Mental health risks for migrants and refugees

In the context of globally increasing migration and forced displacement, the mental health of migrants and refugees has become a critical public health and social issue. Research consistently shows that these populations face a heightened risk of developing mental disorders due to cumulative stressors across the migration process. This article explores the mechanisms underlying this increased vulnerability and discusses their implications for research, practice, and psychotherapy.

Why is mental health among migrants and refugees an important topic today?

Mental health is today more than ever at the center of social, health policy, and scientific discourse. Its importance for both individual and global health is increasingly recognized as fundamental. At the same time, it is evident that certain population groups have an elevated risk of developing mental disorders, including migrants and refugees (Hernandez et al., 2004; World Health Organization [WHO], 2022). Against the background of globally increasing migration and forced displacement, addressing and researching the mental health of migrants and refugees has become essential and necessary. Particularly, the consequences derived from this knowledge and the competencies required in professional fields such as psychotherapy are of specific concern.

The aim of this article is to outline explanatory approaches addressing why and to what extent migrants and refugees exhibit an increased vulnerability to mental disorders, as well as to identify the central mechanisms underlying this vulnerability. To this end, key social and structural influencing factors are examined in order to develop a differentiated understanding of the underlying processes.

What do current migration and refugee statistics tell us? Why is migration particularly relevant in urban contexts such as Barcelona?

Current research indicates that in 2020, a total of 281 million international migrants were living worldwide, representing 3.6 percent of the global population  (McAuliffe & Oucho, 2024). Of these, approximately 135 million were women, accounting for 3.5 percent of the global female population, and 146 million were men, representing 3.7 percent of the global male population. In addition, 28 million international migrants were children, corresponding to 1.4 percent of the world’s child population. Furthermore, 169 million labor migrants were recorded globally in 2019.

In Barcelona, a marked  internationalisation of the population can be observed, particularly in central districts such as Ciutat Vella, El Raval, and the Barri Gòtic (Ajuntament de Barcelona, 2024). Demographic developments indicate a long-term decline in Spanish nationals alongside a significant increase in residents with foreign citizenship, especially from non-EU countries. This demographic shift highlights the growing importance of international migration in urban contexts and represents a key contextual factor for analyzing the psychological vulnerability of migrants and refugees (Ajuntament de Barcelona, 2024).

Do migrants and refugees show higher rates of mental health problems than the general population?

In parallel with these demographic developments, the World Health Organization (WHO, 2022) reports that the prevalence of depression and anxiety disorders among refugees and migrants is elevated across different phases of displacement and migration. This increased vulnerability can be attributed to a range of individual, social, and environmental factors that accumulate before, during, and after migration. Refugees and migrants affected by conflict and war are particularly at risk of developing post-traumatic stress disorder (PTSD) as well as other mental disorders.

Younger migrants and adolescents are especially vulnerable to trauma-related psychological stress. With regard to psychotic disorders and schizophrenia, empirical evidence remains limited, indicating a substantial need for further research. Nevertheless, existing studies suggest that the prevalence of psychosis among migrants is elevated in several countries.

This increased prevalence is often associated with the cumulative effects of social disadvantage, exclusion, and stressors across different stages of the migration process. Children of refugees, asylum seekers, and undocumented migrants are also particularly affected, showing a significantly higher prevalence of mental health problems compared to the host population. Overall, these groups are frequently confronted with specific stressors occurring before, during, and after migration (WHO, 2022).

Hernandez et al. (2004) examined the one-year prevalence of psychiatric disorders among Hispanics and White individuals in a large population-based sample comprising 4,559 participants. The aim of the study was to analyze group differences in the prevalence of mental disorders and to identify factors contributing to these differences. The results showed that Hispanic participants, predominantly Mexican Americans, were more likely than White participants to meet the criteria for at least one psychiatric diagnosis during the previous year. They also exhibited higher one-year prevalence rates for various anxiety disorders.

