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. 2023 Jun 7:1–10. Online ahead of print. doi: 10.1007/s10597-023-01145-7

Prevalence, Correlates, and Impact of Psychiatric Disorders and Treatment Utilization Among Muslims in the United States: Results from the National Epidemiological Survey of Alcohol and Related Conditions

Fardowsa Ahmad 1, Faten AlZeben 2, Wid Kattan 2, Huda Yahya Alyahyawi 2, Ahmed N Hassan 1,2,3,4,5,✉
PMCID: PMC10244856  PMID: 37285047

Abstract

There is a paucity of research on the true prevalence of psychiatric disorders in Muslim Americans. This research aims to explore the prevalence, correlates and impact of mood disorders, anxiety disorders, and posttraumatic stress disorders (PTSD) in Muslims as compared with a non-Muslim sample. We used propensity scores to match 372 individuals who self-identified as Muslims from The National Epidemiologic Survey on Alcohol and Related Conditions III with a control group (n = 744) from the same dataset. The prevalence of psychiatric disorders was similar in Muslim Americans and non-Muslims. Help-seeking was generally low, but Muslims with a lifetime history of PTSD were less likely than non-Muslims with PTSD to seek help through self-help groups (2.2% vs. 21.1%, p < 0.05). Moreover, Muslims with mood disorders experienced lower mental health scores compared to non-Muslims with mood disorders. Efforts need to be made to identify psychiatric disorders in this faith group and engage in treatment.

Keywords: Psychiatric disorders, Muslims, Prevalence, Correlates, Treatment utilization, Impact

Introduction

Mood disorders, anxiety disorders, and post-traumatic stress disorders (PTSD) are among the most prevalent mental health conditions, comprising nearly one third of all mental health diagnoses made in the United States (US) (Merikangas et al., 2010). According to the World Health Organization, in developed countries, mental health disorders contribute to greater disability than all other illnesses, including heart disease and cancer (“WHO highlights urgent need to transform mental health and mental health care”, n.d.). These disorders can be highly comorbid (Brady et al., 2000), impact quality of life (Mittal et al., 2006), and increase the need for individuals to access health services (Fogarty et al., 2008). Where disorder point prevalence, which captures the proportion of individuals with a condition over a timeframe of interest, may limit information on the true extent of disorder prevalence, lifetime prevalence allows us to understand the proportion of individuals in a population who have ever had a disorder within their lifetime (Kessler et al., 2005). In the general population, the lifetime prevalence of mental health disorders has been shown to be 6.8% for PTSD and 21.4% for mood disorders, with anxiety disorders having the highest prevalence at 31.2% (Kessler et al., 2005).

Belief systems such as religion and spirituality form important domains of health, shaping wide-ranging patient perceptions on health, illness, and health-related behaviours (Swihart et al., 2021), and are salient considerations when assessing a patient’s background and outcomes in mental health care. Muslims comprise 1.1% of the total US population, forming an ethnic, racial, and socioeconomically heterogeneous minority group (Pew Research Center, 2010). Despite being dubbed the fastest-growing religious group in the US (Pew Research Center 2017), there is still scarce data on the true prevalence of psychiatric disorders within this population (Basit & Hamid, 2010). The limited available data on the prevalence of Muslim-Americans seeking treatment indicate a prevalence of 15% for anxiety disorders, 9% for mood disorders and 10% for PTSD in this population (Basit & Hamid, 2010).

