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Alkhatib S, Johnson K, Balasundaram R, Burney A, Kline N, Griner S. The effect of Islamophobia on the mental health of Muslim Americans following the tragedy of September 11th. HPHR. 2024;85. https://doi.org/10.54111/0001/GGGG9
The events of September 11th, 2001 (9/11) triggered a surge of Islamophobia in the United States (U.S.), further marginalizing Muslims and individuals associated with Islam. This review examines the persistent discrimination and harassment faced by Muslim Americans post-9/11, the resultant mental health challenges, and the need for further research on this topic.
Post-9/11, Muslim Americans, including those who consider themselves American citizens, have faced persistent discrimination and harassment. This violent harassment has significantly impacted the mental health of Muslim Americans and their future generations. Muslim women, due to their visible religious attire like the hijab, are particularly targeted, leading to a marked decline in their mental health. Additionally, Muslim immigrants face heightened scrutiny and special security checks, exacerbating their mental health challenges. Despite 59% of Muslims in America being African Americans, their experiences of Islamophobia receive less visibility compared to South Asian and Arab Muslims, who are more commonly associated with Islam in public perception. The changing political climate has intensified the discrimination faced by Muslim immigrants, further deteriorating their mental well-being.
The surge of Islamophobia post-9/11 has had lasting negative impacts on the mental health of Muslim Americans, particularly women and immigrants. Despite the significant challenges faced by Muslim Americans, public health research has not adequately addressed the long-term effects of Islamophobia on their mental health. This review highlights the need for comprehensive research to understand the scope of Islamophobia and its enduring impacts on Muslim Americans, addressing the current gaps in the scholarship on this critical issue.
Islamophobia, a term developed in the late 1990s and early 2000s by political activists and international organizations, conceptualizes harmful rhetoric and actions directed at Muslims and Islam, primarily in Western liberal democracies.1 Originally, Islamophobia referred to a “fear of Islam by liberal Muslims and Muslim feminists”.2 However, post-September 11, 2001 (9/11), it has come to denote fear and hatred of Muslims by non-Muslims. For this paper, Islamophobia is defined as the stigmatization, irrational fear, and dislike or hatred against Islam and its practitioners.1
Muslim Americans are U.S. citizens who practice the faith of Islam and reside in the U.S.3 As of 2022, about 3.45 million Muslims live in the U.S. – representing about 1.1% of the total population, with 59% being African American.3 Additionally, an estimated 63% of American Muslims are immigrants, and 25% are second-generation Americans. The aftershocks of 9/11 trapped Muslim Americans who were born and raised in the U.S. in an unprecedented wave of retaliation – particularly impacting native-born Muslims who face intersectional discrimination based on race and religion.
The 9/11 attacks, the suicide attacks on the Twin Towers by Al-Qaeda, intensified Islamophobia. Among the 2,996 civilians who lost their lives as an outcome of the strike, only about 28 were reported Arab and Muslim victims.4 This number, however, may not be accurate since many family members of Muslim victims remained silent and did not report the deaths out of fear of being accused of terrorism for months following the hostile environments and societal unease they were experiencing in their “home country” of the U.S. 4 Despite the attackers being extremists, anti-Muslim hate notions and crimes sparked from that day forward to distinguish all Muslims as a “terroristic and violent” people.5 To this day, Muslim Americans continue to face scrutiny, distrust, and discrimination, 5 perhaps best highlighted by recent immigration policies from the Trump administration that restricted the number of Muslims permitted to enter the U.S.6 Through telephone surveys of U.S. adults done every 2-3 years after the incident, researchers found significantly more discriminative perspectives against Muslims as compared to any other religion – ranking Islam as being more likely a religion to encourage violence.3 More Americans were found to have negative views than positive views regarding Islam, with 38% unfavorable attitudes.3 In 2016, fifteen years following the atrocity of 9/11, 60% of Muslim Americans reported facing some form of harassment or discrimination, surpassing all other religious groups present in the U.S.7 With growing concern, the Arab American Institute administered a survey to Arab Americans four weeks after 9/11, polling acts of harassment Muslim and Arab Americans have been facing in those weeks. Of the 508 responses collected, 50% said they knew someone of an Arab background who had experienced harassment, and 20% reported having personally experienced discrimination since the attack.8
