The reunification of Germany after the separation between 1949 and 1990 has offered a unique chance of studying the impact of socialization, political transformation, and migration on mental health. After the Second World War (WWII), the two parts of Germany were rebuilt in different and antagonistic political systems. While the Federal Republic of Germany (FRG), today's old federal states plus West Berlin, was rebuilt after the model of the Western allies, the German Democratic Republic (GDR) followed the socialist model. Conditions of socialization and living drifted apart between the two German states, and specific risk and protective factors for mental health evolved corresponding to the specific experiences in the two political systems. According to socialist ideology in particular women and lower classes were integrated into the labor force minimizing experiences of unemployment and reducing inequality. Development of qualification, continuing education, and child and healthcare could have acted as protective factors in the GDR, whereas social inequality and traditional gender roles in the FRG may have been risk factors for mental health for women and lower classes. On the other hand, experiences of political repression and incarceration have been shown to induce physical complaints, anxiety, and depression in the GDR.

The “fall of the Berlin wall” and the subsequent formal accession of the GDR to the FRG brought immense economic, cultural, and political transformation. Despite large monetary transfer to rebuild the new states, the former East German population suffered from the loss of social and vocational security: several million inhabitants lost their jobs (1), and many moved to the West (2) and the remaining population often perceived themselves as second class citizens (3). Results regarding mental health indicators, however, were scarce and mixed. A large nationally representative survey reported higher prevalences of mental disorders in the Western states in 1998/9 (4) concerning substance abuse, depression, somatoform disorders, social anxiety, and eating disorders. Brähler et al. (5) found participants residing in the Eastern states reported more physical symptom load. In a large representative survey with 5,036 participants in 2006, male and female participants from the Eastern states reported higher levels of anxiety and depression than those from the Western states (6–8). Negative effects of transformation (e.g., extremely high rates of previously unknown unemployment in the Eastern state in the course of economical reorganization) and persistent economic disadvantages may have compromised mental health in the Eastern states. In the meantime, living conditions, and general and mental health have also converged. Depression was even lower in the Eastern states in 2019 (9), and recently, the younger generation fared better under pandemic conditions in the Eastern than in the Western states (10).

In previous surveys, we have shown that mental health has shifted between generations who grew up under different living conditions. Particularly those born before 1945 have often been exposed to bombing, expulsion from their homes, loss of their primary caretakers (in particularly their fathers), hunger, and other atrocities of World War II. As we have found, adverse war experiences have been associated with increased anxiety and depression many decades after the end of WWII (11).

Migration is considered a process of more or less permanent and distant relocation, usually between different countries, often fraught with multiple losses, uncertainties, and perils in the process. Additional adjustment required to the different cultural, legal, economic, and political system has been termed acculturation. Learning new behaviors, customs, and languages and adjusting to new social demands often becomes a major life stress with different adaptive (integration and assimilation) or maladaptive outcomes (12). A substantial proportion of the German population was subjected to life-threatening experiences of flight or expulsion before 1946. Fifty-seven years after the end of WWI, those afflicted reported worse quality of life, health, and wellbeing and suffered from increased panic attacks (11). Based on a total of about three million people, a large proportion of the East German population has subsequently fled to West Germany from 1948 to 1989 (13). Motives ranged from escape from political oppression, restricted freedom of movement, education or choice or persecution, and the wish to reunite with family members living in West Germany to economical motives due to higher living standards in the West. The vast majority fled illegally, which was heavily persecuted by incarceration, losses of social contacts, property, social status, and careers of those caught and their next to kin. Following the construction of the border wall to prevent flight in 1961, more and more refugees were arrested, injured, or killed in the process. Following reunification, large proportions of the population of the Eastern states resettled in the Western states, and only recently, the proportions of those moving from the Eastern to the Western states and vice versa have become balanced. For the latter groups, a healthy migrant effect can also be postulated, that is, physically and mentally healthy citizens seek migration.

In 2006, we compared a sizable representative sample of three groups as follows: those residing in the Eastern states of Germany, in the Western states of Germany, and those migrating from Eastern to Western Germany. We distinguished the following three cohorts: (a) born until 1945, the end of World War II, (b) and the decades between 1946 and 1967, as well as (c) and between 1968 and 1989, the fall of the wall between GDR and FRG.