Religiosity has been shown to both improve the health of American Muslims and prevent illness (Laird et al., 2007); however, Muslims in the US also face unique risk factors that might affect the prevalence of certain mental health disorders and treatment utilization. As is often true for visible minorities, these include, but are not limited to, marginalization and challenges with acculturation (Ahmed & Reddy, 2007), alongside multiple forms of discrimination, such as racism, xenophobia, and Islamophobia (Chaudhry & Li, 2011; Samari et al., 2018). Immigration has been found to impact mental health, with evidence showing that individuals immigrating from countries with greater political instability or cultural dissimilarity face greater risk of developing mental health disorders (Aroian & Norris, 2003). Muslims may also self-stigmatize their mental health with the belief that mental illness is due to an issue with their faith, leading to denial or a lack of treatment (Al-Natour et al., 2021). Muslims may further underutilize health services (Ahmed & Reddy, 2007) and, when contrasted with other minority groups, have been found to have a greater likelihood of developing mental health issues (Tanhan & Strack, 2020). In this vein, research shows that nearly one in every three Muslims experience perceived anti-Muslim discrimination in healthcare settings (Martin, 2015). Discrimination is highly detrimental and has been found to co-occur with anxiety, depression, and paranoia (Hodge et al., 2016; Rippy & Newman, 2006). Political factors in the US also play a role, with the altered political climate following 9/11 shown to have detrimentally impacted the mental health of Muslims (Abu-Ras & Abu-Bader, 2009). In a study by Abu-Ras and Suarez investigating risk factors for depression and PTSD, the only significant predictor of PTSD in Muslims was the perception of lower safety post 9/11 (Abu-Ras & Abu-Bader, 2009). Adverse mental health outcomes associated with discrimination remain inadequately investigated in the American Muslim population (Samari et al., 2018).

By 2050, Muslims are projected to become the second most populous faith group in the US (Pew Research Center 2017). yet, at present, there is a paucity of research on the lifetime prevalence of mental health disorders in Muslim Americans. As such, it is important for healthcare providers to understand the prevalence of specific mental health disorders amongst Muslims in America and their corresponding treatment-seeking behaviours. This paper will use a representative national sample from the United States to report the prevalence of mood disorders, anxiety disorders, and posttraumatic stress disorders, as compared to a matched sample from the general public. We also aim to compare the treatment utilization and the impact of these disorders in Muslims compared to a matched control group. The aim of this study is to elucidate the specific mental health issues facing American Muslims and address what disparities, if any, there may be. Our goal is to inform evidence-based, culturally competent, and targeted clinical interventions—while also highlighting the need for culturally responsive mental health services that provide preventative approaches to mental health and effective treatment.

Methods

Sample and Procedures

The National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC – III) is a national representative dataset that was conducted using face-to-face surveys between April 2012–June 2013. The full sample consisted of household non-institutionalized adults aged 18 years and older in the United States. The participants were selected randomly using multistage probability sampling. Certain ethnicities (African American, Asian, and Hispanic) were oversampled. The overall response rate was 60%. More details can be found in Grant et al. (Grant et al., 2015) The Institutional Review Board from the National Institute of Alcohol Abuse and Alcoholism approved the protocol of this study (Grant et al., 2015).

372 individuals self-identified as Muslims, out of 36,309 individuals in NESERC III, were included in this study. To ensure accurate comparison, we used a control group (n = 744) from the general population (NESARC III) that was matched based on several known risk factors for the development of mental illness as described below. This matched individuals affiliated with any religion except Islam or no religion.

Matching Variables

We used the propensity score matching methods to match Muslim individuals with individuals from the general public in the NESARC III dataset. We estimated a propensity score for the probability of having a mental illness by matching participants from the Muslim group with participants from the control group. We also used known risk factors for mental illnesses from previous research (Stuart, 2010), to match people from both groups, including sex, ethnicity, family environmental stressors (i.e., lived with a biological parent during childhood, a biological parent died before the age of 18, and parents divorced before the age of 18), family history of depression, family history of alcohol use disorder, family history of drug use disorder, childhood maltreatment experiences, immigration status, and personality disorders (antisocial, borderline, and schizotypal) (Bas-Sarmiento et al., 2017; Colvin et al., 2014; Koenen et al., 2007; Newton-Howes et al., 2010; Sareen, 2014). We did not match age and substance use since these factors might be affected by the psychiatric illness itself and therefore violate the propensity score matching (Stuart, 2010).

