{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T10:12:28Z","timestamp":1775211148108,"version":"3.50.1"},"reference-count":64,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Maastricht University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) Background: Approximately half of all refugees living in Germany experience discrimination, which may negatively affect their mental health. Moreover, German refugees have experienced hostility, especially in eastern regions. (2) Aims: We examined the effect of perceived discrimination on refugees\u2019 mental health in Germany, with a particular focus on possible regional differences of refugee mental health and perceived discrimination. (3) Method: The data of 2075 refugees who arrived in Germany between 2013 and 2016, from a large-scale survey, was analysed using binary logistic regression. The refugee health screener, 13-item version, was used to assess psychological distress. All effects were investigated for the entire sample and both sexes independently. (4) Results: A third of refugees experienced discrimination which increased the risk of psychological distress (OR = 2.25 [1.80, 2.8]). Those living in eastern Germany were more than twice as likely to report experiences of discrimination, compared to their counterparts living in western Germany (OR = 2.52 [1.98, 3.21]). Differences were noted between males and females, and religious attendance. (5) Conclusions: Perceived discrimination is a risk factor for refugee mental health, particularly female refugees in eastern Germany. An east\u2013west regional difference may be explained by socio-structural factors, rural placement, differential historical exposure to migrant populations, and a greater presence of right-wing and populist parties in eastern Germany.<\/jats:p>","DOI":"10.3390\/ijerph20054409","type":"journal-article","created":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T03:06:43Z","timestamp":1677726403000},"page":"4409","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Geographical Disparities and Settlement Factors and Mental Health of Refugees Living in Germany"],"prefix":"10.3390","volume":"20","author":[{"given":"Julian","family":"Grabo","sequence":"first","affiliation":[{"name":"Global Health, Maastricht University, 6221 LK Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8411-8919","authenticated-orcid":false,"given":"Gerard","family":"Leavey","sequence":"additional","affiliation":[{"name":"Bamford Centre for Mental Health & Wellbeing, Ulster University, Coleraine BT51 5SA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,1]]},"reference":[{"key":"ref_1","unstructured":"UNHCR (2021, April 23). Global Trends: Forced Displacement 2019. United Nations High Commissioner for Refugees. Available online: https:\/\/www.unhcr.org\/globaltrends2019\/#:~:text=One%20per%20cent%20of%20the,to%20outpace%20global%20population%20growth.&text=During%202019%2C%20an%20estimated%2011.0%20million%20people%20were%20newly%20displaced."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Zaragoza-Cristiani, J. (2015). Analysing the Causes of the Refugee Crisis and the Key Role of Turkey: Why Now and Why So Many?, Robert Schuman Centre for Advanced Studies. Research Paper No. RSCAS.","DOI":"10.2139\/ssrn.2704901"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1177\/13634615211002690","article-title":"Refugee mental health and human rights: A challenge for global mental health","volume":"58","author":"Kronick","year":"2021","journal-title":"Transcult Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1093\/eurpub\/ckw010","article-title":"Refugees mental health\u2014A public mental health challenge","volume":"26","author":"Lindert","year":"2016","journal-title":"Eur. J. Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1002\/wps.20438","article-title":"The contemporary refugee crisis: An overview of mental health challenges","volume":"16","author":"Silove","year":"2017","journal-title":"World Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1001\/jama.2009.1132","article-title":"Association of Torture and Other Potentially Traumatic Events with Mental Health Outcomes among Populations Exposed to Mass Conflict and Displacement: A Systematic Review and Meta-analysis","volume":"302","author":"Steel","year":"2009","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bogic, M., Njoku, A., and Priebe, S. (2015). Long-term mental health of war-refugees: A systematic literature review. BMC Int. Health Hum. Rights, 15.","DOI":"10.1186\/s12914-015-0064-9"},{"key":"ref_8","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_9","doi-asserted-by":"crossref","first-page":"e68","DOI":"10.1192\/bjo.2020.54","article-title":"Anxiety, depression and post-traumatic stress disorder in refugees resettling in high-income countries: Systematic review and meta-analysis","volume":"6","author":"Henkelmann","year":"2020","journal-title":"BJPsych. Open"},{"key":"ref_10","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\u2014A systematic review and meta-analysis","volume":"69","author":"Lindert","year":"2009","journal-title":"Soc. Sci. Med."