Review Article

Exploring mental health patterns of African international university students in Germany: A review

Introduction

Research suggests that immigrant students often show similar or even higher levels of psychological adjustment than their native peers, particularly regarding life satisfaction and self-esteem.^1,2 However, one key factor influencing their sociocultural and psychological adjustment is cultural identity, which refers to a person’s sense of belonging to specific cultural groups and the emotions tied to these memberships.³ Cultural identity is a multifaceted concept involving elements like self-categorization, affiliation, commitment to ethnic groups, identity exploration, and the perceived importance of group participation. Among these, attachment and commitment to cultural identity are significant.⁴

The benefits of identity integration, however, are only sometimes agreed upon. Some studies, such as those by Nguyen and Benet-Martínez, argue that it supports sociocultural and psychological adaptation.⁵ Other research has shown mixed results, suggesting that the effectiveness of identity integration may depend on factors like the outcome being measured, the specific immigrant group, or the diversity of the mainstream environment.^6-8 These variations could explain the inconsistent findings across studies, as noted by Birman and Simon.⁹

Higher education is becoming increasingly globalized, leading to many international students attending German institutions, including many from Africa. Understanding the factors that help these students and their families, particularly those from Africa, adjust to their new environment is a critical scientific and societal issue, especially as the global immigrant population continues to rise. Despite the growing presence of immigrant students, more research is needed to explore how they adapt to their new surroundings.⁶

While a substantial body of research has examined the mental health challenges immigrant students in Germany face, few studies focus specifically on the experiences of African immigrant students. Their struggles and experiences are often overlooked and understudied despite their significant presence. This study aims to address these gaps by focusing on the mental health challenges African international students face in Germany. This review explores their adaptation difficulties and the availability of support services to inform targeted interventions and policies to improve their well-being.

A key issue impacting the mental health of African immigrant students is the stigma surrounding explicit racism in Germany. This stigma makes it difficult to recognize and address racism as a significant factor affecting their well-being, leading to underreporting and a lack of awareness about its profound psychological impact. Addressing racism is crucial to fully understanding the mental health patterns of this population.¹⁰

Racism based on skin color and ethnic origin is widespread in Germany, as highlighted in recent reports like the Afrozensus 2020,¹⁰ and studies by Ball et al.¹¹ Such discrimination can have profound effects on African immigrant students, often resulting in chronic stress, anxiety, and other mental health challenges. Recognizing and addressing these issues is essential for developing effective mental health interventions tailored to this group.

Methods

Study design

This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure transparency and thoroughness in identifying, selecting, and analyzing studies. The review aimed to explore the mental health challenges of African international university students in Germany, focusing on their adaptation difficulties and access to culturally sensitive mental health services.

Search strategy

A comprehensive literature search was performed using PubMed and Google Scholar. The following search terms were employed: “mental health,” “stress,” “anxiety,” “depression,” “African international students,” and “Germany.” Boolean operators were applied to refine the search, ensuring the retrieval of all relevant studies. Only peer-reviewed articles that focused on African international students in Germany were included. Studies not related to African students or conducted outside Germany were excluded.

Study selection

The study selection process involved three stages: Title and abstract screening: Two independent reviewers screened titles and abstracts to identify potentially relevant articles. Articles that did not meet the inclusion criteria were excluded at this stage.

Full-text review: Full-text versions of studies that passed the initial screening were retrieved and reviewed. Both reviewers independently evaluated the studies against the inclusion criteria, which focused on mental health outcomes in African international students in Germany. Any discrepancies in study selection were resolved through discussion, and if necessary, a third reviewer was consulted to reach a consensus.

Final inclusion: Only studies that met all the inclusion criteria after full-text review were included in the final analysis.

Data extraction and analysis

Data were extracted from the included studies, focusing on key areas such as mental health challenges (anxiety, depression, stress), cultural adaptation issues, and access to mental health services. The review highlighted a significant gap in the literature, with only one study fully meeting the inclusion criteria, indicating the need for more focused research on this population (Figure 1).

Close

Figure 1.

Prisma flow diagram

Figure 1.

