Background: Arab refugees plus immigrants living in the United States may be exposed to political, economic,
social, plus environmental stressors that may affect their mental health. Yet, little is known regarding mental health
outcomes among Arab Americans. The purpose of this study was to measure depression plus anxiety levels among
Arabs in Southeast Michigan plus determine whether these levels differ by resident status: refugee, immigrant, or
U.S. born.
Methods: We conducted a cross-sectional study in a convenience sample of 275 adults who self-identify as Arab
living in Southeast Michigan. Participants were recruited from a non-profit health plus social services organization
between August–November 2015. Data were collected via self-administered questionnaires, using standardized
instruments to assess depression plus anxiety symptoms.
Results: All three resident groups exhibited high mean levels of depression plus anxiety. Refugees reported higher
levels of depression plus anxiety than either immigrants or U.S. born Arab Americans. After adjustment for
sociodemographics, differences between U.S. born Arab Americans plus refugees were statistically significant
for depression (b = 2.84; 95% CI: 0.21, 5.47), but not for anxiety. Refugees had significantly higher depression
scores (b = 3.18, 95% CI: 1.52, 4.84) plus anxiety scores (b = 1.31, 95% CI: 0.11, 2.50) than immigrants. Those
reporting political violence plus religious persecution as reasons for immigration had the highest levels of
depression plus anxiety.

Analysis
The analysis for this study was restricted to those with
complete self-reported age, sex, plus resident standing data (n = 275). The sample consisted of refugees (n
= 67), immigrants (n = 153), plus U.S. born Arab Americans (n = 55). To test the association between resident
status plus depression plus anxiety outcomes, we fitted a
linear regression type for each outcome with U.S. born
Arab Americans serving as reference category for resident status. Each type also included control variables
for age, sex, duration living in the U.S., education, and
marital status. In both models, interaction between resident standing plus duration living in the U.S. were tested to
see if mental health outcomes associated with resident
status varied as a function of time since arriving in the
U.S. In order to test differences between refugees and
immigrants, we repeated the aforementioned models
with immigrants as reference group. All models were fitted in SAS 9.4. An exploratory analysis examining mean
depression plus anxiety levels by reason for immigration
was also conducted.