{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T22:51:24Z","timestamp":1785797484536,"version":"3.56.0"},"reference-count":43,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T00:00:00Z","timestamp":1670025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Emerging Fields Initiative (EFI) Fund of the Friedrich-Alexander University Erlangen-N\u00fcrnberg","award":["4_Phil_04"],"award-info":[{"award-number":["4_Phil_04"]}]},{"name":"STAEDTLER","award":["4_Phil_04"],"award-info":[{"award-number":["4_Phil_04"]}]},{"name":"Deutsche Forschungsgemeinschaft","award":["4_Phil_04"],"award-info":[{"award-number":["4_Phil_04"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The aim of this online, register-based cross-sectional study was to investigate the frequency of psychological distress and protective factors among 136 Syrian students in Germany. The survey measured depression and anxiety (Patient Health Questionnaire-4), post-traumatic stress (Impact of Event-Scale-6), as well as resources social support (ENRICHD Social Support Instrument), optimism (Optimism\u2013Pessimism-2 Scale) and religiosity (Duke Religion Index). A total of 26.50% of the sample were female. A total of 38.93% met criteria for clinically relevant depressive respectively generalized anxiety symptoms and 15.72% showed prominent PTSD scores. Participants screened positive for mental distress reported significantly less social support (p = 0.001) and less optimism (p = 0.002) than participants without mental distress. In multiple regression analyses, higher levels of feeling welcome in Germany, social support and intrinsic religiosity were significantly associated with lower levels of depression and generalized anxiety. Significant associations with lower PTSD levels were found with higher levels of social support and optimism. The results show that Syrian students in Germany are more psychologically burdened compared to other Syrian refugee samples, except for PTSD. This suggests that besides the stress caused by flight and trauma, stressors such as studying and social isolation could be considered as additional impediments for mental health and require intervention measures.<\/jats:p>","DOI":"10.3390\/ijerph192316200","type":"journal-article","created":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T02:56:26Z","timestamp":1670208986000},"page":"16200","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Which Protective Factors Are Associated with the Mental Health of Syrian Students in Germany? A Register-Based Cross-Sectional Study"],"prefix":"10.3390","volume":"19","author":[{"given":"Remy Rahim","family":"Hosari","sequence":"first","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-University Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4978-6158","authenticated-orcid":false,"given":"Andrea","family":"Borho","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-University Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Morawa","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-University Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yesim","family":"Erim","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-University Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,3]]},"reference":[{"key":"ref_1","unstructured":"Dillabough, J.-A., Fimyar, O., McLaughlin, C., Azmeh, Z.A., Jebril, M., Abdulhafez, A., Abdullateef, S., Abedtalas, M., Alabdullah, S., and Alibrahim, Z. (2011). The State of Higher Education in Syria Pre-2011, CARA Curriculum Activity Risk Assessment."},{"key":"ref_2","unstructured":"Colleen McLaughlin, J.-A.D. (2019). Syrian Higher Education System Facing \u2018Complete Breakdown\u2019 after Eight Years of War, University of Cambridge."},{"key":"ref_3","unstructured":"Dillabough, J.-A., Fimyar, O., McLaughlin, C., Azmeh, Z.A., Jebril, M., Abdulhafiz, A.H., Abdullateef, S., Abedtalas, M., Abdullah, S.A., and Husien, Y.A. (2019). Syrian Higher Education Post 2011: Immediate and Future Challenges, Council for At-Risk Academics."},{"key":"ref_4","unstructured":"Horn, H. (2022, October 19). Saving Syria\u2019s \u2018Lost Generation\u2019. The Atlantic, Available online: www.theatlantic.com\/international\/archive\/2015\/10\/syria-university-students-education\/412174."},{"key":"ref_5","unstructured":"(2022, October 19). Ausl\u00e4ndische Studierende in Deutschland nach Herkunftsl\u00e4ndern 2020\/2021. Available online: https:\/\/www.daad.de\/de\/der-daad\/was-wir-tun\/zahlen-und-fakten\/mobilitaet-auslaendischer-studierender\/."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Borho, A., Viazminsky, A., Morawa, E., Schmitt, G.M., Georgiadou, E., and Erim, Y. (2020). The prevalence and risk factors for mental distress among Syrian refugees in Germany: A register-based follow-up study. BMC Psychiatry, 20.","DOI":"10.1186\/s12888-020-02746-2"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/S0140-6736(05)61027-6","article-title":"Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review","volume":"365","author":"Fazel","year":"2005","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.socscimed.2009.04.032","article-title":"Depression and anxiety in labor migrants and refugees \u2013 A systematic review and meta-analysis","volume":"69","author":"Lindert","year":"2009","journal-title":"Soc. Sci. