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Mental Health of Arab Americans: Cultural Considerations for Excellence of Care

  • Imad MelhemEmail author
  • Zeina Chemali
  • Ashlee Wolfgang
Chapter
Part of the Current Clinical Psychiatry book series (CCPSY)

Abstract

Immigrants from the Middle East constitute the highest proportion of migrants worldwide. Arab Americans, who make up the majority of Middle Eastern populations in the United States, are a heterogeneous group with diverse cultural, ethnic, and religious backgrounds. Despite this heterogeneity, these immigrants may share a similar experience of migration and acculturative process.

This group remains poorly understood despite significant media and public attention it has received in recent years, and its diversity is often missed in clinical assessments and treatments. This is especially true in the mental health field where there is a significant paucity of evidence-based knowledge that can impede a professional’s ability to provide culturally sensitive treatments.

Unfortunately, professionals working with people of Arab origins may find only limited data to guide their understanding and treatment of the mental health problems of this population. Only few clinical studies have looked into the risk factors and the mental disorders of Arab Americans. The available research has been largely explorative in nature and remains negligible compared to studies involving other US minority groups.

Many cultural and religious considerations should guide the provision of culturally sensitive mental health services to Arab Americans. A good understanding of help-seeking attitudes and the obstacles to obtaining mental health services would better guide the creation of effective strategies for healthcare delivery in this growing community and mitigate against unsafe practices by both providers and patients.

As this community diversifies further and undergoes the process of acculturation, the mental health characteristics and needs of the Arab American population will continue to evolve. The scope and momentum of current research, education, and service delivery should parallel this evolution.

This chapter aims to provide clinicians, educators, and professionals with a better understanding of this community. It begins with a sociodemographic overview of Arab Americans and their immigration patterns followed by a review of the characteristics of their mental health. It then presents the cultural considerations pertinent to a culturally sensitive understanding of this population. Blended case vignettes are used to illustrate the cultural complexity encountered in the clinical setting. Finally, the chapter concludes with clinical recommendations to the professional treating Arab Americans.

Keywords

Arab world Mental health Traditional healing Language Family Gender Acculturation 

