Mental Health, Religion & Culture

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/cmhr20

Discrimination and mental health of Christians

in Egypt: coping trajectories and perceived
posttraumatic growth

Ibrahim A. Kira & Hanaa Shuwiekh

To cite this article: Ibrahim A. Kira & Hanaa Shuwiekh (2021): Discrimination and mental health of
Christians in Egypt: coping trajectories and perceived posttraumatic growth, Mental Health, Religion
& Culture, DOI: 10.1080/13674676.2020.1832454

To link to this article: https://doi.org/10.1080/13674676.2020.1832454

Published online: 09 Mar 2021.

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MENTAL HEALTH, RELIGION & CULTURE
https://doi.org/10.1080/13674676.2020.1832454

Discrimination and mental health of Christians in Egypt:

coping trajectories and perceived posttraumatic growth
Ibrahim A. Kiraa,b and Hanaa Shuwiekhc
a
Center for Cumulative Trauma Studies, Stone Mountain, GA, USA; bCenter for Stress, Trauma and Resiliency,
Georgia State University, Atlanta, GA, USA; cPsychology department, Fayoum University, Fayoum, Egypt

ABSTRACT ARTICLE HISTORY

The impact of discrimination on the Egyptian Christians minority’ Received 24 May 2020
mental health has never been evaluated. The current study Accepted 1 October 2020
utilised Egyptian data that included 247 Christian. The data
KEYWORDS
included measures for discrimination, identity salience, interfaith Christian minority in Egypt.
spirituality, religiosity, “Will to Exist, Live and Survive” (WTELS), Coptic; mental health; “will-
reappraisal, self-esteem, posttraumatic growth, collective to-exist-live; and survive”;
existential annihilation anxiety (Col-EAA), psychopathology, and discrimination
post traumatic stress disorder (PTSD). We conducted a T-test,
stepwise regressions, and path analysis. Discrimination predicted
Col-EAA and PTSD, while WTELS and spirituality were protective
against Col-EAA. Discrimination had direct effects on higher Col-
EAA, and indirect effects on higher PTSD, internalising and
thought disorders, and negative effects on self-esteem. Col-EAA
had negative effects on reappraisal, self-esteem, and positive
effects on PTSD, externalising, internalising, and thought
disorders. Identity salience had positive effects on reappraisal and
indirect effects on self-esteem. It had indirect effects on lower
externalising, internalising, and thought disorders. Discrimination
negatively impacts Egyptian Christian mental health. However,
their strong identity, WTELS, and interfaith spirituality are
protective factors. We discussed the implications of these results
from mental health and social justice perspectives.

Introduction
Unfortunately, there are socioeconomic and power dynamics that dictated historically, in
most cases, the inevitability of social-structural violence and social oppression (Sidanius &
Pratto, 1993). Further, discrimination against different minorities, with different intensi-
ties, was and still is the norm, not the exception, across different developed and develop-
ing countries and recorded history. Discrimination and other different forms of oppression
have a severe mental and physical health impact on the victims. For example, a study on a
nationally representative sample of England found that people who experienced religious
discrimination have a two-fold increase in the risk of common mental disorders indepen-
dent of their ethnicity, skin colour, or suspected paranoid traits (Ordanova et al., 2015).
However, a high number of victims develop different coping trajectories and paths to

CONTACT Ibrahim A. Kira kiraaref@aol.com

© 2021 Informa UK Limited, trading as Taylor & Francis Group
2 I. A. KIRA AND H. SHUWIEKH

posttraumatic growth. Religious discrimination is especially severe as it violates core iden-

tity and core beliefs.
Further, religious identity and religiosity are usually related to active coping to stress
(Park, 2007). Additionally, a person’s identity, in general, is another source of strength
and resilience. However, a recent Canadian study (Vang et al., 2019) found that religious
discrimination diminished the well-being of both minority and majority religious group
members alike. The study of different personal and group discrimination types (e.g., dis-
crimination because of colour, ethnicity, religion, culture, and sexual orientation) and the
genocide and holocaust have advanced our knowledge of these dynamics. We argue that
the common denominator in all of these intersected types of severe stressors is that they
target different aspects of the same individuals’ social and status identities that determine
the person’s (and his or her group) position in the social hierarchy (Kira et al., 2019a).
Examples are discrimination against Jews in Nazi Germany, and discrimination against
blacks and American Indians and other minorities in the US (e.g., Schmitt et al., 2014),
and discrimination against immigrant and ethnic minorities in Europe (e.g., De Freitas
et al., 2018). Discrimination is associated negatively with various functions such as
lower self-esteem, increased PTSD, internalising, externalising, thought disorders, poor
physical health, and changes in the pattern of cortisol response (the stress hormone)
and allostatic load indicators(e.g., Paradies et al., 2015).
Religious discrimination undermines the persons’ self-evaluations presumably because
it conveys a negative message about their religious identity, which they internalise
(Harter, 1999). Different empirical studies focused on various violated collective identities
and found that violating identities (i.e., by discrimination) have adverse mental health
effects. Different meta-analyses (Pascoe & Smart Richman, 2009; Williams et al., 2003) sup-
ported significant associations between such identity violations, internalising and exter-
nalising disorders, general distress, depressive symptoms, anxiety, substance abuse,
anger, psychosis, and negative associations with happiness, life satisfaction, and
mastery. Religious identity involves identification with religious groups and encompasses
three main dimensions: religious commitment and belonging, religious identity achieve-
ment, and religious faith and practices. According to social identity theory (Tajfel & Turner,
1979), social groups are an essential source of individual and collective self-esteem.
Related members’ self-esteem is tied to the status of the social group. Thus, disparaged
social groups may experience a loss of well-being, given the strong association
between self-esteem and well-being (Cooper et al., 2017).
Christians in Egypt (mostly Coptic) are one of the minorities whose suffering of dis-
crimination and its impact are empirically understudied. Christians are a sizable minority
in Egypt that is subjected for long, particularly in Upper Egypt, and especially recently
(post-Arab-Spring) to micro and macro aggressions that intensified with the advent of
extremist groups in the regions that violently targeted them (e.g., Brownlee, 2013;
Ibrahim, 2018). Christian religious identity is central and salient for Egyptian Christian
(Hasan, 2003). Constructing, deconstructing, and reconstructing self-identity are related
to the individual’s executive self’s real and mere existence. Identities are pre-cognitive,
pre-affective self-schemas that regulate perceptions, appraisals, emotions, and behaviour
(Kira, 2019; Kira et al., 2019a; Kira, Shuwiekh, Rice, et al., 2017; Oyserman et al., 2007).
Increased identity salience was found to be significantly associated with higher reapprai-
sal (emotion regulation), higher posttraumatic growth (PTG), and lower PTSD (Kira et al.,
 MENTAL HEALTH, RELIGION & CULTURE 3

2011, 2019a). Studying social identity identified two key modules: salience and militancy
(Kira et al., 2011). While identity salience is the degree of identification and commitment
to the group, identity militancy is the degree to which the individual is ready to act on his/
her commitment and fight for the group.
Pre-Arab Spring oppression impacted both Muslims and Christians in Egypt with
different profiles of suffering. The impact of different stressors and traumatic stressors
related to oppression and other stressors on both Christians’ and Muslims’ PTSD, psycho-
pathology, and potential PTG is poorly understood, especially for the Egyptian Christians
minority compared to the Muslim majority. Oppression and discrimination pose an exis-
tential collective identity threat and can trigger existential anxieties concerning the future
of the threatened collective identity (for example, being or belonging to a Christian min-
ority) (e.g., Kira et al., 2019b). Threats to group existence can trigger extinction salience
(Kira, 2002; Wohl et al., 2010). Simultaneously, the strength of belonging to identity can
be a protective factor in the trajectory toward PTG (Morris et al., 2011). An empirical
study found that existential anxiety specific to concerns about the group’s destiny is
differentiated from general anxiety (Kira, Templin, et al., 2012).
“Will to Exist, Live and Survive” (WTELS) is another protective factor that the research
found to buffer against the harmful impact of oppression and discrimination and lead to
PTG (Kira et al., 2019c, 2020a). The study found that WTELS have significant effects on
reducing existential annihilation anxieties and psychopathology. Further, the study
found that WTELS have strong positive effects on higher PTG, emotion regulation (reap-
praisal), and self-esteem. The results indicated that both the measurement and the struc-
tural models of WTELS were strictly invariant across gender, regional, age, and religious
and national groups.
One promising explanatory process that can help explain the link between discrimi-
nation and mental health problems is emotion regulation (Harrell et al., 2011). Emotion
regulation refers to individuals’ abilities to control which emotions they possess, when
they get them, and how they express and experience them (Gross, 1998). Emotion regu-
lation and dysregulation are central features of childhood and adolescent psychopathol-
ogy. The emotion regulation strategy of reappraisal was proposed as another pathway to
coping with PTSD and other psychopathology syndromes that may result from religious
discrimination and achieve desired perceived or actual PTG (Tedeschi et al., 2017).
Further, the literature provided replicated empirical evidence of the positive corre-
lation between religiosity and various psychological, relational, and physical health
(Koenig et al., 2012). Further, the empirical literature proposed that interfaith spirituality
can be protective and a healing factor for different psychopathology (Kira et al., 2019b).
The research suggested that spirituality is a critical factor in Coptic Orthodox women’s
resilience in Egypt (Agaibi, 2014).
There is no empirical research that compared between Egyptian Christians and
Muslims’ mental health. No previous studies evaluated the effects of discrimination’s
micro and macroaggressions on Egyptian Christian minorities (mostly Coptic) on their
mental health. Further, there are no studies that explored their coping trajectories to
these adversities. The current study explores the differences in trauma exposure and
mental health between Egyptian Christians and Muslims. The objective is to measure
the impact of discrimination suffered by Egyptian Christians on their mental health
4 I. A. KIRA AND H. SHUWIEKH

