Sense of coherence as a pathway linking war trauma and post-migration stress to mental health functioning among refugees and asylum seekers in the Netherlands

INTRODUCTION: Refugees carry a cumulative burden of past trauma and ongoing post-migration stress, yet the mechanisms linking these to mental health functioning remain incompletely understood. Sense of coherence - a salutogenic orientation comprising comprehensibility, manageability, and meaningfulness - may help account for these associations. We tested sense of coherence as a mediator of both associations and compared the relative weight of the two stressor domains.

METHODS: A cross-sectional sample of 151 refugees and asylum seekers in the Netherlands (84.1% with a residence permit) completed the LEC-5, PMLP, SOC-13, and OQ-45.2 in person with research-assistant support across Dutch, English, and Arabic. We conducted multiple regression and three PROCESS Model 4 mediation analyses, including a parallel mediation with sense of coherence and post-migration stress as simultaneous mediators.

RESULTS: Both stressors predicted poorer functioning, with post-migration stress substantially stronger than trauma exposure (b = .40 vs. .17). Sense of coherence was the strongest correlate of functioning (r = -.57) and statistically mediated both cross-sectional associations. In the parallel mediation, sense of coherence and post-migration stress mediated the trauma-functioning association, and the direct effect was no longer statistically significant once both were included. Family-oriented stressors dominated the burden profile: worries about family in the country of origin (78.8%), missing family (73.5%), and uncertainty about the future (70.9%).

DISCUSSION: As a personal-resilience construct shaped by - not insulated from - external conditions, sense of coherence warrants sustained attention in this population.