Introduction

In the previous chapter, we showed the hazardous and perilous encounters of African migrants as they journey to Europe through the Sahara Desert, conflict-laden Libya and the dangerous Mediterranean Sea together with difficulties experienced upon arrival in Europe. In spite of the fatalities associated with these journeys, it is noteworthy that there is a scarcity of empirical studies examining the impact of migration stressors on mental health and PTSD of African migrants who have successfully arrived in Europe. Most research carried out in this area chiefly concentrates on refugees and asylum seekers from the war-torn Syria, Iraq, Afghanistan and other Middle East countries, while neglecting migrants from Africa especially those of sub-Saharan origin. To the best of our knowledge, the only available evidence in the literature is the study of Pannetier, Lert, Jauffret Roustide, and du Loûa (2017) that examined the role of migration paths and transnational ties on mental health (measured in terms of anxiety and depression) of sub-Saharan African migrants in France. In expanding existing knowledge, we examined the impact of pre- and post-migration stressors on mental health and PTSD of African migrants in five EU countries (Germany, France, Italy, Spain, and the Netherlands) plus the UK. In addition, our methodology was not only quantitative, we also included qualitative research tools to holistically understand the migration experience.

Quantitative analysis was performed on migrants’ data within and across the six countries. The same procedure was followed in the qualitative analysis with the goal of identifying push-and-pull factors of migration, pre-mid-and-post experience of migrants in specific European countries, intentions to return to home country, coping mechanisms and recommendations provided by migrants on ways to improve their conditions in Europe. The present chapter contextualizes and discusses the results emanating from both the quantitative and the qualitative analyses.

Pre-migration Stressors, Mental Health and PTSD

Generally, all six European countries taken together, our findings show that pre-migration stressors are predictive of both mental health and PTSD of migrants. However, the influence of these stressors is weak on mental health compared to PTSD. This pattern shows relative variations when results are compared among migrants in the different European countries. For example, in France and UK, we found that pre-migration stressors do not impact either PTSD and/or mental health problems. In Germany, the Netherlands, and Spain, pre-migration stressors were predictive of PTSD only. Collectively, findings confirmed previous results (Pannetier, Lert, Jauffret Roustide, & du Loûa, 2017; Le et al., 2018; Schubert, Punamäki, Suvisaari, Koponen, & Castaneda, 2019), suggesting the impact of pre-migration trauma history and stressors on PTSD and mental health problems among sub-Saharan Africans in France. But why do pre-migration stressors have no significant impact on migrants in France and the UK in the current study? Possibly, the effect of pre-migration stressors on migrants have waned over time due to better integration pathways (such as common official languages, business relations, existing social networks, cultural attachments) existing in these countries given their deep post-colonial ties with sub-Sahara African countries (Giménez-Gómez, Walle, & Zergawu, 2017). Alternatively, the zero impact of pre-migration stressors may indicate that majority of African migrants sampled in UK and France predominantly sought a furthering of their education, who did not experience major pre-migration difficulties. Invariably, the relative relief from difficulties experienced in home countries and during transit may have suppressed the impact of earlier-life stressors and a trauma history on mental health problems.

Post-migration Stressors, Status of Migrants, Mental Health and PTSD

In contrast to the relatively small influence of pre-migration stress on migrants’ mental health, we found an alarmingly strong impact of post-migration stressors on mental health problems among migrants across all six European countries under scrutiny with a more profound impact in France, Italy, and Spain. Qualitative findings showed that migrants undergo a whole lot of challenges in destination countries in Europe ranging from irregular status, rigorous documentation processes, unemployment/underemployment, inadequate camp accommodation, high cost of housing, discrimination, abuse of rights to racism, disdain, and being perceived as criminals and given suspicious looks by natives. One astonishing pattern in qualitative findings is that, migrants in France, Italy, and Spain (where high impact of post-migration stressors was found) reported more racism problems. This may imply that continual presence of racist behaviors in some—if not all—included European countries may be germane to mental health difficulties experienced by African migrants. Racism behaviors are displayed by natives when it comes to employment of African migrants. Apart from the fact that degree certificates obtained in home countries are not recognized for employment, migrants who are lucky to get an employment are employed in low status jobs (Jaspars & Buchanan-Smith, 2018; Martin et al., 2016). In addition, migrants who work as attendants may not be patronized because whites prefer to patronize fellow whites.

