Copyright © 2005 This document is copyrighted material. Under copyright law, no parts of this document may be reproduced without the expressed permission of the author. An Abstract of Arab American Mental Health in the Post September 11 Era: Acculturation, Stress, and Coping Mona M. Amer Submitted as partial fulfillment of the requirements for the Doctor of Philosophy in Psychology The University of Toledo May 2005 Persons of Arab (North African/ Middle Eastern) descent have faced unique psychosocial stressors due to the socio-political backlash following the World Trade Center attacks. These are compounded by traditional acculturation challenges, leading to increased psychological distress. This study satisfies an urgent need to better understand the acculturation and mental health experiences of Arab Americans by comprehensively and rigorously investigating hypotheses introduced in the previous literature. Participants were 611 Arab Americans from 35 U.S. states who completed a secure Internet form. Variables assessed were: acculturation (Vancouver Index of Acculturation- Modified Arab Version), acculturative stress (SAFE Acculturation Stress Scale- Revised; included issues of discrimination and American foreign policy), family functioning (Family Assessment Device- General Functioning Subscale), social support iii (Personal Resource Questionnaire85- Revised), religious coping (Brief Arab Religious Coping Scale), anxiety (Beck Anxiety Inventory), depression (Center for Epidemiologic Studies- Depression Scale), and a socio-demographics survey. Seven research foci were examined. First, 13 socio-demographic indexes hypothesized to relate to acculturation (including SES, generation status, length of residence in the U.S., English vs. Arabic language use, and Arabic TV viewing) were found to relate to American identity in the expected directions, while most indexes did not relate to Arab identity. Second, participants reported significantly higher anxiety and depression compared to normative samples and studies with other ethnic minority groups. Third, as hypothesized, integrated and assimilated individuals reported less stress, anxiety, and depression compared to those who were separated or marginalized. Fourth, as hypothesized, acculturation stress correlated with anxiety and depression, and both family functioning and social support related to less stress and less psychological distress. However, religious coping did not correlate with mental health. Fifth, contrary to the hypotheses, females did not demonstrate greater stress or psychological distress compared to males. Consistent with hypotheses, Christians demonstrated significantly less acculturative stress, anxiety, and depression compared to Muslims. Finally, structural equation modeling was used to develop a tenable model that explained the complex interactions among SES, acculturation, stress, mental health, and coping resources. Specific and practical recommendations are provided for clinical intervention, community programming and policy planning, and future research. iv Dedication This dissertation is dedicated to my family, my father mother and sisters, the coolness of my eyes. v Acknowledgements All praise and thanks due to Allah, the Compassionate, the Merciful, for blessing me with the strength and guidance to complete this project. Without His endless grace and bounty, none of this would have been possible. He is the Compeller, the Creator, the All-Knowing, and the All-Wise. I would like to express my deepest appreciation to Dr. Joseph Hovey, my advisor. His patient and thoughtful mentorship has helped nurture and shape my interests and scholarship to what it is now. Only with his flexibility, kindness, creativity, and endless support was I able to reach this accomplishment. Special heartfelt gratitude goes to my dissertation committee members for their invaluable feedback. Thanks to Dr. Paula Dupuy for initiating an internal dialogue of cultural and personal sensitivity that struck a chord with me four years ago and has resonated throughout my work since. Dr. Funk has been my solid reference point amidst the challenges of graduate school, and I appreciate her constant and kind encouragement, consultation, and insight. I thank Dr. Peg Hull Smith for her thoughtful and challenging critiques and her enthusiasm for integrating culture in study. I am moreover appreciative of Dr. Mojisola Tiamiyu’s infectious optimism and thorough critical feedback, as well as her sense of community justice, which was interwoven in the pages of this work. No amount of thanks could express what I feel for my loving family for their neverending support and prayers. My father continues to be my role model with his kindness, passion for education and scientific inquiry, and