References

  1. 1.
    Inhorn MC, Serour GI. Islam, medicine, and Arab-Muslim refugee health in America after 9/11. Lancet [Research Support, US Gov’t, Non-PHS Review]. 2011;378(9794):935–43.Google Scholar
  2. 2.
    Fukuyama M. Taking a universal approach to multicultural counseling. Counsel Educ Supervis. 1990;30:6–17.CrossRefGoogle Scholar
  3. 3.
    Kulwicki A. Health issues among Arab Muslim families. In: Aswad BC, Bilge B, editors. Family and gender among American Muslims: issues facing Middle Eastern immigrants and their descendants. Philadelphia: Temple University Press; 1996.Google Scholar
  4. 4.
    Shaheen JG. The TV, Arabs. Bowling Green: State University Popular Press; 1984.Google Scholar
  5. 5.
    Suleiman MW. Arabs in the mind of America. Battelboro: Amanda Books; 1988.Google Scholar
  6. 6.
    Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med [Case Reports]. 1978;88(2):251–8.CrossRefGoogle Scholar
  7. 7.
    Saechao F, Sharrock S, Reicherter D, Livingston JD, Aylward A, Whisnant J, et al. Stressors and barriers to using mental health services among diverse groups of first-generation immigrants to the United States. Community Ment Health J [Research Support, Non-US Gov’t]. 2012;48(1):98–106.CrossRefGoogle Scholar
  8. 8.
    Derr AS. Mental health service use among immigrants: a systematic review. Psychiatr Serv. 2015;67(3):265–74.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Shannon PJ, Vinson GA, Cook TL, Lennon, Mental Health Service Use Among Immigrants in the United States: A Systematic Review E. Characteristics of successful and unsuccessful mental health referrals of refugees. Adm Policy Ment Health Ment Health Serv Res. 2016;43(4):555–68.CrossRefGoogle Scholar
  10. 10.
    Gladding S. Counseling: a comprehensive profession. New York: Macmillan; 1992.Google Scholar
  11. 11.
    al-Krenawi A, Graham JR. Culturally sensitive social work practice with Arab clients in mental health settings. Health Soc Work [Review]. 2000;25(1):9–22.CrossRefGoogle Scholar
  12. 12.
    Abraham N. Arab Americans. In: Vecoli RJ, Galens J, Sheets A, Young RV, editors. Gale encyclopedia of multicultural America. New York: Gale Research; 1995.Google Scholar
  13. 13.
    Amer MM, Hovey JD. Anxiety and depression in a post-September 11 sample of Arabs in the USA. Soc Psychiatry Psychiatr Epidemiol. 2012;47(3):409–18.PubMedCrossRefGoogle Scholar
  14. 14.
    Amer MM, Hovey JD. Socio-demographic differences in acculturation and mental health for a sample of 2nd generation/early immigrant Arab Americans. J Immigr Minor Health [Research Support, Non-US Gov’t]. 2007;9(4):335–47.CrossRefGoogle Scholar
  15. 15.
    El-Sayed AM, Tracy M, Scarborough P, Galea S. Suicide among Arab-Americans. PLoS One [Research Support, NIH, Extramural Research Support, Non-US Gov’t]. 2011;6(2):e14704.Google Scholar
  16. 16.
    Lipson JG, Meleis AI. Methodological issues in research with immigrants. Med Anthropol. 1989;12(1):103–15.PubMedCrossRefGoogle Scholar
  17. 17.
    Foundation AAI. Demographics. 2012. http://aai.3cdn.net/2b24e6a8711d521148_5ym6iv4b5.pdf. Accessed Apr 2013.
  18. 18.
    Nydell M. Communicating with Arabs. In: Yarmouth M, editor. Understanding Arabs: a guide for Westerners. Yarmouth: Intercultural Press; 1987.Google Scholar
  19. 19.
    Hassoun R. Arab American health and the process of coming to America: lessons from the metropolitan Detroit area. In: Suleiman MW, editor. Arabs in America: building a new future. Philadelphia: Temple University Press; 1999.Google Scholar
  20. 20.
    Hattar-Pollara M, Meleis AI. Parenting their adolescents: the experiences of Jordanian immigrant women in California. Health Care Women Int. 1995;16(3):195–211.PubMedCrossRefGoogle Scholar
  21. 21.
    Abudabbeh N. Arab families. In: Goldrick M, Giordano J, Pearce JK, editors. Ethnicity and family therapy. 2nd ed. New York: Guilford Press; 1996.Google Scholar
  22. 22.
    Naff A. Arabs. In: Thernstrom S, editor. Harvard encyclopedia of American ethnic groups. Cambridge: Harvard University Press; 1980. p. 128–36.Google Scholar
  23. 23.
