El-Awad Usama, Eves Robert, Hachenberger Justin, Bozorgmehr Kayvan, Entringer Theresa M, Hecker Tobias, Razum Oliver, Sauzet Odile, Lemola Sakari
Faculty of Psychology and Sports Sciences, Bielefeld University, P.O. Box 10 01 31, Bielefeld, 33501, Germany.
Faculty of Medicine, University Clinic of Psychiatry and Psychotherapy, Virchowstraße 65, 32312 Luebbecke, Ruhr University Bochum (Campus OWL), Bochum, Germany.
BMC Public Health. 2025 Jul 29;25(1):2582. doi: 10.1186/s12889-025-23660-w.
On their way to host countries, refugees are often exposed to severe adversity, including cumulative experiences of fraud, extortion, robbery, detention, and shipwrecks, as well as prolonged, life-threatening small boat crossings. However, little research has examined the long-term impact of such peri-migration stressors on subsequent stress and mental health after arrival. This study explored how cumulative exposure to potentially traumatic events (PTEs) and small boat crossings before arrival affected psychological distress in Middle Eastern refugees, considering the mediating role of post-migration stress in the years following resettlement in Germany.
Longitudinal data from the IAB-BAMF-SOEP Survey of Refugees collected at three survey waves (2016, 2018, and 2020; = 541, = 38.77, 14% female) were analyzed using a causal mediation approach with linear mixed models. Self-reports of cumulative exposure to PTEs and small boat crossings in the Mediterranean indicated peri-migration stressors, while perceived discrimination and migration-related worries reflected post-migration stress. Psychological distress was assessed using a general health questionnaire.
PTEs were significantly associated with higher migration-related worries (β = 0.10, < .001). Migration-related worries significantly mediated the association between PTEs and psychological distress (ACME = 0.02, 95% CI [0.01, 0.04], < .001; ADE = 0.07, 95% CI [0.03, 0.11], < .001). In contrast, perceived discrimination did not mediate this link. However, small boat crossings were significantly associated with higher perceived discrimination (β = 0.11, < .001), which in turn mediated their association with psychological distress (ACME = 0.05, 95% CI [0.02, 0.08], < .001), while the direct effect was non-significant. These indirect effects intensified over time.
Peri-migration stressors may contribute to long-term mental health issues in refugees via their post-migration stress experiences. However, these mediation pathways may differ, underscoring the need for nuance and further investigation. Addressing both early traumatic experiences and post-migration adversities, such as discrimination and migration-related worries, is crucial to mitigating refugees’ long-term psychological distress. These findings highlight the importance of early prevention and intervention efforts that address post-migration stress as a key factor in reducing the long-term mental health burden among refugees.
The online version contains supplementary material available at 10.1186/s12889-025-23660-w.
在前往东道国的途中，难民常常面临严重的困境，包括遭受欺诈、敲诈勒索、抢劫、拘留和海难等一系列经历，以及长时间危及生命的小船渡海旅程。然而，很少有研究考察这种迁移前应激源对抵达后的后续应激和心理健康的长期影响。本研究探讨了在抵达前累积暴露于潜在创伤性事件（PTEs）和小船渡海经历如何影响中东难民的心理困扰，并考虑了在德国重新安置后的几年中迁移后应激的中介作用。
使用线性混合模型的因果中介方法，对在三个调查波次（2016年、2018年和2020年；n = 541，平均年龄 = 38.77岁，14%为女性）收集的来自IAB - BAMF - SOEP难民调查的纵向数据进行分析。自我报告的在地中海地区累积暴露于PTEs和小船渡海情况表明了迁移前应激源，而感知到的歧视和与迁移相关的担忧反映了迁移后应激。使用一般健康问卷评估心理困扰。
PTEs与更高的与迁移相关的担忧显著相关（β = 0.10，p <.001）。与迁移相关的担忧显著中介了PTEs与心理困扰之间的关联（ACME = 0.02，95%置信区间[0.01, 0.04]，p <.001；ADE = 0.07，95%置信区间[0.03, 0.11]，p <.001）。相比之下，感知到的歧视并未中介这种联系。然而，小船渡海与更高的感知到的歧视显著相关（β = 0.11，p <.001），这反过来又中介了它们与心理困扰的关联（ACME = 0.05，95%置信区间[0.02, 0.08]，p <.001），而直接效应不显著。这些间接效应随着时间的推移而增强。
迁移前应激源可能通过难民的迁移后应激经历导致长期心理健康问题。然而，这些中介途径可能不同，这凸显了需要细致入微的研究和进一步调查。解决早期创伤经历以及迁移后逆境，如歧视和与迁移相关的担忧，对于减轻难民的长期心理困扰至关重要。这些发现强调了早期预防和干预措施的重要性，这些措施将解决迁移后应激作为减轻难民长期心理健康负担的关键因素。
在线版本包含可在10.1186/s12889 - 025 - 23660 - w获取的补充材料。
