Skip to main content
. 2023 Jul 5;23:1289. doi: 10.1186/s12889-023-15931-1

Table 2.

Overview of the included studies

Author(s)(Year) Country Study population / Year(s) of data collection Study design Risk and protective factors of the PMLS Symptoms Size of association Outcome measure Co-/Variables Study quality (MMAT)
Depression Anxiety PTSD
Barbieri et al. (2021) [21] Italy

African refugees and Asylum Seekers (n = 122)

2016–2019

 Cross-sectional study

Legal status

(asylum seeker vs. visa [Ref])

 - - PCL-5

Sociodemographic factors (age, gender, education);

Post-migration factors (legal status, duration of residence, employment, accommodation);

Trauma-related factors (number of trauma types)

 High
- -
⇅

OR3vs1 = 1.24 [CI 0.12, 13.02]

OR3vs2 = 9.44 [CI 0.66, 134.93]

OR2vs1 = 0.13 [CI 0.01, 2.16]

Duration of residence

(months since residing in host country)

 - -
- -
⇅

OR3vs1 = 0.97 [CI 0.91, 1.04]

OR3vs2 = 0.95 [CI 0.90, 1.00]

OR2vs1 = 1.03 [CI 0.97, 1.08]

Employment

(unemployed vs. employed [Ref])

 - -
- -
⇅

OR3vs1 = 1.59 [CI 0.48, 5.21]

OR3vs2 = 2.19 [CI 0.77, 6.24]

OR2vs1 = 0.73 [CI 0.23, 2.26]

Accommodation

(large-reception centers with > 1000 people vs. small-medium reception centers with < 1000 people [Ref])

 - -
- -
↑

OR3vs1 = 12.77 [CI 1.49, 109.44]

OR3vs2 = 6.68 [CI 1.81, 24.61]

OR2vs1 = 1.91 [CI 0.19, 18.81]
Böge et al. (2020) [22] Germany / Jordan

Syrian refugees and asylum seekers (n = 89)

2017–2018

 Cross-sectional study

Social support

(MSPSS)

 ↓ β = -0.240 [CI NA]

PHQ-9

GAD-7

HTQ

 - Moderate
↓ β = -0.042 [CI NA]
↓ β = -0.230 [CI NA]

Borho et al. (2020)

[23]

 Germany

Syrian refugees (T1: n = 200, T2: n = 108)

T1: 2017; T2: 2019

 Two-wave longitudinal study Perceived discrimination ↑

βT1 = 0.235 [CI 0.219, 3.552]

βT2 = 0.271 [CI 0.383, 2.769]

PHQ-9

GAD-7

ETI

Sociodemographic factors (age, gender, education);

Trauma-related factors (number of traumatic events);

Post-migration factors (accommodation, employment, duration of residence, future validity of permit, discrimination)

 High
↑

βT1 = 0.263 [CI 0.359, 2.988]

βT2 = 0.335 [CI 0.700, 2.738]
↑ N.A

Future validity of permit

(in months)

 - N.A
- N.A
↓

N.A

βT2 = -0.184 [CI -0.388, -0.035]

Duration of residence

(months since residing in host country)

 - N.A
- N.A
- N.A

Accommodation

(Collective accommodation center, Own apartment alone or with family, Shared flat)

 - N.A
- N.A
- N.A

Costa et al. (2020)

[24]

 Germany

Diverse refugee sample (n = 560)

2018

 Cross-sectional study Subjective social status (3 or more steps down vs. no change [Ref]) ↑ B = 1.048 [CI NA]

PHQ-2

GAD-2

Sociodemographic factors (sex, age, education);

Post-migration factors (SSS mobility, SSS in country of origin, duration of residence)

 Moderate
↑ B = 1.006 [CI NA]
- -
Subjective social status (1 or 2 steps down vs. no change [Ref]) ↓ B = -0.176 [CI NA]
↑ B = 0.114 [CI NA]
- -
Subjective social status (1 or 2 steps up vs. no change [Ref]) ↓ B = -0.499 [CI NA]
↓ B = -0.985 [CI NA]
- -
Subjective social status (3 or more steps up vs. no change [Ref]) ↑ B = 0.19 [CI NA]
↑ B = 0.269 [CI NA]
- -

Georgiadou et al. (2018)

[25]