boundless motivation and focus. I am grateful for my mother’s love, patience, and encouragement in this difficult vi project; she hoisted me up whenever I stumbled or stalled. Hoda, with her wisdom and advice, has been my special companion throughout this process. And Sophi, with her laughter, carried me through the grayest of days. Sincere appreciation is extended to members of the Greater Toledo Arab community who helped fashion the ideas at the core of this study. Alexander Rezcallah provided important assistance, and I thank him for the countless hours he spent distributing surveys and pondering the results. Thanks also to Nasser El-Okdi and the Arab Student Union, my lovely friend Sana Jouejati (“Al-Faham”), “Tante” Mahasen Kassem, Nader Qaimari from the Greater Toledo Association of Arab Americans, Dr. Sabry Gohara, Dr. Mostafa Ibrahim (Michigan), and Dina Sabry from the Coptic Club for also taking time from their busy schedules to advocate and educate about this study. I would like to extend my gratitude to Dr. Christine Fox at The University of Toledo for her ongoing review of my work with the Rasch model. The Yale statistical clinic provided a fertile ground for me to explore the interrelations among the variables in this study using the intriguing G-plus. Thanks also to Dr. Christian Connell at Yale University for his input and demonstrations with SEM and Amos. Finally, I would like to express my gratefulness to the larger Arab American community, especially all the participants who took this work seriously enough to complete the study and pass the message on. Moments of kindness from people such as Marvin Wingfield from the ADC, Souhail Kassabri from the Arab American Community Center in Cleveland, Rev. Bassam J. Abdallah from the Lutheran ministries in Indiana, and Dr. Mohamed Farrag from ACCESS Dearborn lifted my hopes and gave me the motivation to continue on. All the Arab American individuals, cultural centers, vii professional associations, social service organizations, university clubs, churches, mosques… there are just too many to name and I thank them all. It is my sincere desire that this research serves as a gift to the community in return. viii Table of Contents Abstract …………………………………………………………………………….. iii Dedication ………………………………………………………………………….. v Acknowledgements ………………………………………………………………… vi Table of Contents ………………………………………………………………….. ix List of Tables ………………………………………………………………………. xiv List of Figures ……………………………………………………………………… xvi I. Introduction ………………………………………………………………………. 1 Acculturation and Mental Health Theory and Research ……………………... 5 Definitions and Models of Acculturation ……………………………… 5 Psychological Adaptation and Acculturative Stress …………………… 17 Acculturation, Family Functioning, and Social Support ………………. 23 Religious Coping and Mental Health of Acculturating Individuals …… 28 Arab American Acculturation and Mental Health …………………………… 32 Definitions and Demographics of “Arabs” and “Arab Americans” …… 33 Acculturation Strategies within a Historical Context ………………….. 38 Acculturation Strategy, Acculturative Stress, and Mental Health …….. 42 The Arab American Family: Stress and Social Support ……………….. 52 Religion and Religious Coping ………………………………………… 60 Definition of Terms ………………………………………………………….. 61 Aims of the Present Study ……………………………………………………. 64 ix II. Methods …………………………………………………………………………. 68 Participants …………………………………………………………………… 68 Measures ……………………………………………………………………... 82 Vancouver Index of Acculturation- Modified Arab Version (VIA-A) … 82 SAFE Acculturation Stress Scale- Revised (SAFE-R) ………………… 89 McMaster Family Assessment Device- General Functioning Subscale (FAD-GF)……………………………………………………………….. 91 Personal Resource Questionnaire- Part 2- Revised (PRQ85-R) ……….. 92 Brief Arab Religious Coping Scale (BARCS) …………………………. 94 Validity …………………………………………………………… 97 Reliability ………………………………………………………… 100 Category Functioning …………………………………………….. 102 Final Questionnaire ………………………………………………. 104 Beck Anxiety Inventory (BAI) ………………………………………… 104 Center for Epidemiologic Studies- Depression Scale (CES-D) ………... 109 Socio-Demographics Survey …………………………………………… 111 Procedures ……………………………………………………………………. 112 III. Data Analyses ………………………………………………………………….. 120 Rasch Rating Scale Analysis ………………………………………………… 120 Validity ………………………………………………………………… 121 Reliability ………………………………………………………………. 122 Category Functioning Diagnostics ........................................................... 123 x Descriptive and Bivariate Statistics ………………………………………….. 125 Structural Equation Modeling ………………………………………………... 126 The Structural Regression Model ……………………………………… 127 Model Specification and Identification ………………………………… 128 Data Preparation and Screening ………………………………………... 128 Model Estimation Procedures