Relationship between traumatic events, somatization, psychological distress, and quality of life in female refugees in Germany.

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.