 Germany

Syrian refugees (n = 200)

2017

 Cross-sectional study

Future validity of permit

(in months)

 ↑ β = 0.12 [CI -0.04, 0.24]

PHQ-9

GAD-7

ETI

Sociodemographic factors (sex, age, education, illiterate, marital status);

Post-migration factors (accommodation, duration of residence, duration of residence permit, future validity of permit);

Pre-/Peri-migration factors (escape journey, escape duration);

Trauma-related factors (number of traumatic events);

Health-related factors (PHQ-9 score, GAD score, ETI score, mental health treatment)

 Moderate
↑ β = 0.05 [CI -0.07, 0.13]
↓ β = -0.20 [CI -0.58, -0.01]

Duration of residence permit

(in months)

 ↓ β = -0.15 [CI -0.22, 0.03]
↓ β = -0.08 [CI -0.13, 0.05]
↑ β = 0.19 [CI -0.04, 0.46]

Duration of residence

(in months)

 ↓ β = -0.03 [CI -0.16, 0.11]
↑ β = 0.08 [CI -0.04, 0.15]
↓ β = -0.09 [CI -0.43, 0.11]

Accommodation

(own apartment / with family vs. collective accommodation center / with others [Ref])

 ↑ β = 0.03 [CI -0.95, 1.70]
↓ β = -0.01 [CI -1.04, 0.82]
↑ β = 0.01 [CI -2.40, 2.89]

Groen et al. (2019)

[26]

 Netherlands

Afghan and Iraqi refugees and asylum seekers (n = 57)

2012–2015

 Mixed-methods study

Legal status

(asylum vs. refugee [Ref])

 ↑ β = 0.193 [CI -0.143, 0.560]

HSCL-25

HTQ

Sociodemographic factors (age, sex);

Post-migration factors (PMLD, acculturation, legal status);

Trauma-related factors (number of experienced traumas)

 High
↑
↑ β = 0.241 [CI -0.096, 0.628]

Acculturation

(CRM-BS)

 ↓ β = -0.113 [CI -0.625, 0.239]
↓
↓ β = -0.112 [CI -0.642, 0.247]

PMLD

(PMLP-CL)

 ↑ β = 0.428 [CI 0.170, 0.710]
↑
↑ β = 0.396 [CI 0.140, 0.713]

Gühne et al. (2021)

[27]

 Germany

Syrian refugees (n = 133)

2018–2019

 Cross-sectional study

Social support

(ESSI)

 ↓ N.A

PHQ-9

PDS-5

Sociodemographic factors (age, sex, number of household members);

Post-migration factors (employment, social support, duration of residence)

 High
- -
↓ N.A

Duration of residence

(months since residing in host country)

 ↑ β = 0.016 [CI NA]
- -
↑ β = 0.050 [CI NA]

Employment

(employed vs. unemployed [Ref])

 ↓ β = -2.506 [CI NA]
- -
↓ β = -4.871 [CI NA]

Hecker et al. (2018)

[28]

 Switzerland

Diverse refugee sample (n = 94)

2015–2016

 Cross-sectional study

Social support

(SPS)

 - - ITQ

Sociodemographic factors (gender);

Trauma-related factors (trauma exposure);

Post-migration factors (social support, PMLD)

 Moderate
- -
↑

β = 0.13 [CI NA]

β = 0.22 [CI NA] (for DSO)

PMLD

(PMLD-CL)

 - -
- -
↑

β = 0.17 [CI NA]

β = 0.42 [CI NA] (for DSO)

Kaltenbach et al. (2018)

[29]

 Germany

Diverse refugee sample (n = 57)

2015–2017

 Longitudinal study Legal status - N.A

PHQ-9

PSS-I

PCL-5

 - High
- -
- N.A
Duration of residence - N.A
- -
- N.A

PMLD

(PMLD-CL)

 - N.A
- -
↑ N.A

Leiler et al. (2019)

[30]

 Sweden

Diverse refugee sample (n = 577)

2016–2017)

 Cross-sectional study

Legal status

(asylum seekers vs. individuals with residence permit)

 - N.A

PHQ-9

GAD-7

PC-PTSD

 - Moderate
- N.A
- -

Nissen et al. (2021)

[31]

 Norway

Syrian refugees (n = 902)