    Naff A. Arabs in America: a historical overview. In: Abraham SY, Abraham N, editors. Arabs in America: building a new future. Detroit: Wayne State University, Center for Urban Studies; 1983.Google Scholar
  24. 24.
    Erickson CD, al-Timimi NR. Providing mental health services to Arab Americans: recommendations and considerations. Cultur Divers Ethnic Minor Psychol [Review]. 2001;7(4):308–27.CrossRefGoogle Scholar
  25. 25.
    Suleiman MW, Abu-Laban B. Arab Americans: Continuity and change. Arab Studies Quarterly. 1989;11(2/3):1–13.Google Scholar
  26. 26.
    El-Badry S. The Arab-Americans. Am Demogr. 1994;16(1):22–30.Google Scholar
  27. 27.
    Naff A. Becoming American: the early Arab immigrant experience. Carbondale: Southern Illinois University Press; 1985.Google Scholar
  28. 28.
    Jamil H, Hakim-Larson J, Farrag M, Kafaji T, Jamil LH, Hammad A. Medical complaints among Iraqi American refugees with mental disorders. J Immigr Health. 2005;7(3):145–52.PubMedCrossRefGoogle Scholar
  29. 29.
    Jamil H, Hakim-Larson J, Farrag M, Jamil LH. A retrospective study of Arab American mental health clients: trauma and the Iraqi refugees. Am J Orthopsychiatry. 2002;72(3):355–61.PubMedCrossRefGoogle Scholar
  30. 30.
    U.S. Department of Homeland Security (DHS) Office of Immigration Statistics. 2016 yearbook of immigration statistics. Washington, DC: DHS Office of Immigration Statistics; 2017. https://www.dhs.gov/immigration-statistics/yearbook/2016.Google Scholar
  31. 31.
    Migration Policy Institute. Middle Eastern and North African immigrants in the United States. January 2018. https://www.migrationpolicy.org/article/middle-eastern-and-north-african-immigrants-united-states.
  32. 32.
    World Bank Prospects Group. Annual remittances data. October 2017 Update.Google Scholar
  33. 33.
    Salari S. Invisible in aging research: Arab Americans, Middle Eastern immigrants, and Muslims in the United States. Gerontologist. 2002;42(5):580–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Jaber LA, Brown MB, Hammad A, Nowak SN, Zhu Q, Ghafoor A, et al. Epidemiology of diabetes among Arab Americans. Diabetes Care [Research Support, Non-US Gov’t Research Support, US Gov’t, PHS]. 2003;26(2):308–13.Google Scholar
  35. 35.
    Moradi B, Hasan NT. Arab American persons’ reported experiences of discrimination and mental health: the mediating role of personal control. J Couns Psychol. 2004;51(4):418–28.CrossRefGoogle Scholar
  36. 36.
    Abu-Ras W, Abu-Bader SH. Risk factors for depression and posttraumatic disorder (PTSD): the case of Arab and Muslim Americans post-9/11. J Immigr Refug Stud. 2009;7:393–418.CrossRefGoogle Scholar
  37. 37.
    Rippy AE, Newman E. Perceived religious discrimination and its relationship to anxiety and paranoia among Muslim Americans. J Muslim Ment Health. 2006;1:5–20.CrossRefGoogle Scholar
  38. 38.
    Gorkin M, Masalha S, Yatziv G. Psychotherapy of Israeli-Arab patients: some cultural considerations. J Psychoanal Anthropol. 1985;8:215–30.Google Scholar
  39. 39.
    Zayed TM. Conceptual and practical understanding of counseling in Islam. MOJPC. 2017;2(1):15–27.Google Scholar
  40. 40.
    Ahmed S, Reddy LA. Understanding the mental health needs of American Muslims: recommendations and considerations for practice. J Multicult Couns Dev. 2007;35:207–16.CrossRefGoogle Scholar
  41. 41.
    Meleis A. Arab students in Western universities. J High Educ. 1982;53:439–47.Google Scholar
  42. 42.
    Bazzoui W. Affective disorders in Iraq. Br J Psychiatry. 1970;117(537):195–203.PubMedCrossRefGoogle Scholar
  43. 43.
    al-Krenawi A, Graham JR. Gender and biomedical/traditional mental health utilization among the Bedouin-Arabs of the Negev. Cult Med Psychiatry [Review]. 1999;23(2):219–43.CrossRefGoogle Scholar
  44. 44.
    al-Krenawi A, Graham JR. Tackling mental illness: roles for old and new disciplines. World Health Forum. 1996;17(3):246–8.PubMedGoogle Scholar
  45. 45.
    Gorkin M, Othman R. Traditional psychotherapeutic healing and healers in the Palestinian community. Isr J Psychiatry Relat Sci. 1994;31(3):221–31.PubMedGoogle Scholar
  46. 46.
