Fundamentals of Mental Health

Fundamentals of Mental Health

The moderating role of social support in the relationship between acculturation stress and psychological problems among Afghan immigrants living in Iran

Document Type : Research Paper

Authors
Parwiz Majedi 1
Fariba Zarani 1
Mahmood Heidari 1
Leili Panaghi 2
1 Department of Clinical Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran.
2 Family Research Institute, Shahid Beheshti University, Tehran, Iran.
10.22038/jfmh.2026.93409.3318
Abstract
Introduction: Migration is a multifaceted and stressful experience often accompanied by acculturative stress, which can significantly affect the mental health of migrants. Perceived social support is considered an important protective factor that may buffer the adverse psychological effects of this stress. The present study aimed to examine the moderating role of different sources of social support in the relationship between acculturative stress and psychological symptoms among Afghan migrants living in Iran.

Materials and Methods: This descriptive-correlational study was conducted on 580 Afghan migrants aged 18 years and older, selected through convenience and snowball sampling. Data were collected using the Acculturative Stress Scale, the Multidimensional Scale of Perceived Social Support, and the Symptom Check List-90. Pearson correlation and moderation analysis using PROCESS Macro (Model 1) were performed.

Results: The findings indicated that acculturative stress was positively and significantly associated with all psychological symptoms, whereas social support showed a negative and significant relationship with these symptoms. Importantly, among the different types of social support, only support from friends demonstrated a significant moderating effect: higher levels of friend support attenuated the impact of acculturative stress on psychological symptoms.