Although blurred impressions of Islamophobia existed in the U.S. prior to the events of 9/11, the tragedy triggered a phenomenon that would hinder the peace, safety, and health of Muslim Americans and their future generations of Muslim American children. 9/11 also fueled widespread misunderstanding and misrepresentation of the religion of Islam, falsely racializing Islamophobic notions despite the salient diversity of the Muslim community in America. Experiencing racial or ethnic discrimination has been repeatedly investigated and verified to be a major trigger for psychological and physiological distress that is destructive to health.9 The discrimination and life stressors that result from Islamophobia in the U.S. have since then been the leading cause of adverse mental health outcomes for Muslim Americans – eliciting increased rates of fear, stress, anxiety, worry, insecurity, and isolation.10
Post-9/11 studies have examined the impact of Islamophobia on Muslim Americans’ mental health. Since the tragedy, the Department of Justice has investigated over 800 cases involving violence, threats, vandalism, and arson against persons perceived to be Muslim or to be of Middle Eastern or South Asian origin.11 A systematic literature review conducted in 2017 examined work on the racialization of the religion of Islam, and how Islamophobia has been a prominent form of discrimination.12 The search scoped 53 articles, with nearly half being studies that examined mental health outcomes. Results show a clear relationship between Islamophobia and poor mental health, suboptimal health behaviors, and unfavorable care-seeking behaviors.12 Another investigation examined the association between individual, demographic, and sociocultural predictors for depression and posttraumatic stress disorder (PTSD) among 350 Arab and Muslim Americans following the events of 9/11. Results allude to age, education, marital status, and access to support as the most revealing in predicting depression and PTSD among the sample – denoting more practitioners and community service workers who are competent in assisting Arab and Muslim American victims are needed to aid in coping with trauma and in providing an informal support system that can alleviate the worsening of adverse mental health outcomes.13
In one study, 43%, 15%, and 9% of Muslim Americans (n=875) were diagnosed with adjustment disorder, anxiety disorders, and mood disorders respectively – demonstrating challenges with discrimination and marginalization in society as leading causes.14 Further, being perceived as Muslim and racialized as Arab can increase the risk of violence. Results of a Detroit area survey among Arab Americans found that 25% of respondents reported facing some form of personal or familial abuse, with 15% having bad experiences related to their ethnicity.15 These experiences generated increased psychological distress, reduced happiness, and diminished overall health, manifesting in higher rates among Muslim Arabs than Christians in the sample.15 Another survey reported findings from a sample of 601 adult Arab Americans from 35 states, where one-fourth of participants reported moderate to severe anxiety levels, and one-half reported depression compared to four other minority groups.16
Islamophobia is a significant source of long-term stress – with the allostatic load affecting one’s life by impacting individual health outcomes, interpersonal relationships, and community interactions, specifically those that take place in healthcare settings. A study examining perceived discrimination and its association with subclinical paranoia and anxiety reported findings from 152 Muslim Americans that deduced a significant relationship between the two investigated variables.17 Through the lens of religious coping theory, a 2011 study examined the methods utilized by 138 Muslims living in the U.S. to cope with stressful interpersonal events following the 9/11 attacks.18 Most participants reported experiencing at least one stressful interpersonal event, as it related to them being Muslim. The most common of these acts consisted of hearing anti-Muslim comments, being verbally harassed, and undergoing “special” security checks in airports. 18 Among those participants who practiced positive religious coping techniques, like a sense of connectedness with others, had higher rates of posttraumatic growth, yet those with negative religious coping methods such as having a less secure relationship with God, a tenuous and ominous view of the world, and a religious struggle to find and conserve significance in life, were associated with depression, isolation, stress, and anger. 18
Feelings of stress can also compound to negatively affect health especially if access to treatment and care is restricted. Islamic attitudes towards medicine have been assessed, as well as how they can influence Muslims’ engagement with the U.S. healthcare system. One review highlights the vast challenges some Muslim patients endure in seeking and receiving medical care, with barriers being poverty, language, and discrimination.19 Another study identified being Muslim as a determinant of adverse health exposures, where 15% of participants reported having bad experiences in a healthcare setting as a product of revealing or discussing their ethnicity.20,15
Despite studies that strive to determine a relationship between Islamophobia post 9/11 and the effect on Muslim Americans’ mental health, there still exists empirical, theoretical, and methodological gaps in the literature. Aside from the survey administered in 2016 to 35 states assessing non-Muslim attitudes toward their Muslim counterparts, very limited work has been done on this. Such data could serve as useful information that guides efforts to mitigate the prejudice displayed against this group. Additionally, more needs to be understood regarding Muslim Americans’ attitudes towards seeking healthcare access for their mental health, and barriers to doing so. There is also a strong need for research and implementation that targets programs and methods of counseling that are most effective and culturally competent for the wellbeing of Muslim American communities – especially following spikes of Islamophobia and anti-Muslim hate crimes that resulted from 9/11.21