Measures

DSM-5 Psychiatric and Substance Use Disorders Diagnoses

A fully structured interview measure, the DSM-5 version of Alcohol Use Disorder and Associated Disabilities Interview Schedule 5 (AUDADIS-5), was used by NESARC III to measure and diagnose mood disorders, anxiety disorders, eating disorders, personality disorders, alcohol/drug use disorders and tobacco use disorder. The mood disorders tested included lifetime major depressive disorder, bipolar affective disorder or persistent depressive disorder. The test-retest reliability was fair (k = 0.40) (Hasin & Grant, 2015). The evaluated anxiety disorders included lifetime generalized anxiety disorder, social anxiety disorder, specific phobia, panic disorder and agoraphobia. The test-retest reliability was fair to good (k = 0.35–0.54) (Hasin & Grant, 2015). Personality disorders included schizotypal personality disorder, antisocial personality disorder and borderline personality disorder with very good test-retest reliability (k = 0.67–0.71) (Hasin & Grant, 2015). Alcohol or drug use disorder included any lifetime severity of alcohol use disorder, cannabis use disorder, opioid use disorder, heroin use disorder, sedative use disorder, cocaine use disorder, stimulant use disorder, hallucinogen use disorder, inhalant/solvent use disorder, club drug use disorder or any other drug use disorder. The test-retest reliability of these diagnoses was fair to good (k = 0.40–0.62) (Hasin & Grant, 2015).

Treatment Utilization

Treatment utilization was defined by the self-reported help sought from various sources for mood disorders, anxiety disorder and PTSD. Help sought from anyone, from health professionals, and from self-help groups were reported and compared to non-Muslims with these disorders.

Quality of Life

NESARC III used the 12-item Short Form health survey (SF-12) to measure health-related quality of life using this 12-item questionnaire (Ware et al., 1996). In this study, we focused on three health domains out of eight measured by SF-12: mental health-related scale, role emotional (effect of emotional problems on work/activities productivity and quality), and social functioning.

Statistical Analyses

To complete the matching using propensity score, we estimated the average treatment effect (ATT) (Stuart, 2010), which estimates the average effect on the risk of developing mental illnesses for individuals identified as Muslims. We estimated the propensity score for the probability of an individual having a mental illness using multivariable logistic regression (Dugoff et al., 2014). We paired each participant from the Muslim group with 2 participants from NESARC III (n = 35,037) who had similar propensity scores. We used 1:2 ratio matching to get multiple good matches with the control group, as there were many more participants in the control group (n = 35,937) than in the Muslim group (n = 372) (Stuart, 2010). According to our diagnostics (see below), this matching outperformed 1:1 matching in our sample. We matched without “replacement,” such that a participant from the control group could be matched only once.

We used numeric and visual diagnostic methods to ensure good matches from both groups. Subsequently, we calculated standardized differences in means to numerically assess the balance. This was accomplished by dividing the difference in means for each matched variable by the standard deviation in the Muslim group (Stuart, 2010). We considered matching to be good if the standardized difference in means was less than 0.2, meaning that each participant from the Muslim group had a match from the control group within ± 0.2 standard deviations of the estimated propensity score for that variable (Rubin, 2001). We were able to find good matches from the control group (n = 744) for each individual from the PTSD group (n = 372).

We estimated the weighted mean and percentage with their standard errors for the demographics and clinical features of the Muslim and non-Muslim groups. The weighted mean and percentage, with their standard errors, were estimated for Muslims with mood disorders, anxiety disorders, and PTSD. Additionally, we used logistic regression to evaluate the association between each demographic variable/clinical variable and lifetime diagnosis of mood disorders, anxiety disorders or PTSD. Logistic regression was also used to compare the association between self-identification with Muslims and lifetime risk of mental illnesses controlling for age, sex, highest education, ethnicity, marital status, income, United States-born status, mood disorders, anxiety disorder, PTSD, eating disorders, alcohol or drug use disorder, tobacco use disorder, personality disorders, family history of alcohol/drugs, and family history of depression.

We listed the percentages and their standard errors of the most common places where help was sought for mood disorders, anxiety disorders and PTSD.

Analyses were conducted using the Software for Survey Data Analysis (SUDAAN) Version 11, which uses Taylor series linearization in variance estimation to account for the complex sampling. The level of significance was set at p < 0.05.

