When USA Today highlighted research by psychologist Mona M. Amer, PhD, in an article about the mental health of Muslim and Arab Americans' mental health in 2006, the publicity didn't just bring kudos from her colleagues. It also prompted death threats from strangers.

"I received all these emails from people who were very upset because the story was a little sympathetic toward Muslims and Arabs," says Amer, now an assistant professor of psychology at the American University of Cairo. "I saw articles online where people were saying if they are depressed, that means they're crazy and shouldn't even be living in this country."

The rhetoric hasn't softened since then, thanks to anti-Muslim campaign messages from political candidates, hearings on Muslim radicalization on Capitol Hill and the controversy over a proposed Islamic center near Ground Zero. According to the Pew Research Center, the number of Americans with favorable views of Islam dropped from 41 percent in 2005 to 30 percent in 2010.

Now Amer and other researchers are examining the impact 9/11 and its aftermath have had on Muslim Americans' well-being. What they've found is anxiety, depression and even post-traumatic stress disorder among a population some call doubly traumatized—first by the attacks themselves and then by the finger-pointing that followed. But they've also found effective coping and resilience, especially among young Muslim Americans.

The psychological impact

Determining 9/11's impact on Muslims in the United States is difficult, says Amer, because there's no baseline.

"Prior to 9/11, there was virtually nothing published that related to the mental health of Muslims in the United States," says Amer, former editor in chief of the Journal of Muslim Mental Health. "After that, there has been a handful of studies." Most, she adds, aren't based on empirical evidence.

Amer's own work, which she believes includes the largest and most demographically diverse look at Arab-American mental health, attempts to address that problem. The news isn't good, she says.

In a paper forthcoming in Social Psychiatry and Psychiatric Epidemiology, for example, Amer and psychologist Joseph D. Hovey, PhD, of the University of Toledo examined anxiety and depression rates among more than 600 adult Arab-Americans in 35 states. The majority of the study participants were Muslims.

Half the study participants had depression serious enough to warrant further assessment, they found. A quarter reported moderate to severe anxiety. Those rates are higher than those of the general public and other minority groups, says Amer, citing ongoing racial profiling, discrimination and other stressors unique to Arabs as causes.

The results should be interpreted with caution, say the authors, noting that the use of English and an Internet-based methodology may have skewed the sample toward younger, better educated and more affluent participants. But the results are especially striking given Arab-Americans' reluctance to admit mental health problems, says Amer. About half of the participants were American-born and didn't face the added stress of immigration, she points out. And Arab-Americans tend to have higher education and income than other Americans, which serve as protective factors.

"There are things that are said in the media about Arabs and Muslims that would never be tolerated or said about any other group," says Amer. "You receive constant messages about how your community is full of terrorists, ignorant people, oppressive people."

Arab-Americans in New York City are especially vulnerable, says Wahiba Abu-Ras, PhD, an assistant professor at Adelphi University's School of Social Work.

"Arab-Americans were traumatized three-fold," says Abu-Ras, citing the devastation of the attack itself, the backlash from individuals and new government policies targeting this population, such as the Patriot Act. That trauma only added to people's existing trauma, says Abu-Ras. "Many people come from conflicted areas, like Iraq and Palestine," she says. And immigration itself can be traumatic. In a 2008 study published in the Journal of Muslim Mental Health (Vol. 3, No. 2), Abu-Ras and a co-author conducted focus groups with a small, non-random sample drawn from a community in Brooklyn to assess 9/11's impact on Arab New Yorkers. Participants—all but four of them Muslim—revealed fear of hate crimes and threats to their safety, anxiety about the future, isolation and loss of community and stigmatization.

Those fears were justified, says Abu-Ras. In a 2009 study of 102 New York Muslims published in Traumatology (Vol. 15, No. 3), she and a co-author found that hate-fueled incidents were common. Twenty-five percent of participants reported verbal assaults, 22 percent reported workplace discrimination, 19 percent reported unprovoked interrogation by government agents and 19 percent reported physical assaults.