In the qualitative study, migrants reported that sub-Saharan Africans are targets of discriminatory attitudes and behaviors in Europe. The persistent nature of prejudice and discrimination in Europe hinders migrants’ integration and adaptation in host communities (de Freitas et al., 2018; European Commission, 2011). Asides racism and discrimination, language is another major post-migration factor serving as impediment to integration and positive mental health of migrants in all included European countries. For example, buying groceries is accompanied with difficulty as migrants needed to spend a lot of time on Google translation before going to the supermarkets. Even in a country like France where language should not be a barrier for African migrants from Francophone countries, it is often also required for migrants to be proficient in the use English language before they can get employment. Collectively, these outcomes provide support for past studies suggesting the negative influence of post-migration living difficulties on mental health of refugees and migrants from Africa and other mixed nationalities (Pannetier, Lert, Jauffret Roustide, & du Loûa, 2017; Schick et al., 2018).

In addition, an examination of further specific stressors at post-migration showed that post-migration sexual abuse predicted mental health problems among migrants in France, Italy and Spain. Post-migration sexual abuse may stem from sexual traffickers and networks forcing vulnerable migrants into sex work in many European countries (Marsicanoa, Lydie, & Bajos, 2013). For example, in France qualitative results confirm that human trafficking still persists among African migrants where (mostly) female migrants are coerced into prostitution and used as sex slaves until they are able to refund traveling expenses incurred (by traffickers) in bringing them to Europe.

Further, feelings of threat in the post-migration phase were found to associate with mental health problems among migrants in Germany, France, Italy, and Netherland. The threat of being deported to home country may also contribute to poor mental health in terms of anxiety and depression. African migrants whose asylum application is denied or who are still carrying expired refugee papers are in constant fear of police arrest and subsequent deportation (Pannetier, Lert, Jauffret Roustide, & du Loûa, 2017). This is because the salience of the skin color of sub-Saharan Africans in Europe makes them more vulnerable to police checks compared to migrants from other racial groups.Footnote 1

Results also demonstrate that post-migration stressors predict PTSD but in a reversed direction. We found increased stressors predicting lower PTSD levels, but much higher levels of general mental health problems. This suggests that post-migration stressors do not induce PTSD, nor do they seem to worsen existing posttraumatic stress and symptoms. The direction of this result can be acknowledged as logical, given that post-migration stressors are not traumatic, violent or war-related, whereas at the same time they are present permanently and they are numerous. Our result is consistent with the study of Laban et al. (2004), where post-migration difficulties associated with prolonged asylum procedures accelerated mental health problems such as anxiety and depression but not PTSD levels among Iraqi asylum seekers in the Netherlands.

As a post-migration issue, the legal status of African migrants was also found to predict both adverse mental health and PTSD across the European countries under scrutiny. Specifically, being an unauthorized migrant was found to predict mental health problems and PTSD albeit at a marginal level. However, when results are considered from the different European countries, it is realized that status of migrants was only generally associated with mental health problems and not PTSD. It is noteworthy that the association between migrant status and mental health problems were stronger for migrants in Germany and the Netherlands. For instance, results obtained from qualitative analyses confirm that it takes longer years for status of migrants to be determined in these two countries. In Netherlands, migrants may remain in a camp for 7–8 years, while being exposed to poor health facilities and vulnerability to suicidal thought and trauma. Even when a resident permit is granted in a country like Germany, the permit is found to be restrictive, sometimes even despite being married to a native. This result supports Pannetier, Lert, Jauffret Roustide, and du Loûa’s (2017) study where irregular or illegal status is associated with poor mental health among sub-Saharan African migrants. It further supports the proposition that treating undocumented immigrants as unwanted people constituting a social menace has far reaching implications on their health outcomes (Viruell-Fuentes, Miranda, & Abdulrahim, 2012; Castañeda et al., 2015). Generally, undocumented migrants are expected to have poor mental health since they may not be able get legal employment, welfare assistance from the government for daily sustenance and access to professional health-care (Pavli & Maltezou, 2017; Plambech, 2017).