Results

Out of 372 individuals who self-identified as Muslims in NESARC III, there were 62 individuals with mood disorders (15.29%, SE:2.60); 42 individuals with anxiety disorders (9.96%, SE: 1.73); and 20 individuals with PTSD (3.62%, SE:0.81). Among the 62 Muslim individuals with mood disorders, there were 53 individuals with Major Depressive Disorder (MDD), 17 individuals with dysthymia (persistent depressive disorder), and six individuals with bipolar affective disorder. 16 individuals had a lifetime diagnosis of both MDD and dysthymia. Out of the 42 Muslim individuals with anxiety disorders, 19 had specific phobia, 6 had social anxiety disorder, 14 had panic disorder, 7 had agoraphobias, and 14 had generalized anxiety disorder. 18 individuals had more than one anxiety disorder.

Muslims were more likely to be younger and non-married than non-Muslims in the control group (Table 1). There were more substance use disorders, except for tobacco use disorder, in the non-Muslim control group than in the Muslim group. All other demographics and clinical characteristics were similar between the two groups.

Table 1.

Comparison of the demographics and clinical variables between the Muslims group and the matched control group

Demographics Muslim group (n = 372) Control group (n = 744) P-value
Prevalence % (SE) Prevalence % (SE)
Age: Mean (SE) 40.68 (1.04) 46.67 (0.76) 0.00
Sex: Female 43.69 (3.14) 40.48 (2.16) 0.40
Race: White 61.39 (3.13) 62.82 (2.31) 0.70
Marital status: Married 34.92 (3.16) 44.14 (2.26) 0.02
Marital status: Non-married 65.08 (3.16) 55.86 (2.26)
Highest educational level: Higher than high school education 74.76 (2.66) 69.62 (1.86) 0.14
Income: $35, 000 or greater 34.02 (3.22) 40.07 (2.15) 0.13
Born in the United States 73.30 (2.51) 71.77 (1.95) 0.62
Religion affiliation
 Muslim 100 (0.00) 0.00 (0.00) –
 Christian 0.00 (0.00) 66.21 (2.35) –
 Jewish 0.00 (0.00) 2.23 (0.75) –
 Buddhist 0.00 (0.00) 5.49 (1.13) –
 Hindu 0.00 (0.00) 6.16 (1.33) –
 Other religion 0.00 (0.00) 6.62 (1.02) –
 No religious affiliation/agnostic/atheist 0.00 (0.00) 13.29 (1.49) –
Family history of depression 29.03 (2.66) 32.74 (2.01) 0.25
Family history of alcohol 14.50 (2.11) 16.93 (1.58) 0.37
Family history of drugs 15.01 (2.12) 15.94 (1.68) 0.73
Personality disorders 6.20 (1.22) 9.46 (1.31) 0.07
Childhood maltreatment score 25.19 (0.50) 25.18 (0.32) 0.97
Lifetime eating disorder 0.70 (0.41) 0.96 (0.38) 0.63
Lifetime PTSD diagnosis 3.62 (0.81) 4.43 (0.72) 0.43
Lifetime anxiety disorder 9.96 (1.73) 11.97 (1.41) 0.32
Generalized anxiety disorder 3.79 (1.18) 5.64 (0.86) 0.15
Agoraphobia 0.96 (0.44) 1.15 (0.41) 0.76
Panic disorder 3.36 (1.01) 3.10 (0.79) 0.84
Social anxiety disorder 0.95 (0.45) 2.28 (0.54) 0.05
Specific phobia 4.73 (1.15) 3.81 (0.80) 0.51
Lifetime mood disorder 15.29 (2.60) 17.58 (1.58) 0.44
Bipolar affective disorder 1.92 (1.13) 3.24 (0.79) 0.34
Dysthymia (persistent depressive disorder) 3.31 (0.95) 4.19 (0.85) 0.48
Major depressive disorder 12.79 (2.15) 12.36 (1.27) 0.86
Lifetime alcohol/drug use disorder 10.85 (2.10) 19.98 (1.87) 0.00
Lifetime tobacco use disorder 18.42 (2.32) 17.02 (1.56) 0.60
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Bold: statistically significant