We assessed anxiety and depression as the most common indicators of mental distress in the general population by the standardized self-report scales of the PHQ-2 for depression (14) and the Generalized Anxiety Scale Gad-7 (8). Additionally, we assessed resilience (15) and self-esteem (16) as mental health resources, along with life satisfaction (17).

The purpose of this article was to compare mental distress, resources, and life satisfaction (1) between residents of East and West Germany and migrants who have fled from East to West Germany before reunification and (2) between the three generations (born before 1945, 1946–1967, and 1968–1989).

As Figures 1A,B shows that depressive and anxiety symptoms were higher in women compared to men and in Eastern residents and in East to West migrants compared to Western residents. Additionally, more depressive symptoms were reported by the oldest (war) vs. the younger generations. As indicated by significant interactions in sex by generation, however, only the oldest women had increased scores compared to subsequent generations: (born before 1945: depression women M = 1.20; men 0.86, p < 0.001; anxiety women M = 3.32; men 2.58; p < 0.05).

Regarding resilience, as can be seen in Figure 1C, men reported slightly higher scores than women. The highest resilience was reported by Eastern compared to Western residents. East/West migrants had the lowest resilience. Across generations, resilience was lowest in the oldest compared to the two younger groups. As indicated by interactions, women in the oldest group reported the lowest resilience (p < 0.001), and women in the East/West migrants group also reported the lowest resilience (p < 0.05) compared to residents from the Western, respectively Eastern states.

Figure 1D shows that men and women did not differ regarding self-esteem. Lower self-esteem was reported by East–West migrants compared to Eastern and Western residents. As indicated by interaction (p < 0.05), the lowest self-esteem was reported by East and West migrants from the generation born from 1946 to 1967.

Figure 1E portrays that overall life satisfaction was not affected by gender. However, life satisfaction was higher in the Western population compared to those in the East and East/West migrants. Regarding generations, the oldest one reported the lowest overall life satisfaction compared to the middle and the youngest generations. Again, life satisfaction was lowest among women in the oldest generation (p < 0.001).

Table 2 shows the single dimensions of life satisfaction, according to gender, residency, and cohort. Women reported higher satisfaction with friendships, partnership, sexuality, and family life, whereas men were more satisfied with leisure time and health. Satisfaction with specific dimensions was highest in those residing in the Western states regarding income, friendships, leisure time activities, and housing. Interestingly, migrants from East to West Germany reported lower satisfaction with income, and housing and the lowest levels of satisfaction with family (compared to East and West). There was no difference regarding the partnership. Satisfaction with income was higher in women among Eastern residents but otherwise higher in men. Satisfaction with friendships was lowest in the oldest group and highest in the youngest group. Women in the youngest group were least satisfied. Regarding family life, the middle age group was most satisfied. While in the oldest group men were more satisfied, women were more satisfied in the younger groups. Men in the oldest groups had higher scores and women in the younger groups. Satisfaction with partnership and sexuality was lowest in the oldest group. As the interaction indicates, the lowest scores were found for women in the oldest and the highest for women in the youngest group. The lowest satisfaction was found in male migrants and the highest in male West Germans. Satisfaction with leisure time was highest in the youngest group, and the highest satisfaction was found in men in the West (interaction). Satisfaction with housing, work, and health was lowest in the youngest group. Men in the west were most satisfied with their profession (M = 3.61), whereas men and women in the East least (M = 3.07). Health satisfaction was highest in men from the West.

Our data show that mental health was strongly related to sex, residency, respectively migration, and generation. As in previous analyses, women reported higher distress (8) and lower resilience than men (18). They reported higher satisfaction with friendships, partnership, sexuality, and family life, whereas men were more satisfied with leisure time and health. Residents of the Western states reported the lowest burden of distress (depressive and anxiety symptoms) and the highest overall life satisfaction, exceeding both residents from the Eastern states and migrants from the Eastern to the Western states. Life satisfaction in residents of the Western states was highest regarding friendships, leisure time activities, income, and living conditions. Residents from the Eastern states reported the highest resilience. Migrants from the Eastern to the Western states, however, reported the lowest resilience and self-esteem. They reported lower satisfaction with income, living conditions (compared to the Western residents), and the lowest levels of satisfaction with family (compared to East and West).

Regarding generation, the highest depression scores were reported by the oldest generation who also reported the lowest resilience and overall life satisfaction compared to the two younger generations. Satisfaction with specific dimensions was highest in those residing in the Western states regarding income, friendships, leisure time activities, and housing. Interestingly, migrants reported lower satisfaction with income, and housing and the lowest levels of satisfaction with family (compared to East and West). There was no difference regarding the partnership.

