A multifactorial model of factors associated with PTSD, anxiety and depression among migrants in Spain

Abstract

Background Migrants are at increased risk for mental health problems due to stressors before, during, and after migration. However, evidence on the factors associated with migrant mental health in Spain remains limited. Objectives To examine how four domains– (1) sociodemographic and psychological characteristics, (2) migration-related factors, (3) social and occupational conditions, and (4) health-related quality of life factors–are associated with post-traumatic stress disorder (PTSD), anxiety, and depression among migrants. Methods A cross-sectional survey was conducted between June 2021 and October 2022 among 509 adult migrants residing in Spain. PTSD, anxiety, and depression were assessed with the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5), the 7-item Generalized Anxiety Disorder Scale (GAD-7), and the Composite International Diagnostic Interview (CIDI), respectively. Multivariable logistic regression and Tobit models were used to examine associations between the four domains and mental health outcomes. Results Women reported higher anxiety and depression, whereas younger age was associated with higher anxiety. Migrants from the Americas reported higher anxiety and depression, whereas those from Europe exhibited greater PTSD symptomatology, although this finding should be interpreted with caution given the very small European subsample. Childhood trauma was positively associated with PTSD, anxiety, and depression. Regarding migration-related factors, frequent acculturative stress and longer length of stay in Spain were associated with higher anxiety, whereas travelling alone was associated with higher depression. Within the post-migration social environment, perceived discrimination was positively associated with both PTSD and anxiety. Regarding pandemic-related factors, COVID-19-related stress was positively associated with PTSD but inversely associated with depression, whereas general stress was consistently associated with all three mental health outcomes. Lower physical quality of life was associated with higher anxiety and depression, while lower mental quality of life was associated with worse PTSD, anxiety, and depression. Conclusion The findings support a multifactorial understanding of migrant mental health, highlighting the combined influence of pre-migration adversities, migration-related experiences and post-migration conditions. Interventions targeting modifiable factors, particularly acculturative stress, perceived discrimination, and quality of life, may contribute to improving mental health among migrant populations.