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European Journal of Psychotraumatology logoLink to European Journal of Psychotraumatology
. 2025 Jun 24;16(1):2511524. doi: 10.1080/20008066.2025.2511524

Temporal associations between cultural identity conflict and psychological symptoms among Syrian young adults with refugee backgrounds: a four-wave longitudinal study

Asociaciones temporales entre el conflicto de identidad cultural y los síntomas psicológicos en jóvenes sirios de origen refugiado: un estudio longitudinal de cuatro etapas

Haza F Rahim a,CONTACT, Trudy T M Mooren a,b, Jeroen W Knipscheer a,b, Joanne M Chung c, Odilia M Laceulle d, Paul A Boelen a,b
PMCID: PMC12884984  PMID: 40552372

ABSTRACT

Objectives: The current study examined temporal associations between cultural identity conflict and psychological symptoms (posttraumatic stress [PTS] and anxiety/depression) in Syrian young adults, who recently migrated to the Netherlands. It was hypothesized that cultural identity conflict predicts intraindividual changes in PTS and anxiety/depression symptoms, in a course of one year, adjusting for trait-like stable invariant levels of both constructs.

Methods: Data were obtained from Karakter, a four-wave longitudinal study, with a sample of 158 Syrian young adults with refugee backgrounds (n = 96 at wave 4); 69% men and age range 18–35. Levels of cultural identity conflict, PTS, and anxiety/depression were assessed four times, over 13 months.

Results: Random intercept cross-lagged panel model analyses showed relative stability in levels of cultural identity conflict, PTS, and anxiety/depression from one wave to the next. No significant concurrent associations were found between deviations from people’s usual levels of cultural identity conflict and PTS symptoms. Additionally, the results revealed two significant negative cross-lagged associations between cultural identity conflict and PTS. No cross-lagged associations were found between cultural identity conflict and anxiety/depression, except one negative directional effect from anxiety/depression at wave 2 to cultural identity conflict at wave 3.

Conclusions: Findings indicate that after accounting for between-person differences, cultural identity conflict and psychological symptoms refer to stable, within-person processes over time. We speculate that early intervention focused on PTS, anxiety/depression as well as experienced cultural identity conflict may prevent these problems from becoming chronic, among Syrians with refugee backgrounds in the post-migration context.

KEYWORDS: Posttraumatic stress, psychological symptoms, refugees, cultural identity conflict, bicultural

HIGHLIGHTS

  • In a four-wave longitudinal study over 13 months, 158 Syrian young adults with refugee backgrounds were followed, and their levels of cultural identity conflict, posttraumatic stress, and anxiety/depression were assessed at each wave.

  • Relative stability in levels of cultural identity conflict, posttraumatic stress, and anxiety/depression was observed from one wave to the next.

  • Early interventions targeting cultural identity conflict and psychological symptoms may help prevent the development of long-term mental health problems.

1. Introduction

War and conflict have led to many people experiencing displacement and forced migration worldwide. As of 2021, the civil war in Syria had forced at least 6.6 million Syrian people to flee their country and seek refuge elsewhere in safer places, including neighbouring countries (UNHCR, 2021). Migration-related stressors may increase vulnerability for the development of psychological symptoms in Syrian people, which emphasizes the need for adequate mental health care in the country of resettlement (Löbel & Jacobsen, 2021). Research has consistently indicated that rates of psychological symptoms are higher among recently resettled people who have experienced war-related events and unsafety in home countries, compared to non-war affected general populations (Bogic et al., 2015; Patanè et al., 2022). For example, relatively high rates of posttraumatic stress disorder (PTSD; 11.4–29.9%), anxiety (13.5–36.1%), and depression (14.5–40.2%) have been observed in Syrian people who have fled their country (Acarturk et al., 2021; Georgiadou et al., 2018; Hassan et al., 2016; Sijbrandij et al., 2020; Tinghög et al., 2017). Additionally, longitudinal research in refugee populations revealed high prevalence of symptoms specifically PTSD and depression, even decades after resettlement (Blackmore et al., 2020; Marshall et al., 2005).

The development of psychological symptoms is related to exposure to stressors and traumatic experiences in the country of origin or during the flight (Carswell et al., 2011; Fazel, 2018). Yet, research has shown that current stressors in the country of residence (e.g. challenges during resettlement and adaptation to a new culture) are equally or even more important risk factors for long-term psychological symptoms in refugee populations (Chen et al., 2017; Hassan et al., 2016; Sleijpen et al., 2017; Tingvold et al., 2015). For example, resettlement stress, such as family separation, social integration difficulties, and discrimination, can increase risks for long-term mental health issues (Chen et al., 2017). Moreover, the presence of psychological symptoms strongly undermines integration processes, especially for young people who have recently arrived in host countries (Campbell et al., 2018; Löbel & Jacobsen, 2021). It can impact the ability to obtain employment, striving for goals, and develop meaningful social relationships (Dang et al., 2021). Therefore, it is important to understand potential stressors and challenges during resettlement of refugees, including Syrian young adults, so the needs of this population can be met in a critical stage to foster long-term mental health.

