ANN ARBOR, Mich. — For the first time, researchers have connected mental health issues in Arab Americans and American Muslims with reported bias and discrimination following the 9/11 terrorist attacks. The researchers say their study is the first representative, population-based investigation of the health and psychological impacts of September 11 on Arabs and Muslims living in the United States.  The study was published in the American Journal of Public Health on December 17, 2009. University of Michigan researchers found that one quarter of Detroit-area Arab Americans reported personal or familial abuse because of race, ethnicity or religion following 9/11, and that has led to higher odds of adverse health effects.  Muslim Arabs also reported higher rates of abuse than Christians, said lead author Aasim I. Padela, M.D., a Robert Wood Johnson Foundation Clinical Scholar in the University of Michigan’s Department of General Medicine and clinical instructor in the Department of Emergency Medicine.Padela and co-author Michele Heisler, M.D., associate professor of Internal Medicine at U-M and assistant professor of Health Behavior and Health Education in U-M’s School of Public Health, used data from a face-to-face survey of Arab Americans administered in 2003.The Detroit Arab American Study (DAAS) in 2003 was a companion survey to the 2003 Detroit Area Study (DAS), using a representative sample drawn from the three-county Detroit metropolitan area and an oversample of Arab Americans from the same region.  The data contained respondent information concerning opinions on their experiences since the September 11, 2001, attacks on the World Trade Center and the Pentagon, social trust, confidence in institutions, intercultural relationships, local social capital, attachments to transnational communities, respondent characteristics, and community needs. The study, funded by the Russell Sage Foundation and conducted by University of Michigan researchers,  surveyed 1,016 Arab Americans.  The mean age of the respondents was 43.6 years.  Fifty-four percent of the respondents were female, and 58% were Christians. Most had lived in the United States for more than 10 years (81%), had health insurance coverage (83%), and were married (71%).Padela and his colleagues utilized data from the DAAS to look at the impact of discrimination and abuse upon health markers in this same sample.The initial study has been criticized by some as not being truly representative of the community in the 9/11 aftermath.  Arab Americans and American Muslims were cited as having more trust in law enforcement agencies than the non-Arab participants, for instance. This was considered highly unlikely in the anti-Arab and anti-Muslim hysteria that reigned at the time.  Because respondents chose whether or not to participate, it was generally felt that non-response bias had skewed those results.Padela says, however, that the initial study had a  73% participation rate, too high to be the sole cause for what appeared to be skewed results. He said if further analysis had been done, other causal factors may have been determined.  Most respondents in the study sample had lived in the U.S. for greater than 10 years and findings of more trust may be related to such persons feeling more comfortable in the U.S. than more recent immigrants.Estimates of the American Muslim population vary widely but average 5.4 million, consisting of equivalent numbers of African Americans, South Asians, and Arabs.  In addition, up to 2.5 million non-Muslim Arabs reside in the United States.Prejudice, discrimination, and violence against Muslims and Arabs have increased since September 11. The Federal Bureau of Investigation reported a 1600% increase in hate crimes against these populations in the year after the events of September 11. Similarly, in a population-based survey of Middle Eastern Arabic speaking adults in the United States, approximately 30% of Arabs and 50% of Muslims reported discrimination in the eight months after September 11.  Mosques and Muslim-owned businesses were vandalized, and individuals Muslim in appearance were verbally abused, physically assaulted, and, in some cases, murdered. And, as last week’s arrests of extremist Christian militia members in Michigan, Ohio and Indiana have shown, the hate continues.  Every week incidents of an anti-Muslim nature occur.U.S. governmental policies have also targeted Muslims and Arabs and their community organizations. Muslim civic and religious organizations have been raided by the FBI, Muslim charities have had their assets frozen, and racial profiling has occurred at airports and on the streets.  Further coloring the social environment are the U.S.-led wars in Afghanistan and Iraq. These wars may create increased tension between the general American population and people of Afghani and Iraqi ancestry residing in the United States, in addition to increasing psychological distress among the U.S.-based relatives of Iraqis and Afghanis.”Padela says those who reported abuse showed a higher probability of having psychological distress, lower levels of happiness and poorer perceptions of health status.What’s disturbing about the findings is that residents in greater Detroit live in a large, well-established Arab community, where they might be expected to be protected from abuse, Padela says. Most of the respondents also had access to health insurance.”Negative associations of perceived post-911 abuse or discrimination might be much worse in less concentrated Arab populations within the United States,” Padela says.Approximately 490,000 Arabs reside in Michigan, and more than 80 percent of those live in metro Detroit’s Wayne, Oakland and Macomb counties. Arabs are the third largest ethnic population in Michigan, with a history dating back multiple generations. This community is the largest concentration of Arabs outside of the Middle East.”I was interested in the health effects that anti-Muslim and anti-Arab abuse and discrimination have had on members of the community,” Padela says when asked what motivated him to undertake the work. “There is little to no work on this, but we know from other populations (such as African Americans) that racial and ethnic discrimination have deleterious health effects.” Padela was surprised that there were no differential effects on Muslims.”Once people experienced abuse and/or discrimination the health effects were similar in Muslims and non-Muslims. One would think that Muslims might have worse health effects because the anti-Muslim sentiments were so strong, but that was not the case.”Racial and ethnic abuse and discrimination can have lasting effects, and many of those afflicted may not be seeking adequate care, Padela says. Some may fear racial or ethnic discrimination from health care providers, he says.Others may worry about the stigma of admitting to a mental health problem, made worse by a culture that historically has not fully accepted mental illness, Padela says.The lesson here? “We need better screening for these conditions. Those who take care of Muslims and/or Arabs need to ask their patients about their psychological distress and whether they feel discriminated against and/or abused.  Once we screen we can then suggest strategies to deal with the problems and we can talk about it. We also need Arab and Muslim community organizations to partner with health systems to address this social context of discrimination and abuse.” “Untreated psychological distress leads you to do something bad, like smoking, drinking, or other unhealthy responses. It becomes a vicious cycle,” Padela says. “We may be missing an entire spectrum of people who are most stigmatized.””We know that anti-Arab and anti-Muslim hate crimes are still higher than they were pre-9/11,” Padela says. “Years after, we think this is over. But not only is it not over, it’s having negative health consequences and we’re not doing anything to address it.”The study was funded with support from the Robert Wood Johnson Foundation Clinical Scholars program.