},{"key":"ref_11","unstructured":"Priebe, S., Giacco, D., and El-Nagib, R. (2016). Public Health Aspects of Mental Health among Migrants and Refugees: A Review of the Evidence on Mental Health Care for Refugees, Asylum Seekers and Irregular Migrants in the WHO European Region, World Health Organization, Regional Office for Europe."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1017\/S2045796016000172","article-title":"The mental health of civilians displaced by armed conflict: An ecological model of refugee distress","volume":"26","author":"Miller","year":"2017","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1007\/s11920-021-01262-8","article-title":"Mental Health Outcomes of Unaccompanied Refugee Minors: A Rapid Review of Recent Research","volume":"23","author":"Bamford","year":"2021","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1007\/s11920-016-0723-0","article-title":"The Relationship between Post-Migration Stress and Psychological Disorders in Refugees and Asylum Seekers","volume":"18","author":"Li","year":"2016","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"643704","DOI":"10.3389\/fpsyt.2021.643704","article-title":"A Systematic Review of Factors Affecting Mental Health and Well-Being of Asylum Seekers and Refugees in Germany","volume":"12","author":"Hajak","year":"2021","journal-title":"Front. Psychiatry"},{"key":"ref_16","first-page":"1","article-title":"A systematic review of risk and protective factors of mental health in unaccompanied minor refugees","volume":"31","author":"Christiansen","year":"2020","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1007\/s10935-017-0492-5","article-title":"Effect of Perceived Discrimination on Depressive Symptoms in 1st- and 2nd-Generation Afghan-Americans","volume":"38","author":"Alemi","year":"2017","journal-title":"J. Prim. Prev."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Alemi, Q., and Stempel, C. (2018). Discrimination and distress among Afghan refugees in northern California: The moderating role of pre- and post-migration factors. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0196822"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1007\/s10903-015-0251-8","article-title":"Beyond Trauma: Post-resettlement Factors and Mental Health Outcomes Among Latino and Asian Refugees in the United States","volume":"18","author":"Kim","year":"2016","journal-title":"J. Immigr. Minor. Health"},{"key":"ref_20","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_21","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12992-020-00655-3","article-title":"Immigration, perceived discrimination and mental health: Evidence from Venezuelan population living in Peru","volume":"17","author":"Mougenot","year":"2021","journal-title":"Glob. Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.psychres.2018.11.028","article-title":"The mediating role of self-esteem on the relationship between perceived discrimination and mental health in South American immigrants in Chile","volume":"271","author":"Cabrera","year":"2019","journal-title":"Psychiatry Res."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Wong, W.C.W., Cheung, S., Miu, H.Y.H., Chen, J., Loper, K.A., and Holroyd, E. (2017). Mental health of African asylum-seekers and refugees in Hong Kong: Using the social determinants of health framework. BMC Public Health, 17.","DOI":"10.1186\/s12889-016-3953-5"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ziersch, A., Due, C., and Walsh, M. (2020). Discrimination: A health hazard for people from refugee and asylum-seeking backgrounds resettled in Australia. BMC Public Health, 20.","DOI":"10.1186\/s12889-019-8068-3"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1111\/1475-6773.13222","article-title":"Understanding how discrimination can affect health","volume":"54","author":"Williams","year":"2019","journal-title":"Health Serv. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1016\/j.socscimed.2010.07.018","article-title":"Longing to belong: Social inclusion and wellbeing among youth with refugee backgrounds in the first three years in Melbourne, Australia","volume":"71","author":"Gifford","year":"2010","journal-title":"Soc. Sci. Med."},{"key":"ref_27","unstructured":"Antidiskriminierungsstelle des Bundes (2021, April 15). Diskriminierungsrisiken f\u00fcr Gefl\u00fcchtete in Deutschland. Available online: https:\/\/www.antidiskriminierungsstelle.de\/DE\/ThemenUndForschung\/Ethnische_Herkunft\/Gefluechtete_und_Neuzugewanderte\/Diskriminierungsrisriken\/gefluechtete_node.html."