Syrian people face many challenges when building a new life in host countries, including economic stress, language barriers, discrimination, and adapting to new cultural norms (Berry, 2005; Porter & Haslam, 2005; Wu et al., 2021). Specifically, reconsidering one’s own cultural identity could be a major challenge during the process of adaptation to the dominant culture (Groen et al., 2018; Ryan et al., 2008; Ward et al., 2011). People are faced with the task of integrating elements, such as cultural norms, of both the heritage and the host culture into their cultural identity. Cultural identity conflict can arise when discrepancies between the norms and values of the heritage and host cultures are experienced as incompatible (Mann et al., 2017; Rahim et al., 2023). It is defined as the intrapersonal perception of conflicting cultural dimensions within oneself (Phinney et al., 2001; Ward et al., 2011). Cultural identity is a framework of norms and values that guides behaviour and fosters belonging to a cultural group, which can be disrupted for people with refugee backgrounds who lose resources that were based in the home country, like community and emotional support systems (Bhugra & Becker, 2005; Groen et al., 2018; Ryan et al., 2008). For young people, belonging to a community and connecting with the host culture supports integration and long-term overall psychological wellbeing (Correa-Velez et al., 2010; Ryan et al., 2008). Cultural identity conflict, linked to adaptation challenges as well as psychological symptoms (Kira et al., 2017; Ndengeyingoma et al., 2014; Ward et al., 2011), may therefore play a crucial role in the presence of psychological symptoms over time in recently resettled Syrian people.

Several studies provide evidence that post-migration difficulties, such as cultural adaptation challenges and post-migration stressors, influence the long-term mental health of people with refugee backgrounds. Kaltenbach et al. (2018) found that stressors experienced during the resettlement stage, such as social isolation and discrimination, significantly contribute to psychological symptoms (e.g. anxiety and depression) over the course of a year. Similarly, Kira et al. (2017) showed that these stressors, particularly cultural adaptation difficulties, predict ongoing psychological distress, highlighting the importance of the integration process for long-term mental health. Research by Mezzich et al. (2009) further suggests that refugees who face fewer post-migration challenges generally report less psychological symptoms. Although no studies specifically address cultural identity conflict, these studies suggest that cultural identity conflict, a key issue during the adaptation phase (Mezzich et al., 2009), may also play a crucial role in the long-term mental health of refugees, as it is strongly linked to the challenges they face during resettlement (Kira et al., 2017).

Furthermore, the experience of war-related events can cause conflict in the perception of oneself (Yohani, 2015). People with refugee backgrounds who show higher levels of PTS may experience more difficulties reconciling and negotiating oppositional demands from both the heritage and host culture, and in turn, be at risk for experiencing cultural identity conflict (Yohani, 2015). Additionally, one of a few longitudinal studies among people with refugee backgrounds by Tingvold et al. (2015), revealed that psychological stress in early resettlement has long-term effects on acculturation difficulties in later stages of life (e.g. integrating cultures into one’s identity; Berry, 2005).

To our knowledge, there are no studies exploring temporal relationships between cultural identity conflict and psychological symptoms amongst people with refugee backgrounds. Therefore, it remains unclear whether higher levels of cultural identity conflict increase psychological symptoms or elevated symptomatology precede higher levels of cultural identity conflict. Gaining knowledge about temporal associations between cultural identity conflict and psychological symptoms in people with refugee backgrounds has theoretical and clinical relevance. Theoretically, it provides insights in the interplay between cultural identity conflict and the development of psychological symptoms, which contributes to more understanding of the mental health of refugee populations. In a clinical context, it helps the understanding of the aetiology of commonly reported symptoms in refugee populations in the post-migration stage, providing knowledge about targets for interventions in people with elevated psychological symptoms. Subsequently, this contributes to the likelihood that more tailored and culturally sensitive treatments can be offered to individuals who need psychological care after resettling in a new country. In the current study, we specifically focused on Syrian refugees, as they represent a relevant group in the Netherlands who have recently experienced migration, allowing for a direct assessment of post-migration challenges.

1.1. The current study

The current study examined the temporal relationships between cultural identity conflict and psychological symptoms in a sample of Syrian young adults who had recently resettled in the Netherlands. The study sample completed measures of cultural identity conflict and psychological symptoms on four occasions over one year. In so doing, we focused on PTS and anxiety/depression symptoms considering that these are most commonly observed symptoms in people with refugee backgrounds (cf. Rahim et al., 2023). We used random intercept cross-lagged panel modelling (RI-CLPM); this method allowed us to explore the dynamics of these relationships while accounting for stable individual differences through the random intercepts.