Coping Among Migrants

Overall, we found that African migrants across the six European countries predominantly adopt behavioral disengagement coping in dealing with migration stressors. One may first ask, what is meant when we speak of a coping strategy ‘behavioral disengagement.’ According to the Encyclopedia of Behavioral Medicine, a synonym of ‘behavioral disengagement’ is ‘seeking distraction’ (Gellman & Turner, 2013). Our quantitative study shows that migrants in France and the UK demonstrated similar pattern in the use of behavioral disengagement. As noted in qualitative findings, the use of behavioral disengagement in France may be an aftermath of frustration in response to difficulties and delay in documentation process, underemployment and human trafficking persisting among African migrants in the country. Qualitative findings further show that migrants in France and the UK may also resort into using religious coping. It may be implied that once migrants become frustrated and disengaged from dealing with the stressors, they find solace in religion and count on God for sustenance. This may, at the same time, not be a very productive coping strategy in a largely secular environment and may push the migrant into a lifestyle that once again makes them different from the mainstream of the receiving country.

The general finding that African migrants make use of behavioral disengagement coping may indicate that they have rescinded into learnt helplessness and gave up dealing with the rigorous and rigid documentation process involved in attaining legal status in European countries. Perhaps they believe survival is dependent on their willingness to give up on conditions of racism and discrimination in Europe since there is little they can do being in foreign lands. The use of behavioral disengagement which is a maladaptive strategy of coping with stress may well provide an understanding of why there is a strong influence of post-migration stressors on mental help problems as found in results of quantitative analysis.

Apart from France and the UK, other countries where migrants utilize behavioral disengagement but in combination with other coping strategies include Germany and Spain. For example, migrants in Germany also cope with stressors by using active coping, instrumental support, positive reframing, planning and religious coping. These methods of coping were confirmed in our qualitative findings where migrants in Germany reported plans on how to improve on educational status, actively secure legal status by employing the services of lawyers, seeking help of political party members and getting advice from “good” Germans during religious services. In Spain, there is also the use of denial, substance use, emotional support and active coping in adjusting to racism, discriminatory attitudes, documentation problems and unemployment.

Like in Germany, African migrants in the Netherlands make use of a combination of active coping and planning in dealing with migration stressors. This is reflected in qualitative findings where migrants report acts of resilience, avoidance of trouble, showing self-discipline and self-respect. The use of these adaptive coping traits may explain why the influence of post-migration stressors were found to be comparatively lower in the Netherlands given the use of adaptive coping methods. However, results from qualitative analysis seem to suggest migrants in Netherlands may also abuse drugs and sleeping pills to overcome stressors.

Migrants in Italy predominantly utilize self-blame and planning to a lower degree. In addition, migrants may also use substance to cope with stressors. Further, there is a certain pattern of coping in one or the other European country. Migrants in countries like France, Spain and Italy, where post-migration stressors were found to be highly associated with mental health problems tend to adopt more of maladaptive coping which include behavioral disengagement, substance use, self-blame, and denial.

The general finding that African migrants use behavioral disengagement as coping strategies contradict the findings of studies that have used the COPE instrument. For example, Rwandan migrants in Belgium and Finland have been reported to employ instrumental support and substance use respectively (Banyanga, Björkqvist, Akademi, & Österman, 2018). Among Latino immigrants, Vaughn and Roesch (2003) reported the use planning, religion, active coping, positive reinterpretation, emotional venting, and emotional support. This suggests that African migrants in the six European countries investigated may have difficulties in responding positively to the post-migration stressors experienced in Europe. The general use of behavioral disengagement may have far reaching consequences on their ability cope and on integrated into host communities. However, the use of religious coping, planning, positive reframing and substance use among migrants in some specific countries tend to support findings of previous studies (e.g. Bloch, Sigona, & Zetter, 2009; Bortel, Martin, Anjara, & Nellums, 2019).

