Post-migration living difficulties, discrimination, and mental health of traumatized refugees in Germany: data from the refuKey project for timely and need-adapted treatment in a stepped-care setting.

Asylum seekers and refugees (ASR) experience many short-term and long-term post-migration stressors, e.g. discrimination after resettlement, leading to increased psychiatric morbidity in this population. Using data from the state-funded stepped-care project refuKey based in Lower Saxony, Germany, that aims to provide better mental health care access for ASR, we investigated the relationship between post-migration stressors and mental health in treatment-seeking ASR. In our naturalistic multi-centric study we assessed mental health (e.g. symptoms of depression, anxiety, traumatization, etc.), post-migration living difficulties, and perceived discrimination in ASR before and after treatment using questionnaires in eight languages consisting of internationally validated scales. Participants displayed poor mental health before, and significantly improved mental health parameters after treatment (p < 0.001). Post-migration living difficulties and perceived discrimination significantly predicted all mental health outcomes before treatment (p < 0.001) but not the treatment effects. However, perceived discrimination only contributed significantly to the prediction of quality-of-life and traumatization. Our findings suggest that refuKey-treatment helps despite the presence of post-migration living difficulties. Asylum policies should aim at reducing and overcoming post-migration living difficulties due to the strong association to mental health levels in treatment-seeking ASR.