    Al-Rowaie OO. Predictors of attitudes toward seeking professional psychological help among Kuwait University Students. Blacksburg: Virginia Polytechnic Institute and State University; 2005.Google Scholar
  47. 47.
    Fabreka H. Psychiatric stigma in non-Western societies. Compr Psychiatry. 1991;32:534–51.CrossRefGoogle Scholar
  48. 48.
    Abudabbeh N, Nydell MK. Transcultural counseling and Arab Americans. In: McFadden J, editor. Transcultural counseling: bilateral and international perspectives. Alexandria: American Counseling Association; 1993.Google Scholar
  49. 49.
    Pumariega AJ, Rothe E, Pumariega JB. Mental health of immigrants and refugees. Community Ment Health J [Review]. 2005;41(5):581–97.CrossRefGoogle Scholar
  50. 50.
    Carlsson JM, Mortensen EL, Kastrup M. Predictors of mental health and quality of life in male tortured refugees. Nord J Psychiatry [Research Support, Non-US Gov’t]. 2006;60(1):51–7.CrossRefGoogle Scholar
  51. 51.
    Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet [Meta-Analysis Research Support, Non-US Gov’t Review]. 2005;365(9467):1309–14.Google Scholar
  52. 52.
    Gorman W. Refugee survivors of torture: trauma and treatment. Prof Psychol Res Pract. 2001;32:443–51.CrossRefGoogle Scholar
  53. 53.
    American Psychiatric Association. Appendix I: outline for cultural formulation and glossary of cultural-bound syndromes. 4th ed. Washington, DC: American Psychiatric Association; 2000.Google Scholar
  54. 54.
    Jackson M. Counseling Arab Americans. In: Lee C, editor. Multicultural issues in counseling. 2nd ed. Alexandria: American Counseling Association; 1997.Google Scholar
  55. 55.
    Dwairy M. Psychotherapy in competition with culture: a case study of an Arab woman. Clin Case Stud. 2002;1(3):254–67.CrossRefGoogle Scholar
  56. 56.
    Comas-Diaz L, Greene B, editors. Women of color: integrating ethnic and gender identities in psychotherapy. New York: Guilford Press; 1994.Google Scholar
  57. 57.
    Almeida R, Wood R, Messineo T, Font R.. The cultural context model: an overview In: McGoldrick M, editor. Re-visioning family therapy: race, culture and gender in clinical practice. New York: Guilford Press; 1998.Google Scholar
  58. 58.
    Gilligan J. Preventing violence. New York: Thames and Hudson; 2001.Google Scholar
  59. 59.
    Nobles AY, Sciarra DT. Cultural determinants in the treatment of Arab Americans: a primer for mainstream therapists. Am J Orthopsychiatry. 2000;70(2):182–91.PubMedCrossRefGoogle Scholar
  60. 60.
    Grossbard-Schechtman S, Neuman S. The extra burden of modern wives: clues from Israeli women’s labor supply. Econ Dev Cult Change. 1998;46:491–518.CrossRefGoogle Scholar
  61. 61.
    Meleis A. Between two cultures: identity, roles, and health. Health Care Women Int. 1991;12:365–77.PubMedCrossRefGoogle Scholar
  62. 62.
    Frewat-Nikowitz S. Spirituality and social work practice: the example of the Arab population in NYC. Unpublished paper presented at the school for Social Work, Columbia University, New York; 2007.Google Scholar
  63. 63.
    Berry JW. Conceptual approaches to acculturation. In: Chun KM, Organista PB, Marin G, editors. Acculturation: advances in theory, measurement, and applied research. Washington, DC: American Psychological Press; 2003.Google Scholar
  64. 64.
    Berry JW, Kim U. Acculturation and mental health. In Daesin PR, Berry JW and Sartorius N, editors. Health and cross-cultural psychology: Toward applications. (pp. 207–236). Thousand Oaks: sage Publications Inc: 1998.Google Scholar
  65. 65.
    Meleis AI, Lipson JG, Paul SM. Ethnicity and health among five Middle Eastern immigrant groups. Nurs Res [Comparative Study Research Support, Non-US Gov’t]. 1992;41(2):98–103.Google Scholar
  66. 66.
    Montgomery E, Foldspang A. Discrimination, mental problems and social adaptation in young refugees. Eur J Pub Health [Research Support, Non-US Gov’t]. 2008;18(2):156–61.CrossRefGoogle Scholar
  67. 67.
    Hovey JD, King CA. Suicidality among acculturating Mexican Americans: current knowledge and directions for research. Suicide Life Threat Behav. 1997;27(1):92–103.PubMedGoogle Scholar
  68. 68.
