Interconnected challenges: examining the impact of poverty, disability, and mental health on refugees and host communities in Northern Mozambique

Background: Poverty, disability, and mental health may reinforce one another. Forced displacement can compound these challenges, yet comparable data on displaced and non-displaced groups in the same setting are scarce. This study examines associations among mental health, disability, pessimism, loneliness, self-esteem, and financial security for refugees and nearby host communities in Mozambique. Methods: Ultra-poor adults-refugees (n = 134) and Mozambican nationals living near the settlement (n = 314)-were identified using a World Bank poverty scorecard. Surveys captured depression (PHQ-9), anxiety (GAD-7), disability (Washington Group Short Set), and socioeconomic characteristics. Results: Symptom rates are high in both groups-depression: 34% (refugees) vs. 29% (hosts); anxiety: 25% overall-with women reporting higher levels. Disability prevalence is substantial (refugees 25%; hosts 22%). Respondents with disabilities show markedly higher rates of depression (≈2×) and anxiety (≈3×). Financial security is negatively associated with symptom scores: a one-unit-higher financial security index correlates with a 0.069 lower anxiety score ( p < 0.05) and a 0.069 lower depression score ( p < 0.01). Pessimism is positively associated with poorer mental health; anxiety and depression are more than 2.5× as prevalent among chronically pessimistic respondents. Loneliness shows no clear association with anxiety or depression in this sample, whereas low self-esteem is strongly associated with both; prevalence of GAD and depression is more than twice as high among those with low self-esteem. Conclusions: We document strong associations between poverty, disability, and mental health. These patterns underscore the importance of strengthening mental and public health services for both refugees and hosts, with particular attention to women and disabled individuals.