Prevalence

Overall, the prevalence of lifetime mood disorders, anxiety disorders, and PTSD was similar in the Muslim group (15.3%, 10%, and 3.6%, respectively) compared to the non-Muslim control group (17.6%, 12%, and 4.4%, respectively) (Table 1). The prevalence of social anxiety disorder was lower in the Muslim group (1.0%) than in the non-Muslim control group (2.3%), although the difference was of marginal statistical significance. All other types of mood disorders and anxiety disorders were similar between the two groups. After controlling for demographics and clinical variables, the odds of having a mood disorder in Muslims were similar to that in the non-Muslim control group (OR: 0.95; 95%CI: 0.57–1.59; p = 0.85). Correspondingly, there was no significant difference between groups for anxiety disorder or PTSD (OR: 0.96; 95%CI: 0.56–1.63; p = 0.87, OR: 0.77; 95%CI: 0.33–1.76; p = 0.53, respectively).

Sociodemographic Correlates

Table 2 summarizes the associations between demographic variables and mood disorders, anxiety disorders, and PTSD in Muslims. Being single, divorced or widowed was associated with a greater likelihood of having a lifetime mood disorder (OR = 2.38, 95% CI = 1.19–4.76) and a lifetime anxiety disorder (OR = 2.16, 95% CI = 1.02–4.55) compared to married individuals. Those who were born outside the U.S. were less likely to have lifetime mood disorders (OR = 0.49, 95% CI = 0.26–0.94), and especially, lifetime PTSD (OR = 0.22, 95% CI = 0.06–0.87) compared to Muslims born in the U.S.

Table 2.

Prevalence and OR of lifetime mood disorders, anxiety disorders and PTSD by demographics in Muslims (n=372)

Demographics Lifetime mood disorder (n = 62) Lifetime anxiety disorder (n = 42) Lifetime PTSD (n = 20)
Prevalence % (SE) OR (95% CI) Prevalence % (SE) OR (95% CI) Prevalence % (SE) OR (95% CI)
Sex
 Male 50.77 (7.20) 0.77 (0.40–1.46) 42.12 (8.07) 0.53 (0.26–1.08) 49.15 (11.86) 0.74 (0.28–1.97)
 Female 49.23 (7.20) Ref 57.88 (8.07) Ref 50.85 (11.86) Ref
Race
 Non-White 50.84 (6.20) 0.60 (0.35–1.03) 66.73 (7.98) 1.29 (0.62–2.70) 77.85 (9.03) 2.27 (0.76–6.73)
 White 49.16 (6.20) Ref 33.27 (7.98) Ref 22.15 (9.03) Ref
Marital status
 Non-married 52.54 (8.73) 2.38 (1.19–4.76) 51.60 (8.17) 2.16 (1.02–4.55) 43.31 (11.51) 1.44 (0.53–3.90)
 Married 47.46 (8.73) Ref 48.40 (8.17) Ref 56.69 (11.51) Ref
Highest educational level
 High school or less 15.36 (5.16) 0.49 (0.22–1.10) 31.42 (8.04) 1.41 (0.64–3.12) 22.17 (10.03) 0.84 (0.27–2.56)
 Higher than high school education 84.64 (5.16) Ref 68.58 (8.04) Ref 77.83 (10.03) Ref
Income
 Less than $35,000 82.95 (7.68) 0.66 (0.21–2.04) 90.73 (5.99) 1.47 (0.35–6.11) 100 (0.00) NA
 $35,000 or higher 17.05 (7.68) Ref 9.27 (5.99) Ref 0.0 (0.00) Ref
Urbanicity
 Rural 0.0 (0.00) NA 0.0 (0.00) NA 0.0 (0.00) NA
 Urban 100 (0.00) Ref 100 (0.00) Ref 100 (0.00) Ref
Born in the United States
 No 39.53 (7.35) 0.49 (0.26–0.94) 43.11 (9.58) 0.44 (0.19–1.00) 60.50 (16.12) 0.22 (0.06–0.87)
 Yes 60.47 (7.35) Ref 56.89 (9.58) Ref 39.50 (16.12) Ref
Attending religious services
 Yes 39.30 (8.46) 1.31 (0.60–2.85) 52.62 (9.57) 0.71 (0.31–1.60) 38.37 (13.92) 1.32 (0.40–4.37)
 No 60.70 (8.46) Ref 47.38 (9.57) Ref 61.63 (13.92) Ref
Religious belief is very important
 No 39.59 (7.04) 1.28 (0.65–2.52) 27.23 (7.22) 0.68 (0.30–1.55) 37.92 (13.31) 1.16 (0.35–3.79)
 Yes 60.41 (7.04) Ref 72.77 (7.22) Ref 62.08 (13.31) Ref
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Bold: statistically significant. Ref reference, NA not applicable

