Results from the VIOLIN study: verbal violence against voluntary migrants and refugees in German public institutions, discrimination and their association with mental health—an online-cross-sectional study

Theoretical background
Verbal violence and discrimination are psychological stressors for migrants and increase the likelihood of mental illness. This cross-sectional online survey examined the frequency of occurrences of institutional verbal violence (IVV) and discrimination reported by voluntary migrants and refugees in Germany, as well as their association with mental health.

Methods
Adult voluntary migrants and refugees in Germany were recruited for the online survey using snowball and community-based sampling. Measurement instruments included the Everyday Discrimination Scale (EDS), the Patient Health Questionnaire 2 (PHQ-2), the Generalized Anxiety Disorder Scale 2 (GAD-2), and the self-developed 24-item IVV Questionnaire. Voluntary migrants were compared to refugees and women to men. T-tests for independent samples and multiple linear regression analyses were calculated.

Results
The data of 137 refugees and 388 voluntary migrants in Germany were evaluated. Since living in Germany, migrants experienced IVV most frequently in public transport (53%), immigration offices (53%), medical practices (48%), hospitals (41%), and city council/district offices (38%). Female voluntary migrants experienced IVV significantly more frequently than male voluntary migrants (p = 0.018). There were no significant differences between refugees and voluntary migrants (p = 0.50), nor gender differences among refugees (p = 0.69) in their experiences of IVV. Experiences of discrimination were less than once a year per person. Refugees showed significantly more symptoms of clinical depression than voluntary migrants (p < 0.001), but the frequency of symptoms of generalized anxiety were comparable in both groups (p = 0.08). Being a refugee (β=-0.12; p = 0.02), low life satisfaction (β=-0.26; p < 0.001), frequent experiences of IVV (β = 0.15; p = 0.002) and discrimination (β = 0.23; p < 0.001) showed significant association with increased symptoms of depression. Significant predictors for elevated symptoms of generalized anxiety were low life satisfaction (β=-0.24; p < 0.001), experiences of IVV (β = 0.24; p < 0.001) and discrimination (β = 0.26; p < 0.001), as well as a low sense of belonging to the country of origin (β=-0.09; p = 0.03).

Conclusion
The results show the need for additional action to reduce IVV against migrants and refugees, especially in the identified public institutions focusing on immigration offices, health care institutions and city councils/district offices. Training and supervision could be set up for the employees of these institutions as IVV has a negative impact on mental health.