Prisma flow diagram

Results

Mental health outcomes

In comparison to their counterparts from other areas, African international students in Germany experience noticeably more significant levels of stress, anxiety, and other mental health conditions. These students’ higher anxiety is mainly ascribed to their encounters with racism and cultural remoteness. Due to their culturally different backgrounds, African students frequently find it challenging to fit in with Germany’s social and academic standards. The absence of support systems exacerbates this transition challenge and can result in feelings of loneliness, increased stress, and, in certain situations, depression. Although these problems are acknowledged, there is a dearth of thorough research that focuses on the mental health of African students, which restricts the number of treatments that can be created to address their unique requirements.

Cultural and social factors

Cultural distance, or the difference between African students’ home cultures and the host culture in Germany, has been identified as a significant determinant of mental health outcomes. It is more challenging for students to socially and intellectually adjust to their new surroundings when there is a broader cultural gap. Explicit and implicit racism, which many African students frequently encounter, makes this challenge much more difficult. In Germany, prejudice based on skin color and ethnic background is widespread, according to reports like the Afrozensus 2020.¹⁰ Due to social isolation and prejudice, African students experience prolonged stress, which exacerbates their mental health issues. Furthermore, it is challenging for these students to publicly discuss these issues or find suitable support networks in Germany due to the shame associated with racism. Their plight is exacerbated by the lack of knowledge and candid conversation about the psychological effects of racism, which frequently results in underreporting of mental health issues.¹²

Access to mental health services

Accessing mental health care can be challenging for African international students, even if there is an apparent demand for such support. Germany lacks culturally competent care, and these therapies are frequently not customized to fit their specific cultural demands. Due to a lack of knowledge about available services, mistrust of the healthcare system, or a perception of cultural insensitivity from healthcare professionals, many African students choose not to seek professional assistance. Since many students do not feel comfortable expressing their psychological struggles in a foreign language, the language barrier also significantly hinders students’ ability to utilize mental health facilities properly. Furthermore, the unique racism and prejudice issues that African students face could not be sufficiently addressed by mental health providers. African foreign students continue to be marginalized because of the dearth of culturally competent assistance, which also hinders their capacity to manage mental health concerns.

Discussion

Cultural background, challenges, and mental health issues

The mental health of university students is influenced by several factors, including their cultural background.¹³ Depression and anxiety are the two most common mental health issues faced by college students globally, with up to 35% of cases among university students attributed to these conditions.¹⁴ Despite a significant body of literature on immigration and mental health, research specifically focused on the mental health of immigrant students remains limited despite their growing numbers in higher education worldwide. For instance, during the 2019–2020 academic year, the U.S. hosted over 1 million international students, according to the Institute of International Education (IIE).¹⁵ UNESCO reported that over 6 million students were enrolled in higher education abroad in 2019.¹⁶

Immigrant students face challenges such as financial difficulties, unemployment, and a lack of social support, all of which can negatively impact their mental health. In addition to these everyday immigrant experiences, international students also face unique challenges related to adjusting to a new language, educational system, and culture, which further increases their vulnerability to mental health problems.¹⁷ These challenges affect their personal, academic, economic, and sociocultural lives.¹⁸

The primary obstacles international students face include: language barrier, racism, discrimination, culture shock, and difficulty forming social networks.¹⁸ Culture shock, in particular, can lead to issues such as eating disorders, sleep disturbances, loneliness, and acculturation stress. Building a social network with local peers is crucial for international students to help them integrate into the host culture and maintain motivation.^17,19,20 Additionally, international students often struggle to understand their instructors’ expectations, adapt to new teaching methods, and use unfamiliar technology and evaluation systems.¹⁸

Prejudice and racism exacerbate these mental health challenges. For example, in Canada, 29% of international students report experiencing discrimination based on culture or religion, and 25% report discrimination based on race.¹⁸ Administrative difficulties further contribute to the mental health challenges international students face. Unlike permanent residents, they are ineligible for government-funded integration support.¹⁸ Moreover, they often pay significantly higher tuition fees—sometimes three times more than local students—which creates financial stress that can lead to anxiety and other mental health conditions.¹³