Although ‘Muslim’ is a religious identity and does not in any way pertain to race, the line between racism and religious discrimination is often blurred22, and Muslim is often conflated with Arab. Islamophobia has developed into a form of discrimination through the racialization of the religion – resulting in the antagonization of individuals who may not be Muslim but instead exhibit physical features that may be falsely perceived as attributable to a Middle Eastern or South Asian country that predominantly practices the faith.23 Following the events of 9/11, Islamophobia has undermined health equity across different ethnic groups – making the resulting stigma and discrimination prominent forms of social determinants of health. What rippled these notions drastically further across the American world were the anti-Muslim and Xenophobic sentiments preached by Donald Trump in his presidential political campaigns.24 Trump trafficked anti-Muslim rhetoric, progressed an Islamophobic administration in the country, and enacted strict immigration policies – reigniting a simmering fire in the U.S. that never went out, and widening the gap between Muslim Americans and health.25 For some individuals, there exists intersectionality between other aspects of their identity besides their faith which was the main target of such hostile sentiments. These “shunned” aspects such as gender, race, and immigration status, may compound in individuals who exhibit multiple of them to aggravate mental health outcomes, as will be discussed in detail below.
There are substantive mental health disparities by gender.7 Each year in the U.S., 1 in every 5 women is diagnosed with a mental health disorder. 7 Being a Muslim Woman, given the more obvious outward display of religious identity through the form of a head covering or hijab, is more attributable to higher rates of emotional trauma than of their male counterpart.” 7 The hijab can also place the woman at a higher risk of being a target of harassment or discrimination or avoiding seeking healthcare when necessary, especially since veiling is often met with antagonism in the U.S., as there is an association of the hijab with the Islamic faith which can hinder quality or accessibility of treatment. 7 The fear of seeking healthcare can stem from a social stigma against women that considers the disclosure of mental illness to be “shameful”.26 Furthermore, there exists a precedent of Muslim American women being treated less courteously by healthcare providers, which further exacerbates their barriers to seeking healthcare.27 There is also a dread of being judged by society that is felt by women who choose to wear the hijab, and this can lead to religious guilt, low self-esteem, and self-criticism that is detrimental to a woman’s emotional and mental health.28 A study conducted in 2006 assessed birth outcomes for Arabic-named women in California before and after 9/11 and found a disturbing elevated risk of poor birth outcomes for Arabic-named women as compared to any other group (Non-Hispanic White, Black, Asian and Pacific Islander, Native American, and Hispanic).29 These results demonstrate the deleterious effects that racial and ethnic discrimination have on women’s health, reaching as far as their unborn future generations.
Being Black and African American (B/AA) in the U.S. places one at higher rates of adverse mental health outcomes due to the historic trauma and violence faced by this population.30 In the 1700s, the first Muslims to arrive in the U.S. were slaves from West Africa. Slave-related restrictions forced the conversion of the slaves’ faith to Christianity, making it impossible for them to establish any real Islamic community.31 One prominent figure in the black Muslim community, Malcolm X, reignited the interest in Islam as its very foundation – which was heavily important for B/AAs at the time – was rooted in social justice. From then, the B/AA and the immigrant community were parallel in growth and spread in America. For this reason, embracing Islam, as well as their Black identity was fundamental to B/AA following 9/11 to show belonging and support for their in-group. 31 At the time of writing, B/AA people represent about one-third of the American Muslim community and thus experience the same religious discrimination faced by many Muslim Americans in addition to the auxiliary stressors of systemic racism that B/AA face in their day-to-day lives.32 Since Muslims are often racialized as Arab or South Asian, B/AA Muslims can become less visible to islamophobia. However, 66% of Black Muslims report experiencing racial discrimination.32 This fusion of race and religion produces a unique set of unsparingly higher risks of depression, anxiety, PTSD, and other behavioral problems for this largely neglected sub-population of American Muslims. There exists a gap in the literature in studies with B/AA Muslims, and hence the lack of supportive data examining the relationship between race, religion, and health here.
