Migration and Mental Health: What Does the Research Say?

What does research on immigrant mental health show? Risk and protective factors, acculturation, discrimination and social support, in plain language.

Migration is an experience as old as human history. Today millions of Turks also live abroad: some are the children and grandchildren of families who left as workers decades ago, and others are young professionals who set out in recent years for education or a career. In psychology and psychiatry, immigrant mental health has long been a subject of interest. Research shows that migration is not in itself a cause of illness, but that conditions before, during and after migration can significantly affect mental health. In this article we summarise well-known findings in the field in plain language, and look at what this knowledge may mean for your daily life and what you can do to protect yourself.

A note: in this article we do not give exact figures or percentages. Migration research can produce different results depending on the country, the immigrant group, the period and the methods used. Here we only talk about trends that are generally accepted in the field.

Why Is Immigrant Mental Health Studied as a Separate Subject?

Migration means that many things change in a person's life at the same time: language, work, social circle, climate, food, everyday habits, even the way a person defines themselves. In psychology, so many changes happening together are seen as a significant adjustment load.

Researchers usually examine the migration experience in three periods:

• Before migration: Why the person migrated, whether the migration was voluntary, the difficulties they experienced in their country and the resources they have.
• The migration process: The conditions of the journey, how separations were experienced, uncertainties.
• After migration: Living conditions in the new country, work and housing situation, legal status, language, social support and experiences of discrimination.

Studies suggest that post-migration conditions are especially decisive for mental health. In other words, the same person's mental health can follow a noticeably different course depending on the kind of environment they encounter in the new country.

Common Difficulties and Signs in Immigrant Mental Health

The psychological difficulties frequently studied among immigrants in research are as follows:

• Anxiety and stress symptoms: Uncertainty, legal status, job security and worries about the future.
• Depressive symptoms: Especially in those experiencing loneliness, lack of social support and loss of status.
• Feelings of grief and loss: Longing related to the country, family, friends and former life left behind.
• Post-traumatic symptoms: Especially in those who have experienced forced migration, war or violence.
• Physical complaints: Symptoms such as headaches, stomach problems and fatigue, in which psychological distress is expressed through the body.
• Sleep problems: Due to the effects of both stress and living conditions such as shift work.

The presence of these symptoms alone does not amount to a diagnosis. But they should be taken into account when they last a long time and affect daily life. For more information on the general stress caused by migration, you can look at the article on immigrant stress.

What Does the Research Say? Risk and Protective Factors

The "healthy immigrant" observation

An observation often discussed in the field is that people who migrate may, in the first years of migration, be in a similar or even better position than the local population on some health indicators. One reason given for this is that people who decide to migrate generally have a certain level of health and resilience. However, some studies suggest that this advantage can decrease over the years, together with adverse living conditions and stressors.

Acculturation and styles of adjustment

Acculturation is the process of change that individuals and groups go through when different cultures come into contact. Researchers describe different paths that people can follow in this process: keeping their own culture while also taking part in the new one, remaining attached only to their own culture, leaving their own culture behind and fully conforming to the new one, or becoming distant from both cultures.

In many studies, people who can take part in the new society while preserving their own cultural identity have generally been reported to show better psychological adjustment. Feeling cut off from both cultures, on the other hand, has been associated with higher stress and loneliness. This finding shows that the dilemma of "either we must fully adapt or we must preserve our own culture" is not actually necessary. We covered the question of identity between two cultures in more detail in our article on identity between two cultures.

Discrimination

One of the findings that stands out consistently in research is that perceived discrimination is negatively related to mental health. Alongside overt discrimination, everyday experiences that are small but repeated have also been shown to be linked to stress, anxiety and depressive symptoms. This finding has led to discrimination being treated not only as a social issue but also as a public health issue.

Social support

Social support is described as one of the strongest protective factors in immigrant mental health. Trustworthy relationships, family ties, community networks and friendships built in the new country can buffer the negative effects of stress. Loneliness and social isolation, in turn, are among the risk factors.

Language and access to services

Studies show that a language barrier can make it harder to seek and benefit from mental health services. Services that are culturally sensitive and offered in a language the person can understand are thought to support participation in therapy and the therapeutic relationship.

Differences between generations

First-generation immigrants and the second and third generations who are born and raised abroad can face different difficulties. In the first generation, the language barrier, hard working conditions and homesickness come to the fore, while in later generations the search for identity, the question of belonging and being caught between the expectations of the family and the expectations of the society they live in may be more pronounced.

What should you keep in mind when reading research?

In the news or on social media about migration and mental health, you may come across striking headlines. When evaluating this information, it helps to remember a few points. A relationship found in a study does not always mean a cause-and-effect relationship. A result obtained for an immigrant group in one country may not be valid for a different group in another country. Also, group averages do not describe the experience of individuals. Your story, beyond statistics, is your own.

The Effect of Migration on the Family and Children: What Do the Findings Show?

Research shows that parents' mental health can affect children's adjustment. Parents who are stressed, lonely or under economic pressure may find it harder to accompany their children with patience. On the other hand, a warm, supportive and consistent family environment is described as an important protective factor for immigrant children.