The aims of the study were threefold. The first aim was to explore associations between the degree to which participant’s levels of cultural identity conflict and psychological symptoms (i.e. PTS and anxiety/depression) deviate from their trait levels, one wave to the next. It was expected that significant and strong temporal associations from one wave to another would be found for cultural identity conflict as well as psychological symptoms (e.g. deviations in levels of cultural identity conflict at Wave 1 [W1] predicting deviations in levels of cultural identity conflict at Wave 2 [W2]). Our second aim was to explore the within-person associations between cultural identity conflict and symptoms within the same wave. Specifically, we sought to examine whether fluctuations in cultural identity conflict within an individual would be associated with simultaneous fluctuations in psychological symptoms. We hypothesized that deviations from trait levels of cultural identity conflict were associated with deviations from trait levels of psychological symptoms. Finally, our third aim was to explore temporal associations between cultural identity conflict and symptoms. Based on other longitudinal research (Tingvold et al., 2015; Yohani, 2015), we hypothesized that fluctuations in cultural identity conflict at one wave would predict fluctuations in symptoms at the subsequent wave, such that increases in cultural identity conflict would be associated with increases in symptoms, while accounting for stable individual differences. We anticipated that, conversely, one’s deviations from one’s trait level on psychological symptoms would not predict deviations from their trait level on cultural identity conflict.

2. Methods

2.1. Participants and procedure

The current study is part of a 13-month longitudinal research project with a total sample of Syrian origin young adults, who were currently living in the Netherlands (Chung et al., 2021; Karakter project, 2017; https://www.karakterproject.nl/). Inclusion criteria for participants were (1) being of Syrian-origin (having the Syrian nationality), (2) fluency in reading and writing Arabic (the questionnaires were presented in Arabic), (3) being between the ages of 18- and 35-years old, and (4) having entered the Netherlands between 6 and 60 months prior to participation in the study. Participants’ age at the first wave, ranged from 18 to 35 years (M = 27.82, SD = 4.71); 109 (69.0%) were male. Participants were living in the Netherlands between 6 and 60 months with a mean length of stay of 37.82 months (SD = 14.47). Participants identified themselves with the Arabic ethnicity (79.1%), Kurdish ethnicity (5.7%), Assyrian ethnicity (4.4%), Turkish ethnicity (1.9%), Armenian ethnicity (0.6%), or another ethnicity (4.4%); 3.8% of the participants chose the option ‘I would rather not say’. Additionally, participants affiliated with the Islamic religion (57%), no religion (22.2%), Christianity (7.6%), another religion (3.2%), and 9.5% chose the option ‘I would rather not say’. The majority was granted residency in the Netherlands (91.8%). Highest level of education was primary and secondary school in 6.4% (n = 10), high school in 19.6% (n = 31), vocational school in 12% (n = 19), university of applied sciences in 4.4% (n = 7), university in 55.7% (n = 88), post-master/PhD in 0.6% (n = 1), respectively; 1.3% (n = 2) did not respond to this question.

The recruitment of participants occurred through organizations that serve people with refugee backgrounds (e.g. language schools, asylum seeker centres, and refugee support organizations), as well as through advertisements on social media platforms in Arabic and Dutch, which included a reference to the project website. When participants signed up for participation, they were contacted by the research team to arrange a data collection appointment. Four waves of data collection took place over 13 months, with approximately 3 months in between the waves. In the first three waves, the assessments took place at participants’ home or at a public location (e.g. town hall). Members of the research team, with at least one Arabic speaking researcher, were always present at the data collection appointment. All members of the data collection team were trained to interact with and support people who have experienced trauma by completing an online course (i.e. Psychological First Aid Online from the National Child Traumatic Stress Network [https://www.nctsn.org/resources/psychological-first-aid-pfa-online]). At the start of each data collection appointment, information regarding the background of the research, the research procedure, privacy issues, and compensation was given to the participant in Arabic, followed by the signation of an informed consent form. It took 50–60 min to complete the questionnaire on a tablet, registered in Qualtrics. The fourth (and final) wave was completely online (including help and assistance) with no research team member being physically present. The study was approved by the Medical Ethics Review Committee of Utrecht University (METC Protocol ID: NL66459.041.18). A cultural advisory board was involved during all phases of the study. The members of this board provided advice (e.g. discussing the approach of sensitive topics and giving feedback on questionnaires and other materials) to enhance the cultural sensitivity of the study.

2.2. Measures

All measures in the current study, except the Harvard Trauma Questionnaire (HTQ), were translated from English to Arabic via a forward- and back-translation procedure (Bot, 2020) to be able to present questionnaires in the native language of the participants. The Arabic version of the HTQ (Mollica et al., 1992) was already available.

2.2.1. Demographic variables

Items were administered regarding the participants’ ethnicity, age, gender, religious affiliation, highest completed educational level, refugee status, and length of stay in the Netherlands.