2018 -2019

 Cross-sectional study

Legal status

(quota refugee vs. asylum seeker [Ref])

 ↑ OR = 1.35 [CI 0.69, 2.65]

HSCL-25

HTQ

Sociodemographic factors (gender, age, education, marital status);

Post-migration factors (legal status, duration of residence);

Migration-related factors (arrived with friends/alone, length of flight, family members resettled in host country);

Trauma-related factors (potentially traumatic experience)

 Moderate
↑ OR = 1.78 [CI 0.91, 3.49]
↑ OR = 1.20 [CI 0.60, 2.39]

Legal status

(family reunion vs. asylum seeker [Ref])

 ↓ OR = 0.95 [CI 0.46, 1.98]
↑ OR = 1.28 [CI 0.62, 2.65]
↑ OR = 1.32 [CI 0.63, 2.79]

Duration of residence

(years since residing in host country)

 ↑ OR = 1.52 [CI 1.13, 2.05]
↑ OR = 1.52 [CI 1.14, 2.04]
↑ OR = 1.30 [CI 0.96, 1.75]

Nutsch & Bozorgmehr (2020)

[32]

 Germany

Diverse refugee sample (n = 4,136)

2016

 Cross-sectional study

Language skills

(moderate vs. good [Ref])

 ↑ OR = 1.144 [CI 0.841, 1.557] PHQ-2

Sociodemographic factors (age, sex, marital status, education, nationality);

Post-migration factors (legal status, asylum interview, employment, satisfaction with accommodation, language skills, loneliness);

Psychosocial factors (self-esteem, resilient coping behavior, life satisfaction, anxiety)

 High
- -
- -

Language skills

(bad vs. good [Ref])

 ↑ OR = 1.239 [CI 0,907, 1.692]
- -
- -

Loneliness

(LS-S)

 ↑ OR = 1.143 [CI 1.103, 1.184]
- -
- -

Legal status

(rejected status vs. recognized status or asylum seekers [Ref])

 ↑ OR = 1.344 [CI 1.062, 1.701]
- -
- -

Asylum interview

(yes vs. no [Ref])

 ↓ OR = 0.710 [CI 0.556, 0.908]
- -
- -

Employment

(unemployed vs. employed [Ref])

 ↑ OR = 1.483 [CI 1.037, 2.121]
- -
- -
Satisfaction with accommodation ↓ OR = 0.943 [CI 0.909, 0.978]
- -
- -

Renner et al. (2021)

[33]

 Germany

Syrian refugees (n = 133)

2018–2019

 Cross-sectional study

Social support

(ESSI)

 ↓ B = -0.32 [CI NA]

PHQ-9

GAD-7

PDS-5

Sociodemographic factors (age, sex, education, living alone);

Post-migration factors (employment, financial hardship, social support, connection to country of origin);

Trauma-related factors (variability of traumatic events,);

Psychosocial factors (self-efficacy, stigma, life satisfaction);

Other factors (Religiousness)

 High
↓ B = -0.20 [CI -0.39, 0.01]
↓ B = -0.55 [CI -0.98, -0.05]

Employment

(employed vs. unemployed [Ref])

 ↓ B = -1.51 [CI NA]
↓ B = -1.70 [CI -3.59, 0.17]
↓ B = -1.37 [CI -5.40, 2.93]

Financial hardship

(income < 500€ vs. income > 500€ [Ref])

 ↑ B = 0.64 [CI NA]
↑ B = 0.88 [CI -1.34, 3.54]
↑ B = 7.04 [CI 0.79, 13.72]

Schiess-Jokanovic et al. (2021)

[34]

 Austria

Afghan refugees (n = 93)

2019–2020

 Randomized Controlled Trail (RCT) Language acquisition and barriers - - ITQ - Moderate
- -
- N.A
Family concerns - -
- -
- N.A
Perceived discrimination - -
- -
- N.A
Distress of asylum procedure - -
- -
- N.A
Socioeconomic living situation - -
- -
- N.A

Sengoelge et al. (2020)

[35]

 Sweden

Diverse refugee sample (n = 455)

2016–2018

 Cross-sectional study

Social and financial hardship

(RPMS)

 ↑ B = 0.786 [CI 0.598, 1.021] HSCL-25 - Moderate
↑
- -

Social support

(ESSI)

