The effects of immigrant women’s anxiety levels on their sexual distress: A cross-sectional study

Abstract

Background

During the migration process, people do not merely change their geographical location, but also enter a phase of interaction and adaptation between different cultures. Migration often leads to a radical break from cultural values and brings about profound changes in individuals’ lives. The literature suggests that individuals who become separated from their culture may experience psychosomatic symptoms such as anxiety and depression, and that there is a relationship between cultural adaptation and sexual life. The present research was conducted to determine the effects of immigrant women’s anxiety levels on their sexual distress.

Methods

This descriptive and cross-sectional study was conducted with 300 immigrant women living in Istanbul between March 15, 2024, and August 31, 2024. The research data were collected using the Information Form, Beck Anxiety Inventory, and Female Sexual Distress Scale. Number, percentage, mean, standard deviation, minimum and maximum scores, ANOVA, independent samples t-test, Cronbach’s α, Pearson’s correlation tests, and linear regression analysis were used to analyze the data.

Results

Women’s mean age is 32.56 ± 8.98, 22.7% are high school graduates, 63% have social security, and 28.3% live in traditional families. The highest number of immigrants are from Syria, and the most obvious reason for migration is war. Of immigrants, 37.3% preferred Türkiye since it is safe, and 54% experience communication barriers and social problems the most since they are immigrants. Women scored an average of 32.68 ± 17.32 points on the Beck Anxiety Inventory, and 59% had severe anxiety. Furthermore, they scored an average of 25.66 ± 15.03 points on the Female Sexual Distress Scale, and 74% had sexual distress.

Conclusion

There is a statistically significant, positive, and high-level correlation between women’s anxiety levels and sexual distress levels. The level of anxiety explains 88% of the change in sexual distress.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-23647-7.

Background

The phenomenon of migration, which is as old as the history of humanity, refers to the geographical displacement of individuals with the aim of spending all or part of their lives [1, 2]. Migration is a multifaceted phenomenon based on individuals’ desires or compelling reasons [3–6]. In accordance with the World Migration Report published in 2021, there are approximately 281 million international immigrants and 82.4 million forcibly displaced refugees and asylum seekers across the world [7]. Women make up approximately 48% of the global migrant population [7]. This situation is also called the feminization of migration.

The migration process cannot be considered as a single stage; on the contrary, it is considered a series of events that occur under the influence of numerous factors over a long period of time. The said process involves various factors that may cause individuals to become prone to mental disorders. These factors can be listed as war, ethnic or religious conflicts, unemployment, political pressure, poverty, inequalities, search for better standards of living, familial reasons, access to health services, climatic changes, and natural disasters [8, 9]. Especially past traumatic experiences affect the cultural adaptation process of the immigrants [10].The reasons for migration among women may partially vary. They may include escaping gender-based discrimination and political violence and gaining more social independence [11].

Migration leads to fundamental changes in family and social structures and brings about a radical detachment from cultural values, which may cause a feeling of uncertainty by increasing stress and anxiety [12–15]. Stress factors exposed to at different stages of migration cause immigrants to have higher risks of physical and mental diseases than the local population [16]. The migration process, in the short or long term, makes migrant women more susceptible to developing mental health disorders compared to non-migrant women [16, 17].Common mental problems among immigrants are post-traumatic stress disorder, anxiety disorder, depression, culture shock, and disability [18–20]. Mental disorders are observed at a higher rate in women compared to men [21].Women experience the effects of migration twice as much since they are exposed to discrimination both due to their gender and their immigrant identity. This makes them more vulnerable to sexual abuse, rape, and acts of violence [22, 23].

The migration brings about a process of interaction and adaptation between different cultures. In Berry’s acculturation model, it is stated that the integration of migrants into the new society has a positive impact on acculturation [24].Immigrants may experience deeper changes in their sense of self, including core beliefs, behaviors, and relationships, along with the stress of cultural adaptation [10]. High levels of cultural adaptation stress can lead to mental health problems [25]. Additionally, it is noteworthy that there is a positive relationship between migrants’ cultural adaptation and their sexual desire and arousal [26].

It is also possible to associate traumas experienced by immigrant women with sexual distress. Sexual distress refers to the impairment in sexual desire and psychophysiological changes in the sexual response cycle. Female sexual distress is a multidimensional disease with a significant impact on well-being and may also significantly affect mental state, sense of self, and quality of life [27, 28]. It is thought that anxiety makes it difficult for an individual to experience sexual arousal by affecting the autonomic nervous system’s functioning and inhibiting physiological arousal and, thus, plays a role in the development and continuation of sexual distress in women [29].

