Carrying what came after: post-migration difficulties and depression among refugees and asylum seekers

Abstract Background Refugees and asylum seekers encounter numerous post-migration living difficulties (PMLDs) that can substantially affect their mental health. However, the role of PMLDs remains insufficiently explored, particularly in clinical refugee populations. This study aimed to identify subgroups based on patterns of PMLD by examining their relationship with depressive symptoms and determining which stressors function as key bridges. Methods This study reports a secondary analysis of baseline data from the ReTreat trial. Data were collected from 141 refugees and asylum seekers enrolled in a multicentre randomized controlled trial of a culturally adapted CBT program in Germany. Participants completed measures of depressive symptoms (PHQ-9) and post-migration stressors (27-item checklist). Latent Profile Analysis (LPA) was used to identify distinct burden profiles. Exploratory Factor Analysis (EFA) examined the dimensionality of PMLDs. Network analysis was conducted to investigate symptom–stressor connectivity. Results Three latent profiles emerged: Class 1 showed elevated distress across all domains; Class 2 was characterized by family separation and homesickness; and Class 3 exhibited minimal post-migration stress. EFA of PMLDS supported a four-factor solution: institutional/legal stressors, structural hardship, health/service access, and emotional/family-related strain. Depressive symptoms differed significantly across profiles, with highest scores in the high burden group (Class 1). Network analysis identified institutional/legal and emotional/family-related stressors as central bridge nodes linking PMLDs to depressive symptoms. Conclusions PMLDs are multidimensional and heterogeneously distributed among forcibly displaced individuals. Legal insecurity and emotional strain are particularly influential in connecting environmental hardship to depressive symptoms. Trial registration This study uses baseline data from a registered randomized controlled trial (DRKS00021536).