Predictors associated with symptoms of depression & anxiety during the COVID-19 among MENA immigrants in Houston, Texas

Abstract

Very limited knowledge is available regarding the mental health of the immigrant population in the USA. We aim to assess the factors affecting the mental health of immigrants living in Houston from war-inflicted and stable countries of Middle Eastern and North African (MENA) origin during the pandemic. This cross-sectional study was conducted among the MENA immigrants using a validated survey of sociodemographic, general health, and COVID-19 questions. Multivariable logistic regression models assessed sociodemographic and clinical predictors of depression and anxiety. The outcome of interest was categorized as “moderate or severe” versus “minimal or mild” for depression and anxiety. Total of 94 participants completed the study, with the sample rate of "moderate or severe" symptoms of anxiety and depression being 29.78% and 64.89%, respectively. Multivariable regression analysis for depression showed that immigrants from war-inflicted countries of origin were less likely to report “moderate or severe” depression compared to immigrants from stable countries (OR = 0.082, 95% CI 0.012–0.551). Individuals with excellent overall health (OR = 0.074, 95% CI = 0.013–0.414) had a significantly lower likelihood of “moderate or severe” depression than those who reported fair/poor health. Non-smokers (OR = 0.068, 95% CI = 0.012–0.377) were less likely to report “moderate or severe” depression in comparison to those who engage in smoking behavior. Participants who responded to the question that they tried hard to avoid thoughts of COVID-19 were less likely to have symptoms of “moderate or severe” depression compared to participants who responded, “No” (OR = 0.110, 95% CI = 0.017–0.712). Those who have” excellent/good knowledge” (OR = 0.0146, 95% CI = 0.022–0.946) about the prevention of COVID-19 spread were less likely to have “moderate or severe” depression compared to those who had “average/poor/terrible”. Multivariable regression analysis revealed smoking as a significant predictor of anxiety, with non-smokers demonstrating a lower likelihood of experiencing "moderate or severe" anxiety than smokers (OR = 0.21, 95% CI = 0.06–0.84). MENA immigrant communities in the USA have diverse immigration experiences, cultural backgrounds, and instability issues in their home countries, possibly elevating the risk of depression and anxiety during the COVID-19 crisis. Predictors identified should be considered by policymakers when developing targeted interventions to ensure the mental and social well-being of immigrant communities in the USA.