The influence of migration status and perceived discrimination on mental health in Belgium

Abstract Background Cross-sectional data from the Belgian Health Interview Survey have documented higher levels of psychological distress among non-European and second-generation migrants compared to native Belgians. Previous research has widely recognised discrimination as a key social determinant that negatively impacts mental health within migrant populations. However, limited research has explored how this association evolves over time. This longitudinal study examines trends in anxiety and depression among first- and second-generation migrants, and those who identify with discriminated groups. Methods We used data from three waves of the BELHEALTH cohort, collected online in September 2022, March 2024, and March 2025, among 7,352 Belgian residents aged 18+. Mental health symptoms were assessed using the GAD-7 and PHQ-9. Participants were grouped into five categories: native Belgians, European (Eu) migrants, non-Eu migrants, second-generation Eu migrants and second-generation non-Eu migrants. Respondents also indicated whether they were part of a group that they felt was discriminated, based on their ethnicity, skin colour, religion, nationality or language. Mixed linear models were used to compare mental health outcomes across categories between 2022 and 2025. Results Second-generation non-European migrants showed a significantly higher risk of developing anxiety (β = 0.67, CI95% 0.03;1.32) and depression (β = 1.1, CI95% 0.4;1.8) vs. non-migrants, though this became non-significant after adjusting for age, sex and education (F = 2.2, p = 0.07). However, discrimination based on ethnic background significantly increased the likelihood of anxiety (β = 1.7 CI95% 0.9;2.4) and depression (β = 2.0 CI95% 1.2;2.8) over time, even after adjustment. Conclusions Perceived discrimination was a stronger predictor of anxiety and depression than migration status alone. Tackling discrimination is essential to improving mental health conditions of the migrant population in Belgium. Key messages • Ethnic discrimination, more than migration status per se, is a key predictor of anxiety and depression over time in Belgium. • Reducing ethnic discrimination is essential to improving mental health among the migrant population in Belgium.