Muslim Young Adult Mental Health and the 2016 US Presidential Election | Adolescent Medicine | JAMA Pediatrics | JAMA Network
[Skip to Navigation]
Sign In
Research Letter
Impact of Policy on Children
October 5, 2020

Muslim Young Adult Mental Health and the 2016 US Presidential Election

Author Affiliations
  • 1Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
  • 2Department of Health Law Policy and Management, Boston University School of Public Health, Boston, Massachusetts
  • 3Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
  • 4Now with Department of Public Health, Wayne State University, Detroit, Michigan
  • 5Now with Department of Health Policy and Management, UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, California
JAMA Pediatr. 2020;174(11):1112-1114. doi:10.1001/jamapediatrics.2020.3694

Population health is affected by sociopolitical events, particularly in groups specifically threatened by those events.1 The 2016 presidential election was associated with a rise in anti-Muslim rhetoric, policy, and hate crimes.2,3 Donald Trump called for banning Muslim immigrants.3 We assessed whether the election was associated with changes in the mental health of Muslim college students, an underresearched population potentially facing mental health inequities.4 We further tested whether Muslim individuals who are religious, who are often targets for greater levels of discrimination,5 were most strongly affected.

Methods

Survey data were from a random sample of students 18 years or older from 90 colleges and universities participating in the Healthy Minds Study6 in the 14 months before or after the election. This survey was approved by institutional review boards at all schools, and all participants provided written informed consent.

We assessed a binary outcome defined by exceeding cutoff scores for clinically significant depression, anxiety, or eating disorders (≥15 on the Patient Health Questionnaire–9 or the Generalized Anxiety Disorder–7 or ≥3 on the Sick, Control, One, Fat, Food [SCOFF] questionnaire). Key independent variables were the timing of survey completion (after vs on or before November 8, 2016), Muslim identity (students selecting “Muslim” when providing religious affiliation, with multiple selections possible), and religiosity (students who indicated religion as “important” or “very important” vs “somewhat important,” “neutral,” “not important,” or “very unimportant”).

We adjusted for differences between students who responded and those who did not respond using sample probability weights (inverse of response probability) based on institutional data on sex, race/ethnicity, academic level, and grade point average. We tested for changes in the proportion of Muslim students reporting clinically significant mental health symptoms surrounding the election beyond changes experienced by non-Muslim individuals, using a difference-in-difference logistic regression. We also tested for unique associations for Muslim individuals who were religious. We adjusted for school and self-reported student characteristics known to be associated with mental health (Table). These analyses were conducted between November 2019 and June 2020. Analyses used a 2-sided P < .05 as a threshold for statistical significance and were performed in Stata version 15.1 (StataCorp).

Table.  Sample Characteristics Before and After the 2016 Election (N = 75 578)a,b
Sample Characteristics Before and After the 2016 Election (N = 75 578)a,b

Results

The survey response rate was 25%. A total of 75 578 students (56.78% women; 2.24% Muslim) participated. Student and school characteristics are presented for the periods before and after the election for Muslim and non-Muslim participants (Table). Differences between the groups were mostly stable over time. Mental health in Muslim and non-Muslim individuals changed approximately in parallel before the election, with no significant differential change from fall 2015 to spring 2016.

Controlling for changes experienced by non-Muslim participants, the election was associated with a rise of 7.0 (95% CI, 1.0-13.0) percentage points in the proportion of Muslim students experiencing clinically significant mental health symptoms in the 14 months postelection compared with the 14 months prior. Changes from before to after the election were largest for Muslim individuals who were religious, at 10.9 (95% CI, 3.7-18.1) percentage points (vs 8.1 [95% CI, −3.5 to 19.7] percentage points for Muslim individuals who were nonreligious, 3.5 [95% CI, 1.3-5.8] percentage points for non-Muslim individuals who were religious, and 2.8 [95% CI, 1.1-4.6] percentage points for non-Muslim individuals who were nonreligious) (Figure).