2.2.2. Cultural identity conflict

The Ethno-Cultural Identity Conflict Scale (ECIC-S) developed by Ward et al. (2011), was used for tapping the degree to which participants experienced cultural identity conflict. The scale consisted of 20 items (e.g. ‘In general, I do not think that people from my ethnic group know the real me’). Respondents rated their agreement with each item on 5-point scales ranging from 1 = strongly disagree to 5 = strongly agree. Higher scores equated higher degrees of cultural identity conflict. Ward et al. (2011) found support for the reliability and construct validity within minority samples. In the current sample, coefficient alpha for internal consistency of all four waves ranged from .92 to .93.

2.2.3. Anxiety and depression

The Patient Health Questionnaire-4 (PHQ-4; Kroenke et al., 2009) was used to assess symptom levels of anxiety and depression within the past two weeks, with higher scores indicating more anxiety and depression symptoms. It includes four items (e.g. ‘Little interest or pleasure in your activities’). Respondents rated how often they felt negatively affected by complaints in the last two weeks on 4-point scales with anchors 1 = not at all to 4 = (almost) every day. The reliability and cross-cultural validity of the scale were supported by research conducted among refugee and migrant populations (Tibubos & Kröger, 2020). In the current sample, coefficient alpha of all four waves ranged from .79 to .85.

2.2.4. PTS symptoms

PTS symptoms were measured using the first 16 items of the 45-item HTQ Part IV (Mollica et al., 1992). These items represented PTS symptoms (e.g. ‘Sudden emotional or physical reaction when reminded of the most hurtful events’). Participants were asked to indicate the extent to which symptoms bothered them in the past week on 4-point scales with anchors 1 = not at all to 4 = extremely. Item scores were summed such that a higher score indicated more PTS symptoms. Research has supported good psychometric properties of the scale in cross-cultural samples (Mollica et al., 1992; Shoeb et al., 2007). In the current sample, coefficient alpha of all four waves ranged from .89 to .91.

2.3. Statistical analyses

Descriptive statistics were calculated using IBM SPSS Statistics. First, we calculated mean scores and standard deviations on study measures. Second, zero-order bivariate associations between cultural identity conflict, PTS, and anxiety/depression symptoms across all four waves were analysed using Pearson correlation coefficients. Third, two RI-CLP models were conducted in Mplus Version 8 to test bidirectional relationships, where within-person deviations from the expected level of cultural identity conflict predicted within-person deviations from the expected level of PTS, and anxiety/depression symptoms across four waves (W1, W2, W3, and W4), by using mean scale scores for the ECIC, HTQ-IV, and PHQ-4. In the first model, cultural identity conflict and PTS were included. In the second model, cultural identity conflict and anxiety/depression were entered. Autoregressive paths (e.g. cultural identity conflict at W1, W2, W3, and W4) were estimated in the analyses to model the stability of deviations from trait levels across the waves. Associations among deviations from trait levels of cultural identity conflict and deviations from trait levels of psychological symptom measures (PTS and anxiety/depression) within each wave (e.g. cultural identity conflict W1 with PTS W1) were also included in the analyses. Furthermore, cross-lagged paths (e.g. deviations from trait levels of cultural identity conflict at W1 predicting deviations from trait levels of PTS at W2) were estimated in the analyses to test the temporal associations between deviations from people’s stable aspects of cultural identity conflict and deviations from people’s stable aspects of symptom levels of PTS and anxiety/depression across four waves. The model fit was interpreted using the root mean square error of approximation (RMSEA; value < .06), the Comparative Fit Index (CFI; value > .95), and the Tucker and Lewis Index (TLI; value > .95) (Hu & Bentler, 1999). All coefficients are reported in standardized form.

3. Results

3.1. Descriptive statistics and bivariate associations between the study variables

Table 1 shows means, standard deviations, and score ranges of all study variables as well as their intercorrelations (Pearson correlation). Sample sizes varied across all four waves ranging from n = 157 to n = 158 at W1, n = 110 at W2, n = 96 at W3, and n = 94 to n = 96 at W4. Positive zero-order correlations were found between cultural identity conflict and PTS symptoms among all four waves. Regarding anxiety/depression, only cultural identity conflict at W3 did not correlate with anxiety/depression at W4.

Table 1.

Descriptive statistics and correlations between study variables.