In addition to financial strain, international students are under pressure to excel in demanding academic programs while meeting study visa requirements. Cultural barriers may prevent some students from discussing their mental health concerns, and unfamiliarity with the local healthcare system can hinder access to necessary support.^21,22

Another critical issue is the lack of discourse and vocabulary around racism, often driven by political considerations and the absence of racial statistics in some countries. This hampers practical discussions about racial discrimination and its impact on mental health. For instance, second and third-generation Germans of African descent frequently experience racial discrimination, but they often lack the language to articulate their experiences adequately. The absence of widely accepted terms, such as “Black,” complicates efforts to address their mental health needs, which are further compounded by racial trauma.²³

Psychological adaptation and cultural identity

Psychological adaptation is essential for fostering resilience, physical health, and future professional success, as identified by Ward et al.^24,25 For teenagers, cultural identity, particularly ethnic identity, plays a crucial role in promoting psychological adaptation. According to Tajfel and Turner’s social identity theory, a strong sense of self-esteem is positively linked to identifying with one’s in-group, the group one considers their own.²⁶ Favorable comparisons between in-groups and out-groups contribute to a positive social identity and enhance self-esteem. Phinney highlighted ethnicity as a critical factor in defining social group membership.²⁷

Immigrants often perceive ethnic and mainstream groups as in-groups, viewing them as sources of significance. However, as Jasinskaja-Lahti et al note, immigrants may experience rejection and difficulties within mainstream society, diminishing their sense of affiliation with its members.²⁸ While most studies show a positive correlation between psychological adaptation and ethnic identity,^29,30 some research suggests that ethnic identification can negatively affect adaptation in specific contexts.³¹ Still, ethnic identity tends to be more significant for the psychological adjustment of immigrant students than mainstream identification.

Acculturation research has extensively explored the relationship between ethnic identity and psychological adaptation, generally finding that positive emotions tied to ethnic group membership contribute to better psychological well-being.^32,33 In contrast, fewer studies have examined the link between psychological adaptation and mainstream identification, with mixed results. Some studies show a positive association,^33,34 while others find no impact of mainstream identity on psychological adaptation.^35,36

Most of this research, however, has been conducted in the U.S., where diversity-oriented policies are more common. In more assimilative environments like Germany, studies have shown no significant connection between mainstream identification and psychological adaptation.^35,36 These studies, which focused on Turkish immigrant teenagers, may only partially apply to African immigrant populations.

For African immigrant students and “Black” Germans of African descent, systemic racism and discrimination pose significant challenges to fully integrating into German society. Despite efforts to assimilate, these individuals often face exclusion from White German communities due to their skin color and ethnicity, leading to feelings of marginalization and alienation. This lack of acceptance as fully integrated members of society complicates their psychological adaptation, contributing to mental health issues such as anxiety and depression.^10,11

Acculturation and academic adaptation

Educational research on the relationship between acculturation orientations and school-related outcomes is critical, especially given many international students’ academic challenges. According to Searle and Ward, an immigrant student’s adaptation to school is an example of sociocultural adaptation, as it involves the skills necessary for navigating daily life in a new environment.³⁷

Research in educational science has often focused on how acculturation influences school adaptation. Berry et al, for example, examined the relationship between acculturation patterns and school-related sociocultural adaptation among immigrant students. They found that integration, which combines aspects of national and ethnic cultures, was beneficial for reducing behavioral problems and improving school adjustment among immigrant adolescents.¹ Structural equation modeling further supported the link between integration and successful sociocultural adaptation, showing that ethnic orientation positively influenced adaptation. In contrast, national orientation, or assimilation, did not have a more substantial impact than ethnic identification.³⁸

Schachner et al used PISA data from six European countries to investigate the indirect effects of immigrant adolescents’ acculturation orientations on school adjustment through a sense of school belonging. Their findings indicated that a mainstream orientation was often positively correlated with educational outcomes, while an ethnic orientation was advantageous only in multicultural nations like Finland or Belgium.³⁹

Makarova and Birman compiled research on acculturation and academic success in school settings, with a particular focus on minority students. Most studies conducted in the U.S. demonstrated that while assimilation sometimes benefited academic progress, integration was generally the most effective strategy for positive school-related outcomes.⁴⁰

