The Impact of COVID-19 Traumatic Stressors on Mental Health: Is COVID-19 a New Trauma Type

COVID-19 is a new type of trauma that has never been conceptually or empirically analyzed in our discipline. This study aimed to investigate the impact of COVID-19 as traumatic stress on mental health after controlling for individuals' previous stressors and traumas. We utilized a sample of (N = 1374) adults from seven Arab countries. We used an anonymous online questionnaire that included measures for COVID-19 traumatic stress, posttraumatic stress disorder, anxiety, depression, and cumulative stressors and traumas. We conducted hierarchical multiple regression, with posttraumatic stress disorder, depression, and anxiety as dependent variables. In the first step, in each analysis, we entered the country, gender, age, religion, education, and income as independent variables (Kira, Traumatology 7(2):73-86, 2001; Kira, Torture, 14:38-44, 2004; Kira, Traumatology, 2021, https://doi.org/10.1037/trm0000305). In the second step, we entered cumulative stressors and traumas as an independent variable. In the third step, we entered either COVID-19 traumatic stressors or one of its subtypes (fears of infection, economic, and lockdown) as an independent variable. Finally, we conducted structural equation modeling with PTSD, depression, and anxiety as predictors of the latent variable mental health and COVID-19 as the independent variable. Results indicated that COVID-19 traumatic stressors, and each of its three subtypes, were unique predictors of PTSD, anxiety, and depression. Thus, COVID-19 is a new type of traumatic stress that has serious mental health effects.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11469-021-00577-0.

The Burden of and Factors Associated with Age-Related Eye Diseases in Arab American Adults

To estimate the age- and sex-adjusted proportions of cataract, diabetic retinopathy, glaucoma, and macular degeneration among the Arab American community, a notably understudied minority that is aggregated under whites. The Arab American Eye Study is a multicenter retrospective chart review involving 10 years of electronic medical records (1/1/2010 through 1/1/2020). The study sample included 1390 Arab Americans and 4950 whites 45 years of age and older, totaling 6340 subjects. Arab Americans were identified using an Arab American name algorithm. Subjects with race variables other than white or Arab American or those under age 45 were excluded from the study. Age- and sex-adjusted proportions of cataract, diabetic retinopathy, glaucoma, and macular degeneration were determined. Odds ratios with 95% confidence intervals were used to examine the association between race/ethnicity and eye diseases. Of the 6340 participants (4950 whites and 1390 Arab Americans), males comprised 46.3% and the median age group was 55-64 years. Arab Americans displayed higher age- and sex-adjusted proportions of cataracts (45.4% versus 40.7%), dry age-related macular degeneration (10% versus 8.9%), glaucoma (8% vs 6%), and diabetic retinopathy (11.7% versus 4.2%). Fully adjusted logistic regression revealed that Arab Americans were 19% more likely to have cataracts (OR 1.19; 95% CI 1.05, 1.35) and 272% more likely to have diabetic retinopathy (OR 2.72; 95% CI 2.17; 3.41). Results from the Arab American Eye Study suggest that the burden of cataract and diabetic retinopathy is significantly higher among Arab Americans in comparison to whites.

The differential mental health impact of COVID-19 in Arab countries

COVID-19 pandemic’s mental health impact on Arab countries is under-researched. The goal of this investigation was to study the differential impact of COVID-19 on the mental health of Arab countries. A questionnaire including measures of COVID-19 traumatic stress, PTSD, depression, anxiety, and cumulative stressors and trauma was distributed anonymously online in seven Arab countries (Egypt (N = 255), Kuwait (N = 442), Jordan (N = 216), Saudi Arabia (N = 212, Algeria (N = 110), Iraq and Palestine (N = 139)). We used ANOVA and stepwise regression to analyze the data. For each country, regression, PTSD, depression, and anxiety were dependent variables; we entered in the first-step, gender, age, religion, education, and income. In the second step, we entered “cumulative stressors and traumas.” In the third step, we entered COVID-19 traumatic stress. The ANOVA results indicated that the differences in COVID19 traumatic stress, PTSD, depression, and anxiety between the countries were significant. Post-hoc analysis indicated that Egypt is significantly higher than all the other Arab countries in COVID-19 traumatic stress, PTSD, anxiety, and depression. The subsample from Palestine and Iraq had a significantly higher cumulative trauma load than the other Arab countries but did not have higher levels of COVID-19 traumatic stress or PTSD. Stepwise regression indicated that COVID-19 traumatic stress accounted for significant variance above and beyond the variance accounted for by previous cumulative stressors and traumas for anxiety in all countries and PTSD and depression in all countries except for Algeria. We discussed the implications for these results for the urgent mental health needs of Arab countries.