As migrants adapt to the host culture, a process of cultural adaptation occurs for both groups, leading to long-term psychological and sociocultural adjustments. Culture is also one of the fundamental structures that shape individuals’ perceptions, attitudes, and behaviors regarding sexuality. Sociocultural norms and oppressive gender roles can have an impact on a person’s sexual life [30]. Some studies have indicated that migrant women are more prone to experiencing sexual satisfaction disorders [31–33].Since the sexual norms of the host culture can affect a person’s sexual self-concept, sexual behaviors, and sexual self-esteem, the individual’s sexuality may be reconsidered [34].

The current work aimed to investigate the effects of immigrant women’s anxiety levels on their sexual distress.

Method

Research design

The present research is a descriptive and cross-sectional study. The research was conducted in the provincial center of Istanbul, located in the Marmara region of Turkey, between March 15, 2024, and August 31, 2024.

Participants

The study population consisted of immigrant women living in Istanbul province. Immigrant women are from Syria, Afghanistan, Iraq, Uzbekistan, Turkmenistan, Yemen, China, Palestine and Iran, and their exact numbers in the region are not known. The sample size was calculated using the sample selection formula in cases where population is unknown. According to the formula, it was necessary to include at least 251 women in the sample to represent the population. Three hundred and fifteen women were reached to avoid data loss, and then 15 individuals with inconsistent answers were excluded from the study. The research was completed with 300 women.

Inclusion criteria

• Women aged between 18 and 49 years,

• Women who could communicate in Turkish,

• Married women,

• Immigrant women who were sexually active.

Exclusion criteria

• Women with diagnosed psychological and sexual problems,

• Women who refused to take part in the research.

Data collection tools

The research data were collected using the Information Form prepared by the researcher, the Beck Anxiety Inventory, and the Female Sexual Distress Scale.

Information form

This form consists of questions prepared by the researcher concerning women’s descriptive characteristics and migration (Appendix-1).

Beck anxiety inventory

This inventory measures the frequency of anxiety symptoms experienced by an individual [35, 36]. The said inventory comprises 21 items, and each item is scored between 0 and 3. An increase in the score indicates the severity of the anxiety experienced by the individual. Whereas scores between 0 and 7 on the scale indicate minimal anxiety/normal anxiety, scores between 8 and 15 refer to mild anxiety, scores between 16 and 25 indicate moderate anxiety, and scores between 26 and 63 refer to severe anxiety. Cronbach’s alpha coefficient in the Turkish version of the scale is 0.93 [36], and it was found to be 0.90 in this study.

Female sexual distress scale (FSDS)

The scale was developed to determine women’s sexual distress levels [28, 37]. It is a five-point Likert scale consisting of 13 items. Each question on the scale is scored between 0 and 4. The scale items are scored as “Never = 0, Rarely = 1, Occasionally (Sometimes) = 2, Often (Mostly) = 3, and Always = 4,” and the scores obtained from the scale vary between 0 and 52. The scale’s cut-off score is reported to be 11.5. Women scoring twelve and above are interpreted as having “sexual distress,” and a high score on the scale indicates high distress. Cronbach’s alpha coefficient in the Turkish version of the scale is 0.98 [37], and it was found to be 0.97 in this study.

Data collection

Data were collected through face-to-face interviews with individuals encountered in social areas (such as parks, gardens, cafes, and shopping malls) in regions where immigrants live in high density. All immigrant women who lived in the region within the specifed period, met the inclusion criteria, and volunteered to participate in the study were included in the study without using any sampling method. The questions in the survey form were read to women by the researcher, and the women were asked to answer them. The interview lasted approximately 20 min. Ethics committee approval was obtained from the Clinical Research Ethics Committee of Atatürk University Faculty of Medicine (Date: 21/02/2024, Number: B.30.2.ATA.0.01.00/111) prior to the study. The data collection process began after the women who met the research criteria were informed about the study and their approval was received. Ethical principles and the Declaration of Helsinki were adhered to during the study.

Data analysis

The data were analyzed using the SPSS for Windows 22 package program. Number, percentage, minimum and maximum values, mean and standard deviation, independent samples t-test, variance, Pearson’s correlation, Spearman’s correlation, Kruskall-Wallis, and Mann-Whitney U were used to analyze the data. The conformity of the data to the normality assumption was calculated with the “Kurtosis” and “Skewness” coefficients (± 2).

Results

Immigrant women’s mean age was 32.56 ± 8.98, their husbands’ mean age was 35.90 ± 8.95, and they had been married for an average of 11.01 ± 9.42 years. Women’s mean number of children was 3.07 ± 2.24, and the mean length of stay in Türkiye was 6.98 ± 3.45 years (data are not presented in the table).

