cultural and social expectations. Acculturative stress is usually experienced by those who are in the process of acculturating to the dominant society by adapting the dominant culture's language and norms [2]. Berry and colleagues [2] described acculturative stress as "a reduction in health status (including psychological, somatic, and social aspects) of individuals who are undergoing acculturation, and for which there is evidence that these health phenomena are related systematically to acculturation phenomena" (p. 491). Drawing on broader stress and adaptation theory (e.g., [3]), Berry [4] claimed that acculturative stress is a stress reaction to life events that are rooted in the experience of acculturation. Individuals experience change events that challenge their cultural understandings about how to live. Such stress arises from multiple aspects of the acculturation process, such as learning new and sometimes confusing cultural rules and expectations, dealing with experiences of prejudice and discrimination, and managing the overarching conflict inherent in maintaining elements of the old culture while incorporating elements of the new [4–6]. The aspects of acculturative stress that are salient to college students may relate to language proficiency, unfamiliarity with prevailing cultural practices, cultural self-consciousness, the experience of conflicting value systems, and experiences of discrimination (e.g., [7–9]). In previous research, acculturative stress has repeatedly been found to be associated with mental-health problems such as anxiety and depression, feelings of alienation, identity confusion, and heightened levels of psychosomatic symptoms [2,10–12]. Among international college students and college students from cultural-ethnic minorities, acculturative stress has been associated with a number of psychological challenges, including depression [13,14].

#### *1.2. Protective Factors: Sense of Coherence and Coping Strategies*

General models of stress posit that perceiving a situation as being threatening or beyond one's coping abilities causes stress and leads to negative affect [3,15]. Resilience studies (e.g., [16]) have highlighted the importance of identifying protective factors that reduce the negative effects of stressful events and encourage positive outcomes. Sense of coherence and coping strategies have been identified as the main stress-buffering variables.

#### 1.2.1. Sense of Coherence

Sense of coherence (SOC) refers to a permanent attitude according to which individuals view and understand life and is a measure of the capacity to assess and use available resistance resources to maintain and improve health when faced with stressful situations [17]. In other words, SOC can be defined as a way of viewing life and the ability to manage the stressors that are faced in life [18].

According to Antonovsky [17], SOC is an important resource that enables people to manage stress, to evaluate their external and internal resources, and to identify and use those resources, in order to promote effective coping and adjustment. SOC explains why individuals experiencing stressful or challenging events in their lives are capable of dealing with them [17]. This sense develops during childhood and early adulthood and stabilizes around the age of 30 (in the period of early adulthood [19]). However, Eriksson [20] claimed that SOC tends to increase with age over one's whole lifespan. Researchers have argued that SOC is a construct that develops differently, according to environmental characteristics and life experiences [21]. SOC integrates three components: comprehensibility, manageability, and meaningfulness. Comprehensibility refers to the individual's ability to perceive life events as comprehensible and consistent, and to reasonably predict what will happen in the future. Manageability refers to the ability of the individual to understand that the resources at one's disposal are sufficient to cope with life's difficulties. Meaningfulness is the extent to which an individual feels that life makes sense emotionally [19]. Meaningfulness motivates an individual to seek resolutions to events or situations that are considered stressful [22]. Antonovsky claimed that an ability to define stressors as irrelevant, neutral, or even as a challenge indicates that a person has a strong SOC, while considering a stressor as endangering one's well-being is indicative of low SOC [19]. Previous literature has stated that SOC has important positive effects on reactions to stress, as well as problem-solving and emotional coping in general, particularly among individuals who are members of ethnic and cultural minorities [23–26]. Previous research has found that an individual with a strong SOC is more likely to feel less stress and to have more social support that can

be called upon in his or her efforts to cope with stress [19,27]. Previous cross-sectional studies have reported a significant inverse correlation between SOC and depression [28]. Researchers have also found that a strong SOC is associated with fewer depressive symptoms [29]. According to a review conducted by Eriksson and Lindström [30], SOC is strongly, negatively related to perceived depression; stronger SOC is associated with fewer symptoms of perceived depression.

Previous research on SOC in Eastern-collectivistic contexts such as the Arab minority in Israel has revealed two important findings. First, researchers found lower levels of SOC among the Arab minority [23,31]. Second, over time, changes in SOC levels were observed (higher levels) and SOC became a strong predictor of stress reactions [24]. However, this important resource has not been previously examined among the Arab student population and it is important to evaluate the levels and implications of SOC on depressive symptoms among Arab students.

