Discrimination and Negative Health Outcomes Among American Muslims

Background and Purpose: Since 9/11 Muslims have frequently been targets of discrimination. Yet, despite the link between discrimination and negative health outcomes, little, if any, research has examined this relationship with American Muslims. This study sought to address this gap in the literature by examining the relationship between discrimination and two health outcomes of critical importance to social workers—depression and substance use—in tandem with the protective effects of spirituality. Drawing from stress/coping theory, a theoretically-based model was developed and tested using structural equation modeling (SEM) with a national sample of Muslims. Based upon prior related research, it was hypothesized that higher levels of discrimination would predicts higher levels of both depression and substance use, and spirituality would mediate the relationship between discrimination and both health outcomes.

Methods: To obtain a national sample of self-identified Muslims for this cross-sectional study, a purposive, snowball sampling strategy was used to identify Islamic organizations in the US (N=22). After pilot testing, surveys were administered online to members of organizations who agreed to participate in the study. The mean age of the resulting sample (N=265) was approximately 38 years (SD=11.77), and a majority were: Sunni (86%), female (69%), married (58%), held graduate degrees (57%), born outside the US (52%), and a plurality self-identified as Middle Eastern (37%).

In addition to demographic items, the self-report survey included measures of perceived discrimination [developed by the Pew Research Center]; depression [assessed with the short form of the Center for Epidemiological Studies Depression Scale (CES-D)]; substance use; and spirituality. SEM was conducted using AMOS. Preliminary analyses indicated some variables were highly skewed. Mardia’s test of multivariate normality was not supported, violating a key assumption upon which Maximum Likelihood estimation is based. Accordingly, the asymptotically distribution free estimator was used.

Results: After validating the measurement model, the fit of the structural model was assessed with four widely recommended fit indices: normed chi-square, CFI, RMSEA, and SRMR. The values for the fit indices indicated a good fit between the data and the proposed model [χ²=34.50 (df=30, p=.26), normed χ²=1.15, CFI=.97, RMSEA=.02 (90% CI, .00-.05), and SRMR=.06].

Partial support was found the for the study hypotheses. Discrimination predicted higher levels of depressive symptoms. Discrimination did not, however, predict higher levels of substance use. Spirituality did not function as a mediator. Rather, spirituality exhibited an independent effect on both depression and substance use. In other words, higher levels of spirituality predicted lower levels of depression and substance use, apart from the effects of discrimination.

Implications: NIMH data indicate that depression accounts for more disability than any other mental or behavioral disorder. Given the link between discrimination and depression identified in this study, efforts are needed to advocate with, and on behalf of, Muslims to help ameliorate the discrimination they frequently encounter. At the micro level, the results regarding the potential protective effects of spirituality on depression and substance use have important implications for practitioners. Specifically, the findings suggest the importance of incorporating Muslims’ spiritual strengths into therapy.