 ↑ B = -0.103 [CI NA]
↑
- -

Solberg et al. (2020)

[36]

 Sweden

Diverse asylum-seeker sample (n = 455)

2016–2018

 Cross-sectional study

Language difficulties

(yes vs. no [Ref])

 ↑ OR = 1.95 [CI 1.18, 3.23]

HSCL-25

HTQ

Sociodemographic factors (gender, age, education, marital status);

Trauma-related factors (potentially traumatic pre-/peri-migratory events);

Post-migration factors (discrimination, language difficulties, financial hardship, missing social life back home, sadness due to lack of family reunification, social isolation, family conflicts)

 Moderate
↑ OR = 2.02 [CI 1.26, 3.26]
↑ OR = 5.43 [CI 1.87, 5.18]

Missing social life back home

(yes vs. no [Ref])

 ↑ OR = 2.09 [CI 1.23, 3.57]
↑ OR = 2.18 [CI 1.31, 3.62]
↑ OR = 1.23 [CI 0.74, 2.04]

Sadness due to lack of family reunification

(yes vs. no [Ref])

 ↑ OR = 1.14 [CI 0.65, 2.01]
↑ OR = 1.32 [CI 0.77, 2.27]
↓ OR = 0.76 [CI 0.43, 1.33]

Family conflicts

(yes vs. no [Ref])

 ↑ OR = 9.44 [CI 2.81, 31.72]
↑ OR = 4.72 [CI 2.09, 10.70]
↑ OR = 3.85 [CI 1.76, 8.42]

Social isolation

(yes vs. no [Ref])

 ↑ OR = 3.10 [CI 1.76, 5.44]
↑ OR = 3.97 [CI 2.34, 6.71]
↑ OR = 5.69 [CI 3.25, 9.96]

Perceived discrimination

(yes vs. no [Ref])

 ↑ OR = 4.26 [CI 1.43, 12.70]
↑ OR = 2.22 [CI 1.01, 4.90]
↑ OR = 5.43 [CI 2.00–14.75]

Financial hardship

(yes vs. no [Ref])

 ↑ OR = 3.58 [CI 1.91, 6.72]
↑ OR = 2.95 [CI 1.70, 5.13]
↑ OR = 5.85 [CI 3.14, 10.89]
Strømme et al. (2021) [37] Norway, Lebanon

Syrian refugees (n = 353)

T0: 2017–2018

T1: 2018–2019

 Longitudinal study

Social support

(poor vs. not poor [Ref])

 ↑

RRT0 = 1.6 [CI 1.2, 2.1]

RRT1 = 6.2 [CI 3.6, 10.8]

 HSCL-10

Sociodemographic factors (age, gender)

Post-migration factors (social support, economy);

 High
↑
- -

Economy

(Poor vs. not poor [Ref])

 ↑

RRT0 = 1.1 [CI 0.7, 1.7]

RRT1 = 4.5 [CI 2.6, 7.9]
↑
- -

Tinghög et al. (2017)

[38]

 Sweden

Syrian refugees (n = 1,215)

2016

 Cross-sectional study

Language difficulties

(yes vs. no [Ref])

 ↑ OR = 2.39 [CI 1.78, 3.19]

HSCL-25

HTQ

Sociodemographic factors (gender, age, education, marital status);

Trauma-related factors (potentially traumatic pre-/peri-migratory events);

Post-migration factors (discrimination, language difficulties, financial hardship, missing social life back home, sadness due to lack of family reunification, social isolation, family conflicts)

 Moderate
↑ OR = 1.77 [CI 1.30, 2.40]
↑ OR = 2.77 [CI 2.00, 3.83]

Missing social life back home

(yes vs. no [Ref])

 ↑ OR = 2.37 [CI 1.74, 3.23]
↑ OR = 2.00 [CI 1.46, 2.81]
↑ OR = 2.90 [CI 1.97, 4.27]

Sadness due to lack of family reunification

(yes vs. no [Ref])

 ↑ OR = 1.41 [CI 1.06, 1.86]
↑ OR = 1.26 [CI 0.93, 1.71]
↑ OR = 1.49 [CI 1.08, 2.05]

Family conflicts

(yes vs. no [Ref])

 ↑ OR = 4.87 [CI 2.25, 10.53]
↑ OR = 2.51 [CI 1.29, 4.92]
↑ OR = 5.16 [CI 2.56, 10.40]