Upon examining the correlation between various variables and anxiety and sexual distress, there was a statistically significant, positive, and low-level correlation between the ages of the women and their husbands and the mean scale scores, and a statistically significant, positive, and moderate-level correlation between the duration of marriage and the number of children and the mean scale scores (p < 0.05, Table 1). Furthermore, a statistically significant, positive, and high-level correlation was revealed between anxiety and sexual distress (p < 0.05, Table 2).

Table 1.

Examination of the relationship between various variables and scales

Variables		BAI	FSDS
Age	r	0.428	0.406
	p	0.000*	0.000*
Spouse’s age	r	0.433	0.407
	p	0.000*	0.000*
Duration of marriage (years)	r	0.519	0.503
	p	0.000	0.000*
Number of children	r	0.524	0.504
	p	0.000*	0.000*
Duration of stay in Türkiye (years)	r	0.097	0.081
	p	0.094	0.160

r Pearson’s correlation tests

*:p<0.001

Table 2.

Examination of the relationship Between BAI and FSDS

Scale		BAI	FSDS
BAI	r	1	0.938
	p	-	0.000
FSDS	r	0.938	1
	p	0.000	-

r: Pearson’s correlation tests

*:p<0.001

The regression analysis conducted to reveal the effects of anxiety levels on sexual distress demonstrated a significant correlation between anxiety levels and sexual distress (R = 0.938, R²_adjusted = 0.880, F_(1,298) = 2190.299; p = 0.000). The level of anxiety explains 88% of the change in sexual distress (Table 3).

Table 3.

Linear Regression analysis showing the Effect of Anxiety Level on sexual distress

Variable	Beta	Standard Error	Standard Beta	t	p	95% Confidence Interval
Constant Coefficient	−0.941	0.643	-	−1.464	0.144	−2.207	0.324
BAI	0.814	0.017	0.938	46.801	0.000*	0.780	0.848

Linear regression analysis

*:p<0.001

Discussion

As seen from the research results, 59% of the immigrant women participating in the study had severe anxiety (Table 4). According to the reports, while the global prevalence of anxiety disorders among women is 4.08%, it is 15.7% in Türkiye [38]. Immigrant women have higher anxiety levels than the local population. It is known that individuals separated from their culture may experience psychosomatic symptoms [25, 34]. It has been reported that refugee women with low sociocultural adaptation levels experience intense psychological symptoms such as anxiety, depression and somatization [39].The literature also confirms that immigrants have higher anxiety levels compared to the general population [40, 41]. These data reveal that the difficulties faced by immigrant women are universal and cause similar results in different geographies.

Table 4.

Distribution of minimum-maximum values and mean scores of numerical variables and scales

Variable	n	Min.	Max.	±SD
Age	300	18.00	49.00	32.56±8.98
Spouse’s age	300	21.00	57.00	35.90±8.95
Duration of marriage (years)	300	1.00	37.00	11.01±9.42
Number of children	300	0	9.00	3.07±2.24
Duration of stay in Türkiye (years)	300	1.00	19.00	6.98±3.45
Scales
Beck Anxiety Inventory (0-63 points)	300	2.00	59.00	32.68±17.32
No anxiety	8	2.6(%)
Mild anxiety	65	21.7(%)
Moderate anxiety	50	16.7(%)
Severe anxiety	177	59.0(%)
Female Sexual Distress Scale (0-52 points)	300	0
No distress	78	26.0(%)
Distress present	222	74.0(%)

n number, % percentage, Min.,Max minimum- maximum scores, mean, SD standard deviation

Of the immigrant women, 74% suffered from sexual distress (Table 4). Studies have demonstrated that immigrants may experience higher levels of sexual distress and tend to have less sexual knowledge, less liberal attitudes, and lower rates of desire, arousal, and pleasure than non-immigrant women [42]. A study has revealed that the sociocultural adaptation levels of immigrant women living in Türkiye are low [39]. It is stated that there is a positive relationship between the cultural adaptation of immigrants and sexual desire and arousal [26]. Because culture is one of the fundamental structures that shape individuals’ perceptions, attitudes, and behaviors regarding sexuality. The results of this study demonstrated that women’s levels of education and employment status significantly affected anxiety levels and sexual distress (Table 5). This result agrees with the research results in the literature [43, 44]. It is considered that the increase in the level of education positively impacts sexual health by increasing the ability to cope with anxiety and stress. Increasing economic independence and easier access to social support networks among working women may reduce the risk of sexual distress by decreasing anxiety levels.

Table 5.