    Organista P, Organista KC, Kurasaki K. Overview of the relation between acculturation and ethnic minority mental health. In: Chun KM, Organista PB, Martin G, editors. Acculturation: advances in theory, measurement, and applied research. Washington, DC: American Psychological Association; 2003.Google Scholar
  69. 69.
    Assari S, Lankarani MM. Discrimination and psychological distress: gender differences among Arab Americans. Front Psych. 2017;8(23):1–10.Google Scholar
  70. 70.
    Kulwicki A, Khalifa R, Moore G. The effects of September 11 on Arab American nurses in metropolitan Detroit. J Transcult Nurs. 2008;19(2):134–9.  https://doi.org/10.1177/1043659607313071.PubMedCrossRefGoogle Scholar
  71. 71.
    Padela AI, Heisler M. The association of perceived abuse and discrimination after September 11, 2001, with psychological distress, level of happiness, and health status among Arab Americans. Am J Public Health. 2010;100(2):284–91.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Hammami R. Women, the Hijab and the intifada. http://www.merip.org/mer/mer164/women-hijab-intifada. Accessed Apr 2013.
  73. 73.
    Takolia N. The hijab has liberated me from society’s expectations of women. The Guardian. 2012.Google Scholar
  74. 74.
    Ali OM, Milstein G, Marzuk PM. The Imam’s role in meeting the counseling needs of Muslim communities in the United States. Psychiatr Serv [Research Support, Non-US Gov’t]. 2005;56(2):202–5.Google Scholar
  75. 75.
    El-Sayed AM, Galea S. The health of Arab-Americans living in the United States: a systematic review of the literature. BMC Public Health. 2009;9(272):1–9.Google Scholar
  76. 76.
    Meleis AI, La Fever CW. The Arab American and psychiatric care. Psychiatr Care. 1984;12(2):72–86.Google Scholar
  77. 77.
    Haddad L, Hoeman S. Home healthcare and the Arab-American client. Home Healthc Nurse. 2000;18(3):189–97.PubMedCrossRefGoogle Scholar
  78. 78.
    American Psychiatric Association. Homosexuality and civil rights: position statement. 1973.Google Scholar
  79. 79.
    Fowers BJ, Davidov BJ. The virtue of multiculturalism: personal transformation, character, and openness to the other. Am Psychol. 2006;61:581–94.PubMedCrossRefGoogle Scholar
  80. 80.
    Sharon E, Emmerich A, Parekh R. Diversity dialogue: an innovative model for diversity training. In: Parekh R, editor. The Massachusetts General Hospital textbook on diversity and cultural sensitivity in mental health. New York: Humana Press; 2014. p. 191–212.CrossRefGoogle Scholar
  81. 81.
    Dossani S. Being Muslim and Gay. In: Que(e)rying religion. New York: The Continuum; 1997.Google Scholar
  82. 82.
    Dunne BW. Homosexuality in the Middle East: an agenda for historical research. Arab Stud Q. 1990;12:55–82.Google Scholar
  83. 83.
    Clarke M. New kinship, Islam, and the liberal tradition: sexual morality and new reproductive technologies in Lebanon. J R Anthropol Inst. 2008;14:153–69.CrossRefGoogle Scholar
  84. 84.
    ILGA. Worldwide legislation. 2017. Retrieved from ilga.org/country/Lebanon.
  85. 85.
    American Psychiatric Association. Principles of medical ethics with annotations especially applicable to psychiatry. Washington, DC; 2013.Google Scholar
  86. 86.
    American Psychological Association. The American Psychological Association ethical principles of psychologists and code of conduct. Washington, DC: American Psychiatric Association; 2017.Google Scholar
  87. 87.
    American Psychological Association. American Psychological Association report of the task force on appropriate therapeutic responses to sexual orientation. Washington, DC: American Psychological Association; 2009.Google Scholar
  88. 88.
    Rodriguez EM. At the intersection of church and gay: religion, spirituality, conflict, and integration in gay, lesbian, and bisexual people of faith. Diss Abstr Int. 2006;67:1742.Google Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Neurobehavioral Medicine ConsultantsSaint ClairsvilleUSA
  2. 2.Division of Global Psychiatry, Department of Neurology and PsychiatryMassachusetts General Hospital-Harvard Medical SchoolBostonUSA
  3. 3.Counseling and Psychological Services, Carnegie Mellon UniversityPittsburghUSA

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