As a result, participants' sense of safety declined dramatically, the researchers found. While the vast majority of study participants reported feeling safe or extremely safe before 9/11, afterward more than 82 percent felt unsafe to extremely unsafe in the United States. And while the small sample size means the findings can't be generalized, the authors note, the study found that feeling less safe was a predictor of post-traumatic stress disorder.

Coping methods

The coping methods Muslim Americans choose play a crucial role in how well they handle ongoing discrimination and harassment, says psychologist Hisham Abu-Raiya, PhD, an assistant professor in the Bob Shapell School of Social Work at Tel Aviv University.

In a 2011 paper published in Psychology of Religion and Spirituality (Vol. 3, No. 1), Abu-Raiya and his co-authors surveyed 138 Muslims living in the United States. Most reported experiencing at least one stressful event related to their Muslim identity, such as anti-Muslim comments, special airport security checks and discrimination.

Participants used both religious and non-religious means of coping with these stressful events.

The non-religious coping strategy of reaching out to others—both Muslims and non-Muslims—resulted in positive changes, such as personal strength and an appreciation of life. Those who isolated themselves from others experienced greater depression and anger, the researchers found.

The 9/11 attacks also prompted study participants to intensify their religious practices, whether that meant praying, fasting, attending a mosque or reading the Koran. But when it comes to religious coping strategies, says Abu-Raiya, the specifics matter.

"Positive religious coping was, 'I feel the love of God or Allah,' 'I prayed to get consolation,' 'I read the Koran' or 'I sought support from others at a mosque,'" he explains. "Negative religious coping methods were things like, 'I felt God was punishing me because of bad actions I did or because of a lack of devotion.'"

Positive religious coping was associated with greater post-traumatic growth, the researchers found, while negative religious coping was associated with higher levels of depression.

"The positive religious coping methods can be really helpful to people dealing with stressful events in general and the 9/11 attacks in particular," says Abu-Raiya. "Psychologists should be aware of these and try to help clients use the positive ones and avoid the negative ones."

The next generation

How will the post-9/11 generation of Muslim Americans fare?

It's tough to be a young Muslim in the United States, says Selcuk R. Sirin, PhD, co-author of "Muslim-American Youth: Understanding Hyphenated Identities Through Multiple Methods" (2008) and an associate professor of applied psychology at New York University.

In one of Sirin's studies, published in 2007 in Applied Development Science (Vol. 11, No. 3), for example, 84 percent of the 12- to 18-year-old Muslim American participants revealed that they had faced at least one act of discrimination in the previous year.

And yet, says Sirin, most of the young people he has studied are comfortable with what he calls their "hyphenated identities" as both Muslims and Americans. "They seem to be pretty happy sitting on the hyphen," he says. "They don't feel the need to pick one over the other."

Instead of using questions that force participants to choose identity A or B, Sirin's research uses a series of questions about the degree to which participants identify with their Muslim and American identities. He also uses "identity maps" that allow participants to express their identities pictorially. Among his research participants, 61 percent have hybrid identities, 29 percent have parallel identities that they "commute" back and forth between and 11 percent have conflicted identities.

That strong sense of American-ness gives young Muslims resilience, says Sirin. "They feel that they're Americans, they have certain rights and can stand up for their rights," he says.

Young Muslim American women in particular take advantage of opportunities to educate people, says Sirin. "If you're perceived as oppressed, uneducated and unsophisticated, people try to help you," he explains, adding that stereotypes of Islamic terrorists mean that people don't approach Muslim-American boys and men. "It seems like it opens doors."

The fact that young Muslims can experience high levels of discrimination and still identify as Americans is a uniquely American phenomenon, adds Sirin.

"In Europe, Muslims are denied the possibility of becoming an integral part of the country they have settled for generations," he says. "After two generations in Germany, Turks still don't call themselves Germans, for example. That's not the case in the United States."

Rebecca A. Clay is a writer in Washington, D.C.