and explore their coping trajectories and their pathways to perceived post-traumatic
growth.

Research hypotheses
Hypothesis 1: There are significant differences in trauma, and mental health profiles
between Egyptians, Christians (minority), and Muslims (majority), with Christians, have
more collective identity traumas and higher perceived discrimination and more severe
PTSD and psychopathology symptoms. On the other hand, Christians have higher identity
salience and militancy that usually get stronger under discrimination exposure.
Hypothesis 2: In Christians, discrimination will be associated with Col-EAA, but not with
psychic or physical EAA.
Hypothesis 3: While discrimination is the predictive variable of Col-EAA, WTELS is a sig-
nificant protective factor against Col-EAA in Egyptian Christians.
Hypothesis 4: While discrimination is a predictive variable of PTSD, interfaith spirituality
is a robust protective factor against the harmful impact of discrimination on Egyptian
Christians.
Hypothesis 5: Interfaith spirituality and emotion regulation (reappraisal) is the protec-
tive variables against psychopathology in Egyptian Christians.
Hypothesis 6: Identity salience will predict positive reappraisal (emotion regulation),
higher self-esteem, and lower externalising, internalising, and thought disorders in Egyp-
tian Christians.
Hypothesis 7: WTELS and discrimination are predictive factors of perceived posttrau-
matic growth in Egyptian Christians.

Methods
Procedures and participants
The current research is secondary data analysis. While the original data sampled Egyp-
tians, it included almost equal numbers of Egyptian Christian and Muslims, making it
ideal for studying this had never been studied Christian minority group. The original
data used the Egyptian sample to validate a new measure for interfaith spirituality and
test its invariance between Muslims and Christians (Kira et al., 2019b). The original
study used a purposive snowball sampling strategy to obtain a diverse sample of
participants.
Recruitment (in the original study) was conducted using researchers’ institutional and
personal networks (e.g., mosques, churches, colleges). The goal was to obtain a sample of
14 years and older participants representing adults and adolescents, Christians and
Muslims, different regional cultures in the Egyptian society, and the two genders. The
study was conducted in three Egyptian communities that culturally and geographically
represent the different mix in Egyptian society: Fayoum (Middle Egypt) (N = 184), Qena
(Upper Egypt) (N = 210), and Giza/ Cairo city (N = 96), (which is mostly a melting pot of
diversities).
Three teams of graduate students in clinical psychology (a different team in each city)
interviewed participants under their advisors’ direct supervision. The teams increased the
 MENTAL HEALTH, RELIGION & CULTURE 5

recruitment of Christians to compare Muslims and Christians in this predominantly

Muslim country. The sample included 490 participants, with 41.4% females. It included
different ages and localities. Age ranged from 14 to 75, with Age Mean = 26.03, SD =
10.90, with 20.4% adolescents.
For Muslims (N = 243) age ranged from 15 to 75 (Mean = 29.29, SD = 13.27). For Chris-
tians (N = 247) age ranged 14 and 51 (Mean = 22.83, SD = 6.49). Table 1 includes the basic
demographics of the two subsamples: Muslims and Christians (for the original study
details, see Kira, 2019b).
The interviews and questionnaires were administered to participants beginning the
first week of October through the first week of December of 2017. The participation
was completely voluntary. The research team informed each participant about the
general goals of the study who signed informed consent. Parental consents were obtained,
for participants under 18, in addition to their assents. The interview/ questionnaire took 45–
60 min to complete. The IRB of the sponsoring academic institution approved the study. No

Table 1. Demographic characteristics of the participants in the Christians and Muslims sub-samples.
Christian subsample N = 247 Muslim subsample N = 243
Distribution Frequency Percent (%) Frequency Percent (%)
Gender
(1) Male 91 36.8 112 46.1
(2) Female 156 63.2 131 53.9
Age groups
Adolescents 57 23.1 43 17.7
Adults 190 76.9 200 82.3
Current work
(1) Employee 23 9.3 60 14.5
(2) Worker 3 1.2 12 4.9
(3) Merchant 5 2.0 7 2.9
(4) Professional 5 2.0 6 2.5
(5) Physician 3 1.2 3 1.2
(6) Retired 1 .4 6 2.5
(7) Student 195 78.9 121 49.8
(8) Other 12 4.9 48 19.8
Marital status
(1) Married 35 14.20 105 43.2
(2) Single 210 85.00 127 52.3
(3) Widow 2 .80 6 2.5
(4) Divorced 00 .00 2 .8
(5) Other 00 .00 2 1.2
Socio-economic status
(1) Very poor 4 1.6 1 .04
(2) Poor 5 2.0 5 2.1
(3) Enough 181 73.3 187 77.0
(4) High 50 20.2 39 16.0
(5) Very high 7 2.8 11 4.5
Education
(1) Illiterate 1 .4 29 11.9
(2) Read and write 1 .4 5 2.1
(3) Elementary 00 .00 3 1.2
(4) Intermediate 1 .4 8 3.3
(5) High school 63 25.5 71 29.2
(6) College 168 68.00 86 35.4
(7) Post-graduate 13 5.3 41 16.9
Regional origin
(1) Fayoum (Middle Egypt) 8 3.2 176 72.4
(2) Qena (Upper Egypt) 173 70.0 37 15.2
(3) Cairo (Mix) 66 26.7 30 12.3
6 I. A. KIRA AND H. SHUWIEKH

incentives were offered to participants. The study focused more on the Christian subsample
and utilised some of the original study scales and subscales that measured discrimination,
emotion regulation, PTG, spirituality, and mental health.

Measures
Independent variables
Cumulative Stress and Trauma Scale (CST-S) short version: It includes 32 items (Kira et al.,
2008). CST-S is grounded on the development -based trauma platform (DBTF) (e.g.,
Kira, 2001, 2019; Kira et al., 2008; Kira, Shuwiekh, et al., 2018, 2019; Kira, Lewandowski,
et al., 2014; Kira, Omidy, et al., 2014). The CST-S evaluates cumulative stressors and
traumas concerning its mere occurrence, frequency, type, and negative and positive apprai-
sals. The scale is designed to classify a sample of 29 stressors into seven stressors/trauma
types. Additionally, it includes three items that measure chronic and significant life stressors.
The seven types of stressors/ traumas include collective identity traumas (e.g., discrimi-
nation and oppression). They include personal identity trauma (e.g., early childhood
traumas such as child neglect and abuse). They include status identity/achievement
trauma (e.g., failed business, fired and drop out of school) (non-criterion A traumas). They
also include survival trauma (e.g., get involved in combat, car accidents, and natural disas-
ters). They include attachment trauma, secondary trauma (i.e., indirect trauma impact on
others), and gender discrimination. Participants were asked to specify their experience
with each event on a five-point Likert-type Scale (0 = never; 4 = many times). The CST-S
has shown adequate internal consistency (α = .85) (Kira et al., 2008; Kira, Fawzi, et al.,
2013), test-retest stability (.95 in 4 weeks), and predictive, convergent, and divergent val-
idity. The measure has been translated into various languages, including Arabic, Polish,
Spanish, Turkish, Korean, Burmese, and Yoruba. In the present analysis, we used the cumu-
lative stressors and traumas occurrence sub-scale. The current alpha of cumulative stressors
and traumas occurrence is .86, and.73 for the discrimination subscale.
Identity Salience Scale (ISS) (Kira et al., 2011): ISS is a 10-item measure. The measure con-
sists of questions like “I feel personally threatened by hate crimes committed against the
members of my religion, race, culture or ethnic group or another group of my belonging
or myself”. Another question is, “Sometimes I wish to die or kill somebody or myself before
my ethnic, or nation or religion any other group of my belonging harmed, eliminated or sub-
jugated”. The answer specifies how much the respondents agree or disagree on a scale from
one to seven (1 = entirely disagree; 7 = absolutely agree). Higher scores suggest greater group
identity salience; lower scores suggest more personal identity salience.
The measure has two subscales: Identity commitment and identity militancy (ready to
die for your group). The alpha for the measure was .80. The alpha for the commitment
Subscale = .74, and 75 for the militancy Subscale (Kira, Ashby, et al., 2013). Three weeks,
test-retest stability was .76. The study found that the measure possesses good predictive
validity, as higher collective identity traumas were associated with higher group identity
salience. Higher identity salience predicted higher mortality salience and existential
annihilation anxiety (Kira et al., 2019c; Kira, Shuwiekh, Rice, et al., 2017). In the present
study, we used identity commitment as a measure for group identity salience. We used
militancy as one of the coping strategies for collective identity trauma of oppression,
through different forms of active resistance and readiness to sacrifice or die for the
 MENTAL HEALTH, RELIGION & CULTURE 7