                Correlations        
  Descriptive statistics Cultural identity conflict Anxiety/depression Posttraumatic stress
Measure and wave N M SD Range W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
Cultural identity conflicta                              
 W1 157 2.47 0.73 1–4.75 .75** .76** .67** .40** .30** .25** .28** .44** .36** .47** .44**
 W2 110 2.38 0.75 1.05–4.15   .84** .71** .35** .35** .35** .28* .51** .52** .48** .45**
 W3 96 2.36 0.74 1.20–4.10     .78** .31** .22* .28** .17 .32** .26* .39** .32**
 W4 94 2.37 0.80 1.10–4.75       .37** .36** .38** .31** .40** .41** .41** .41**
Anxiety/depressionb                              
 W1 158 2.40 0.75 1–4         .51** .34** .24* .61** .51** .40** .41**
 W2 110 2.33 0.70 1–4           .59** .48** .46** .58** .58** .55**
 W3 96 2.35 0.67 1–4             .53** .35** .52** .59** .50**
 W4 96 2.34 0.71 1.25–4               .35** .35** .40** .56**
Posttraumatic stressb                              
 W1 157 2.02 0.57 1–4                 .77** .68** .67**
 W2 110 1.98 0.58 1–3.50                   .78** .74**
 W3 96 1.91 0.55 1.06–3.06                     .78**
 W4 94 1.91 0.63 1–3.40                      
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Note: W = Wave. *p < .05, **p < .01, ***p < .001.

a

Scale range: 1–5.

b

Scale range: 1–4.

3.2. Random intercept cross-lagged models

The fit indices of both random intercept cross-lagged models indicated adequate model fit. For the model with cultural identity conflict and PTS, indices were χ2(9) = 9.808, p < .37, CFI = 0.999, TLI = 0.996, RMSEA = .024. For the model with cultural identity conflict and anxiety/depression indices were χ2(9) = 5.142, p < .82, CFI = 1.000, TLI = 1.000, RMSEA < .001.

3.2.1. Temporal associations among levels of cultural identity conflict and PTS

Figure 1 presents standardized autoregressive effects, reflecting associations among wave-specific deviations from a person’s stable-trait level. Additionally, within-person associations between cultural identity conflict and PTS among individuals within the same wave and cross-lagged effects among people’s deviations from their stable levels of cultural identity conflict and their deviations from their stable levels of PTS symptoms are presented. Several significant autoregressive effects were found for cultural identity conflict (W3 to W4) and PTS symptoms (W1 to W2 and W3 to W4). No significant concurrent associations were found between deviations from people’s usual levels of cultural identity conflict and PTS symptoms. Regarding cross-lagged effects, no clear directional effects were found (Figure 1). Notably, deviations from people’s usual levels of cultural identity conflict at W1 negatively predicted deviations from people’s usual levels of PTS symptoms at W2, with greater fluctuations from one’s usual level of cultural identity conflict predicting lesser fluctuations from one’s usual level of PTS symptoms. Additionally, greater deviations from one’s usual level of PTS symptoms at W2 were predictive of lesser deviations from one’s usual level of cultural identity conflict at W3.

Figure 1.

Figure 1.

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Deviations from stable levels of cultural identity conflict and PTS over time: standardized autoregressive, concurrent, and cross-lagged effects.

Note: CIC = Cultural Identity Conflict, PTS = Posttraumatic Stress. *p < .05, **p < .01, ***p < .001

3.2.2. Temporal associations among levels of cultural identity conflict and anxiety/depression

Figure 2 presents standardized autoregressive effects, concurrent associations, and cross-lagged effects among deviations from trait levels of cultural identity conflict and deviations from trait levels of anxiety/depression at each wave. Significant autoregressive effects were found for both cultural identity conflict and anxiety/depression symptoms. Furthermore, in none of the waves significant concurrent associations were found. Regarding cross-lagged effects, no consistent effects were found. There was a significant negative directional effect from anxiety/depression symptoms at W2 to cultural identity conflict at W3; greater deviations from trait levels of cultural identity conflict were predicted by lesser deviations from trait levels of symptoms.

Figure 2.

Figure 2.

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Deviations from stable levels of cultural identity conflict anxiety/depression over time: standardized autoregressive, concurrent, and cross-lagged effects.

Note: CIC = Cultural Identity Conflict, A/D = Anxiety/depression. *p < .05, **p < .01, ***p < .001. ap = .06.

4. Discussion

The current study examined temporal associations between levels of cultural identity conflict and psychological symptoms, namely PTS and anxiety/depression symptoms in Syrian young adults who recently settled in the Netherlands. By implementing RI-CLPM, we investigated the between-person level and within-person level relationships between cultural identity conflict and psychological symptoms over time. We focused on people from Syria because they represent a large and significant migrant group in the Netherlands, especially after the 2015 migration wave (UNHCR, 2021), making them an important population for understanding how resettlement after displacement impacts mental health.

A first main finding was that cultural identity conflict showed individual stability in deviations from people’s usual levels from one wave to the next over the course of 13 months. For Syrian people with refugee backgrounds, the difficulty of integrating two cultural identities – Syrian and Dutch – may lead to heightened conflict during periods of acculturation, potentially due to ongoing challenges in balancing the values, norms, and expectations of both cultures (Yohani, 2015). This heightened conflict may carry forward to future time points and remain persistent. Conversely, when an individual experiences less cultural identity conflict, for instance through constructive cultural adaptation (Tingvold et al., 2015), these lower levels tend to be maintained over time.