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s10903-009-9227-x","article-title":"Perceived Discrimination among Three Groups of Refugees Resettled in the USA: Associations with Language, Time in the USA, and Continent of Origin","volume":"11","author":"Hadley","year":"2009","journal-title":"J. Immigr. Minor. Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/j.1747-7379.2007.00113.x","article-title":"Discrimination and Well-Being: Perceptions of Refugees in Western Australia","volume":"42","author":"Fozdar","year":"2008","journal-title":"Int. Migr. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1093\/eurpub\/ckm073","article-title":"Discrimination, mental problems and social adaptation in young refugees","volume":"18","author":"Montgomery","year":"2008","journal-title":"Eur. J. Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1080\/01402382.2016.1215614","article-title":"The dark side of the German \u2018welcome culture\u2019: Investigating the causes behind attacks on refugees in 2015","volume":"40","year":"2017","journal-title":"West Eur. Politics"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2158244014532819","article-title":"\u201cWho Are These Foreigners Anyway?\u201d The Content of the Term Foreigner and Its Impact on Prejudice","volume":"4","author":"Asbrock","year":"2014","journal-title":"SAGE Open"},{"key":"ref_33","first-page":"1","article-title":"Refugees welcome? A dataset on anti-refugee violence in Germany","volume":"3","author":"Strasheim","year":"2016","journal-title":"Res. Politics"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Entorf, H., and Lange, M. (2019). Refugees Welcome? Understanding the Regional Heterogeneity of Anti-Foreigner Hate Crimes in Germany. (30 January 2019), ZEW-Centre for European Economic Research.","DOI":"10.2139\/ssrn.3390218"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1093\/esr\/jcaa055","article-title":"Explaining Ethnic Violence: On the Relevance of Geographic, Social, Economic, and Political Factors in Hate Crimes on Refugees","volume":"37","author":"Liebe","year":"2021","journal-title":"Eur. Sociol. Rev."},{"key":"ref_36","unstructured":"Liebig, S., Goebel, J., Grabka, M., Schr\u00f6der, C., Zinn, S., Bartels, C., Fedorets, A., Franken, A., Gerike, M., and Griese, F. (2020). Data for Years 1984\u20132019 v36 ed., SOEP."},{"key":"ref_37","unstructured":"Pfister, G. (2022, December 07). Fremdenfeindlichkeit in Deutschland? Einstellungen Gegen\u00fcber Ausl\u00e4ndern 2016. Doctoralthesis, Universit\u00e4t W\u00fcrzburg, W\u00fcrzburg, Germany. Available online: https:\/\/opus.bibliothek.uni-wuerzburg.de\/frontdoor\/index\/index\/docId\/16807."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Cassens, I.L.M., and Scholz, R. (2009). Die Bev\u00f6lkerung in Ost-und Westdeutschland, VS Verlag f\u00fcr Sozialwissenschaften.","DOI":"10.1007\/978-3-531-91832-7"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/1368430203006001010","article-title":"Ethnic Prejudice in East and West Germany: The Explanatory Power of Intergroup Contact","volume":"6","author":"Wagner","year":"2003","journal-title":"Group Process. Intergroup Relat."},{"key":"ref_40","first-page":"59","article-title":"Sozialpsychologische Analysen und Erkl\u00e4rungen von Fremdenfeindlichkeit in Deutschland. [Social psychological awareness and explanations for hostility toward foreigners in Germany]","volume":"32","author":"Wagner","year":"2001","journal-title":"Z. F\u00fcr Soz."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"182","DOI":"10.2307\/146245","article-title":"A Statistical Analysis of Crime against Foreigners in Unified Germany","volume":"32","author":"Krueger","year":"1997","journal-title":"J. Hum. Resour."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s11577-016-0361-x","article-title":"Wer ist in Deutschland willkommen?","volume":"68","author":"Czymara","year":"2016","journal-title":"KZfSS K\u00f6lner Z. F\u00fcr Soziologie Und Soz."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1027\/1864-9335\/a000397","article-title":"Support for Refugee Integration in West and East Germany","volume":"51","author":"Hellmann","year":"2020","journal-title":"Soc. Psychol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1111\/j.1475-6765.2008.00784.x","article-title":"Immigration sceptics, xenophobes or racists? Radical right-wing voting in six West European countries","volume":"47","author":"Rydgren","year":"2008","journal-title":"Eur. J. Political Res."},{"key":"ref_45","unstructured":"Br\u00fccker, H., Rother, N., Schupp, J., Gostomski, C., B\u00f6hm, A., Br\u00fccker, H., Fendel, T., Friedrich, M., Giesselmann, M., and Holst, E. (2016). IAB-BAMF-SOEP-Befragung von Gefl\u00fcchteten: \u00dcberblick und Erste Ergebnisse, IAB-Forschungsbericht."