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1001\/jama.294.5.602","article-title":"Predisplacement and Postdisplacement Factors Associated With Mental Health of Refugees and Internally Displaced Persons: A Meta-analysis","volume":"294","author":"Porter","year":"2005","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e046065","DOI":"10.1136\/bmjopen-2020-046065","article-title":"Qualitative study on mental health and well-being of Syrian refugees and their coping mechanisms towards integration in the UK","volume":"11","author":"Paudyal","year":"2021","journal-title":"BMJ Open"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1186\/s13690-021-00745-7","article-title":"Quality of life among Syrian refugees in Germany: A cross-sectional pilot study","volume":"79","author":"Nebl","year":"2021","journal-title":"Arch. Public Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1097\/00004583-199509000-00013","article-title":"Posttraumatic stress disorder across two generations of Cambodian refugees","volume":"34","author":"Sack","year":"1995","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Miller, J.K., McDougall, S., Thomas, S., and Wiener, J. (2017). The Impact of the Brain-Derived Neurotrophic Factor Gene on Trauma and Spatial Processing. J. Clin. Med., 6.","DOI":"10.3390\/jcm6120108"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1037\/0022-006X.76.2.184","article-title":"Mental health of Somali adolescent refugees: The role of trauma, stress, and perceived discrimination","volume":"76","author":"Ellis","year":"2008","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1002\/jts.21749","article-title":"Trauma history and psychopathology in war-affected refugee children referred for trauma-related mental health services in the United States","volume":"25","author":"Betancourt","year":"2012","journal-title":"J. Trauma Stress"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1023\/A:1024710902534","article-title":"Pathways from war trauma to posttraumatic stress symptoms among Tamil asylum seekers, refugees, and immigrants","volume":"12","author":"Steel","year":"1999","journal-title":"J. Trauma Stress"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1097\/01.nmd.0000188977.44657.1d","article-title":"Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands","volume":"193","author":"Laban","year":"2005","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"R\u00f6nnau-B\u00f6se, M., Fr\u00f6hlich-Gildhoff, K., Bengel, J., and Lyssenko, L. (2022). Resilienz und Schutzfaktoren, Bundeszentrale f\u00fcr Gesundheitliche Aufkl\u00e4rung.","DOI":"10.36198\/9783838558615"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"110260","DOI":"10.1016\/j.jpsychores.2020.110260","article-title":"Special issue flight and migration","volume":"138","author":"Erim","year":"2020","journal-title":"J. Psychosom. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"109905","DOI":"10.1016\/j.jpsychores.2019.109905","article-title":"War trauma exposed refugees and posttraumatic stress disorder: The moderating role of trait resilience","volume":"129","author":"Fino","year":"2020","journal-title":"J. Psychosom. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"711451","DOI":"10.3389\/fpubh.2021.711451","article-title":"Syrian Refugee Youth Resettled in Norway: Mechanisms of Resilience Influencing Health-Related Quality of Life and Mental Distress","volume":"9","author":"Dangmann","year":"2021","journal-title":"Front. Public Health"},{"key":"ref_22","first-page":"223","article-title":"Exploring the role of faith in resettlement among Muslim Syrian refugees","volume":"37","author":"Hasan","year":"2018","journal-title":"J. Relig. Spir. Soc. Work. Soc. Thought"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1093\/geront\/gnu073","article-title":"The Protective Effects of Religiosity on Depression: A 2-Year Prospective Study","volume":"56","author":"Ronneberg","year":"2016","journal-title":"Gerontologist"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Morawa, E., and Erim, Y. (2018). Health-Related Lifestyle Behavior and Religiosity among First-Generation Immigrants of Polish Origin in Germany. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15112545"},{"key":"ref_25","first-page":"16","article-title":"Optimism in trauma and growth: A path analysis of former war-related displaced persons","volume":"2","author":"Acquaye","year":"2018","journal-title":"J. Pedagog. Res."},{"key":"ref_26","first-page":"330","article-title":"PTSD, Optimism, Religious Commitment, and Growth as Post-Trauma Trajectories: A Structural Equation Modeling of Former Refugees","volume":"7","author":"Acquaye","year":"2017","journal-title":"Prof. Couns."