Treatment Utilization

The prevalence of seeking help from any source among Muslims with mood disorders or anxiety disorders (53.7% and 39.8%, respectively) was less than in non-Muslims (62.9% and 45.8%, respectively). However, the differences were not statistically significant (Table 3). Seeking help from health professionals or self-help groups was also not statistically different among Muslims with these psychiatric disorders compared to non-Muslims. While help-seeking for PTSD was similar in the Muslim group compared to the control group, the prevalence of help-seeking in a group setting for PTSD was significantly lower in the Muslim group than in the control group.

Table 3.

The prevalence of help-seeking behaviours in the Muslim group compared with a control group

Help-seeking behaviours Individuals with lifetime mood disorder in the Muslim group
(n = 62)
% (SE)		 Individuals with lifetime mood disorder in the control group
(n = 139)		 P-value
Any help 53.70 (7.30) 62.94 (4.96) 0.32
Health professional 42.06 (8.04) 57.90 (4.78) 0.11
Self-help group 7.96 (3.91) 16.30 (3.66) 0.18
Help-seeking behaviours Individuals with lifetime anxiety disorder in the Muslim group
(n = 42)
% (SE)		 Individuals with lifetime anxiety disorder in the control group
(n = 100)		 P-value
Any help 39.82 (8.60) 45.75 (6.13) 0.58
Health professional 39.06 (8.63) 39.51 (5.74) 0.97
Self-help group 3.11 (2.39) 10.78 (3.86) 0.13
Help-seeking behaviours Individuals with lifetime PTSD disorder in the Muslim group
(n = 20)
% (SE)		 Individuals with lifetime PTSD disorder in the control group
(n = 43)		 P-value
Any help 67.12 (9.86) 61.96 (8.55) 0.68
Health professional 48.22 (13.56) 53.11 (8.31) 0.75
Self-help group 2.22 (2.23) 21.05 (7.82) 0.04
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Bold: statistically significant

Impact of Psychiatric Disorders

The scores on all subscales of the SF-12 were lower in the Muslim group compared to those in the non-Muslim control group, although these differences were not statistically significant for most disorders (Table 4). However, in those with mood disorders, the mental and emotional role scores of the SF-12 in Muslims were significantly lower than in non-Muslims.

Table 4.

The impact of mood, anxiety and PTSD in the Muslim group on norm-based mental health, norm-based role emotional, and norm-based social functioning SF-12 subscales compared with a control group

SF-12 subscale Muslim individuals with mood disorders Control group with mood disorders p-value Muslim individuals with anxiety disorders Control group with anxiety disorders p-value Muslim individuals with PTSD Control group with PTSD p-value
Mental health: mean (SE) 43.91 (1.44) 47.87 (1.16) 0.04 45.33 (2.00) 49.33 (1.30) 0.10 42.28 (3.34) 45.52 (2.44) 0.44
Role emotional: mean (SE) 39.92 (1.92) 45.45 (1.01) 0.02 40.82 (2.38) 44.91 (1.41) 0.13 – – –
Social functioning scale: mean (SE) 43.67 (1.98) 46.24 (1.25) 0.28 42.30 (2.32) 46.37 (1.51) – 33.34 (3.89) 41.41 (2.65) 0.13
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Bold values are statistically significant (p < 0.05)

Discussion

Mental health disorders and their lack of treatment are serious public health issues in the US, and with Muslims forming a minority religious group, it is important to understand prevalence data to inform clinical care. This study compared Muslims and a matched group of non-Muslims in the United States with regard to the prevalence and correlates of DSM-5 psychiatric disorders based on a large nationally representative sample of Americans assessed in 2012–2013. The analysis of this study highlights several key findings. From the population of self-identified Muslims, 3.62% of individuals were found to have lifetime PTSD, 15.3% of individuals were found to have lifetime mood disorders and 9.96% of individuals were found to have lifetime anxiety disorders. While these results were similar to the control group (where prevalence was determined to be 4.4%, 17.6%, and 12%, respectively) and while there were no statistically significant differences found, the Muslim group had a slightly lower prevalence for each of these disorders. There was also a trend towards a lower likelihood of experiencing social anxiety disorder.