group. The scale’s alpha was .88 in current data, with an alpha of .80 for commitment and
.87 for militancy subscales.

Mediating variables
Interfaith Spirituality Scale (IFS) (23 items), (Kira, Shuwiekh, Al-Huwailah, et al., 2019). The
measure initially consisted of four components: asceticism, close relationship with the
creator, divine love, and meditation. The subject was requested to specify if each state-
ment is true for him/her on a scale from 1 to 4, with (4) Mostly true about me, and (1)
Not True about me. The instruction presented a detailed description of spirituality as
“the feeling of a direct relation with your maker, and your ability to transcend yourself”.
With “Creator” indicates “the force that sets totality into existence, as you understand
it”. The scale showed good convergent, divergent, predictive, and structural validity,
good internal consistency, and stability. In current data, it has an alpha of .97.
Religiosity Scale is five items that had been used previously with similar populations
(e.g., Kira et al., 2006). It consists of items that assess the constant observance of religion.
It also consists of items about congregating with persons from the same faith, reading
their faith’s scripture, and contributing to charities. In current data, the scale has an
alpha of 70.
The Will to Exist, Live and Survive (WTELS) measure (Kira, Shuwiekh, Kucharska, Al-Huwai-
lah, & Moustafa, 2019; I. A. Kira et al., 2020a): The scale consisted of six items that deal with
different facets of WTELS, and thrive. It comprises statements such as “I am motivated by a
drive to live”; “My will to exist and survive adversity is generally”. Each statement was
marked by the participant on a five-point scale; “4” indicates very strong, “3” indicates
strong, “2” indicates neutral, “1” indicates drained/ depleted, and “0” indicates extremely
depleted or I have no will to survive. Confirmatory and Exploratory factor analyses verified
that the scale contains a uni-factor structure. The factor structure was strictly invariant
across religious, cultural, and gender groups. The scale has a good test-retest reliability
of .82 (four weeks interval). The WTELS was found to have good convergent, divergent,
and predictive validity. It predicted a significant decrease in internalising, externalising,
thought disorders, suicidality, and existential anxiety and predicted increased self-
esteem, reappraisal, and post-traumatic growth (Kira, Shuwiekh, Kucharska, Al-Huwailah,
& Moustafa, 2019). In current data, the scale has an alpha of .82.
Emotion Regulation Questionnaire: The ERQ (Gross & John, 2003) consists of 10 items
measuring two emotional regulation strategies: a reappraisal (6 items) and Suppression
(four items). An example of the Reappraisal items is: (I control my emotions by changing
the way I think about the situation I am in). An example of Suppression items is:(I control
my emotions by not expressing them). The participants were asked to rate each item on a
seven-point Likert-type Response Scale. Higher scores on each subscale mean more usage
of the emotional regulation strategy. The scale authors (Gross & John, 2003) reported
good internal consistency (α = .79 for Reappraisal, and .73 for Suppression) and 3-
month test-retest stability = .69, and adequate convergent and discriminant validity
with both older and younger adults. The scale was translated earlier into Arabic and
used in previous studies and found to have good psychometrics in Arabic (e.g., Kira, Shu-
wiekh, Al-Huwailah, et al., 2019). In the present study, Suppression has (α = .78), and Reap-
praisal has (α = .89).
8 I. A. KIRA AND H. SHUWIEKH

The Rosenberg Self-Esteem Scale (RSES) is a 10-item measure that assesses total self-
esteem (Rosenberg, 1965). Each item is rated on a four-point Likert-type scale from
strongly agree (3) to strongly disagree (0). The measure is divided into five negatively
and five positively worded items. The RSES has been translated and adapted to various
languages, including Turkish and Arabic. Its alpha reliability ranged between .85 and
.88. In the current study, its alpha is .74.

Outcome variables
The Post-Traumatic Growth Inventory (PTGI); (Tedeschi & Calhoun, 1996). PTGI is a 21 item
scale). PTGI is a 21 item scale. It measures potential positive life transformations (e.g.,
better relationships with others, a better understanding of life) after a traumatic event/
s. The participant was requested to specify the extent to which this perceived transform-
ation happened due to a potential predicament/s that may have ensued due to the cumu-
lative impact of stressors and traumas he/she ever encountered. In responding to each
question, participants respond on a scale from 0 (I did not experience this change due
to my experience) to 5 (I experienced this change to a very significant degree). Tedeschi
and Calhoun (1996) found the internal consistency (alpha) of the total PTGI to be .90. They
found that it has test-retest stability of .71. The Arabic version of the measure found, in
several studies, to have robust psychometric properties (Kira et al., 2012; Kira, Abou-
Mediene, et al., 2013; Kira, Abou-Mediene et al., 2012). In the present study, it has an
alpha of .90.
Existential Annihilation Anxieties measure (EAA) (Kira, et al., 2012; Kira, et al., 2013,
2020b): It is a 15-item scale that assesses anxieties associated with four types of existential
threats: threats to personal identity, threats to collective identities, threats to social status
identity, and the threat to the person’s physical identity. An example of the items that rep-
resent collective identity threats is:
Sometimes I feel the threat of extermination/ annihilation/ subjugation (that is, the threat of
destruction or “getting rid” of my group) because of discrimination or stereotyping or acts
committed against me, my race, religion, culture, or ethnic or cultural group.

Each statement is scored on a scale from 0 = disagree to 3 = strongly agree. The scale has
four subscales: Psychic EAA related to personal identity trauma (psychic), EAA related to
collective identity trauma, EAA related to Social status traumas, and EAA related to fear of
physical death. EAA scale was highly correlated with PTSD (.50), cumulative stressors and
traumas, depression, thought disorder, internalising, externalising, and suicidality. It was
associated with poor reported physical health, gender, and other discriminations, and
sexual abuse. It was negatively correlated with WTELS, spirituality, religiosity, self-
esteem, and emotion-regulation. A critical cut-off point of 21 or more is proposed to dis-
criminate between those critically high in EAA. In current data, the measure had an alpha
of .90, and its Col-EAA has α = .87.
Psychopathology Scale (Kira, Shuwiekh, & Kucharska, 2017) is a 20-item measure that
screens and identifies adults and adolescents who are likely to have internalising, exter-
nalising and substance abuse and thought disorders. It includes three Subscales: Interna-
lising, externalising and psychoticism/ dissociation. Exploratory and Confirmatory Factor
Analysis in different data sets in Egypt and Poland yielded three factors: Internalising,
Externalising, and Psychoticism validating its conceptual structure. In the items, the
 MENTAL HEALTH, RELIGION & CULTURE 9