Social isolation

(yes vs. no [Ref])

 ↑ OR = 3.40 [CI 2.39, 4.83]
↑ OR = 2.42 [CI 1.70, 3.46]
↑ OR = 3.29 [CI 2.27, 4.78]

Perceived discrimination

(yes vs. no [Ref])

 ↑ OR = 5.68 [CI 2.83, 11.41]
↑ OR = 5.49 [CI 2.79, 10.81]
↑ OR = 5.96 [CI 2.97, 11.94]

Financial hardship

(yes vs. no [Ref])

 ↑ OR = 3.46 [CI 2.14, 5.60]
↑ OR = 3.46 [CI 2.14, 5.60]
↑ OR = 4.31 [CI 2.49, 7.45]

Walther et al. (2020)

[39]

 Germany

Diverse refugee sample (n = 4,325)

2016

 Cross-sectional study Language skills ↓ β = ‐0.156 [CI -0.261, -0.052] PHQ-4

Geographical factors (federal states of Germany);

Sociodemographic factors (sex, age, education, country of origin, marital status);

Post-migration factors (duration of residence, legal status, seeking family reunification, accommodation, employment, number of (language) courses, social contacts, language skills);

Pre-/Peri-migration-related factors (number of flight reasons, arrived in host country alone, negative flight experience);

Other factors (Religiousness)

 High
↓
- -

Language and integration courses attended

(number of courses)

 ↓ β = ‐0.013 [CI -0.105, 0.079]
↓
- -

Seeking family reunification

(seeking vs. not seeking [Ref])

 ↑ β = 1.111 [CI 0.805, 1.417]
↑
- -

Social contacts

(time with people from host country)

 ↓ β = -0.176 [CI -0.270, -0.082]
↓
-

Social contacts

(time with people from country of origin)

 ↓ β = -0.079 [CI -0.172, 0.013]
↓
- -

Legal status

(subsidiary protection vs. refugee status or asylum [Ref])

 ↑ β = 0.493 [CI 0.021, 0.965]
↑
- -

Legal status

(awaiting outcome vs. refugee status or asylum [Ref])

 ↑ β = 0.495 [CI 0.288, 0.702]
↑
- -

Legal status

(suspension of deportation vs. refugee status or asylum [Ref])

 ↑ β = 0.749 [CI 0.137, 1.362]
↑
- -

Employment

(currently working vs. currently not working [Ref])

 ↓ β = -0.422 [CI -0.710, -0.134]
↓
- -

Employment

(not seeking work vs. currently not working [Ref])

 ↑ β = 0.312 [CI -0.016, 0.640]
↑
- -

Accommodation

(private accommodation vs. refugee housing facility [Ref])

 ↓ β = -0.446 [CI -0.658, -0.233]
↓
- -

↑ increase, ↓ decrease, OR Odds Ratio, RR Relative Risk, β standardized beta-coefficient, B unstandardized beta-coefficient, CI Confidence Interval, N.A. Not available. numbers in bold statistically significant associations, MMAT Mixed Methods Appraisal Tool;

Measurements of exposures: CRM-BS Cortes-Rogler-Malgady Bicultural Scale, ESSI ENRICHD Social Support Instrument, LS-S Loneliness Scale-SOEP, MSPSS Multidimensional Scale of Perceived Social Support, PMLD-CL Post-Migration Living Difficulties Checklist, PMLP-CL Post-Migration Living Problems Checklist, RPMS Refugee Post-Migration Stress Scale

Measurements of outcomes: ETI Essen Trauma Inventory, GAD-2 Generalized Anxiety Disorder-2, GAD-7 Generalized Anxiety Disorder-7, HSCL-10 Hopkins Symptoms Checklist-10, HSCL-25 Hopkins Symptoms Checklist-25, HTQ Harvard Trauma Questionnaire, ITQ International Trauma Questionnaire, PCL-5 PTSD Checklist for DSM-5, PDS-5 Posttraumatic Diagnostic Scale for DSM-5, PHQ-2 Patient Health Questionnaire-2, PHQ-4 Patient Health Questionnaire-4, PHQ-9 Patient Health Questionnaire-9, PSS-I PTSD Symptom Scale – Interview Version for DSM-IV