#### 1.2.2. Coping Strategies

Coping processes are complex responses that occur when an individual attempts to remove a source of stress or a perceived threat from his or her environment. The reaction to an event has been found to be as important as the event itself [32]. Coping strategies include cognitive or behavioral efforts to manage situations appraised as taxing or exceeding a person's resources [3]. A common characteristic of many coping taxonomies has been the distinction between strategies that are active and oriented toward confronting the problem (i.e., active coping strategies) and strategies that entail an effort to reduce tension by avoiding dealing with the problem (i.e., avoidant coping strategies [33]). Research on the effects of coping strategies on adjustment has found that active coping strategies are more effective and that they moderate the adverse influence of negative life events on psychological functioning [34,35]. In contrast, avoidant coping strategies tend to be associated with psychological distress [33,35–37].

Berry [4] noted that, when acculturative stress is not managed well, it will increase and its effect will be even more negative. In addition, if such stressors become overwhelming, the immediate effects can be significantly negative and damaging, even to the point of personal crises, anxiety, and depression. When acculturative problems (stressors) arise, but are successfully managed, stress levels are similarly low and the immediate effects are positive [38].

#### 1.2.3. Coping Strategies in a Collectivistic Cultural Context

Sociocultural groups appear to generate not only consensual belief systems concerning the origin and meaning of stressors, but also beliefs concerning the most appropriate means to cope with stressors. Empirical investigations of coping strategies across cultures have yielded mixed findings. However, overall, there is significant support for the idea that individuals from collectivistic cultural contexts are more likely to use avoidant coping strategies [39,40], whereas individuals from individualistic cultural contexts are more likely to use active and problem-focused coping strategies [40,41]. Among Arab students in Israel (specifically Bedouin Arabs), levels of active coping strategies are similar to those found in Israeli Jewish society [42]. However, Arab students have also reported using more avoidant coping strategies than Jewish students [42]. This study provides support for the important role of avoidant coping strategies. Bedouin Arab students tend to be more depressed because they tend to use avoidant coping strategies more often. That is, they attempt to reduce tension by avoiding dealing with problems (i.e., behavioral disengagement, self-distraction, denial, and self-blame [42]).

#### *1.3. Gender Di*ff*erences in Acculturative Stress, SOC, Coping Strategies, and Depression*

Gender has a variety of effects on the acculturation process. There is substantial evidence that women may be at greater risk for problems in the acculturative process than men (e.g., [43,44]). Female immigrants reported higher levels of acculturative stress than men across multiple domains including homesickness, social isolation, employment barriers, discrimination, and civic disengagement [44]. Attempts by women to take on the new roles available in the "new" society may bring them into conflict

with their heritage culture, placing them at risk for acculturative stress and negative outcomes [43,45]. In addition, the majority of previous studies have reported higher SOC scores among men [20]. Gender differences have also been found in relation to coping strategies. In general, women tend to exploit social support, affective release, emotional regulation, and emotionally focused and "tend-and-befriend" strategies (which may be considered a form of active coping( [46,47]. In contrast, the coping efforts of men are directed toward "fight-or-flight" responses (i.e., gaining control over the situation and invoking disengagement responses) [47,48]. Gender differences have also been found in levels of depression. For example, women are twice as likely as men to have higher scores on self-reported depression symptom measures [49]. However, previous research among students from a subgroup belonging to the Arab minority in Israel (i.e., Bedouin Arabs) revealed no gender differences in mean levels of depressive symptoms [42,50]. It would be interesting to examine the generalizability of these findings among students from the larger Arab minority.

#### *1.4. Academic-Year Di*ff*erences in Acculturative Stress, SOC, Coping Strategies and Depression*

Previous research suggests that students in the earlier years of their college educations are at higher risk for experiencing psychological distress and depression than students in the later years of their degree programs [51]. One possible explanation is that the period of transition from high school to college is stressful and this stress may be related to elevated rates of depression among these students [51]. Research on the effects of academic-year differences on acculturative stress among Chinese nursing students in Australia found higher levels of acculturative stress in the third year as compared to the second year. However, that study reported no significant differences in acculturative stress between first-year students and second-year students [52]. He et al. [52] compared the SOC levels among first-, second-, and third-year students and found no significant differences between the three groups. It is important to note that most the studies have focused on a single academic year [53] or have not reported comparisons of different years of study [54]. It is important to test whether students in the earlier years of college express different levels of acculturative stress and depressive symptoms. In addition, special attention should be paid to their coping resources and strategies, as compared to the resources and strategies found among students who are further along in their studies.