participant is asked to indicate if the behaviour occurred in the past month (scored 4) or
occurred in the last 2–3 months (scored 3), or in the last 3–12 months (scored 2), or the last
year or more (scored 1), or never happened (scored 0). High scores indicate higher symp-
toms in these areas. Test-retest with four weeks interval yielded good stability coefficients
of .97 for internalising, and .91 for externalising, and .92 for externalising subscales. In the
present study, alpha reliability for internalising was .84, for externalising was .88, and .93
for psychoticism, and .90 for the full scale.
Clinician-administered PTSD Scale CAPS-2 PTSD Measure (CAPS-2) (18 items): Blake et al.
(1995) developed the test to assess PTSD symptoms (DSM IV version). CAPS-2 is a struc-
tured clinical interview that evaluates 17 symptoms rated on frequency and severity on a
five-point scale. CAPS proved to have high reliability, with a range from .92 to .99. CAPS
demonstrated good discriminant and convergent validity. In the current research, we uti-
lised the frequency subscale of CAPS-2 that is broadly used in the psychiatric literature
and is significantly associated with the scale’s total score. The scale in the present
study has a high alpha of .98. The measure has four subscales: re-experiencing, arousal,
avoidance, and emotional numbness or dissociation.
Poor Physical Health Scale (15 items, modified; Kira et al., 2001): The scale was developed
in earlier research on refugees. The high score was positively correlated with higher PTSD,
CTD (cumulative trauma disorders) scores, and older age (Kira et al., 2006). The reliability of
the scale in several studies ranged between 70 and 85. The scale consists of questions about
self-rated health on a five-point Likert-type scale, and other questions on how does health
condition affected his/ her work, her/ his social relationships, and his/her memory (cogni-
tive functioning). The scale also consists of a list of physical health problems, based on ICD-
9-CM codes for selected general medical conditions that include neurological, blood
pressure and digestive system, musculoskeletal, and endocrine disorders. The higher the
score, the worse is the reported health. The scale’s alpha in current data is .75.
Demographic variables: Demographic information was collected and included gender,
age, marital status, religion, education, and socio-economic status (SES). SES was self-
rated, with (1) indicated very low SES, (2) indicated: low SES, (3) in the middle SES, (4) indi-
cated high SES, and (5) indicated very high SES.

Statistical analysis
We used Cohen (1992, p.158) criteria and recommendations to determine the samples’ size
that achieves medium population effect size at power = .80 for α = .05 for the number of vari-
ables. Further, concerning the sample size required for SEM and path analysis, there is no
clear rule regarding how many subjects are required for SEM and path analysis. Nevertheless,
recommendations (Byrne, 2001) are fairly consistent about the following: (1) sample sizes
between 150 and 200 are more desirable than the smaller size, and (2) researchers should
try to have at least five subjects for every estimated parameter. Thus, we planned to have
a sample size around 245, allowing up to 45 parameters to be estimated.
The data were analysed utilising IBM-SPSS 22, as well as Amos 22 software. Inspection of
the variables indicated that missing values were between .5% and 2.5%, percentages below
the 5% cut-off recommended by Tabachnick and Fidell (2013). We used pairwise deletion to
handle the missing values as recommended. We calculated frequencies and basic descrip-
tions. We conducted correlations between the primary variables in the Christian subsample.
10 I. A. KIRA AND H. SHUWIEKH

We conducted independent samples t-test between Christians and Muslims for the main
variables to explore the main differences in their mental health and coping strategies
between Christians and Muslims. We also conducted two mediated path analyses following
the criteria outlined by Baron and Kenny (1986) to test two models. The first model tests the
effects of discrimination on PTSD, mediated/moderated by Col-EAA) and identity salience.
The Path model included discrimination and Identity salience as independent variables
and Col-EAA, reappraisal, self-esteem as mediators/ moderators variables, PTSD, internalis-
ing, externalising, and thought disorders outcome variables. The second model tests the
coping dynamics for religious discrimination that Egyptian Christians use and included dis-
crimination and WTELS as independent variables and PTSD and PTG as outcome variables,
and Col-EAA, interfaith spirituality, religiosity, and reappraisal as mediating variables. We
report direct, indirect, and total effects as standardised regression coefficients. Following
Byrne’s (2012) The criteria for good model fit were a non-significant chi-square (χ²), chi-
square/degrees of freedom (χ²/df > 5), comparative fit index (CFI) values > .90, and root-
mean-square error of approximation (RMSEA) values < .06 (Weston & Gore, 2006). We
used a bootstrapping method with 10,000 bootstrap samples to examine the significance
of direct, indirect (mediated effects), and total effects and 95% bias-corrected confidence
intervals (95% CI) for each variable in the model. To streamline the results, we trimmed
the model by deleting the non-significant paths.

Results
The differences between Muslims and Christians: Compared to Muslims, Christians were
higher in PTSD symptom severity, internalising, externalising, thought disorder, and sui-
cidality (Table 2). More importantly, Christians, compared to Muslims, had significantly
higher existential annihilation anxiety, especially this anxiety related to their collective
existence.
While Muslims were higher in cumulative trauma exposure in general, Christians were
higher in their exposure to certain trauma types than Muslims. They were higher in
exposure to collective identity traumas, especially discrimination (due to their religious
affiliation). While Muslims had higher exposure to type1 traumas, Christians had higher
exposure to type III traumas (the most severe).
On the positive side, Christians, compared to Muslims, had higher identity salience and
militancy, and much less poor, while Muslims had higher self-esteem and cumulative posi-
tive appraisal of traumatic events. There were no significant differences between them in
WTELS, emotion regulation, religiosity, interfaith spirituality, perceived PTG, and health.
For PTSD, we used cut-off criteria of a score ≥34), which produced a high rate of elevated
PTSD for.16.9% of the Muslims and 34% of the Christians. We also calculated probable
clinical PTSD by the DSM-IV-TR criteria (American Psychiatric Association, 2000),
whereby probable PTSD to be assigned upon endorsing one re-experiencing symptom,
three avoidance symptoms, and two hyperarousal symptoms. We included only items
rated from 3 and above. We included those who have at least one survival trauma
type. The rate of PTSD, using this criterion, was 29.58% of the Christians and 15.4% for
the Muslims. Table 2 provides the results of the t-test of the difference between Christians
and Muslims in these variables.
 MENTAL HEALTH, RELIGION & CULTURE 11

Table 2. T-test for the differences between Muslims and Christians in the main variables.
Muslims Christians
Variables M SD M SD d.f. t p
PTSD 16.90 14.74 24.67 17.39 488 −5.33 .000
Internalising 10.67 6.43 12.50 6.11 488 −3.232 .001
Externalising 2.08 3.65 5.81 6.79 488 −7.55 .000
Thought disorders 6.85 6.62 10.43 6.86 488 −5.87 .000
Suicidality .44 .98 .91 1.32 488 −4.44 .000
Existential annihilation anxiety (EAA) 12.14 9.32 18.26 9.24 488 −7.30 .000
Identity status EAA 3.23 3.64 4.96 3.77 488 −5.178 .000
Collective identity EAA 3.43 3.26 5.74 3.64 488 −7.381 .000
Personal identity EAA 3.42 2.74 4.38 2.55 488 −4.001 .000
Physical identity EAA 2.05 2.35 3.18 2.67 488 −4.965 .000
Self-reported poor health 5.43 3.14 5.50 2.8 488 −.27 .784
Religiosity 14.07 2.72 13.74 2.47 488 1.40 .162
Interfaith spirituality 85.75 10.71 84.33 11.62 488 1.40 .161
Cumulative trauma occurrence 3.04 2.90 2.39 2.77 488 2.55 .011
Cumulative positive appraisals 1.35 2.05 .89 1.61 488 2.73 .007
Cumulative negative appraisal 4.33 5.67 4.20 5.89 488 .24 .814
Personal identity traumas .41 .71 .30 .58 488 1.97 .049
Sexual abuse .02 .13 .04 .21 488 −1.28 .202
Physical abuse .28 .54 .18 .42 488 2.33 .020
Collective identity trauma .15 .40 .34 .66 488 −3.81 .000
Poverty .06 .23 .00 .06 488 3.48 .001
Discriminations .07 .32 .32 .67 488 −5.19 .000
Attachment trauma .05 .28 .05 .26 488 .030 .976
Role identity trauma .23 .49 .22 .48 488 .083 .934
Survival trauma .76 .91 .41 .77 488 4.592 .000
Secondary trauma .82 .94 .53 .80 488 3.573 .000
Perpetration trauma .05 .22 .02 .14 488 1.764 .078
Community violence .04 .20 .07 .38 488 −1.004 .316
Birthing trauma .08 .27 .03 .18 488 2.228 .026
Type I trauma 1.17 1.19 .65 .91 488 5.459 .000
Type II trauma .61 .90 .48 .89 488 1.624 .105
Type III trauma .40 . 70 .57 .87 488 −2.296 .022
WTELS 20.55 4.39 20.07 4.19 488 1.24 .217
Reappraisal 27.51 7.54 26.74 7.15 488 1.15 .250
Suppression 17.75 5.17 17.26 5.47 488 1.02 .309
PTG 51.40 26.69 53.42 23.85 488 −.88 .378
Identity militancy 15.86 6.06 17.38 5.43 488 −2.93 .004
Identity salience 19.32 8.93 26.95 8.58 488 −9.66 .000
Self-esteem 20.54 4.81 18.45 4.40 488 5.02 .000

Correlation results in the Christian sub-sample: Discrimination was positively correlated

with personal identity traumas, with secondary traumas, gender discrimination, cumulat-
ive non-traumatic stressors, and Col-EAA. It was not associated with psychic EAA or phys-
ical EAA (for example, fear of death). It was associated with reappraisal (emotion
regulation). Table 3 present these correlations.