In immigrant families, it is common for children to learn the language faster than their parents. This can sometimes lead to children interpreting for their parents and to a change in roles within the family. Some studies suggest that a difference in the pace of acculturation between parent and child can increase conflict within the family.

Growing up bilingual is more often seen as a resource than as a risk. Children who positively recognise their own cultural origin while also being able to feel they belong to the society they live in are thought to be able to develop a stronger sense of self.

Let's say that in a family living in Germany, the parents are worried about their child forgetting Turkish, while the child is worried about looking different from their friends at school. When the parents begin to offer Turkish not as an obligation but as an enjoyable bond within the family, and also show interest in the child's school life, the child can settle more comfortably into both worlds. This fictional example shows the everyday counterpart of the idea of "being able to carry two identities together" described in research.

What You Can Do for Yourself in Light of the Research

Starting from the protective factors described in research, here are some steps you can apply in your daily life:

1. Strengthen your social support network

Try to build connections both within the Turkish community and with the people of the country you live in. An association, a sports club, volunteer work or a parents' group can be good starting points. Keep up regular contact with your loved ones in Turkey too. Research suggests that the quality of relationships matters more than their number; a few trustworthy ties can be more protective than a wide but superficial circle.

2. Allow yourself to carry both cultures

You do not have to choose between keeping your own culture and taking part in the new one. While celebrating your own religious festivals, you can also join local celebrations, and while speaking Turkish, you can also develop the local language.

3. Improve your language skills

Learning the local language makes it easier to access services, find job opportunities and build social relationships. Move forward in small, regular steps without perfectionism. Joining language courses, conversation groups or language exchange meetings can also be a way of meeting new people.

4. Do not carry experiences of discrimination alone

Share the discrimination you experience with people you trust. If necessary, get information from the relevant advice organisations in the country where you live. Remember that discrimination is not about your worth. Talking to people who have had similar experiences can also help you feel you are not alone.

5. Look after your body and your routine

Regular sleep, movement, daylight and balanced nutrition are basic protectors in coping with stress. Especially in northern countries, during the long winter months, take care to spend time outdoors during the day.

6. Notice early

Observe changes in your sleep, appetite and mood. Getting support before symptoms progress is an important protective step that research also emphasises.

Migration is not a fate for mental health. Supportive conditions, strong ties and help received in good time can make the difficulties of migration bearable.

When Should You Seek Professional Support?

You might consider contacting a mental health professional in the following situations:

• If unhappiness, anxiety or lack of motivation has lasted longer than two weeks
• If there are marked changes in your sleep, appetite and energy
• If your work, school or family life is noticeably affected
• If a difficult event from your past keeps coming back to your mind
• If your use of alcohol or substances has increased
• If you feel lonely, worthless or hopeless

If you have thoughts of harming yourself or ending your life, call the emergency number of the country you are in: 112 in EU countries, 911 in the US and Canada, 999 or 112 in the UK, and 000 in Australia. Online therapy is not an emergency intervention service; in situations of serious risk, local emergency services and local psychiatric services are necessary.

How Do We Work in Online Therapy in Your Mother Tongue?

Research suggests that services offered in a language the person can understand and in a way that is sensitive to their cultural context can support participation in therapy. Online therapy in your mother tongue does not have to replace the mental health services in the country where you live; it is an option that can also be used alongside them.

In work based on cognitive behavioural therapy (CBT), the following topics are generally addressed for immigrant mental health:

• Understanding the migration story: Before, during and after migration; losses and gains are talked about together.
• Identifying stressors: Difficulties in areas such as language, work, legal status, discrimination and family relationships are mapped.
• Working with thought patterns: Thoughts such as "I don't belong anywhere" and their effect on feelings are examined.
• Strengthening protective factors: Work is done on the social support network, meaningful activities and daily routines.
• Gaining skills: Stress management, problem-solving and communication skills are developed.

Sessions are held by video, planned with the time difference in mind. A quiet room, headphones and a secure internet connection are enough. Payment is made online; pricing is in TL and payment by international card is possible. For insurance reimbursement, you need to check the insurance conditions in the country where you live. For more information, you can look at the online therapy and Turks abroad pages.

Frequently Asked Questions

Does migrating necessarily affect mental health negatively?

No. Research shows that migration is not in itself a cause of mental disorder; post-migration living conditions, social support and experiences of discrimination are decisive. Many people also gain new strengths through migration.

What is the most important protective factor for immigrant mental health?

There is no single factor, but social support is one of the most frequently emphasised protective factors. Trustworthy relationships, family ties and community networks can ease the effects of stress.

Do second-generation Turks also experience the effects of migration?

Although people born and raised abroad have not migrated themselves, they can be affected by their family's migration experience and by growing up between two cultures. Identity, belonging and family expectations are frequently discussed topics in this generation.

Is the information in this article valid for every country?

The findings summarised here are general trends. There may be differences from country to country, from one immigrant group to another and from person to person. Speaking with a specialist is the best way to assess your own situation.

• #immigrant mental health
• #psychology of migration
• #acculturation
• #discrimination
• #Turks abroad

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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