After 9/11, the immigration system was tarnished in ways it had never been before. As immigration requirements, restrictions, and deportations grew in magnitude, the criminal justice system merged with these philosophies by mandating the incarceration and removal of perceived Arab Muslim noncitizens with minor misdemeanor convictions.33 Regardless of having American citizenship, the “Muslim Ban” (Executive Order 13769), also known as “Protecting the Nation from Foreign Terrorist Entry into the U.S.,” that was ordered by the Trump administration in 2017 affected naturalized Muslim Americans, non-Muslim refugees, and immigrants all the same. Xenophobic sentiments sparked in the Trump era, with ethnocentrism fiercely uniting Americans against a common “enemy.” Popularized feelings of nationalism, self-reported democratic values, and prejudice continued to threaten the security and health of the affected outgroup of Muslim Americans who were repudiated from society.
A retrospective cohort study assessing the utilization of healthcare by individuals from Muslim-majority nations residing in Minnesota after the issuance of the order found that there was a spike in missed primary care appointments and emergency room visits.34 Another study sought to determine the relationship between holding a marginalized identity, in this case being Muslim, with greater experiences of distress as a result of turbulent political situations like the Trump presidency.35 The study concluded that individuals who held a marginalized identity like being a Muslim living in the U.S. had reported greater distress compared to their non-targeted counterparts, and an increase in anxiety levels. 35 Such sociopolitical circumstances propagate Islamophobia and fuel its flame, and research demonstrates the magnitude of the harmful impacts of the discrimination and de-Americanization transcend whether a Muslim was native-born or an immigrant – stripping away the sense of belonging an American Muslim may have to their home country. This disconnection then provokes adverse behaviors like loss of self-identity, self-harm, isolation, and insecurity.10
Based on previous research, future directions should focus on continued mental health awareness, particularly within schools and community organizations, to emphasize the importance of seeking help. Studies have shown that recruiting religious leaders as spokespeople for mental health can be particularly effective, leveraging their authority to promote awareness and services.36,37 Existing interventions, such as those by the Institute for Muslim Mental Health, which mobilizes mental health professionals and trains community leaders, have demonstrated success in bridging gaps between mental health stigma and Muslims seeking help.38 Similarly, IMANA (Islamic Medical Association of North America) educates healthcare professionals to become more competent in treating Muslim American health needs, offers free mental health services, and provides a referral program to match Muslim patients with trained providers.39 Additionally, legal protections, such as the lift of the ‘Muslim Ban’ in 2021 and laws like Title VII of the Civil Rights Act and the Religious Land Use and Institutionalized Persons Act (RLUIPA), help mitigate discrimination.40 Future efforts should build on these interventions by developing more tailored programs for sub-groups within the Muslim American community, such as Muslim women, B/AA Muslims, and children. Finally, community-based participatory research (CBPR) is essential, involving community leaders in the research process to address stigma and misinformation effectively. These directions, grounded in previous research and successful existing interventions, suggest that involving trusted community figures and institutions can lead to more effective approaches to improving mental health outcomes and reducing the impact of Islamophobia on Muslim Americans.
Overall, the events of 9/11 have ignited and sustained a wave of Islamophobia-fueled violence, harassment, abuse, and discrimination against American Muslims living in the United States. This treatment exacerbated adverse mental health outcomes for the population – placing them at increased risks of fear, stress, anxiety, worry, insecurity, and isolation among many more. Examining Islamophobia demonstrates the deleterious health-related consequences of anti-Muslim sentiment. As such, there is a need for efforts that advance health equity for adult Muslim Americans generally, including efforts that focus on sub-groups of Muslims that may be more burdened by other aspects of their identity like women, Black/African American, and non-U.S. citizens.
The author(s) have no relevant financial disclosures or conflicts of interest.
Sarah A. Alkhatib, MPH, CPH, is a PhD student and graduate research assistant in the School of Public Health at the University of North Texas Health Science Center.
Kaeli C. Johnson, MS, is a PhD student and graduate research assistant in the School of Public Health at the University of North Texas Health Science Center.
Rohit Balasundaram, BDS, MPH, is a PhD candidate in the School of Public Health at the University of North Texas Health Science Center.
Aamna Burney, BA, CHW, is a graduate of the University of Texas at Dallas.
Nolan Kline, PhD, MPH, CPH, is an Assistant Professor in the College of Medicine at the University of Central Florida.
Stacey B. Griner, PhD, MPH, CPH, is an Assistant Professor in the School of Public Health at the University of North Texas Health Science Center.
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