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.genhosppsych.2012.12.002","article-title":"The Refugee Health Screener-15 (RHS-15): Development and validation of an instrument for anxiety, depression, and PTSD in refugees","volume":"35","author":"Hollifield","year":"2013","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/NMD.0000000000000469","article-title":"Effective Screening for Emotional Distress in Refugees: The Refugee Health Screener","volume":"204","author":"Hollifield","year":"2016","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1389205","DOI":"10.1080\/20008198.2017.1389205","article-title":"Efficient identification of mental health problems in refugees in Germany: The Refugee Health Screener","volume":"8","author":"Kaltenbach","year":"2017","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref_49","unstructured":"UNESCO (2022, December 07). International Standard Classification of Education (ISCED) 2011. Unesco.Org. Available online: http:\/\/uis.unesco.org\/sites\/default\/files\/documents\/international-standard-classification-of-education-isced-2011-en.pdf."},{"key":"ref_50","unstructured":"Schmidt, K., Jacobsen, J., and Krieger, M. (2020). Soziale Integration Gefl\u00fcchteter Macht Fortschritte, Deutsches Institute f\u00fcr Wirtschaftsforschung diw.de."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1111\/j.1553-2712.2011.01185.x","article-title":"Logistic Regression: A Brief Primer","volume":"18","author":"Stoltzfus","year":"2011","journal-title":"Acad. Emerg. Med."},{"key":"ref_52","unstructured":"BAMF (2021, April 25). Das Bundesamt in Zahlen 2019: Asyl, Migration und Integration. Available online: https:\/\/www.bamf.de\/SharedDocs\/Anlagen\/DE\/Statistik\/BundesamtinZahlen\/bundesamt-in-zahlen-2019.html?nn=284738."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2979","DOI":"10.1080\/1369183X.2020.1757417","article-title":"\u2018It reminds me that I still exist\u2019. Critical thoughts on intersectionality; refugee Muslim women in Berlin and the meanings of the hijab","volume":"47","author":"Paz","year":"2021","journal-title":"J. Ethn. Migr. Stud."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1177\/0019793919875707","article-title":"Multiple Discrimination against Female Immigrants Wearing Headscarves","volume":"73","author":"Weichselbaumer","year":"2019","journal-title":"ILR Rev."},{"key":"ref_55","unstructured":"Allport, G.W. (1979). The Nature of Prejudice (25th Anniversary ed.), Addison-Wesley."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/S0049-089X(03)00037-1","article-title":"Social structural position and prejudice: An exploration of cross-national differences in regression slopes","volume":"33","author":"Kunovich","year":"2004","journal-title":"Soc. Sci. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13033-016-0109-z","article-title":"Causes of and risk factors for posttraumatic stress disorder: The beliefs of Iraqi and Afghan refugees resettled in Australia","volume":"11","author":"Guajardo","year":"2017","journal-title":"Int. J. Ment. Health Syst."},{"key":"ref_58","unstructured":"Hafez, K., and Schmidt, S. (2015). Die Wahrnehmung des Islams in Deutschland: Religionsmonitor-Verstehen Was Verbindet, Verlag Bertelsmann Stiftung."},{"key":"ref_59","first-page":"19","article-title":"Discrimination Unveiled: A Field Experiment on the Barriers Faced by Muslim Women in Germany, the Netherlands, and Spain","volume":"1","author":"Veit","year":"2022","journal-title":"Eur. Sociol. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"113445","DOI":"10.1016\/j.psychres.2020.113445","article-title":"Sex differences in trauma exposure and symptomatology in trauma-affected refugees","volume":"293","author":"Mundy","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_61","unstructured":"Knipp, K. (2022, December 07). Familiennachzug f\u00fcr Fl\u00fcchtlinge: Das Sind Die Regeln. Deutsche Welle 2017. Available online: https:\/\/www.dw.com\/de\/familiennachzug-f%C3%BCr-fl%C3%BCchtlinge-das-sind-die-regeln\/a-41958529."},{"key":"ref_62","unstructured":"Taylor, S.E. (2011). The Oxford Handbook of Health Psychology, Oxford University Press."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1177\/1948550617752062","article-title":"Improving Refugee Well-Being with Better Language Skills and More Intergroup Contact","volume":"10","author":"Tip","year":"2018","journal-title":"Soc. Psychol. Personal. Sci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s00127-005-0911-4","article-title":"Determinants of non-participation, and the effects of non-participation on potential cause-effect relationships, in the PART study on mental disorders","volume":"40","author":"Lundberg","year":"2005","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/4409\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:45:21Z","timestamp":1760121921000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/4409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,1]]},"references-count":64,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20054409"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20054409","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,1]]}}}