Review: Mental Health and Social Isolation among Sub-Saharan African Migrants in Tunisia: A Cross-Sectional Quantitative Study {under peer review}

 

Reviewer: Kateryna Bikir

 

Completed: 20-09-2025 19:15

 

Recommendation: Revisions Required

 

 

	Yes	No	N/A
Is the research question clearly defined?	+
Are the methods appropriate and sufficiently detailed?	+
Is the data analysis robust and replicable?	+
Are the conclusions supported by the results?	+
Is the manuscript well organised and clearly written?	+
Are tables, figures, and supplementary material informative and necessary?	+
Is the abstract an accurate summary of the study?	+
Does the manuscript contribute meaningfully to the field?	+
Is it relevant to the field of mental health or related disciplines that are connected to the scope of the Journal?	+
Are ethical approvals and participant consents adequately described?	+
Have competing interests, funding, and data availability been transparently declared?	+

 

Comments for the authors:

 

The article is current and important. The article investigates how Sub-Saharan African migrants in Tunisia face a complex array of psychosocial stressors, including social isolation, acculturative stress, and structural barriers. This study fills a critical gap by examining psychological distress through quantitative research and its determinants in this population. The article has a clear articulation of research questions and objectives. It makes a valuable contribution to the psychological field of migrants’ mental health and the difficulties they face.

The theoretical framework and literature review could be expanded to include some well-known theories and recent studies. The author reviews in his article the biopsychosocial approach, which emphasizes the importance of understanding human health and illness in their fullest contexts. It would be beneficial in the context of the article to also include Bronfenbrenner’s perspective and socio-ecological system (1979), which explains that multiple systems influence how people deal with forced migration. This view is characterized by the interplay of factors across socio-ecological levels— including individual, family, community, and societal influences—each contributing distinctly to how individuals adapt to the challenges of forced migration. (Fadhlia, T. N., Doosje, B., & Sauter, D. A. (2025). The socio-ecological factors associated with mental health problems and resilience in refugees: A systematic scoping review. Trauma, Violence, & Abuse, 26(3), 598–616. https://doi.org/10.1177/15248380241284594)

The methodology is clearly described, and the methods are appropriate for the research questions.  The limitations are acknowledged. At the same time, some methodological limitations were not fully addressed. The perception of Tunisia as a transit country to Europe could be a significant variable that influences the mental health of refugees and migrants. Refugees experience ambivalence in transit countries due to uncertainty, externalization policies, and lack of clear pathways (Selin Siviş, Verena K. Brändle, Jakob-Moritz Eberl, Sophia Wyatt, Kathrin Braun, Iman Metwally & Hajo G. Boomgaarden (26 Apr 2024): Oscillating Between Hope and Despair: Understanding Migrants’ Reflections on Ambivalence in ‘Transit’, Journal of Immigrant & Refugee Studies, DOI: 10.1080/15562948.2024.2337196). There are studies that show refugees in camps often feel isolated and stigmatized, while integrated models foster better mental health and community relations (Witt, I. (2025). Displacement, camps and perceptions: A quantitative investigation of forced migration, refugee settlement models and host community attitudes in Uganda.) These factors deserve further exploration, as they may compound distress and affect the effectiveness of mental health interventions.

Some claims need more substantial evidence or citations. Specifically, the part on social isolation and loneliness. It is a pervasive and serious public health concern associated with numerous detrimental physical and mental health concerns.  (Hansen, T., Nes, R.B., Hynek, K. et al. Tackling social disconnection: an umbrella review of RCT-based interventions targeting social isolation and loneliness. BMC Public Health 24, 1917 (2024). https://doi.org/10.1186/s12889-024-19396-8)

The author emphasizes the need for culturally sensitive interventions. We agree with this statement and find it essential to promote resilience. This research can inform mental health policy and humanitarian programming in North Africa and similar transit regions. Social support from peers and family, religion/spirituality, and individual coping strategies (e.g., reframing, positive thinking) are crucial for mental health resilience (P Paudyal, N Purkait, J Fey, Mental health resilience among refugees and asylum seekers: a systematic review, European Journal of Public Health, Volume 33, Issue Supplement_2, October 2023, ckad160.1628, https://doi.org/10.1093/eurpub/ckad160.1628 ). Also, it would be beneficial to include some specific interventions or needs for further research in this area in the research perspective section.