While accounting for trait-like differences among individuals, similar patterns of deviations from their typical levels in one wave predicting deviations in the next wave were observed for both PTS and anxiety/depression symptoms. Regarding PTS, the observed persistent nature of these symptoms over time aligns with previous findings by Yohani (2015); it was shown that PTS in individuals with refugee backgrounds, resulting from potentially traumatic events (such as armed conflict), can be long-lasting. For Syrian young adults who have fled their country and faced threats to their identity, relationships, and human rights, feelings of loss may contribute to the persistence of symptoms during the resettlement process (Correa-Velez et al., 2010). On the other hand, when individuals experience fewer PTS symptoms, it is likely that their symptom levels will remain low in the near future.

Regarding anxiety/depression symptomatology, the findings also indicated that fluctuations from an individual’s typical level are stable over time. Syrian people with refugee backgrounds may continue to encounter challenges that keep their symptoms elevated, such as ongoing difficulties related to acculturation or socio-economic factors during the initial years of resettlement (Tingvold et al., 2015). Conversely, less fluctuation in the typical levels of psychological symptoms is predictive of reduced fluctuations in future assessments, potentially due to protective mechanisms (e.g. constructive coping, resilience) in navigating new challenges (Garcini et al., 2016). These findings suggest that for Syrian young adults, the absence of early intervention, when necessary, could lead to prolonged psychological symptoms and be predictive of mental health and adaptation problems in further stages of life.

No concurrent associations were observed between deviations from people’s usual levels of cultural identity conflict and psychological symptoms (PTS and anxiety/depression). The RI-CLPM did not reveal expected bidirectional relationships across the four waves. Only two relationships were found that contradicted our hypothesis. Findings indicated that people who experienced greater changes from their usual levels of cultural identity conflict at W1 tended to have fewer changes from their typical levels of PTS symptoms at W2 and those who had bigger shifts in their typical levels of PTS symptoms at W2 were likely to experience smaller changes from their levels of cultural identity conflict at the subsequent wave. When a Syrian person experiences more fluctuations in their typical level of PTS symptoms, they are likely to feel more stable or consistent in their feelings about their cultural identity in the following period. Possibly, Syrians who experience PTS in the early stage of resettlement may need most of their attention for dealing with the symptoms, and therefore, may have less room for experiencing cultural identity related challenges. Generally, connecting past, present, and future aspects of the identity takes place in further stages of resettlement (seven years after arrival; Gonsalves, 1992). Additionally, in the first years after migration, the heritage culture may be more dominantly present in people who have recently fled; for example, home country related concerns may be more present. As for the other relationships, fluctuations in a person’s expected level of cultural identity conflict were not linked to fluctuations in their expected level of psychological symptoms, nor did changes in psychological symptoms predict changes in cultural identity conflict levels. This indicates that, in a sample of Syrians, increases or decreases in deviations from an individual’s usual level of cultural identity conflict may not be linked to corresponding changes in psychological symptoms (PTS and anxiety/depression), and vice versa. The absence of the expected cross-lagged effects may suggest that in our sample, most of the variability in cultural identity conflict and psychological symptoms is due to stable between-person differences rather than dynamic within-person changes, indicating that individual differences are more trait-like and less influenced by time-varying factors over the course of 13 months.

Reflecting on the negative relationship between cultural identity conflict and PTS symptoms, one possible explanation is the chronicity of PTS in this population. The finding that greater deviations from one’s usual level of cultural identity conflict predicted smaller deviations from their usual PTS level may indicate that, while cultural identity conflict fluctuates, PTS symptoms remain more stable. This aligns with research showing that PTS can persist for many years among refugees and may become chronic without appropriate treatment. For example, prevalence rates of PTS in refugee populations remained stable between 13% and 30%, even six or more years after resettlement (Handiso et al., 2025). Given that participants in our study had been settled in the Netherlands for up to five years, these findings suggest that PTS in Syrian refugees may reflect an ongoing psychological vulnerability that could prevent recovery. Schock et al. (2016) found that even during treatment, new stressful events can reactivate PTS symptoms, with refugees remaining severely distressed despite some improvement in their symptoms. In this context, fluctuations in cultural identity conflict could act as reactivating stressors, especially if they challenge a sense of stability or belonging. This is supported by findings from Yilmaz et al. (2024), who observed that post-migration stressors, such as fear of losing ethnic identity, may contribute to ongoing PTS symptoms in long-term resettled Syrian refugees and therefore may complicate recovery.