Comparison of BAI and FSDS scores based on demographic characteristics

					BAI		FSDS
Variables			n	%	±SD	Test and p value	±SD	Test and p value
Education level	Literate		62	20.7	38.39±17.05	F=4.615 0.001	31.47±14.07	F=5.483 0.000
	Primary School		59	19.7	36.93±17.80		28.86±15.26
	Secondary School		65	21.7	30.34±17.13		23.34±15.63
	High School		68	22.7	29.26±16.19		23.37±13.30
	University		46	15.2	27.91±16.28		20.41±14.72
Employment status	Employed		109	36.3	29.88±16.97	t=−2.130 0.034	23.28±15.14	t=−2.091 0.037
	Unemployed		191	63.7	34.28±17.35		27.03±14.83
Spouse's education level	Literate		49	16.3	38.10±17.17	F=2.486 0.044	30.33±14.77	F=2.004 0.094
	Primary School		36	12.0	31.83±17.98		25.00±16.42
	Secondary School		50	16.7	33.52±18.38		25.92±15.18
	High School		77	25.7	33.58±16.89		26.04±15.08
	University		88	29.3	28.75±16.28		22.86±14.07
Spouse's occupation	Civil Servant		41	13.7	25.05±14.15	F=4.774 0.003	18.71±12.82	F=4.321 0.005
	Worker		123	41.0	32.83±17.46		25.71±15.25
	Freelance		79	26.3	32.43±16.84		26.52±14.44
	Other		57	19.0	38.21±18.04		29.39±15.50
Economic status	Inadequate		142	47.3	32.45±17.47	F=0.152 0.859	25.71±15.25	F=0.188 0.829
	Medium		142	47.3	33.13±17.11		25.87±14.79
	Sufficient		16	5.4	30.81±18.77		23.44±15.93
Health insurance status	Yes		189	63.0	31.76±17.45	t=−1.203 0.230	24.99±15.04	t=−1.014 0.312
	No		111	37.0	34.25±17.06		26.81±14.99
Family type	Extended family		85	28.3	34.29±18.00	t=1.013 0.312	26.54±15.66	t=0.636 0.525
	Nuclear family		215	71.7	32.05±17.04		25.32±14.79
Presence of health problems	Yes		105	35.0	41.10±17.26	t=6.598 0.000	32.75±14.97	t=6.383 0.000
	No		195	65.0	28.15±15.60		21.85±13.64
Mode of last delivery	Vaginal		150	50.0	36.86±17.07	F=12.964 0.000	28.73±14.81	F=11.253 0.000
	Cesarean		131	43.7	29.89±16.66		23.97±14.66
	Non-birth		19	6.3	19.00±12.84		13.16±10.85
Country of origin	Syria		86	28.7	30.91±18.51	F=4.436 0.000	23.20±16.13	F=4.917 0.000
	Afghanistan		43	14.3	30.93±15.46		24.65±13.51
	Iraq		40	13.3	39.13±16.86		32.23±14.07
	Uzbekistan		36	12.0	24.97±15.79		20.31±14.15
	Turkmenistan		26	8.8	28.15±17.89		20.88±13.67
	Yemen		15	5.0	43.00±13.57		34.33±11.11
	China		16	5.3	42.13±11.59		35.06±12.27
	Palestine		16	5.3	44.63±14.33		35.88±11.78
	Iran		16	5.3	27.44±14.12		19.50±12.25
	Other		6	2.0	24.83±15.39		19.83±14.55
Reason for migration	Political		97	32.3	36.91±15.62	F=4.272 0.006	29.62±13.46	F=4.289 0.006
	Economic		67	22.3	28.60±16.99		23.09±14.41
	War		115	38.3	32.68±18.26		24.95±15.99
	Other		21	7.1	26.24±16.52		19.52±14.92
Reason for choosing Türkiye	Because of the close distance		66	22.0	34.74±17.89	F=3.637 0.007	26.21±15.85	F=2.674 0.032
	Safe		112	37.3	33.99±17.00		26.77±14.88
	Economic		80	26.7	31.55±17.27		25.35±14.74
	Education		14	4.7	16.64±9.63		13.29±9.86
	Other		28	9.3	33.86±16.99		27.04±14.63
The most common problems faced	Communication barrier-Social problems		162	54.0	34.22±17.55	F=1.033 0.378	26.68±15.38	F=0.868 0.458
	Economic problems		52	17.3	30.46±16.29		23.17±13.67
	Health problems		14	4.7	28.93±11.82		23.00±13.73
	Other		72	24.0	31.56±18.31		25.69±15.41

n number, % percentage, Min.,Max minimum- maximum scores,  mean, SD standard deviation, t t test in independent groups, F Analysis of variance

