Uncertainty for migrants arriving in Italy fuels mental health crisis: report

According to UNHCR data, Italy hosted over 105,000 forced migrants with refugee or asylum status in 2022. The majority of these migrants came from countries such as Nigeria, Pakistan, Afghanistan, Mali, Somalia and Gambia. These populations are particularly vulnerable due to the various pressures on the migration route and the difficult conditions in the countries of arrival.

“Our team has met many migrants who have arrived in Italy, each with their own unique migration story, but all share common struggles. In many cases, these challenges are incredibly serious and traumatic, often involving violence they experienced before arriving in Italy, particularly for those coming via the Mediterranean and Balkan routes,” shares Eleonora Prina, a psychiatric rehabilitation technician and post-doctoral researcher at the WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation at the University of Verona in Italy.

Prina recalls one particularly heartbreaking story: “I remember a young boy from Somalia who arrived with dreams of becoming a famous footballer. But upon his arrival in Italy, he was diagnosed with a heart condition that ended his chances of pursuing his dream. This didn’t just alter his migration plan—it deeply affected his relationship with his family as well.” 

While each story is different, they are all connected by a common theme: people arriving in Italy face profound instability and uncertainty about their future.

-Eleonora Prina, University of Verona

Migrants in Italy often suffer from symptoms such as anxiety, depression and psychological stress. Particularly worrying is the increased risk of developing post-traumatic stress disorder (PTSD) due to multiple traumatic experiences. In addition, male migrants occasionally exhibit psychotic episodes and an increased risk of substance abuse, often as a means of improving sleep quality.

Causes of distress among migrants and refugees

The mental distress of the migrant population in Italy can be attributed to several factors. Migrants arriving in Italy via the Central Mediterranean route are particularly vulnerable to conflict and interpersonal violence. This route, especially through Libya, is associated with extreme dangers that place a heavy burden on mental health. Added to this are experiences of racism and discrimination after arriving in Italy.

“We identified several challenges that migrants face during their journey, particularly when they take the Mediterranean route. This route often begins in West Africa and passes through Libya, a country where many migrants are subjected to human rights violations, including physical abuse and illegal detention, which increase their vulnerability. I would also add that, based on our discussions with the local organisation here in Verona that provides support to the migrant population, we know that those arriving in Italy via the Balkan route—coming overland through multiple borders—often experience pushbacks at the borders, sometimes involving the use of force. The main challenges we identified for migrants traveling along both of these routes are violence and addiction,” says Prina.

Another factor is the uncertainty regarding asylum status. Migrants with pending asylum applications are often exposed to prolonged psychological stress, which is worsened by the long wait for decisions and the difficulty of finding long-term employment.

"Once they arrive in Italy, the primary challenges shift. Migrants here often face poverty, socioeconomic difficulties, and an uncertain legal status, all of which complicate their ability to find stable housing. Additionally, a critical issue for those entering Italy via the [Mediterranian and Balkan] routes is that they often arrive without a visa, which leads them into a complex system of social control and identification. This legal process can create a dependency on judicial procedures that affect not only their current lives but also their future plans, resulting in ongoing uncertainty. Therefore, legal vulnerability often translates into social and economic vulnerability. When combined with any previous traumas, this has a significant impact on their mental health," Prina points out.

The social determinants of mental health, such as housing, economic opportunities and social integration, also play a crucial role in the development of mental disorders. These factors, along with pre- and post-flight stressors, significantly influence the mental health of refugees.

Groups in particularly vulnerable situations

Among migrants who have resettled in Italy, particularly vulnerable groups are those with low education and socio-economic challenges, especially without stable employment. Poverty contributes significantly to health inequalities between migrants and the general population.

ADVANCE reports three main groups that are considered particularly vulnerable: The first one are refugees from West Africa, particularly Nigeria, due to violence and discrimination on the refugee route and in Italy. The second group are asylum seekers with pending asylum applications who suffer from psychological stress due to long waiting times and difficulties in finding a job.  The third group are migrant women who have poorer health. They are more vulnerable due to ethnic discrimination, interpersonal and gender-based violence as well as irregularly working hours, heavy workloads and emotional stress.

It is essential to recognize that vulnerability affects the entire migrant population.

Although the former named challenges can be more acute for certain subgroups, it is essential to recognize that vulnerability affects the entire migrant population. “While these difficulties may seem particularly relevant to asylum seekers, [our society advisory group] emphasized that all migrants should be recognized as vulnerable. They found it difficult to prioritize one group over another, as all migrants face significant challenges, though in different ways," explains Prina.

Read this European-level policy guidance and priority actions to advocate for mental health with greater respect for human rights while tackling structural injustices.

Existing mental health promotion tools and challenges

Various interventions, such as ethnopsychiatric approaches and the WHO Self-Help+ program, have been successfully implemented to promote mental health. Although the understanding of the effectiveness of mental health promotion programs for migrants in Italy is still limited, the WHO SH+ program shows promising results in the prevention of mental disorders.

One of the primary focuses of the Italian team has been to adapt and improve the WHO Self-Help+ (SH+) program, and explore innovative approaches tailored to the unique needs of migrants in Italy. “While the SH + intervention demonstrated effectiveness as preventive measure by reducing symptom of mental disorder, there is a clear need for further research in this area, including economic analysis as well,” explains Prina.

“With the ADVANCE project, we aim to test two distinct WHO intervention strategies—SH+, a face-to-face group intervention, and DWM, an online intervention. Our aim is to include the entire migrant population, similar to our approach in the RESPOND project, with a particular emphasis on migrants who speak Italian or English. To that end, we are adapting SH+ to better fit the Italian context, and this is something new.”

But that’s not all the project aims to achieve. There is evidence from the RE-DEFINE project – a previous EU project that is now integrated within the ADVANCE framework – that proves the effectiveness of SH+ in preventing the onset of common mental health conditions after using it. However, this effect does not persist beyond six months.

“In response to this, the ADVANCE project will incorporate booster sessions to help sustain the preventive effect over time, including during follow-up assessments. To achieve this, we are collaborating with WHO to develop individual booster sessions for both SH+ and DWM, facilitated by trained helpers. An additional contribution of the project is comparing two different delivery modalities—SH+ delivered face-to-face in a group setting, and DWM delivered individually in a digital format. This approach has never been explored,” ends Prina.

Contact

Eleonora Prina
Researcher, University of Verona
eleonora.prina@univr.it

Sarah Müller
Science Communication Intern, University of Copenhagen
Master student, University of Mannheim

Joyce Anne Quinto
Project and Communications Manager
joyce.quinto@sund.ku.dk

The ADVANCE project has received funding from the EU Horizon Programme under Grant Agreement No. 101080323. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the Health and Digital Executive Agency. Neither the European Union nor the granting authority can be held responsible for them.