Concerning correlates of lifetime mood and anxiety disorders among Muslims, individuals who were not married and those who were not born in the U.S. were more likely to have these disorders. Interestingly, attendance at religious services and the importance of religious belief were unrelated to the lifetime prevalence of depression or anxiety in this faith group. However, it should be noted that religious service attendance here does not account for religious involvement or frequency of attendance, which have been shown to have a protective effect against psychiatric disorders (Balbuena et al. 2013; Koenig et al., 2020) and thus may not reflect the impact of religiosity in this regard. Even when demographic and clinical variables were controlled, the odds of mood disorders, anxiety, or PTSD occurring in Muslims compared with the control group were not found to be significantly different. Amid an ongoing mental health crisis in the US and worldwide, these findings illustrate that Muslims should not be discounted in mental health practice, as they show a similarly high need for mental health treatment relative to the general population. These findings contrast with those on rates of completed suicide (2019) reported in 46 Muslim-majority countries around the world, where the median suicide rate was found to be 5.45 per 100,000 (2.9 per 100,000 in females and 7.45 per 100,000 in males) (Arafat et al., 2022), which is considerably lower than the most recent suicide rate in the United States (13.9 per 100,000 in 2019; NIMH 2022). Eskin et al. also found considerably lower suicide attempts among Muslims in 11 Muslim-majority countries compared to Muslims in the U.S. (Eskin et al., 2020). We also found in the present study that Muslims born outside the U.S. (versus in the US) were less likely to experience depressive disorders. Awaad et al. also found that suicide attempts were much less frequent among those born outside of the U.S. (OR = 0.28, 95% CI 0.15–0.52, p < 0.001) (Awaad et al., 2021). Combined, these findings suggest that cultural influences and pressures of discrimination in the US may be contributing to emotional disorders in American Muslims (Saleem et al., 2019), which may be less likely among Muslim immigrants born in Muslim-majority countries.

Treatment utilization for anxiety and mood disorders—measured by help-seeking behaviours—was found to be lower in the Muslim group as compared with the control group, although these findings were not statistically significant. Findings from previous literature have shown that Muslims underutilize mental health services (Rassool, 2015), have lower help-seeking from mental health professionals (McLaughlin et al., 2022), and among minorities and immigrants, show distrust of mental health providers (Amri & Bemak, 2013; Hassan et al., 2021). Muslims may perceive mental health as a private issue shared only with family (Ciftci et al., 2013), thus opting to pursue less formal treatment reflective of religious and cultural beliefs over traditional mental health service use (Khan et al., 2019). Experiences of discrimination, social exclusion and racism also negatively impact help-seeking behaviours (Amri & Bemak, 2013).

Our study also found that when help-seeking behaviours were compared among the Muslim and control groups, Muslims had lower help-seeking for PTSD in self-help groups (2.22%) as compared with the control group (21.05%), and these findings were statistically significant (p = 0.04). This is an interesting finding, and to our knowledge, there is presently no data demonstrating these results in an American-Muslim population. Lower help-seeking in group settings for Muslim patients can be partly explained by literature indicating that stigma is of crucial importance when evaluating mental health underutilization, given that stigma consistently discourages Muslims from seeking mental health treatment, and this may only be further compounded in a group setting (Amri & Bemak, 2013; Ciftci et al., 2013). These findings have important implications for practice, suggesting that it may be best to avoid recommending PTSD treatment offered in group settings for Muslim Americans.