A further explanation for the absence of within-person effects related to cultural identity conflict and PTS symptoms in the current sample may be that other factors than cultural identity conflict may affect changes in levels of symptoms during the early stages of resettlement. The average duration of stay for participants in this sample was three years, which falls within the ‘destabilization stage’ (6 months to 3 years), as described by Gonsalves (1992). During this stage, people with refugee backgrounds typically remain closely connected with fellow refugees and are engaged with issues related to their home country and family. Former research (Tinghög et al., 2017) indicated that home country related stressors (e.g. separation from family) were strongly associated with PTS symptoms, suggesting they may play a key role in changes in psychological outcomes over time. Building on that, cross-sectional research by Rahim et al. (2023) in the same sample as the current study, identified most common post-migration concerns as family worries, loneliness, boredom, fears of being sent home, and isolation. These findings suggest that, in early resettlement, the focus on home country related issues and immediate post-migration concerns may be more influential on PTS symptoms than cultural identity conflict. While in the current study we did not find a relationship between cultural identity conflict and PTS over the 13-month period, it is possible that this relationship may emerge after a longer period of resettlement. Early resettlement often prioritizes survival needs, leaving little room for identity-related challenges to interfere with psychological symptoms. However, as stability increases and individuals begin to reflect on their bicultural identity, cultural identity conflict may trigger unresolved feelings of loss, disconnection, or cultural tension, potentially amplifying traumatic memories. According to Ehlers and Clark's (2000) model, a disrupted sense of self can make stressors feel more threatening and traumatic memories more difficult to integrate into the autobiographical memory. Over time, cultural identity conflict may become related to PTS as challenges tied to identity and belonging take a more central stage (Gonsalves, 1992), disrupting memory integration and undermining resilience and coping resources when future stress arises. These processes may become more prominent after the initial survival phase of resettlement has passed, as individuals begin to shift their focus towards more self-related concerns.

In the model examining temporal relationships between cultural identity conflict and anxiety/depression symptomatology, no significant cross-lagged effects were found, except for one notable finding. A significant negative directional effect emerged from anxiety/depression at W2 to cultural identity conflict at W3. Specifically, lesser deviations from trait levels of anxiety/depression predicted greater deviations from trait levels of cultural identity conflict. A potential explanation for this relationship is that Syrians with stable levels of symptoms may experience greater fluctuations in cultural identity conflict because mental health stability provides cognitive and emotional resources for engaging with identity challenges. Phinney’s model of ethnic identity development (1990) describes the process of identity development as a process where individuals actively explore their cultural backgrounds and develop a committed sense of belonging, which requires cognitive and emotional resources. When symptoms are absent, people with refugee backgrounds may better reflect on the cultural tensions between their heritage and new culture, potentially increasing variability in cultural identity conflict. In contrast, the presence of symptoms may reduce the focus on cultural identity conflict and resulting in fewer fluctuations. In recently migrated Syrians, home country related factors such as emotional loneliness, loss of social support, and concerns for family left behind (Gleeson et al., 2020; Rahim et al., 2023; Wu et al., 2021) and host country related factors such as discrimination and social exclusion (Giuliani et al., 2018; Neuner, 2023) may play a more significant role than cultural identity conflict in contributing to anxiety and depression symptoms during early resettlement.

The absence of other cross-lagged effects suggests that fluctuations in cultural identity conflict and anxiety/depression may be independent of each other, with fluctuations in one not predicting fluctuations in the other. The lack of the expected relationships could be due to the role of protective factors such as constructive coping strategies and social support, potentially preventing a direct connection between cultural identity conflict and anxiety/depression symptoms. Former research (Garcini et al., 2016) identified protective factors during the resettlement period, indicating that people with refugee backgrounds who have more psychological resources – such as social support, a sense of community, improved language skills, job development, and an optimistic view of the future – are more likely to develop constructive coping strategies. These resources may enable individuals to manage cultural identity conflict and anxiety/depression symptoms separately, thereby preventing significant influence between the two variables over time.

4.1. Directions for future research

Further exploration and replication of these findings are necessary, until then, caution should be applied in interpreting the findings, especially in regard to the small sample size (n = 158) and the risk of an overfitting model. Future research could further explore the dynamic interplay between cultural identity conflict and the development of mental health issues in later stages of resettlement among individuals with refugee backgrounds. Gonsalves (1992) highlighted that resettlement and identity formation often span five to seven years, with identity modification becoming particularly important after five years. Building on this, studies have shown that longer periods of resettlement are associated with heightened psychological distress (Gleeson et al., 2020; Uribe Guajardo et al., 2016). Therefore, future research should examine whether cultural identity conflict is more present once individuals become more rooted in both their heritage and host cultures, and how this relates to psychological symptoms over time. Related to this, the waves in the current study took place every three months; it could be insightful for future research to extend the time in between the waves to observe more long-term changes in the perception of one’s cultural identity and the presence of symptomatology. Additionally, given the lack of consistent findings regarding the reciprocal relationships between cultural identity conflict and anxiety/depression, research could benefit from identifying protective or mediating factors such as social support and resilience (Garcini et al., 2016).