In Germany, studies on the connection between acculturation and academic adaptation have produced mixed results. Edele et al analyzed PISA 2009 data and found that ninth-grade immigrant students’ reading proficiency correlated positively with assimilation and integration. In this case, assimilation was just as beneficial as integration.⁴¹ Schotte et al used data from the German National Educational Panel Study (NEPS) and found varying associations between immigrant students’ academic achievement in math and German, depending on their mainstream and ethnic identification. Their data largely refuted the integration theory, suggesting that acculturation trends vary across ethnic groups and academic outcomes.⁶

Further studies using NEPS data explored how different acculturation profiles relate to the development of immigrant students’ reading ability and overall academic success in secondary school.^42,43 These studies consistently found that assimilated immigrant students often performed as well as or better than native students academically. In the German context, integration and assimilation were shown to be equally adaptable strategies within the educational system.

However, a strong emphasis on either the host culture or the culture of origin can have negative consequences, particularly in discriminatory educational settings. An orientation toward the culture of origin is often linked to disadvantages within the school system.³⁸

Access to mental health services for immigrant students

Dombou et al reviewed the factors influencing immigrant students’ use of mental health services in the US, UK, Canada, China, and Australia. Compared to native students, immigrant students access these services less frequently, often turning to informal support networks such as friends, family, or religious leaders instead. They typically seek professional help only when their issues escalate, with counselling services—frequently offered at their schools—being the most used resource. These services expose them to psychotherapy and other mental health treatments.^18,21

Barriers to access

A significant barrier for African immigrant students in Germany is the lack of a clear framework for discussing their experiences, particularly around racial trauma. This hinders the development of culturally competent care. Without a well-defined understanding of these experiences, mental health professionals may struggle to provide effective treatment, underscoring the need for culturally tailored psychiatric care.^18,44

Barriers to mental health services for immigrant students

Cultural and social factors

Immigrant students may experience cultural pressures and stigma that discourage help-seeking behavior. For example, some Asian students fear being judged negatively for seeking mental health care due to cultural taboos. Men, in particular, face pressure to manage issues independently, further deterring them from seeking help. Distrust in mental health services in host countries also contributes to lower utilization rates.²²

Cultural competency

A perceived lack of cultural understanding by mental health providers can lead to miscommunication and dissatisfaction with services. Rogers-Sirin et al found that cultural competence significantly influences immigrant students’ views on treatment, which may result in their avoiding further consultations.^18,45

Knowledge and language barriers

Immigrant students often lack knowledge about mental health services or the host country’s healthcare system. Limited mental health literacy and language barriers can prevent them from accessing appropriate care.^18,46

Practical and structural obstacles

Logistical challenges such as long wait times, high costs, and concerns about confidentiality further deter students from seeking mental health support. For many immigrant students, unfamiliarity with mental health issues in their home country exacerbates these challenges.^18,47

Social and relational factors

Relationships with their cultural community or host country can also affect students’ help-seeking behaviors. Research shows that students who value collectivism are less likely to seek services, mainly when community members are present. Additionally, strong relationships with advisors or counsellors can reduce emotional stress, making professional help less necessary.^18,22

Facilitators for access

Several factors facilitate immigrant students’ use of mental health services:

Attitudinal factors

Women are generally more open to seeking mental health support. Confidence in mental health professionals and services also plays a role in encouraging students to seek help. A positive attitude toward mental health services, influenced by home and host cultures, can improve access.^18,48

Cultural factors

Acculturation, or the process of adapting to a new culture, often makes immigrant students more open to seeking mental health services. Students who have successfully adjusted to their host country’s culture are more likely to accept mental health treatment and trust healthcare providers.^18,49,50

Knowledge and language skills

Familiarity with mental health issues and higher mental health literacy are strong enablers. Additionally, fluency in the host country’s language improves communication and confidence, allowing students to seek and utilize mental health resources effectively.^18,51,52

Practical experience

Previous positive experiences with mental health services can encourage students to seek further assistance. Confidence in the privacy and confidentiality of counseling services also supports continued use.^18,53

Social and relational factors

Conflicts with academic advisors or counselors can prompt students to seek mental health support. Strong social support networks enable immigrant students to share their struggles and ask for help. At the same time, paradoxically, issues such as loneliness or racism can also drive them to seek assistance.^18,47,51,54

Suggestions to improve the mental health of immigrant students

Immigrant students may be able to access and make use of mental health services in their host countries if certain conditions are met. The utilization of therapy methods suitable for the varied immigrant student population, cooperation with peer mentors, education, and awareness are a few of these. The host nation should raise public awareness of mental health concerns, offer sufficient and continuous access to information about mental health treatment, and outline the advantages of counseling services.