Path analysis results

The First Path Model: The path model had a good fit with the data (Chi-Square = 26.838, df.
= 19, p = .108, CFI = .975, RMSEA = .041). Discrimination had direct effects on Col-EAA, and
indirect effects on PTSD, thought disorders, and internalising disorders, and negative
effects on self-esteem. Discrimination had a direct positive effect and an indirect negative
effect on reappraisal. Its total effects on reappraisal were insignificant.
Col-EAA had direct negative effects on reappraisal, direct and indirect positive effects on
PTSD, externalising, internalising, and thought disorders, and indirect negative effects on
 12
I. A. KIRA AND H. SHUWIEKH

Table 3. Zero-order correlations between discrimination and the main variables.

1 2 3 4 5 6 7 8 9 10 11
1.Discrimination 1
2. Attachment trauma .18** 1
3. Secondary trauma .26*** .18** 1
4.Cumulative stress .20*** .05 .31*** 1
5.EAA- psychic .08 .04 .01 .18** 1
6. EAA collective .19** .03 .06 .17** .37*** 1
7. EAA physical .02 .04 −.09 .10 .32*** .32*** 1
8. Reappraisal .13* .04 .08 .04 −.06 −.17** −.17** 1
9. Identity salience .11 −.02 .08 −.05 −.08 .06 −.06 .19** 1
10.Gender discrimination .17** .14* .19** .34*** .15* .15* .05 .12 −.09 1
11. Personal identity traumas .45*** .24*** .42*** .34*** .11 .102 .02 −.03 −.01 .22*** 1
 MENTAL HEALTH, RELIGION & CULTURE 13

self-esteem. On the other hand, Identity salience, which is higher in Christians, had direct
positive effects in reappraisal (emotion regulation), and indirect effects on self-esteem. It
had indirect negative effects on externalising, internalising, and thought disorders.
Reappraisal had strong direct negative effects on externalising and indirect negative
effects on internalising and thought disorders. Reappraisal had indirect positive effects
on self-esteem. Externalising had direct effects on thought disorders and indirect effects
on internalising disorders. Externalising had indirect negative effects on self-esteem.
PTSD had direct effects on thought disorders, direct and indirect effects on internalising
disorders, and direct negative effects on self-esteem. Thought disorders had direct effects
on internalising disorders. Thought disorders accounted for the highest variance in the
model (R² = .411). Figure 1 presents the direct paths, while Table 4 presents the direct,
indirect, and total effects of each variable and their 95% confidence intervals.
The Second Path Model: The path model had a good fit with the data (Chi-Square =
17.642, df. = 14, p = .224, CFI = .972, RMSEA = .033). Discrimination had direct effects on
Col-EAA, positive direct negative indirect effects on reappraisal, and indirect effects on
higher PTSD, PTG, religiosity, and interfaith spirituality. WTELS had direct negative effects
on a lower Col-EAA. WTELS had a direct effect on higher PTG. It had direct and indirect
effects on higher reappraisal and interfaith spirituality. It had indirect negative effects on
a lower PTSD and indirect effects on higher religiosity. Col-EAA had direct effects on
lower reappraisal (emotional regulation strategy), direct and indirect effects on higher
PTSD, and indirect effects on lower interfaith spirituality and religiosity. Reappraisal had
direct effects on higher interfaith spirituality. It had direct effects on higher PTG and
small indirect effects on lower PTG, but its total effects on PTG is positive. It had small
but significant indirect effects on higher religiosity. Reappraisal had indirect negative

Figure 1. Path Model for the effects of discrimination and identity salience on PTSD, internalising,
externalising, and thought disorders as mediated by collective annihilation anxiety, self-esteem,
and reappraisal.
N = 247 Christians; Chi Square = 26.838; d.f.= 19; p = 108; CFI = .975; RMSEA = .041
14 I. A. KIRA AND H. SHUWIEKH

Table 4. The direct, indirect and total effects of main independent variables and their 95% confidence
intervals.
Endogenous variables
Causal Thought
variables Col-EAA Reappraisal Externalising PTSD disorder Internalising Self-esteem
Discrimination
Direct effects .19* .15* _____ _____ _____ _____ _____
(.06/ (.02/.26)
.33)
Indirect _____ −.04* .01 .04* .04* .05** −.01*
effects (−.09/ (−.04/.07) (.00/.8) (.00/.09) (.01/.11) (−.02/
−.01) −.00)
Total effects .19* .11 .01 .04* .04* .05** −.01*
(.06/ (−.01/.22) (−.04/.07) (.00/.8) (.00/9) (.01/11) (−.02/
.33) −.00)
Identity salience
Direct effects _____ .19* _____ _____ _____ _____ .14+
(.01/.31) (−.00/
.27)
Indirect _____ _____ −.05* −.01+ −.02* −.01* .00*
effects (−.10/ (−.02/ (−.05/−.00) (−.02/ (.00/.01)
−.00) .00) −.00)
Total effects _____ .19* −.05* −.01+ −.02* −.01* .14+
(.01/.31) (−.10/ (−.02/ (−.05/−.00) (.02/.00) (−.00/
−.00) .00) .27)
Col-EAA
Direct effects _____ −.21** .19** .19** .14** .16** _____
(−.33/ (.08/30) (.03/30) (.04/27) (.03/.27)
−.09)
Indirect _____ _____ .06** .04+ .18** .16** −.05**
effects (.02/.11) (−.00/ (.12/.27) (.09/.24) (−.10/
.07) −.02)
Total effects _____ −.21** .25** .23** .32** .32** −.05**
(−.33/ (.13/.36) (.08/.34) (.20/.43) (.17/.41) (−.10/
−.09) −.02)
Reappraisal
Direct effects _____ _____ −.27** _____ _____ _____ _____
(−.39/
−.15)
Indirect _____ _____ _____ −.04+ −.12** −.05* .01*
effects (−.08/ (−.20/−.07) (−.08/ (.00/.02)
−.00) −.02)
Total effects _____ _____ −.27** −.04+ −.12** −.05* .01*
(−.39/ (−.08/ (−.20/−.07) (−.08/ (.00/.02)
−.15) −.00) −.02)
Externalising
Direct effects _____ _____ _____ 14+ .40** _____ _____
(−.01/ (.29/.50)
.26)
Indirect _____ _____ _____ _____ .05+ .19** −.03*
effects (−.00/.09) (.10/.25) (−.06/
−.00)
Total effects _____ _____ _____ .14+ .45** .19** −.03*
(−.01/ (.35/.55) (.10/.25) (−.06/
.26) −.00)
R² .036 .095 .129 .067 .411 .298 .060

effects on lower PTSD. Interfaith spirituality had direct negative effects on a lower PTSD and
higher religiosity. It had small indirect negative effects on lower PTG. PTSD had a direct posi-
tive impact on PTG. PTG accounted for the highest variance in the model (R² = .154). Figure
 MENTAL HEALTH, RELIGION & CULTURE 15

Figure 2. Path Model for the effects of discrimination and Will to Exist, Live and Survive on PTSD, and
PTG as mediated by, collective identity existential annihilation anxiety, interfaith spiritualty, and reap-
praisal.
N = 247 Christians; Chi Square = 17.642, d.f.= 14, p = .224; CFI = .972; RMSEA = .033.

2 presents the direct paths, while Table 5 presents the direct, indirect, and total effects of
each variable and their 95% confidence intervals.