Determinants of Employment among Well-Educated Refugees before and After the 2007 U.S. Economic Recession

Little is known about how the overall employment conditions in a country impact the likelihood of employment of newly arrived refugees. In the current study, we compare employment and determinant of employment of highly educated Middle Eastern refugees to Michigan that arrived before and after the 2007 recession. We also look at self-reported barriers to employment. Results show that the general downturn of the economy made it substantially more difficult to secure employment, even for well-educated refugees. Thus, before the economic downturn, 22.9 % of refugees were unemployed as compared to 55.1 % once the recession had set in (p < 0.01). There were also substantially more self-reported barriers to employment after the economic downturn. The study points to the importance of understanding both individual characteristics and the general employment conditions in the new host country when studying variation in refugee employment success.

Prevalence of antibodies to the hepatitis C virus among Arab and Chaldean Americans in southeast Michigan, USA

OBJECTIVE

The prevalence of antibodies to the hepatitis C virus (anti-HCV) in the United States is estimated to be 1.6%. There are no published studies on the prevalence of anti-HCV among the Arab/Chaldean American population in the United States.

DESIGN

Retrospective review of data collected during an HCV public awareness program conducted by the Arab American and Chaldean Council. Inclusion criteria were that subjects had to be of Arab/Chaldean descent, born in an Arab country, and test positive or negative for anti-HCV using the "Home Access Hepatitis C Test."

MAIN OUTCOME MEASURES

The overall estimated prevalence of anti-bodies to HCV was 5.4% among Arab/Chaldean Americans residing in southeast Michigan.

RESULTS

Four hundred and eighty four participants were tested for anti-HCV. The estimated prevalence among Chaldeans was 2% vs 5.9% among Arabs, which varied according to their country of origin. Anti-HCV positive results were more common in participants with a history of hepatitis (30.4%), jaundice (21.1%), blood transfusion (14.6%), treatment by nonsterile injection (13.6%), and tattoo/body piercing (10%). On binary logistic regression analysis, significant predictors for positive anti-HCV included history of hepatitis (OR: 19, 95% CI 2.58-139.93), blood transfusion (OR: 4.7, 95% CI 1.09-20.56), tattoo or body piercing

CONCLUSION

To our knowledge, this is the first study to report the estimated prevalence of anti-HCV and risk factors among the Arab and Chaldean Americans in the United States. The estimated prevalence of anti-bodies to HCV is 5.4% in this population, a rate that is more than triple the national average. Because of the relatively small sample size and limited geographic region, more studies are needed to evaluate the true prevalence of HCV antibodies in this and other ethnic minority population.

Profiles of trace elements in toenails of Arab-Americans in the Detroit area, Michigan

Exposure to environmental contaminants is complicated by factors related to socioeconomic status, diet, and other culturally conditioned risk behaviors. Determination of a trace element profile in toenails can be used as a tool in biomonitoring the exposure history or assessing the deficiency of a particular element in a study population, which can lead to a better understanding of environmental and disease risks. Toenail clippings from 259 Arab Americans (163 adults, 96 children) residing in a highly industrialized area were analyzed for Al, V, Cr, Mn, Co, Ni, Cu, As, Se, Mo, Cd, Ba, Tl, and Pb using an inductively coupled plasma-mass spectrometer. Mean concentrations were compared with published values, and the influence of age, gender, and other demographic factors were explored. Elevated levels of Ni in this population warrant further investigation. Significant differences in the mean concentration of Al, V, Cr, Mn, Cd, Pb, and Se exist between toenails of adults and children. Pearson correlation coefficients reveal strong significant associations among Cd, Cr, and Tl (p<0.05), in addition to other elements. These investigations provide insight into exposures and factors influencing exposures in this population while adding to the growing fund of knowledge surrounding use of toenails as a marker of exposure.