#### *1.5. Acculturative Stress Among Arab Students in Israel*

The Arab minority in Israel comprises about 21% of the entire population [55]. During the last decade (2008–2018), there was an 80% increase in the number of Arab students in academic institutions of higher learning in Israel [56]. Arab culture differs significantly from Jewish Israeli culture in terms of its emphasis on collectivistic ideals [57]. Jewish culture, being more individualistic and less authoritarian, emphasizes separation, independence, personal development, and achievement [58]. In addition, Arabs also differ from the Jewish majority in terms of language, religion, and other cultural factors [59]. This large cultural distance between the Arab minority and the Jewish majority is expected to increase the acculturative stress experienced by Arab individuals. Discrimination, prejudice, and negative stereotypes and attitudes of the host culture toward the minority group also increase acculturative stress [60]. Arabs in Israel are a largely underprivileged minority with a history of disadvantage in income, education, and employment [61]. They live in segregated residential areas [61]. Despite enjoying full citizenship status, the Arab minority is subject to various forms of discrimination that may contribute to social and economic disparities between them and the Jewish majority [62,63]. These experiences of discrimination are expected to contribute to acculturative stress among Arab students. These students doubt the readiness of the majority to welcome them and tend to feel that they are discriminated against [63]. Members of Arab society, who share more traditional and collectivist values [64], have to adjust to unfamiliar values and codes of behavior and fit in with the majority of students in a more Western-individualistic cultural milieu, which differs substantially from their native culture. To the best of our knowledge, there has been no previous research on acculturative stress within Arab society or specifically among students attending higher

academic institutions within this society. Thus, the current study will address acculturative stress and its associations with depressive symptoms among female and male Arab students at different stages of their academic studies.

#### *1.6. The Current Study*

The main goals of the current study were to explore the associations between acculturative stress, SOC, coping strategies, and depressive symptoms among Arab students from northern and central Israel. Special attention was paid to the roles of those variables in the associations between acculturative stress and depressive symptoms. The current study also investigated gender differences in the levels and roles of SOC and the use of different coping strategies within the Arab minority in Israel. The effects of academic year (Year 1 + 2 vs. Year 3 + 4) on the levels of the study variables and the roles of SOC, active coping, and avoidant coping in the association between acculturative stress and depressive symptoms were also examined.

#### *1.7. Hypotheses*

The following hypotheses were tested:


**Figure 1.** The hypothesized relationships between acculturative stress, avoidant coping, active coping, SOC, and depressive symptoms. SOC: Sense of coherence.

#### **2. Materials and Methods**

#### *2.1. Participants and Procedure*

We employed a cross-sectional research design. One hundred seventy individuals participated in the study, 103 female Arab students and 67 male Arab students from northern and central Israel who were studying at institutions of higher education (i.e., Ben-Gurion University of the Negev, the Hebrew University of Jerusalem, Tel Aviv University, and Haifa University).

The study was approved by the Department's Human Subjects Ethics Committee (Approved Ethics Form No. 0015-009). Participants were approached and included in the study using convenience sampling. All participants were from the northern and central regions of Israel and currently enrolled in an institution of higher learning. Students were recruited with the cooperation of close friends of the second author of this study who study in Israeli universities and by circulating the questionnaire through the social media. Since we used social-media platforms (mainly Facebook), we could not determine the response rate. The process of data collection took three weeks. Arab students were encouraged to complete the questionnaires via a link. The first page of the linked document included an informed-consent form and only students who checked a box to indicate their agreement to participate were directed to complete the full set of questionnaires. The purpose of the research study was also presented to the participants on the first page of that document. The participants were explicitly requested to refrain from providing identifying information. After the participants finished answering the questionnaires, they were presented with a final page that included a full description of the purpose of the study, contact information for the researchers, and a list of references related to the research topic. Arabic versions of the questionnaires were used. Each participant was reimbursed with a coupon for coffee and cake.

#### *2.2. Measures*