Conclusion: These results highlight the protective role of social support particularly support from peers and underscore the need to strengthen social networks and peer-based interventions to promote the mental health of Afghan migrants.
Keywords
Acculturation
Immigrants
Psychological distress
Social support
1.             Mosadeghrad AM, Ghiasi K. [Rethinking refugee and migrant health in Iran: letter to the editor]. Iranian south medical journal 2024; 26(6): 417-19. (Persian)
2.             UNHCR Iran. [cited 2025 Nov 16]. Refugees in Iran. Available from: https://www.unhcr.org/ir/refugees-iran
3.             Kalantzis MA, Chung Xiann Lim S, Dauber AK, Studer-Perez EI, Silverman ZJ, O’Brien WH. Acculturative stress and eating disorder psychopathology: A meta-analysis. Eat Behav 2023; 48: 101694.
4.             Choy B, Arunachalam KSG, Taylor M, Lee A. Systematic review: Acculturation strategies and their impact on the mental health of migrant populations. Public Health Pract 2021; 2: 100069.
5.             Mirzaei H. [Acculturation strategies and mental health of Afghan immigrants in Iran: An anthropological study]. Journal of social work research 2016; 2: 191-242. (Persian)
6.             Allen M, Armenta B, Watters ER, Aflatooni L, Sorenson L. Experiences of acculturation stress in first-generation immigrant children: Examining the relationship among acculturation stress, depression, and family dynamics. J Int Migr Integr 2025; 26(2): 1065-84.
7.             Lerias D, Ziaian T, Miller E, Arthur N, Augoustinos M, Pir T. The role of acculturative stress on the mental health of immigrant youth: A scoping literature review. Community Ment Health J 2025; 61(3): 462-91.
8.             Rahimitabar P, Kraemer A, Bozorgmehr K, Ebrahimi F, Takian A. Health condition of Afghan refugees residing in Iran in comparison to Germany: A systematic review of empirical studies. Int J Equity Health 2023; 22(1): 16.
9.             Alemi Q, James S, Cruz R, Zepeda V, Racadio M. Psychological distress in Afghan refugees: A mixed-method systematic review. J Immigr Minor Health 2014; 16(6): 1247-61.
10.          Brea Larios D, Sam DL, Sandal GM. Psychological distress among Afghan refugees in Norway as a function of their integration. Front Psychol 2023; 14: 1143681.
11.          Martin F, Sashidharan SP. The mental health of adult irregular migrants to Europe: A systematic review. J Immigr Minor Health 2023; 25(2): 427-35.
12.          Neyazi A, Mohammadi AQ, Razaqi N, Rahimi BA, Sifat S, Rahimy N, et al. Health survey on anxiety, depression, and stress in Afghanistan: A large-scale cross-sectional study amid ongoing challenges. Discov Ment Health 2024; 4(1): 38.
13.          Cludius B, Mannsfeld AK, Schmidt AF, Jelinek L. Anger and aggressiveness in obsessive-compulsive disorder (OCD) and the mediating role of responsibility, non-acceptance of emotions, and social desirability. Eur Arch Psychiatry Clin Neurosci 2020; 271(6): 1179-91.
14.          Habib A, Zulfiqar N. A three-generation study of the prevalence and comorbidity of posttraumatic obsessive-compulsive disorder and posttraumatic stress disorder among Afghan refugees. Genealogy 2025; 9(1): 4.
15.          Elahi A, McIntyre JC, Thomas J, Abernethy L, Bentall RP, White RG. Symptoms of paranoia experienced by students of Pakistani. J Nerv Ment Dis 2022; 210(9): 680-85.
16.          Ijadi-Maghsoodi R, Meza JI, Bravo L, Lee K, Kataoka S. Reimagining social and emotional supports in schools for immigrant students: A contextual and structural approach. Acad Pediatr 2024; 24(5): 32-41.
17.          Ersoy M, Akçaoğlu MÖ. The interplay between social support, acculturative stress, perceived stress and generalized anxiety among international students. Curr Psychol 2025; 44(22): 17559-70.
18.          Mohammadsadeghi H, Bazrafshan S, Seify-Moghadam N, Mazaheri Nejad Fard G, Rasoulian M, Eftekhar Ardebili M. War, immigration and COVID-19: The experience of Afghan immigrants to Iran Amid the pandemic. Front Psychiatry 2022; 13: 908321.
19.          Mahmoodi Z, Bahrami G, Ghavidel N, Seddighi H. The effect of social determinants of health on quality of life among Afghan refugees in Iran during the COVID-19 pandemic: A path analysis. BMC Psychiatry 2023; 23(1): 11.
20.          Heidinger E. Overcoming barriers to service access: Refugees’ professional support service utilization and the impact of human and social capital. J Int Migr Integr 2023; 24(1): 271-312.
21.          Lassri D, Gewirtz-Meydan A. Self-compassion moderates the mediating effect of self-criticism in the link between childhood maltreatment and psychopathology. J Interpers Violence 2022; 37(23-24): 1699-722.
22.          Shieh G. Sample size determination for confidence intervals of interaction effects in moderated multiple regression with continuous predictor and moderator variables. Behav Res Methods 2010; 42(3): 824-35.
23.          Majedi P, Zerani F, Heidari M, Panaghi L. [Investigating the psychometric properties of the acculturation stress scale in Afghan immigrants living in Iran]. Journal of cultural psychology 2025; 8(2): 279-93. (Persian)