Discussion and conclusion

The present research makes a unique contribution to the literature by examining for the
first time the effect of discrimination on the mental health of the Christians in Egypt and
their coping trajectories to such discrimination and their pathways to perceived PTG. Reli-
gious discrimination is an existential threat that seems to trigger concerns about the mere
existence of their collective identity as a minority group. Psychic existential annihilation
anxiety introduced in the psychoanalytic literature (Hurvich, 2003) is different from collec-
tive annihilation anxieties suffered by minorities. Collective annihilation anxieties suffered
by minorities are also different from the fear of physical elimination or fear of death (Kira
et al., 2019d). However, Christians’ WTELS and their salient and robust identity seem to
play influential protective factors against such overwhelming collective existential
concerns.
While discrimination predicted the severity of PTSD symptoms, interfaith spirituality
seems to be a potent protective factor. A meta-analysis found evidence of spirituality’s
effect on ameliorating PTSD symptoms in veterans (Smith-MacDonald et al., 2017). In
addition to interfaith spirituality, the emotion regulation strategy of reappraisal was a sig-
nificant protective factor against Egyptian Christians’ psychopathology. The specificity of
16 I. A. KIRA AND H. SHUWIEKH

Table 5. The direct, indirect and total effects and 95% confidence intervals for each variable in the
model.
Endogenous variables
Causal Collective annihilation Interfaith
variables anxiety Reappraisal spirituality PTSD Religiosity PTG
Discrimination
Direct effects .19** .17* ____ ____ ____ ____
(.07/.34) (.05/.27)
Indirect ____ −.04* .02* .03* .01* .04*
effects (−.08/ (.00/.05) (.00/.07) (.00/.02) (.01/.07)
−.01)
Total effects .19** .13* .02* .03* .01* .04*
(.07/.34) (.01/.23) (.00/.5) (.00/.07) (.00/.02) (.01/.07)
Will-to-exist-live-and survive
Direct effects −13* .14* .17* ____ ____ .16**
(−.25/−.01) (.02/.27) (.04/.31) (.05/.25)
Indirect ____ .02* .03** −.08** .05** .02
effects (.00/.06) (.01/.07) (−.14/ (.02/.10) (−.02/.07)
−.03)
Total effects −.13* .16** .20* −.08** .05** .18**
(−.25/−.01) (.04/.32) (.05/.32) (−.14/ (.02/.10) (.05/.27)
−.03)
Collective existential annihilation anxiety
Direct effects ____ −.19** ____ .19** ____ ____
(−.30/ (.05/.29)
−.05)
Indirect ____ ____ −.03* .01** −.01* .01
effects (−.07/−.01) (.00/.03) (−.02/ (−.06/.07)
−.00)
Total effects ____ −.19** −.03* .20** −.01* .01
(−.30/ (−.07/−.01) (.05/.30) (−.02/ (−.06/.07)
−.05) −.00)
Reappraisal
Direct effects ____ ____ .16** ____ ____ .25**
(.02/.29) (.12/.37)
Indirect ____ ____ ____ −.06* .01* −.02**
effects (−.10/ (.01/.07) (−.04/
−.01) −.01)
Total effects ____ ____ .16** −.06* .01* .23**
(.02/.29) (−.10/ (.01/.07) (.11/.36)
−.01)
Interfaith spirituality
Direct effects ____ ____ ____ −.29** 26** ____
(−.40/ (.13/.38)
−.19)
Indirect ____ ____ ____ ____ ____ −.08**
effects (−.12/
−.03)
Total effects ____ ____ ____ −.29** .26** −.08**
(−.40/ (.13/.38) (−.12/
−.19) −.03)
PTSD
Direct effects ____ ____ ____ ____ ____ .27**
(.13/.38)
Indirect ____ ____ ____ ____ ____ ____
effects
Total effects ____ ____ ____ ____ ____ .27**
(.13/.38)
Squared R .052 .076 .062 .124 .066 .154
Notes: *p < .05, **p < .01, ***p < .001.
 MENTAL HEALTH, RELIGION & CULTURE 17

emotion regulation of reappraisal as a Transdiagnostic protective factor against psycho-

pathology is well established in the literature (for meta-analysis, see: Aldao et al., 2010).
Identity salience of Egyptian Christians predicted higher emotion regulation (reapprai-
sal), higher self-esteem and lower externalising, internalising, and thought disorder, which
makes identity a positive pathway to coping with discrimination and other pre-Arab spring
oppression and post-Arab Spring violence by extremists. Previous studies found that, in
coping with perceived discrimination, the strength of identification with the group of
belonging (ethnicity or religion) is associated with decreased mental health symptoms
(e.g., Mossakowski, 2003). However, religious discrimination may undermine their identifi-
cation with a country where many people hold negative attitudes toward their religion
(e.g., Fleischmann & Phalet, 2018). However, those who report more frequent discrimi-
nation lower their national identification over time, which predicts increased minority
identification. Identity threat primed by religious discrimination triggers the development
of more conflicting identification patterns (Fleischmann et al., 2019).
One of the current study’s critical results is that discrimination itself and WTELS are
associated with PTG. Trauma and sufferings were long conceptualised to drive growth
(Tedeschi et al., 2017). However, studies found that the relationships between trauma,
PTSD, and PTG to be nonlinear (Solomon & Dekel, 2007). Nonlinearity means that low
and high intense PTSD will be related to lower perceived PTG, while moderate levels of
PTSD and distress are associated with higher perceived PTG. Studies found similar non-
linear relationships between trauma and PTG (Kanaan et al., 2019; Kira, Abou-Mediene,
et al., 2013).
The other variable that was a significant predictor of PTG was WTELS. In a previous
study, WTELS predicted lower Col-EAA and psychopathology and higher PTG, emotion
regulation, and self-esteem (Kira et al., 2019, 2020a). Several studies found reciprocal
relationships between the will-to-live, one of the components of WTELS, and successful
aging (Shrira et al., 2019). The will to survive, another component of WTELS found to
predict a plethora of coping strategies to oppression among Palestinian adolescents
and was strongly associated with post-traumatic growth. The research found that the
will to survive was associated with decreased depression, PTSD, and comorbid complex
mental health syndromes such as dissociation thought disorder, suicidality, executive
deficits, and improved health (Kira, Alawneh, et al., 2014).
Recent work has identified the complex religious/spiritual struggles, one of the factors
that we did not measure directly in the current study, that uniquely contribute to religious
minorities’ distress. Religious struggle existed mainly in religious minorities exposed to
discrimination, which may be both a cause and effect of distress (Marks et al., 2019).
These struggles can be profound enough to impair emotional and psychological health
(Exline et al., 2011). Future studies can conduct mixed methods research where some par-
ticipants are interviewed to probe the impact of religious/ spiritual struggle triggered by
micro and macro aggressions of religious discrimination.
The study has important implications for the well-being of Christians Egyptians. Reli-
gious discrimination is a threat to mental health, irrespective of religious affiliation.
Findings emphasised that spirituality and not religiosity per se is the significant key
for healing the religious discrimination wounds. Clinicians have an ethical duty to
recognise and support each person’s spiritual and religious identity and ameliorate
various religious biases. The results provide strong evidence of the perils of religious
18 I. A. KIRA AND H. SHUWIEKH

discrimination to mental health and necessitate researchers and practitioners alike to

understand religious discrimination in Egypt and the importance of interfaith spiritual-
ity, emotion regulation of reappraisal as Transdiagnostic strategies of healing the dis-
crimination wounds.
The study has important implications for the well-being of Christians Egyptians. Reli-
gious discrimination is a threat to mental health, irrespective of religious affiliation. Find-
ings emphasised that spirituality and not religiosity per se is the significant key for healing
the religious discrimination wounds. Clinicians have an ethical duty to recognise and
support each person’s spiritual and religious identity and ameliorate diverse religious
bias forms. The results provide strong evidence of the perils of religious discrimination
to mental health and necessitate the need for researchers and practitioners alike to under-
stand religious discrimination in Egypt and the importance of interfaith spirituality,
emotion regulation of reappraisal as Transdiagnostic strategies of healing the discrimi-
nation wounds.

Limitation
One of the limitations in the results is that the differences between Muslims and Christians
in trauma and mental health can be due, at least in part, to differences in demographics.
Future studies may be conducted on better matched or random samples to reach an
accurate judgment on differences. However, our analysis, which focused on the Christians,
lends support to some of these differences.
Another limitation is that we conducted the study in a convenient sample with limited
and biased representation. We recommend more studies that use more representative
community samples. Further, the measures we used depend on participants’ self-
reports, which could be subject to under- or over-reporting of events due to current
symptoms, embarrassment, or social desirability. Also, the study utilised a cross-sectional
design in testing the mediated model of path analysis. Mediated models contain causal
paths that inherently involve time passage, and testing these paths with cross-sectional
data can produce biased estimates. Future studies may use longitudinal studies, if feas-
ible, to retest the proposed model. Further, we should caution that the use of terms
like direct, indirect, and total effects should be understood as they are meant and
intended by its use in path analysis.
Despite these limitations, the current study results highlighted the negative impact of
discrimination on the Christian minority in Egypt and their coping trajectories and their
post-traumatic growth pathways.

Disclosure statement
No potential conflict of interest was reported by the author(s).