Regarding age, satisfaction with friendships, partnership, sexuality, housing, profession, and health were lowest in the oldest group. Satisfaction with leisure time and health was highest in the youngest group.

Overall, our data point to inequalities between the Eastern and Western states regarding mental health 16 years after reunification favoring the residents of the Western states by lower distress and life satisfaction. Higher life satisfaction in the Western states extended to the majority of, but not all dimensions of quality of life: income, friendships, leisure time activities, health, work, and housing. No differences were found regarding family, partnership, and sexuality. These discrepancies may partly reflect the effects of the ongoing transformation of the Eastern states. A lower level of income (Table 1), high rates of unemployment, respectively premature pension decrease satisfaction with income and with work. Recently, we could show that wealth is predictive of life satisfaction (20). The still-increasing wealth gap clearly acts in favor of the wealthier inhabitants of the Western states.

Interactions of residency with gender reflect different living conditions of women and men in former FRG and GDR: Higher satisfaction with income in female Eastern (compared to Western) residents may reflect the fact that a gender pay gap favoring men was and still is a reality in Western, but not former Eastern Germany. Similarly, the high satisfaction with work in Western men compared to women and the comparatively low satisfaction in Eastern men and women may reflect both, the challenge of the transformation with subsequent job losses and shifts, and the male Western role of professional achievement.

Our data shed light on the understudied issue of migration from GDR to FRG. This is a special case of migration, as GDR and FRG were ruled by antagonistic political systems, but shared the language and cultural heritage. Following reunification, migration could be considered simply relocation within one country. Heightened distress in the group of East–West migrants can be considered a consequence of stresses in the premigration process (e.g., political incarceration), the migration process (e.g., mortal danger), and the postmigration (acculturation) process. Their comparatively low satisfaction with family life may also be a consequence of family disruption due to the flight. Lower satisfaction with income and living conditions compared to West German residents may indicate that these migrants see themselves as disadvantaged in West Germany. Consistent with the Interactive Acculturation Model (21), these findings attest to the stresses and adjustments associated with migration from the Eastern to the Western states before reunification. These may have eroded resilience.

A commonality in participants growing up in the GDR and FRG, respectively the migrants, was that mental health was also affected by generation. Those born until 1945, who had experienced the atrocities of World War II, reported worse mental health than the younger generations. Specific decrements in life satisfaction such as leisure time, partnership, or health may be due to the loss of functional capacities and social contacts due to bereavement. Loss of a partner may particularly affect women due to their longer life expectancy as reflected in the lowest rating of partnership and sexuality. As in previous studies, we found that the female gender was associated with more self-reported distress, in participants from Eastern and Western Germany and across generations. Gender effects were most prominent in the oldest generations, who have probably shared the most traditional gender roles in Germany.

“Both effects” considered the effects of socialization in the separated regions as well as the effect of transformation. Recently, we could show that there were subsequent shifts in reported mental distress between the former Eastern and Western states (22). We recently investigated internal migrants again. Their heightened mental distress compared to residents in the Eastern states underlines persistent acculturation stress even when voluntarily and freely moving from the Eastern to the Western states (23). Future studies should not only be limited to larger scale comparisons of regions as in our study but also attend to the significance of smaller scale regional differences (24).

The strengths of the study were the large sample size and the broad array of mental health indicators, including distress, resources, and life satisfaction. We excluded migrants born in other countries, as these were presumed to be a very heterogeneous group in the various migration waves since WWII (12).

We do not know when participants migrated from GDR to FRG, and we do not know their motives (e.g., if they were traumatized by previous incarceration and political persecution). While we had the unique chance to study generation, socialization, migration, and cohort effects on mental health, we are aware that over the past 16 years, mental health has shifted between Eastern and Western states, and there has been a historical change of aging processes and conceptions in midlife which was likely to also affect symptom reporting (25).

All analyses were carried out using SPSS (RRID:SCR_002865).

The raw data supporting the findings of this article will be made available by the corresponding author upon reasonable request.

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.

MB wrote the main manuscript text. AH edited the manuscript. LB prepared figures and tables. GS prepared the analyses. OD and EB supervised. All authors reviewed the manuscript. All authors contributed to the article and approved the submitted version.

This research was supported by the German Federal Ministry of Education and Research (Grant Number 01UJ1911AY).

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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