At the same time, Hispanic participants reported greater difficulties in meeting basic needs, while demonstrating better interpersonal functioning. Further analyses revealed that difficulties in fulfilling basic needs partially accounted for the higher prevalence of psychiatric disorders among Hispanic participants compared to their White counterparts (Hernandez et al., 2004), underscoring the relevance of this issue.

Why Does Migration Increase Psychological Vulnerability?

Possible explanations for this increased vulnerability can be described using the vulnerability–stress model. This model explains the development of mental disorders as the result of an interaction between biological, social, and psychological factors (Schneider & Margraf, 2018). According to this model, mental disorders emerge from the interplay between individual vulnerability (e.g., genetic or biographical factors) and external stressors. Migration and forced displacement increase stress levels through cumulative burdens experienced before, during, and after migration, thereby helping to explain the heightened vulnerability observed in these population groups. 

Another explanatory framework addressing differential vulnerabilities across population groups is Berry’s acculturation model (Berry, 1997). Berry emphasizes that migration involves extensive adaptation demands affecting individual, social, and cultural dimensions. These include learning a new language, adapting to societal values and norms, changes in social roles, and negotiating a sense of belonging within the host society.

Such demands can lead to significant psychological stress, referred to as acculturative stress. Based on the combination of these dimensions, four acculturation strategies are distinguished: integration, assimilation, separation, and marginalization (Berry, 1997). The model assumes that these strategies are differentially associated with psychological distress (Choy et al., 2020).

Migrants and refugees often do not freely choose their acculturation position but are instead pushed into marginalized or separated contexts due to structural barriers, discrimination, legal restrictions, or a lack of social resources. Consequently, acculturative stress increases independently of individual coping capacities. When combined with additional migration-related stressors, such as insecure legal status or precarious living conditions, this stress can substantially undermine psychological resilience (Berry, 1997).

A more recent stress framework, the Conservation of Resources (COR) model, assumes that individuals strive to retain, protect, and build resources, and that stress arises from the threat or actual loss of these valued resources (Hobfoll, 1989). In the context of migration and forced displacement, the risk of resource loss is particularly high, as these processes often involve severe disruptions across multiple resource domains. Object resources include housing, financial security, and material possessions, which may be lost during migration or flight. Condition resources, such as secure residence status, stable employment, and social roles, are often uncertain or limited for migrants and refugees.

Social resources, especially family and community networks, are frequently diminished due to separation, displacement, or social exclusion. Moreover, the COR model emphasizes that not only actual losses but also the persistent threat of further resource loss is experienced as highly stressful (Hobfoll, 1989). Combined with limited opportunities for resource gain, due to language barriers, discrimination, or restricted access to the labor market, this results in a lasting imbalance between stressors and available coping resources. These findings suggest that psychological distress in this context is less attributable to individual deficits and more to structural and social conditions that facilitate repeated resource losses.

Why do migrants with high mental health needs use psychological services less frequently?

An American study from Derr (2016) further demonstrated that immigrants from Asia, Latin America, and Africa, despite having equal or greater mental health needs, utilize psychological services less frequently than non-immigrants. Reduced utilization was particularly evident among men, uninsured individuals, and those without legal residency status. Structural barriers to service use included lack of health insurance, high costs, and language barriers. Research has also shown that social support is especially important for immigrants, and that individuals seeking help for mental health problems typically turn first to family members, friends, or religious leaders (Derr, 2016).

What implications arise for research, practice, and psychotherapy?

Overall, these findings indicate that migrants and refugees not only exhibit increased psychological vulnerability but also make less use of psychosocial care services compared to the majority population. This combination of vulnerability and underutilization cannot primarily be explained by individual factors but is largely attributable to structural barriers such as limited insurance coverage, high costs, language obstacles, and insecure legal status. Additionally, many migrants initially rely on informal support networks before seeking professional help.

These patterns highlight that mental health, illness perceptions, and help-seeking behaviors are deeply embedded in cultural and social contexts. Against this background, Iguality’s work addresses precisely this need and is therefore of essential importance in ensuring adequate and culturally sensitive care, particularly for vulnerable populations, in an increasingly pluralistic society - see also this article on our blog.