References
Agaibi, C. E. (2014). Religion and spirituality: Key factors in resilience in Coptic Orthodox women. In
T. Bryant-Davis, A. M. Austria, D. M. Kawahara, & D. J. Willis (Eds.), Religion and spirituality for
diverse women: Foundations of strength and resilience (pp. 267–280). Praeger.
 MENTAL HEALTH, RELIGION & CULTURE 19

Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psycho-
pathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237. https://doi.org/10.
1016/j.cpr.2009.11.004
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders-IV- TR.
American Psychiatric Association.
Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psycho-
logical research: Conceptual, strategic, and statistical considerations. Journal of Personality and
Social Psychology, 51(6), 1173–1182. https://doi.org/10.1037/0022-3514.51.6.1173
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M.
(1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 8(1),
75–90. https://doi.org/10.1007/BF02105408
Brownlee, J. (2013). Violence against Copts in Egypt. Carnegie Endowment for International Peace.
Byrne, B. M. (2001). Structural equation modeling with AMOS. Lawrence Erlbaum.
Byrne, B. M. (2012). Choosing structural equation modeling computer software: Snapshots of LISREL,
EQS, AMOS, and Mplus. In R. H. Hoyle (Ed.), Handbook of structural equation modeling (pp. 307–
324). The Guilford Press.
Cohen, J. (1992). Statistical power analysis. Current Directions in Psychological Science, 1(3), 98–101.
Cooper, K., Smith, L. G. E., & Russell, A. (2017). Social identity, self-esteem, and mental health in autism.
European Journal of Social Psychology, 47(7), 844–854. https://doi.org/10.1002/ejsp.2297
De Freitas, D. F., Fernandes-Jesus, M., Ferreira, P. D., Coimbra, S., Teixeira, P. M., de Moura, A., Gato, J.,
Marques, S. C., & Fontaine, A. M. (2018). Psychological correlates of perceived ethnic discrimination
in Europe: A meta-analysis. Psychology of Violence, 8(6), 712–725. https://doi.org/10.1037/vio0000215
Exline, J. J., Park, C. L., Smyth, J. M., & Carey, M. P. (2011). Anger toward God: Social-cognitive pre-
dictors, prevalence, and links with adjustment to bereavement and cancer. Journal of
Personality and Social Psychology, 100(1), 129–148. https://doi.org/10.1037/a0021716
Fleischmann, F., Leszczensky, L., & Pink, S. (2019). Identity threat and identity multiplicity among
minority youth: Longitudinal relations of perceived discrimination with ethnic, religious, and
national identification in Germany. British Journal of Social Psychology, 58(4), 971–990. https://
doi.org/10.1111/bjso.12324
Fleischmann, F., & Phalet, K. (2018). Religion and national identification in Europe: Comparing
Muslim youth in Belgium, England, Germany, the Netherlands, and Sweden. Journal of Cross-
Cultural Psychology, 49(1), 44–61. https://doi.org/10.1177/0022022117741988
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General
Psychology, 2(3), 271–299. https://doi.org/10.1037/1089-2680.2.3.271
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes:
Implications for affect, relationships, and well-being. Journal of Personality and Social
Psychology, 85(2), 348–362. https://doi.org/10.1037/0022-3514.85.2.348
Harrell, C. J. P., Burford, T. I., Cage, B. N., Nelson, T. M., Shearon, S., Thompson, A., & Green, S. (2011).
Multiple pathways linking racism to health outcomes. Du Bois Review: Social Science Research on
Race, 8(1), 143–157. https://doi.org/10.1017/S1742058X11000178
Harter, S. (1999). The construction of the self. The Guilford Press.
Hasan, S. S. (2003). Christians versus Muslims in modern Egypt: The century-long struggle for Coptic
equality. Oxford University Press.
Hurvich, M. (2003). The places of annihilation anxieties in psychoanalytic theory. Journal of the
American Psychoanalytic Association, 51(2), 579–616. https://doi.org/10.1177/
00030651030510020801
Ibrahim, V. (2018). Tracing the coptic question in contemporary Egypt. In Rowe, P. S. (Ed.). Routledge
handbook of minorities in the Middle East (pp. 93–102). Routledge.
Kanaan, A., Kira, I., Shuwiekh, H., Kucharska, J., & Al-Huwailah, A. (2019). The dynamics behind low
post-traumatic growth in victims of type III traumas: The case of Syrians and Palestinians.
Traumatology: An International Journal. Advance online publication. https://doi.org/10.1037/
trm0000229
Kira, I. (2002, August). Suicide terror and collective trauma: A collective terror management paradigm.
[Conference Presentation] https://doi.org/10.1037/e316712004-001
20 I. A. KIRA AND H. SHUWIEKH

Kira, I. (2019). Toward an integrative theory of self-identity and identity stressors and traumas and its
mental health dynamic. Psychology, 10(4), 385–410. https://doi.org/10.4236/psych.2019.104027
Kira, I., Abou-Mediene, S., Ashby, J., Lewandowski, L., Mohanesh, J., & Odenat, L. (2012). Post-trau-
matic Growth Inventory: Psychometric properties of the Arabic version in Palestinian adults.
The International Journal of Educational and Psychological Assessment, 11(2), 120–137.
Kira, I., Abou-Mediene, S., Ashby, J., Odenat, L., Mohanesh, J., & Alamia, H. (2013). The dynamics of
post-traumatic growth across different trauma types in a Palestinian sample. Journal of Loss and
Trauma: International Perspectives on Stress & Coping, 18, 120–139. https://doi.org/10.1080/
15325024.2012.679129
Kira, I., Alawneh, A. N., Aboumediane, S., Mohanesh, J., Ozkan, B., & Alamia, H. (2011). Identity sal-
ience and its dynamics in Palestinians adolescents. Psychology, 2(8), 781–791. https://doi.org/
10.4236/psych.2011.28120
Kira, I., Alawneh, A., Boumediene, S., Lewandowski, L., & Laddis, A. (2014). Dynamics of oppression
and coping from traumatology perspective: The example of Palestinian youth. Peace and Conflict:
Journal of Peace Psychology, 20(4), 385–411. https://doi.org/10.1037/pac0000053
Kira, I., Ashby, J. S., Lewandowski, L., Alawneh, A. N., Mohanesh, J., & Odenat, L. (2013). Advances in
continuous traumatic stress theory: Traumatogenic dynamics and consequences of intergroup
conflict: The Palestinian adolescents case. Psychology, 4, 396–409. https://doi.org/10.4236/
psych.2013.44057
Kira, I., Clifford, D., Wiencek, P., & Al-Haidar, A. (2001). Iraqi refugees in Southeast Michigan: First report.
ACCESS Community Health and Research Center.
Kira, I., Fawzi, M., & Fawzi, M. (2013). The dynamics of cumulative trauma and trauma types in adult
patients with psychiatric disorders: Two cross-cultural studies. Traumatology: An International
Journal, 19(3), 179–195. https://doi.org/10.1177/1534765612459892
Kira, I., Lewandowski, L., Chiodo, L., & Ibrahim, A. (2014). Advances in systemic trauma theory:
Traumatogenic dynamics and consequences of backlash as a multi-systemic trauma on Iraqi
refugee Muslim adolescents. Psychology, 5, 389–412. https://doi.org/10.4236/psych.2014.55050
Kira, I., Özcan, N. A., Shuwiekh, H., Kucharska, J., Al-Huwailah, A., & Kanaan, A. (2020b). The cross-
national validity and structural invariance of the Existential Annihilation Anxiety Scale. Current
Psychology. Advance online publication. https://doi.org/10.1007/s12144-019-00591-5
Kira, I. A., Shuwiekh, H., Al-Huwailah, A. H., Lewandowski, L., Alawneh, A.-W. N., Abou-Mediene, S.,. ..
Aljakoub, J. (2019a). The central role of social identity in oppression, discrimination, and social-
structural violence: Collective identity stressors and traumas, their dynamics and mental health
impact. Peace and Conflict: Journal of Peace Psychology, 25(3), 262–268.
Kira, I., Shuwiekh, H., Al-Huwailah, A. H., Zidan, T., & Bujold-Bugeaud, M. (2019). Measuring interfaith
spirituality: Initial validation and psychometrics. Psychology of Religion and Spirituality. Advance
online publication. https://doi.org/10.1037/rel0000242
Kira, I., Shuwiekh, H., Kucharska, J., & Al-Huwailah, A. (2019b). The integrated structural and measure-
ment models of existential annihilation anxieties (EAA) and their potential contribution to clinical
science: Two studies. Psychology, 10(4), 449–480. https://doi.org/10.4236/psych.2019.104031
Kira, I., Shuwiekh, H., Kucharska, J., Al-Huwailah, A., & Moustafa, A. (2019c). “Will to Exist, Live and
Survive” (WTELS): Measuring its role as master/ meta-motivator and in resisting oppression
and related adversities. Peace and Conflict: Journal of Peace Psychology. Advance online publi-
cation. https://doi.org/10.1037/pac0000411
Kira, I., Shuwiekh, H., Rice, K., Al Ibraheem, B., & Aljakoub, J. (2017). A threatened identity: The mental
health status of Syrian refugees in Egypt and its etiology. Identity: An International Journal of
Theory and Research, 3(3), 176–190. https://doi.org/10.1080/15283488.2017.1340163
Kira, I., Templin, T., Lewandowski, L., Clifford, D., Wiencek, E., Hammad, A., Al-Haidar, A., & Mohanesh,
J. (2006). The effects of torture: Two community studies. Peace and Conflict: Journal of Peace
Psychology, 12(3), 205–228.
Kira, I., Templin, T., Lewandowski, L., Ramaswamy, V., Bulent, O., Mohanesh, J., & Abdulkhaleq, H.
(2012). Collective and personal annihilation anxiety: Measuring annihilation anxiety AA.
Psychology, 3(1), 90–99. https://doi.org/10.4236/psych.2012.31015
 MENTAL HEALTH, RELIGION & CULTURE 21