Figure.  Percentage of Students With Clinically Significant Mental Health Symptoms Before and After the 2016 Election
Percentage of Students With Clinically Significant Mental Health Symptoms Before and After the 2016 Election

A, Results of a logistic regression model with a 2-way interaction between the time frame of survey completion variable and Muslim identity variable. B, Results of a logistic regression model with a 3-way interaction between postelection time frame, Muslim identity, and religiosity variables. Graphs display the percentage of students with clinically significant symptoms before and after the 2016 election of Donald Trump. They depict adjusted probabilities from multivariable logistic regression models (n = 73 664). Models were weighted with nonresponse weights. The 95% CIs were corrected for clustering at the school level using Taylor series linearization. Models were adjusted for student and school characteristics in the Table (including student gender identity, race/ethnicity, first-generation status, student age, international status, and sexual orientation and school size, sector, type and graduation rate). Data collected after November 8, 2016, were classified as postelection (data collected on or before November 8 were classified as preelection). Potential seasonality differences between the postelection and preelection period are not unique to Muslim individuals (per unpublished analyses of Healthy Minds data from the 2018-2019 school year [S. Abelson, MPH; written communication; February 4, 2020]).

Discussion

To our knowledge, this is the first national study of Muslim mental health changes through the 2016 election. Our results indicate the election was associated with declines in mental health among Muslim college students significantly beyond the declines experienced by other students. The largest declines occurred for Muslim individuals who were religious.

Limitations include the survey response rate—although typical for such online surveys and representing the best available data—and a small sample size for Muslim individuals who were nonreligious. We adjusted estimates with nonresponse weights based on known characteristics. Unknown differences between preelection and postelection populations could create bias, but we controlled for student and school characteristics and observed little differential variation in these characteristics from before to after the election. We had limited power to assess variations in outcomes by racial identity within Muslim individuals; this should be a priority for future research.

Conclusions

Our findings highlight links between sociopolitical events and mental health, with potential negative consequences for educational and social outcomes among affected groups. Schools and other communities need to consider these concerns in their efforts to support young adults, and researchers should improve understanding of causal mechanisms and potential prevention and intervention strategies.

Back to top
Article Information

Accepted for Publication: July 15, 2020.

Corresponding Author: Sara Abelson, MPH, Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I, Room 3803, Ann Arbor, MI 48109 (sabelson@umich.edu).

Published Online: October 5, 2020. doi:10.1001/jamapediatrics.2020.3694

Author Contributions: Ms Abelson and Dr Lipson had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Abelson, Lipson, Eisenberg.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Abelson, Lipson, Zhou.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Abelson, Lipson, Zhou.

Obtained funding: Abelson, Eisenberg.

Administrative, technical, or material support: Abelson, Lipson, Zhou.

Supervision: Eisenberg.

Conflict of Interest Disclosures: Ms Abelson reported grants from the National Institute of General Medical Sciences during the conduct of the study. No other disclosures were reported.

Funding/Support: A Rackham Merit Fellowship and Center for Research on Ethnicity, Culture and Health Fellowship from the University of Michigan School of Public Health (funded by the National Institute of General Medical Sciences [grant R25GM05864]) provided support to Ms Abelson during the preparation of the manuscript.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Meeting Presentation: Preliminary results were shared at the American Public Health Association Annual Meeting; November 12, 2018; San Diego, California.

Additional Contributions: We thank the schools that participated in the Healthy Minds Survey, Healthy Minds Network staff for coordinating survey implementation and collection, James Abelson, MD, PhD, University of Michigan, for valuable assistance with manuscript editing for clarity and length, and Joseph Dickens, PhD, and Josh Errickson, PhD, University of Michigan, for statistical consulting. The named individuals were not compensated for their contributions.