24.          Zimet GD, Dahlem NW, Zimet SG, Farley GK. The Multidimensional Scale of Perceived Social Support. J Pers Assess 1988; 52(1): 30-41.
25.          Xuan LHS, Wenn JKR, Nie JLK, Elias NSB, Jayazino NAMB, Seok CB. The reliability and validity of Multidimensional Scale of Perceived Social Support (MSPSS) among university students in Malasia. Southeast Asia Psychol J 2024; 12(2): 178-87.
26.          Sepehrinia M, Farahani H, Watson P, Amini N. Psychometric properties and item response theory analysis of the Persian version of the social pain questionnaire. Front Psychol 2024; 15: 1372229.
27.          Khoshroo T, Qorbanpoorlafmejani A, Boland H. [The relationship between psychological capital and family empowerment: The mediating role of meaning in life and perceived social support]. The women and families and cultural‑education 2023; 18(63): 181-212. (Persian)
28.          Abbasi-Ghahramanloo A, Bahadori M, Azad E, Dopeykar N, Mahdizadeh P, Vahedian Azimi A, et al. Mental disorders pattern in staff of a military unit in Iran: The role of metabolic syndrome on latent class membership. BMC Psychiatry 2021; 21(1): 513.
29.          Salmerón-Gómez R, García-García CB, García-Pérez J. A redefined variance inflation factor: Overcoming the limitations of the variance inflation factor. Comput Econ 2024; 65(1): 337-63.
30.          Ahmad A, Passage J, Hanson-DeFusco J. Psychological health of Afghan refugees: A narrative review of key factors in pre-migration and post-migration. Int J Intercult Relat 2025; 105: 102137.
31.          Saeidi M, Sadr S, Samimi Ardestani SM, Nooraeen S. Evaluation of mental health and quality of life among Afghan refugees in Iran. medRxiv 2023.06.05.23290976
32.          Ho KHM, Yang C, Leung AKY, Bressington D, Chien WT, Cheng Q, et al. Peer support and mental health of migrant domestic workers: A scoping review. Int J Environ Res Public Health 2022; 19(13): 7617.
33.          Kristiana IF, Karyanta NA, Simanjuntak E, Prihatsanti U, Ingarianti TM, Shohib M. Social support and acculturative stress of international students. Int J Environ Res Public Health 2022; 19(11): 6568.
34.          Khozaei F, Islam QU, Ramayah T, Ayub N, Carbon CC. Factors contributing to the mental wellbeing of Afghan migrants in Iran during the COVID-19 pandemic. J Migr Health 2024; 9: 100211.
35.          Mahon D. A scoping review of interventions delivered by peers to support the resettlement process of refugees and asylum seekers. Trauma Care 2022; 2(1): 51-62.
36.          EL-Awad U, Lohaus A, Reinelt T. When does social support help? Differential effects on the relationship between post-migration stress and internalizing symptoms in young male refugees and immigrant-origin peers from the Middle East. Child Adolesc Psychiatry Ment Health 2025; 20(1): 9.
37.          Krüger H. Everyday discrimination, co-ethnic social support and mood changes in young adult immigrants in Germany-Evidence from an ecological momentary assessment study. J Migr Health 2024; 9: 100212.
38.          Kirsch J, Maleku A, Kim YK, Aziz T, Dada S. Understanding the role of collective trauma on Afghan refugee mental health: A transformative mixed methods study. J Immigr Minor Health 2026; 28(1): 49-60.
39.          Keshavarzi S, Jetten J, Ruhani A, Fuladi K, Cakal H. Caught between two worlds: Social identity change among second-generation Afghan immigrants in Iran. Journal of community and applied social psychology 2024; 34(5): e2881.
40.          Kerker BD, Barajas-Gonzalez RG, Rojas NM, Norton JM, Brotman LM. Enhancing immigrant families’ mental health through the promotion of structural and community-based support. Front Public Health 2024; 12: 1382600. 
41.          Wulkau L, Racaite J, Bain P, Bramesfeld A, Lindert J. Forced displacement, social support, and resilience: Meta-analytic evidence. J Immigr Minor Health 2025; 28(1): 232-64.
42.          Aroian K, Uddin N, Blbas H. Longitudinal study of stress, social support, and depression in married Arab immigrant women. Health Care Women Int 2017; 38(2): 100-17.
43.          He L, Adnan HBM, Fauzi A, Bin Ibrahim MS. The effect of social media engagement on social integration of elderly migrants in China: The mechanism of perceived social support and psychological resilience. Humanit Soc Sci Commun 2024; 11(1): 1100.
44.          Muhammad Khan, Hassan Farooq. The inconclusive repatriation of Afghan refugees from Pakistan: Prospects and challenges. Central Asia 2022; 89: 67-95.
45.          Kurt G, Ventevogel P, Ekhtiari M, Ilkkursun Z, Erşahin M, Akbiyik N, et al. Estimated prevalence rates and risk factors for common mental health problems among Syrian and Afghan refugees in Türkiye. BJPsych Open 2022; 8(5): e167.
46.          Farahani H, Martikainen J, Golamrej Eliasi L, Tavakol M, Toikko T. Lay perceptions of mental health among Afghan forced migrants residing in Finland. Social Work in Mental Health 2024; 22(5): 645-74.
47.          Hosseini Z, Syed H, Raza Z, Mansouri M, Magan IM, Awaad R. A systematic review of evidence-based interventions for Afghan refugee mental health: A cultural adaptation analysis. Journal of cross‑cultural psychology 2024; 55(1): 25-46.
Fundamentals of Mental Health
Volume 28, Issue 2
March and April 2026
Pages 93-102