When SF-12 subscales were used to evaluate norm-based domains, including mental health, emotional role, and social functioning, Muslim individuals with mood disorders were found to have lower mental health (43.91% and 47.87%, respectively; p = 0.04) and emotional roles compared with the control group (39.92% and 45.45% respectively; p = 0.02) and these findings were statistically significant. This illustrates that, despite having a similar prevalence of highlighted mental health disorders, Muslims experience greater limitations in their usual role activities and social function. This may have clinical consequences. For example, Awaad et al. (2021) reported that compared to other religious groups in the U.S., Muslims were more likely to have attempted suicide at some time in their lives (7.9% of Muslims vs. 5.1% of Protestants, 6.1% of Catholics, and 3.6% of Jews; adjusted OR = 2.18 for Muslims, 95% CI = 1.13–4.22, p = 0.02) (Awaad et al., 2021). These findings were based on the 2019 Institute for Social Policy and Understanding national community-based survey that assessed 2376 Americans, of whom 809 were Muslims.

This study has several key strengths. For one, to the best of our knowledge, this study is one of the few population-based studies comparing Muslims and non-Muslims with psychiatric disorders in the US. Another key strength is that the study provides important epidemiological data on the prevalence of PTSD, anxiety, and mood disorders for which there is currently a knowledge gap in the literature. Furthermore, the psychiatric diagnoses were made by a structured psychiatric interview, and reliable valid measures were used to assess mental, emotional, and social functioning (SF-12).

We also acknowledge that there are a few important study limitations. First, the data collection period for the NESARC-III began a decade ago in 2012 and ended in 2013. A number of changes since then may influence prevalence data on mental health, such as improved mental health awareness, reduced stigma, and worldwide events such as the COVID-19 pandemic. Second, prevalence data from Muslims is drawn from individuals who self-identified as Muslims in their survey. Since there may have been individuals who did not want to identify as Muslim, this can impact the true prevalence data found. Additionally, due to stigma, there may be underreporting of mental health disorders and treatment utilization, particularly amongst Muslims. The small sample of the Muslim group might also affect the accurate representation of this group. The cross-sectional nature of this study prevents any causal inferences concerning the associations between demographic characteristics (such as age and marital status) that differentiate Muslims from non-Muslims in this study. Similarly, differences in rates of psychiatric disorders (e.g., social anxiety disorder) between Muslims and non-Muslims in this study may not be caused by Muslim religious affiliation. Different rates of lifetime mood disorder and PTSD between Muslims born in the US vs. Muslim immigrants (born outside the US) may or may not be due to birthplace, although the results are suggestive of this direction of causation. Prospective cohort studies are needed to confirm the cross-sectional results in the present study. Finally, although data on relevant factors such as schooling and religiosity have been included, there was a lack of available data on important information such as level of religiosity, school, or involvement in the Muslim community. Future research is needed to provide insight into how these factors may influence the prevalence of psychiatric disorders and help-seeking in this population.

Conclusion

This is one of the first population-based studies to examine the prevalence of psychiatric disorders, sociodemographic correlates, help-seeking behaviours and the impact of major psychiatric disorders in American Muslims compared to a matched group of non-Muslims in the United States. Anxiety, PTSD, and mood disorder in Muslim Americans are of similar prevalence to matched controls, although Muslim Americans also encounter greater limitations in usual role activities and social functioning. Despite this, Muslims exhibit lower help-seeking behaviours for anxiety and mood disorders, although these findings are not statistically significant. Treatment utilization in self-help groups is lower for PTSD in Muslims compared with the general population suggesting that Muslim individuals fare better when seeking help in individual settings. Younger Muslims, and those who are not married were at greater risk for psychiatric disorders, particularly mood disorders. These findings can be used to design more effective public health and clinical interventions to improve existing mental health disparities. Given the unique challenges faced by Muslims in the US, further prospective cohort studies are needed to continually evaluate mental health outcomes in this population and determine the direction of the relationship.

Declarations

Conflict of interest

The authors declare no conflict of interest.

Ethical Approval

The authors obtained local approval to conduct this study from the Centre for Addiction and Mental Health’s Research Ethics Board (099-2019-01). This paper was prepared using a limited access dataset obtained from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). This paper has not been reviewed or endorsed by NIAAA and does not necessarily represent the opinions of NIAAA, who is not responsible for the contents.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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