Kira, I. A., Lewandowski, L., Templin, T., Ramaswamy, V., Ozkan, B., & Mohanesh, J. (2008). Measuring
cumulative trauma dose, types, and profiles using a development-based taxonomy of traumas.
Traumatology, 14(2), 62–87.
Kira, I. A. (2001). Taxonomy of trauma and trauma assessment. Traumatology, 7(2), 73–86.
Kira, I. A., Omidy, A. Z., & Ashby, J. S. (2014). Cumulative trauma, appraisal, and coping in Palestinian
and American Indian adults: Two cross-cultural studies. Traumatology: An International Journal, 20
(2), 119–133. https://doi.org/10.1037/h0099397
Kira, I. A., Özcan, N. A., Shuwiekh, H., Kucharska, J., Al-Huwailah, A., & Kanaan, A. (2020a). The com-
pelling dynamics of “will to exist, live and survive” on effecting PTG upon exposure to adversities:
Is it mediated, in part, by emotional regulation, resilience, and spirituality. Traumatology, 26(4),
405–419. https://doi.org/10.1037/trm0000263
Kira, I. A., Shuwiekh, H., Al-Huwailah, A. H., Lewandowski, L., Alawneh, A. W. N., Abou-Mediene, S., &
Aljakoub, J. (2019d). The central role of social identity in oppression, discrimination, and social-
structural violence: Collective identity stressors and traumas, their dynamics and mental health
impact. Peace and Conflict: Journal of Peace Psychology, 25(3), 262–268. https://doi.org/10.1037/
pac0000363
Kira, I. A., Shuwiekh, H., & Kucharska, J. (2017). Screening for psychopathology using the three factors
model of the structure of psychopathology: A modified form of GAIN short screener. Psychology, 8
(14), 2410–2427. https://doi.org/10.4236/psych.2017.814152
Kira, I. A., Shuwiekh, H., Kucharska, J., Fawzi, M., Ashby, J. S., Omidy, A. Z., Abou-Mediene, S., &
Lewandowski, L. (2018). Trauma proliferation and stress generation (TPSG) dynamics and their
implications for clinical science. American Journal of Orthopsychiatry, 88(5), 582–596. https://
doi.org/10.1037/ort0000304
Kira, I. A., Templin, T., Lewandowski, L., & Shuwiekh, H. (2018). A conceptual model and measure-
ment of identity-based, existential annihilation anxieties (EAA). Psychology, 9(6), 1306–1328.
https://doi.org/10.4236/psych.2018.96080
Koenig, H. G., King, D. E., & Carson, V. B. (2012). Handbook of religion and health (2nd ed.). Oxford
University Press.
Marks, L. D., Dollahite, D. C., & Young, K. P. (2019). Struggles experienced by religious minority
families in the United States. Psychology of Religion and Spirituality, 11(3), 247–256. https://doi.
org/10.1037/rel0000214
Morris, B. A., Campbell, M., Dwyer, M., Dunn, J., & Chambers, S. K. (2011). Survivor identity and post-
traumatic growth after participating in challenge-based peer-support programmes. British
Journal of Health Psychology, 16(3), 660–674. https://doi.org/10.1348/2044-8287.002004
Mossakowski, K. N. (2003). Coping with perceived discrimination: Does ethnic identity protect
mental health? Journal of Health and Social Behavior, 44(3), 318–331. https://doi.org/10.2307/
1519782
Ordanova, V., Crawford, M. J., McManus, S., Bebbington, P., & Brugha, T. (2015). Religious discrimi-
nation and common mental disorders in England: A nationally representative population-
based study. Social Psychiatry and Psychiatric Epidemiology: The International Journal for
Research in Social and Genetic Epidemiology and Mental Health Services, 50(11), 1723–1729.
Oyserman, D., Fryberg, S. A., & Yoder, N. (2007). Identity-based motivation and health. Journal of
Personality and Social Psychology, 93(6), 1011–1027. https://doi.org/10.1037/0022-3514.93.6.1011
Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., Gupta, A., Kelaher, M., & Gee, G. (2015).
Racism as a determinant of health: A systematic review and meta-analysis. PLoS One, 10(9), 1–48.
https://doi.org/10.1371/journal.pone.0138511
Park, C. L. (2007). Religiousness/spirituality and health: A meaning systems perspective. Journal of
Behavioral Medicine, 30(4), 319–328. https://doi.org/10.1007/s10865-007-9111-x
Pascoe, E. A., & Smart Richman, L. (2009). Perceived discrimination and health: A meta-analytic
review. Psychological Bulletin, 135(4), 531–554. https://doi.org/10.1037/a0016059
Rosenberg, M. (1965). Rosenberg Self-Esteem Scale (RSE). Acceptance and commitment therapy.
Measures Package, 61(52), 18.
22 I. A. KIRA AND H. SHUWIEKH

Schmitt, M. T., Branscombe, N. R., Postmes, T., & Garcia, A. (2014). The consequences of perceived
discrimination for psychological well-being: A meta-analytic review. Psychological Bulletin, 140
(4), 921–948.
Shrira, A., Carmel, S., Tovel, H., & Raveis, V. (2019). Reciprocal relationships between the will-to- live
and successful aging. Aging & Mental Health, 23(10), 1350–1357. https://doi.org/10.1080/
13607863.2018.1499011
Sidanius, J., & Pratto, F. (1993). The inevitability of oppression and the dynamics of social dominance.
In P. Sniderman, P. Tetlock, & E. Carmines (Eds.), Prejudice, politics, and the American dilemma (pp.
173–211). Stanford University Press.
Smith-MacDonald, L., Norris, J. M., Raffin-Bouchal, S., & Sinclair, S. (2017). Spirituality and mental
well-being in combat veterans: A systematic review. Military Medicine, 182(11–12), e1920–
e1940. https://doi.org/10.7205/MILMED-D-17-00099
Solomon, Z., & Dekel, R. (2007). Posttraumatic stress disorder and posttraumatic growth among
Israeli ex-POWs. Journal of Traumatic Stress, 20(3), 303–312. https://doi.org/10.1002/jts.20216
Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics: International edition. Pearson2012.
Tajfel, H., & Turner, J. (1979). An integrative theory of intergroup conflict. In W. Austin & S. Worchel
(Eds.), The social psychology of intergroup relations (pp. 33–47). Brooks/Cole.
Tedeschi, R. G., Blevins, C. L., & Riffle, O. M. (2017). Posttraumatic growth: A brief history and evaluation.
In M. Warren & S. Donaldson (Eds.), Scientific advances in positive psychology (pp. 131–163). Praeger.
Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive
legacy of trauma. Journal of traumatic stress, 9(3), 455–471.
Vang, Z. M., Hou, F., & Elder, K. (2019). Perceived religious discrimination, religiosity, and life satis-
faction. Journal of Happiness Studies, 20(6), 1913–1932. https://doi.org/10.1007/s10902-018-
0032-x
Weston, R., & Gore Jr, P. A. (2006). A brief guide to structural equation modeling. The counseling psy-
chologist, 34(5), 719–751.
Williams, D. R., Neighbors, H. W., & Jackson, J. S. (2003). Racial/ethnic discrimination and health:
Findings from community studies. American Journal of Public Health, 93(2), 200–208. https://
doi.org/10.2105/AJPH.93.2.200
Wohl, M. J., Branscombe, N. R., & Reysen, S. (2010). Perceiving your group’s future to be in jeopardy:
Extinction threat induces collective angst and the desire to strengthen the ingroup. Personality
and Social Psychology Bulletin, 36(7), 898–910. https://doi.org/10.1177/0146167210372505.