Minor revisions are required to strengthen the article. The article is current and important. The article investigates how Sub-Saharan African migrants in Tunisia face a complex array of psychosocial stressors, including social isolation, acculturative stress, and structural barriers. This study fills a critical gap by examining psychological distress through quantitative research and its determinants in this population. The article has a clear articulation of research questions and objectives. It makes a valuable contribution to the psychological field of migrants’ mental health and the difficulties they face.

The theoretical framework and literature review could be expanded to include some well-known theories and recent studies. The author reviews in his article the biopsychosocial approach, which emphasizes the importance of understanding human health and illness in their fullest contexts. It would be beneficial in the context of the article to also include Bronfenbrenner’s perspective and socio-ecological system (1979), which explains that multiple systems influence how people deal with forced migration. This view is characterized by the interplay of factors across socio-ecological levels— including individual, family, community, and societal influences—each contributing distinctly to how individuals adapt to the challenges of forced migration. (Fadhlia, T. N., Doosje, B., & Sauter, D. A. (2025). The socio-ecological factors associated with mental health problems and resilience in refugees: A systematic scoping review. Trauma, Violence, & Abuse, 26(3), 598–616. https://doi.org/10.1177/15248380241284594)

The methodology is clearly described, and the methods are appropriate for the research questions.  The limitations are acknowledged. At the same time, some methodological limitations were not fully addressed. The perception of Tunisia as a transit country to Europe could be a significant variable that influences the mental health of refugees and migrants. Refugees experience ambivalence in transit countries due to uncertainty, externalization policies, and lack of clear pathways (Selin Siviş, Verena K. Brändle, Jakob-Moritz Eberl, Sophia Wyatt, Kathrin Braun, Iman Metwally & Hajo G. Boomgaarden (26 Apr 2024): Oscillating Between Hope and Despair: Understanding Migrants’ Reflections on Ambivalence in ‘Transit’, Journal of Immigrant & Refugee Studies, DOI: 10.1080/15562948.2024.2337196). There are studies that show refugees in camps often feel isolated and stigmatized, while integrated models foster better mental health and community relations (Witt, I. (2025). Displacement, camps and perceptions: A quantitative investigation of forced migration, refugee settlement models and host community attitudes in Uganda.) These factors deserve further exploration, as they may compound distress and affect the effectiveness of mental health interventions.

Some claims need more substantial evidence or citations. Specifically, the part on social isolation and loneliness. It is a pervasive and serious public health concern associated with numerous detrimental physical and mental health concerns.  (Hansen, T., Nes, R.B., Hynek, K. et al. Tackling social disconnection: an umbrella review of RCT-based interventions targeting social isolation and loneliness. BMC Public Health 24, 1917 (2024). https://doi.org/10.1186/s12889-024-19396-8)

The author emphasizes the need for culturally sensitive interventions. We agree with this statement and find it essential to promote resilience. This research can inform mental health policy and humanitarian programming in North Africa and similar transit regions. Social support from peers and family, religion/spirituality, and individual coping strategies (e.g., reframing, positive thinking) are crucial for mental health resilience (P Paudyal, N Purkait, J Fey, Mental health resilience among refugees and asylum seekers: a systematic review, European Journal of Public Health, Volume 33, Issue Supplement_2, October 2023, ckad160.1628, https://doi.org/10.1093/eurpub/ckad160.1628 ). Also, it would be beneficial to include some specific interventions or needs for further research in this area in the research perspective section.

Minor revisions are required to strengthen the article:

Expand the theoretical framework

Address overlooked methodological variables

Strengthen claims with additional citations