When Mona M. Amer left her job at a Cairo, Egypt, psychiatric hospital to begin psychology graduate school, she aimed to study how acculturation can cause stress in understudied ethnic groups.
An Egyptian-American, Amer quickly noted recent world events had thrust Arab Americans onto the front page of newspapers, yet not on the pages of psychological research journals. She found most multicultural funding sources for Arab Americans since 9/11 look at geopolitical or economic issues.
"Sept. 11 put Arab Americans into the spotlight, and understanding this group became important on a national level," Amer says. "But it amazed me how there could be so much research and attention directed towards Arab politics and Americans' response to the attacks while virtually no one looked at how the events affected Arab Americans' mental health.
"Rushing to study these large-scale issues, people forgot the impact on an individual level," she notes.
That dearth of psychological research spurred Amer, now a fifth-year clinical psychology graduate student at the University of Toledo, to complete a large study of Arab Americans in December 2001 for her master's degree.
Amer, now on internship at the Yale University School of Medicine, extended that work to her dissertation and is completing a comprehensive, Internet-based study on Arab-American acculturation in America.
She says the implications of her major finding-that Arabs, especially Muslims, immersed in American culture might endure more stress than those who stay separate-can help psychologists and communities help both Christian and Muslim Arab Americans adjust to the United States.
TESTING A THEORY
For her master's degree, Amer designed a 139-question survey to measure respondents' Arab-American cultural identity, family relationships and religiosity, among other demographic factors, as well as their feelings of depression, isolation and stress. On a five-point scale, 120 second-generation Arab Americans rated how much they agreed with statements such as, "It bothers me when people pressure me to become part of the main culture."
Previous research has found that individuals who maintain old cultural traditions and ethnic identities while accepting parts of the dominant culture are less likely to experience stress and mental health problems than those who completely segregate or assimilate.
Amer found that Christian Arabs fit the standard, but that Muslim Arabs bucked the trend: They encountered more stress when integrating, a result that puzzled Amer, who completed this line of her research in January 2002. Curious how America's cultural climate after 9/11 might have altered her findings, Amer undertook another larger study for her doctoral dissertation that examined the same questions.
"Arab Americans since Sept. 11 are faced with a lot of stressors, discrimination and backlash," Amer says. "How they respond has a lot to do with their background, and there are big cultural differences between Arab-American groups that many people don't notice."
For example, Amer says, sources such as the U.S. Census and electoral registers count Arab Americans using country of origin. So she found participants by posting on Internet message boards and contacting online community and cultural groups. She encouraged participation by offering money to randomly selected participants.
Yet people still declined to participate because they didn't trust Amer's motives or worried about their confidentiality. Others began the survey, only to get cold feet and stop, she added.
"It's a very private culture that hasn't experienced much research," explains Amer. "They aren't used to having so many questions asked of them."
Amer's tenacity produced a strong population sample despite facing such methodological pitfalls, says her adviser, Joseph D. Hovey, PhD, who chairs the University of Toledo psychology department and serves as director of the school's Program for the Study of Immigration and Mental Health.
"Mona spent months trying to reach groups, but she's tapped into a national sample over the Internet," he says. "It's a snowball technique: She found one online community group, which led her to another, then another. She's had to do things piecemeal, but her creativity and persistence have paid off."
During the past year, Amer accumulated 611 respondents who live in 35 states and come from more than a dozen nations, including Syria, Lebanon, Egypt and Iraq. Sixty percent are female, 70 percent are Muslim and more than one-third are second-generation immigrants.
Her preliminary results are striking: Though 75 percent of respondents are U.S. citizens, they reported feeling greater levels of depression than did respondents in her previous study. Respondents also reported levels of depression far above the U.S. population norms, indicating that Arab Americans suffer more from depression than the mainstream population, she notes.
Looking further, she found that depression and anxiety levels were significantly higher among Muslim participants. The results suggest that Muslim Arabs endure more stress and mental health problems when they try to fit into American society compared with Christian Arabs.
Taken with results from her master's study, Amer's findings suggest that two distinct cultures exist within her Arabic sample-Christians and Muslims. Christian Arabs had significantly better social support and lower stress, depression and anxiety than Muslim Arabs. Muslims showed greater religiosity than their Christian counterparts and were more likely to value their Islamic faith as a way of life. In fact, Muslims who were more religious had better family and social support, which can help reduce stress.
Amer theorizes that, perhaps due to the current geopolitical climate, Muslim Arabs escape stress through segregation-even though in their responses, most Muslims, like Christians, indicated they would rather integrate into American society.
"It seems most Muslims want to integrate yet don't," she says. "This indicates Muslim Arab separation is not accepted, but forced by rejection. These findings question a lot about acculturation theory."
Amer hopes her research encourages others to undertake similar studies, as well as informs community groups about how to best help Arab Americans acclimate to a potentially unwelcoming society.
"It's important to spread information among Arab cultural groups, churches and mosques, because they have a lot of untested beliefs," Amer explains. "They say, 'Go out, integrate and show you are an American,' but those who do may endure more stress."
Amer says her next step is to share her findings with these cultural groups, help them understand how integration can cause stress within the community and develop programs to address the situation.
For example, she says, these groups can provide assistance for immigrants via English classes, individual and family counseling, workshops on parenting children in the West, programs to cope with stress, visa and immigration services, legal consultation, lectures on understanding American culture and advice on how to cope with discrimination.
She also envisions these groups offering youth development programs for second-generation Arab Americans who experience confusion or distress over their cultural identities.
"If the organizations are going to push for greater integration, then it's important they provide the coping skills and resources needed to do so," Amer says.