References
1.
Williams  DR, Medlock  MM.  Health effects of dramatic societal events—ramifications of the recent presidential election.   N Engl J Med. 2017;376(23):2295-2299. doi:10.1056/NEJMms1702111PubMedGoogle ScholarCrossref
2.
Musu  L, Zhang  A, Wang  K, Zhang  J, Oudekerk  BA. Indicators of school crime and safety: 2018 (NCES 2019-047/NCJ 252571). Published 2019. Accessed August 27, 2020. https://nces.ed.gov/pubs2017/2017064.pdf
3.
Costello  MB. The Trump effect: the impact of the presidential campaign on our nation’s schools. Published 2016. Accessed August 27, 2020. https://www.splcenter.org/sites/default/files/splc_the_trump_effect.pdf
4.
Samari  G.  Islamophobia and public health in the United States.   Am J Public Health. 2016;106(11):1920-1925. doi:10.2105/AJPH.2016.303374PubMedGoogle ScholarCrossref
5.
Ikizler  AS, Szymanski  DM.  Discrimination, religious and cultural factors, and Middle Eastern/Arab Americans’ psychological distress.   J Clin Psychol. 2018;74(7):1219-1233. doi:10.1002/jclp.22584PubMedGoogle ScholarCrossref
6.
Lipson  SK, Kern  A, Eisenberg  D, Breland-Noble  AM.  Mental health disparities among college students of color.   J Adolesc Health. 2018;63(3):348-356. doi:10.1016/j.jadohealth.2018.04.014PubMedGoogle ScholarCrossref
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    EXPAND ALL
    Nuancing Muslim American Mental Health Research
    Amelia Noor-Oshiro, MPH | Johns Hopkins University Bloomberg School of Public Health
    It is challenging to conclusively assess the mental health of American Muslims. Recent research denotes a decline in mental health among Muslim young adults after the 2016 U.S. Presidential Election.1 Interpretations of these findings warrant considerations for future research on Muslim mental health.

    Despite comprising only 1% of the overall population, Muslims are disproportionately targeted by discrimination independently of sociopolitical events. Racism, sexism, and xenophobia point to the intersectional and longstanding nature of oppression faced by the American Muslim community. Given the endemic normalization of stigma against American Muslims,2 research scientists must rigorously discriminate symptoms of anxiety or
    depression through post-event assessments. Suggesting the generalizability of the study findings to Muslim young adults implies homogeneity. This marks an invitation to seek community engagement and diversify participants. Community-based participatory approaches may enhance the validity of studies on Muslim mental health.

    Relatedly, operationalizing the population of interest is critical to scientific understanding. Analysis approaches for Muslim mental health research must consider sampling based on immigrant generation. More than forty percent of American Muslims are not foreign-born, but rather native-born second-generation Americans.3 Past research indicates that second-generation immigrants are most at-risk for negative mental health outcomes, such as suicide.4 Current trends in birth rates reveal a burgeoning proportion of second-generation immigrant children, demonstrating urgency in meeting the mental health needs of this at-risk population across racial/ethnic groups.5 Specifying immigrant generation as a variable of interest not only heightens precision, but also, more importantly, promotes comparisons across racial/ethnic groups and strengthens research interventions and implications for multiple minority groups.

    To conduct Muslim mental health research, the conceptual approach of intersectionality is paramount. Given the multiple layers of Muslim identity, it is worth questioning the value of measuring self-assessed importance of religiosity to meaningfully predict discrimination. Racially, around a quarter of American Muslims are Black, and around a third of those who are native-born are non-Black. Capturing the granular intersections of race, gender, garb (or “Muslim visibility”) or other markers of nonconformity offers an opportunity to contribute empirical evidence of intersectionality theory that advances minority mental health disparities research. Quantitative studies are limited in assessing the interactions of intersectional oppressions due to sampling power. Qualitative methods using phenomenological inquiry offer robust insights to the multi-faceted lived experiences of discrimination, which may better serve the intended beneficiaries of this research. Further studies are needed to provide evidence to designate Muslims as a disparity group.
    CONFLICT OF INTEREST: None Reported
    READ MORE
    ×