Relationship between Traumatic Events, Somatization, Psychological distress, and Quality of Life in Female Refugees in Germany

Jenny Jesuthasan^1*James Kenneth Moran²Eva Döring-Brandl¹Ingar Abels³Christine Kurmeyer³Annabelle Starck⁴Ulrich Stangier⁴Jana Gutermann⁴Ulrike Zier⁵Anja Wollny⁶Antje Krüger⁶Kneginja Richter^7,8,9Sabine Oertelt-Prigione^10,11Meryam Schouler-Ocak¹

• ¹Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
• ²Department of Psychiatry and Psychotherapy, Multisensory Integration Lab, Charité Universitätsmedizin, St Hedwig Hospital, Berlin, Germany
• ³Office of the Equal Opportunities Officer, Charité–Universitätsmedizin, Berlin, Germany
• ⁴Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
• ⁵Institute of Occupational, Social, and Environmental Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
• ⁶Institute of General Practice, University Medical Center Rostock, Rostock, Germany
• ⁷University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
• ⁸Faculty for Social Sciences, Technical University Nuremberg GSO, Nuremberg, Germany
• ⁹CuraMed Day Clinic Nuremberg, Nuremberg, Germany
• ¹⁰Institute of Legal Medicine, Charité-Universitätsmedizin, Berlin, Germany
• ¹¹Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands

Theoretical Background: Female refugees often experience traumatic events leading to mental health problems such as depression, anxiety, and somatization which can impact their quality of life. However, the interplay between these factors has rarely been studied to date. Objectives: This study investigates factors that contribute to the symptoms of psychological distress, somatization, and quality of life and the relationship between them. Methods: 594 female refugees in five different reception centers in Germany were included. The cumulative number of traumatic events experienced was defined using the Harvard Trauma Questionnaire and the Posttraumatic Diagnostic Scale. Information from the Hopkins Symptom Checklist, the Symptom Checklist-90, and Eurohis-QoL was used to perform hierarchical regression analysis and serial mediation analysis was conducted using PROCESS Model 6 and bootstrapping. Results: Traumatic experiences had an impact on quality of life, both independently and as well as being mediated by somatization and psychological distress. Furthermore, our study reveals that cumulative trauma influences somatization, which then mediates psychological distress, ultimately leading to a lower quality of life. Cumulative trauma had the highest negative impact on mental health outcomes. Conclusion: Our findings suggest that future research and treatment of female refugees should focus on the role of somatization. Clinical assessments should be broadened with culturally sensitive tools to encompass both somatic and psychological dimensions of distress