Working with peer mentors can also lessen the stigma attached to therapy and mental illness. Psychodynamic and integrated techniques like person-centered counseling and cognitive behavioral therapy are recommended by some research. Eastern philosophy informs mindfulness-based techniques, which are proposed as more suitable. Programs for community-based intervention can lessen the stigma attached to counseling and mental illness.

Enhancing the availability of mental health services while guaranteeing confidentiality can motivate international students to seek help. Lastly, services for immigrant students should be suitable and safe from a cultural standpoint. Immigrant students can make better use of mental health resources in their host countries by attending to these aspects.

Strengths and limitations

This review’s emphasis on an understudied population—African foreign university students in Germany—is one of its most vital points. Critical mental health difficulties that these demographic faces are highlighted in the report, including anxiety, problems adjusting to a new culture, and the effects of racism. Furthermore, adherence to PRISMA recommendations in implementing a systematic review technique guarantees the thoroughness and accuracy of the literature search. This methodical methodology strengthens the validity of the results and lays the groundwork for future studies on this crucial subject.

The review does, however, have a few drawbacks. The main obstacle is the need for more research on African foreign students studying in Germany. It was not possible to do a thorough synthesis of mental health outcomes and experiences due to the low availability of data. Additionally, much of the review’s research was drawn from other international student populations, which could have been more accurate in capturing African students’ distinctive psychological and cultural quirks. Furthermore, the results may have needed to be expanded in breadth by eliminating non-peer-reviewed papers and research done outside of Germany.

Conclusion, Implications, and Future Directions

Focusing on African immigrant students in Germany is essential due to the unique challenges, cultural nuances, and structural barriers they encounter within the educational system. By understanding their experiences, researchers can uncover critical insights into how migration and cultural background impact mental health outcomes. This also sheds light on their coping mechanisms and support networks, providing a comprehensive view of the mental health issues faced by this demographic.

Such research is vital for academia educators, policymakers, and mental health professionals. It equips these stakeholders with the necessary evidence to design targeted interventions that cater specifically to the needs of African immigrant students. Culturally sensitive support systems, including peer groups and counseling services, can promote a more inclusive and adaptable academic environment. Addressing the research gap and amplifying the voices of African immigrant students will contribute to a fairer and more supportive educational experience for all students.

Furthermore, fostering a solid cultural identity within German society, akin to strategies employed by the African diaspora in the United States, could benefit African immigrant students and Black Germans. This involves openly addressing systemic racism and the need to use terms like “Black” and “White” to confront and resolve unequal treatment based on skin color and ethnicity.¹⁰ Honest discussions about these realities are crucial to building a more equitable society.

Lastly, there is an urgent need to address gaps in psychiatric care for those experiencing racial trauma. Many White German mental health professionals may lack the lived experience of systemic racism, resulting in insufficient training to address racial trauma. Increasing education and awareness about the psychological impact of racism is essential to improving care for African immigrant students and Black Germans. Without this focus, racial trauma will remain inadequately addressed, leaving these populations underserved.^55,56

Ultimately, this review highlights the pressing need for more targeted research on the mental health patterns of African immigrant university students in Germany. Such research deepens our understanding of the complex relationship between migration, culture, and mental health and provides the foundation for creating tailored interventions and support networks. Ensuring that the mental health needs of marginalized students are prioritized will foster a more inclusive academic environment where all students can thrive. Therefore, conducting further research on this population is both an academic and moral imperative, crucial for building a more just and supportive educational system.

Competing Interests

The authors declare that they have no competing interests.

Ethical Approval

Not applicable

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