While the husband’s level of education has significant effects on the woman’s anxiety level, the husband’s occupation has significant effects on both the woman’s anxiety and sexual distress levels (Table 5). Women have higher anxiety scores with a decrease in the husband’s level of education. It is possible to explain this situation by the fact that the family’s living conditions change depending on the husband’s level of education and occupation and also by the fact that more material and spiritual support can be provided to women. The study by Yılmaz et al. (2004) also supports these results [45]. Furthermore, it was determined that women with an existing health problem had higher anxiety and sexual distress scores. Health problems may increase women’s risk of sexual distress by increasing their anxiety levels [46].

According to the last mode of delivery, women who had given vaginal birth were associated with higher anxiety and sexual distress (Table 5). It was considered to be due to previous negative birth experiences and the fear of giving birth. Moreover, it is known that perineal stretching and possible scarring with vaginal delivery will reduce sexual pleasure. Some studies have revealed that women who have given vaginal birth have high levels of dyspareunia and low satisfaction with sexual life [47, 48]. Nineteen individuals in the group had not given birth, which is a limitation in terms of statistical reliability.

Immigrant women’s country of origin and their reasons for migrating also affected their anxiety levels and sexual distress. Whereas women who migrated for political reasons had higher levels of anxiety and sexual distress, immigrants from a country of Turkish origin are less likely to experience anxiety and sexual distress (Table 5). This is thought to be related to cultural adaptation [25]. The political reasons for migration include factors such as security concerns, civil wars, wars, regime changes, and governance style. Especially political factors such as human rights violations, oppression, restriction of personal freedoms, inequalities, failure to ensure judicial independence, and military coups constitute the main reasons for migration movements, which results in anxiety and sexual distress [49–51].

According to another result of the study, age, husband’s age, the duration of marriage, and the number of children impact women’s anxiety and sexual distress levels (p < 0.05). The level of anxiety and the probability of sexual distress increase as age progresses [52, 53]. It is thought that anxiety increases during marriage, which is parallel to age, which adversely affects sexual life. Furthermore, the number of children in the family increases with the increased duration of marriage. It is assumed that the increase in the number of children may also increase individuals’ anxiety levels materially and spiritually if their economic conditions and living standards are not at the desired level.

The study revealed a strong relationship between immigrant women’s anxiety levels and the likelihood of experiencing sexual distress. Refugee women face numerous difficulties in the adaptation process in the country they immigrate to [54]. They may face stress factors such as social support networks, language proficiency, health status, education and employment opportunities, and shelter and housing problems during this process. This situation may negatively impact immigrants’ mental health and seriously threaten both their social and individual well-being [55–57]. Studies have demonstrated that mental health problems such as anxiety may occur in the migrating population [58, 59]. Anxiety is also considered one of the most common causes of sexual distress, which is mostly of psychological origin. It is reported that sexual distress is more common in individuals with anxiety disorders [60, 61]. Anxiety prevents the perception of sexual stimuli and adversely impacts physiological responses during sexual arousal, thus suppressing the feeling of sexual pleasure [62, 63]. In light of all this information, it can be stated that there is a relationship between immigrant women’s anxiety levels and sexual distress.

Conclusion and recommendations

The study concluded that most women had severe anxiety and sexual distress, and anxiety levels were positively correlated with sexual distress.

Migration movements significantly impact women’s education, social life, marriage, family relationships, working life, and health. Accordingly, it can be recommended to expand psychosocial support programs and sexual health services for immigrant women, provide individualized care to immigrants, strengthen cooperation with families and social services, and mental health policies should be developed for immigrant women. It is also recommended that multi-center and comparative studies be conducted on the subject.

Limitations and generalizability of the study

The limitations of the study are that the current number of immigrants living in the country cannot be reached, the study was conducted in a single region, and there is no information about the immigrants’ pre-migration status. The study results can be generalized only to immigrant women living in the region where the study was carried out.

Author contributions

ZM: Conceptualization, Methodology, Data curation, Writing- Original draft preparation, ZDÜT: Visualization, Investigation, Supervision, Software, Validation, Writing- Reviewing and Editing.

Funding

No funding was received for this study.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval for the study was obtained from the Ethics Committee of Atatürk University, Faculty of Medicine (Date: 21/02/2024, Number: B.30.2.ATA.0.01.00/111). Immigrant women who met the research criteria were informed about the study, and data were collected after obtaining their informed consent. Hence, Informed consent was obtained from all the participants involved in the study. Ethical principles and the Declaration of Helsinki were adhered to during the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.