Culture Shock?

Findings on value preferences of African migrants to six European countries paint a mixed picture. The most surprising result of our study is that self-direction values are the most cherished value preferences among the studied migrants. This finding seems to support the ‘healthy migrant’ hypothesis. Fellow African stay-puts (folks ‘back home’) prefer such values much less than the migrants studied here. Self-direction values rank 6th (out of ten) on the African continent as evidenced by data from the World Values Survey. Globally, such values rank 2nd. So, African migrants, in this respect even surpass ‘global citizens.’ This finding clearly speaks against the culture shock hypothesis.

The second important finding pertains to tradition values, which predominantly are religious values. ‘Back home’ tradition values are highly cherished (Rank 3 after ‘security’ and ‘conformity’). In the receiving countries tradition values are not held in high regard; typically, they rank 9th out of ten value types. Tradition preferences of African migrants signal that here there may indeed be a major source of culture shock. Among them tradition values rank 6th, meaning preference levels are ‘half way’ between ‘back home’ and what is common in the receiving countries. Migrants who cherish tradition values particularly strongly may indeed encounter difficulties in secular Europe.

A third finding of the assessment of value preferences among African migrants was that value preferences are after all significantly—but far from strongly—related to the experience of post-migration stress and general mental health problem: Cherishing ‘power,’ ‘achievement,’ ‘hedonism,’ and ‘stimulation’ values does not lay the ground for a healthy life style. Values of elbowing one’s way through and seeking pleasure endanger migrants’ mental health and increases the experience of post-migration stress.

One may indeed be entitled to speculate that African migrants are on the one hand well prepared for the European cultural context from a values perspective in that they are prone to seek out their own way (self-direction). At the same time, the—for the migrants—shockingly secular everyday life in Europe is likely to pose hazards to their well-being, because they are surrounded by people who largely disregard traditional values of honoring elders or being devout and humble. This issue clearly needs further attention.

Conclusions

The main conclusion of this study is that both pre- and post-migration stressors influence mental health and PSTD of African migrants in Germany, France, Italy, Netherlands, and the UK. Pre-migration stress exhibits less of an impact than post-migration stress and—if at all—it manifests itself in higher PTSD scores more than in greater general mental health deficits.

Post-migration stressors have a more profound impact on mental health of African migrants compared to pre-migration stressors. They strongly affect the general mental health status of African migrants negatively, while sometimes even being a buffer against PTSD. It seems to be like jumping from the frying pan into the fire, or as one would say in German, der Teufel wird mit Beelzebub ausgetrieben, the devil seems to be exorcized by Beelzebub (another personification of the devil): Post-migration stress seemingly increases anxiety and depression, while reducing the experience of trauma. One is enticed to ask whether PTSD is simply displaced by post-migration stress.

Sources of post-migration stress include irregular status, rigorous and prolonged documentation processes, abuse of rights, unemployment/underemployment, inadequate camp accommodation, family separation, language barrier, high cost of housing, discrimination, racism, disdain, being perceived as criminals and given suspicious looks by natives. Only for very few of these stressors do migrants have remedies at hand, actually, the only one of the enumerated stressors reduceable by the migrants themselves is the language barrier: Quite bleak a prospect, indeed.

African migrants predominantly use a behavioral disengagement method to cope with migration challenges. However, there are variations in specific countries. Similar to general findings, migrants in France and the UK largely utilize behavioral disengagement. Migrants in Netherlands and Germany use a combination of active coping, planning and behavioral disengagement (Germany in particular). While migrants in Italy make use of self-blame and planning, those in Spain employ a combination of emotional support, substance use, behavioral disengagement and denial.

Culture shock does not seem to be the primary a primary source of ill-being among African migrants in Europe. Only the degree of secularism in European societies may appear strange and challenging to someone brought up in Africa, but then, at the same time, African migrants are not prototypical Africans with regard to their values preferences. Other than is the case for Africans ‘back home,’ African who have landed in Europe have a strong preference for doing things ‘their own way,’ clearly an individualist value highly compatible with what Europeans cherish.