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Gottvall, M., Vaez, M., and Saboonchi, F. (2019). Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden. BMC Int. Health Hum. Rights, 19.","DOI":"10.1186\/s12914-019-0214-6"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/s10903-021-01180-0","article-title":"Resilience and Mental Health Among Syrian Refugee Children in Jordan","volume":"24","author":"Dehnel","year":"2021","journal-title":"J. Immigr. Minority Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1686801","DOI":"10.1080\/20008198.2019.1686801","article-title":"Psychological adaptation and posttraumatic stress disorder among Syrian refugees in Germany: A mixed-methods study investigating environmental factors","volume":"10","author":"Ghafoori","year":"2019","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref_30","unstructured":"Giordano, F.G., Boerchi, D., Toro, V.H., Maragel, M., Koteit, W., Yazbek, L., and Castelli, C. (2014, January 8\u201310). Risk and protection in mental health among Syrian children displaced in Lebanon. Proceedings of the Second World Congress on Resilience: From Person to Society, Timisoara, Romania."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Renner, A., J\u00e4ckle, D., Nagl, M., Hoffmann, R., R\u00f6hr, S., Jung, F., Grochtdreis, T., Dams, J., K\u00f6nig, H.-H., and Riedel-Heller, S. (2021). Predictors of psychological distress in Syrian refugees with posttraumatic stress in Germany. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0254406"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jad.2009.06.019","article-title":"A 4-item measure of depression and anxiety: Validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population","volume":"122","author":"Wahl","year":"2010","journal-title":"J. Affect. Disord."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1097\/01.MLR.0000093487.78664.3C","article-title":"The Patient Health Questionnaire-2: Validity of a two-item depression screener","volume":"41","author":"Kroenke","year":"2003","journal-title":"Med. Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"317","DOI":"10.7326\/0003-4819-146-5-200703060-00004","article-title":"Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection","volume":"146","author":"Kroenke","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s00127-009-0073-x","article-title":"Brief measure of posttraumatic stress reactions: Impact of Event Scale-6","volume":"45","author":"Thoresen","year":"2010","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1002\/bimj.200410135","article-title":"Estimation of the Youden Index and its associated cutoff point","volume":"47","author":"Fluss","year":"2005","journal-title":"Biom. J."},{"key":"ref_37","first-page":"16","article-title":"Repr\u00e4sentative Normierung des ENRICHD- Social-Support-Instrument (ESSI)\u2014Deutsche Version","volume":"2","author":"Cordes","year":"2009","journal-title":"Klinische Diagnostik und Evaluation"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1176\/ajp.154.6.885b","article-title":"Religion index for psychiatric research","volume":"154","author":"Koenig","year":"1997","journal-title":"Am. J. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"369","DOI":"10.2307\/1384677","article-title":"A Validated Intrinsic Religious Motivation Scale","volume":"11","author":"Hoge","year":"1972","journal-title":"J. Sci. Study Relig."},{"key":"ref_40","unstructured":"Bouchara, A. (2012). Ausl\u00e4ndische Studenten in Deutschland, Diplom.de."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2854","DOI":"10.1080\/17441692.2022.2026449","article-title":"Perceived discrimination among Syrian refugees in Germany and its associations with mental health","volume":"17","author":"Viazminsky","year":"2022","journal-title":"Glob. Public Health"},{"key":"ref_42","unstructured":"Zielinski, W.J. (2020). A Listening Approach: Equipping Leaders to Listen for PTSD, Air University."},{"key":"ref_43","unstructured":"Unicef (2022, October 19). Landmark Intergenerational Poll Shows Young People Are 50% More Likely than Older Generations to Believe the World Is Becoming a Better Place\u2014Yet Impatient for Action on Mounting Crises. Available online: https:\/\/www.unicef.org\/turkiye\/en\/press-releases\/landmark-intergenerational-poll-shows-young-people-are-50-more-likely-older."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/23\/16200\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:33:30Z","timestamp":1760146410000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/23\/16200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,3]]},"references-count":43,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["ijerph192316200"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192316200","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,3]]}}}