Lastly, future research should examine how host societies can promote mental well-being in young refugees during early resettlement, considering the impact of both home- and host country factors. This includes exploring the role of discrimination and social exclusion, as key risk factors for anxiety and depression (Neuner, 2023). By integrating these factors, research can offer a more comprehensive understanding of the challenges people with refugee backgrounds face, with implications for policies that foster supportive environments and improve mental health outcomes during resettlement.

4.2. Strengths and limitations

Strengths of the current study were the culturally sensitive approach by the researchers through the involvement of a cultural advisory board during all phases of the study, the face-to-face data-collection by trained members of the research team during the first three waves. These strategies facilitated successful recruitment, promoted participant engagement, and enabled the researchers to gain a deeper understanding of the participants’ context. The study had also some limitations. First, small sample sizes (n < 100) can result in both low statistical power and bias in parameter estimates (Mulder, 2023). While the sample size of the current study exceeded 100 in W1 (n = 158), it may be underpowered for detecting statistically significant effects as it decreased towards W4 (n = 96). Although the model fit indices indicated that the RI-CLPM was adequate for the data, the complexity of the model combined with the relatively small sample size may have led to overfitting. We did not modify or constrain any paths post hoc to improve fit, therefore, readers should interpret the findings with caution. Future research with larger samples is needed to confirm these findings.

Secondly, one of the inclusion criteria of the study, was being in the Netherlands between 6 and 60 months. People with refugee backgrounds are in this period most likely in the stage of building a life and facing the challenges in doing so (Gleeson et al., 2020; Gonsalves, 1992). People who experience severe challenges in this process, may have poorer mental health and therefore be less likely to participate in the study, since other things may require attention during this critical stage of resettlement. Therefore, caution should be applied in generalizing the current findings to the Syrian refugee population in general, considering that individuals with severe mental health problems are less likely to participate in studies about psychological symptoms (Woodall et al., 2010).

Regarding representativity, most participants were highly educated (60.7%) and were granted residency in the Netherlands (91.8%), which may contribute to developed job skills and an optimistic view of the future, making this sample more likely to participate in the current study. Moreover, although the longitudinal nature of the study is very valuable, it is likely that people with more psychological resources (e.g. higher levels of resilience and social support systems), carried on with participation in the last waves of the study. Participants with these resources may be more resilient to setbacks and challenges, potentially preventing cultural challenges from leading to changes in psychological symptoms due to the presence of protective factors. Furthermore, the majority of the participants in the current sample, was granted residency (91.8%). Research has shown that the time between arrival in a host country and the grant of residency could be a risk factor for long-term mental health problems; the longer the time awaiting, the more symptoms were observed (Garcini et al., 2016). This means that the results of the current study may not generalize to people who have not received a residence permit. Last, 69% of the sample identified with the male gender, in line with comparable research within refugee populations. Limitation on employment is identified as a strong risk factor for psychological symptoms, especially among men (Gleeson et al., 2020). Given the importance of the providers role as the male gender in the Syrian culture, it would be valuable to include this risk factor in further studies, especially since unemployment is one of the most common stressors in the post-migration stage (Gleeson et al., 2020).

4.3. Potential implications for intervention and policy

Although the findings of the current study offer more implications for future research than for clinical practice, they do provide valuable insights. The findings suggested that in young Syrians the presence of cultural identity conflict and psychological symptoms may be stable over time (i.e. a period of 13 months). Therefore, it seems plausible that early intervention for psychological symptoms, such as PTS and anxiety/depression, may prevent the persistence and exacerbation of these symptoms in the long term (Handiso et al., 2025). Health and social services involved in the early resettlement stage of people with refugee backgrounds, could focus on identifying indicators of PTS and anxiety/depression, after which suitable treatment can be offered accordingly (Tingvold et al., 2015).

4.4. Conclusion

The current study advances our knowledge about the interplay between cultural identity conflict and psychological symptoms among young Syrians with refugee backgrounds. Early adulthood is a critical transitional phase for identity development, particularly for individuals resettling in a new cultural and social environment. For young Syrians recently settling in a new country, early identification of psychological symptoms and support in reconciling their past and present identities may foster long-term psychological well-being and facilitate a constructive integration process. Although cultural identity conflict and psychological symptoms are primarily intrapersonal processes, the surrounding environment significantly influences their manifestation, particularly during early resettlement. The attitudes, opportunities, and inclusivity offered by the host country are crucial, as social exclusion and discrimination can adversely affect these processes (Neuner, 2023). Therefore, fostering integration and psychological wellbeing requires both individual support and inclusive, welcoming environments from host societies.

Acknowledgements

We are grateful to all people who participated in the Karakter project.

Funding Statement

This research was supported by a grant from the John Templeton Foundation’s Pathways to Character Initiative awarded to Joanne M. Chung and Odilia M. Laceulle.

Disclosure statement

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

Data availability statement

The data that support the findings of this study are available from the corresponding author, H.F. Rahim, upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, H.F. Rahim, upon reasonable request.

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