Asylum Seeker and Refugee Mental Health

Various asylum seeker and refugee mental health research studies are looking at the mental health needs of refugees and asylum seekers, including the impact of immigration detention on child asylum seekers. Prof Suresh Sundram and Dr Debbie Hocking have collaborated in the area of forced migrant mental health for 10 years. Between them, they have investigated the social determinants of mental health, and the prevalence and types of mental disorders in refugees and asylum seekers. They have also produced a mental health screening tool - the STAR-MH - for use by non mental health trained professionals to screen for posttraumatic stress disorder and depression to enable onward referral to appropriate health care providers. Their current work focuses on understanding the prevalence and nature of psychiatric disorder in young people with asylum seeking experiences and the development of a similar screening tool.

Papers by Prof Sundram and Dr Hocking

Moral injury related to immigration detention on Nauru: a qualitative study

Background

Immigration detention is associated with detrimental mental health outcomes but little is known about the underlying psychological processes. Moral injury, the experience of transgression of moral beliefs, may play an important role.

Objective

Our aim was to explore moral injury appraisals and associated mental health outcomes related to immigration detention on Nauru.

Methods

In this retrospective study, we conducted in-depth interviews with 13 individuals who had sought refuge in Australia and, due to arriving by boat, had been transferred to immigration detention on Nauru. At the time of the study, they lived in Australia following medical transfer. We used reflexive thematic analysis to develop themes from the data.

Results

Major themes included 1) how participants’ home country experience and the expectation to get protection led them to seek safety in Australia; 2) how they experienced deprivation, lack of agency, violence, and dehumanization after arrival, with the Australian government seen as the driving force behind these experiences; and 3) how these experiences led to feeling irreparably damaged. The participant statement ‘In my country they torture your body but in Australia they kill your mind.’ conveyed these three key themes in our analysis.

Conclusion

Our findings suggest that moral injury may be one of the processes by which mandatory immigration detention can cause harm. Although refugees returned to Australia from offshore detention may benefit from interventions that specifically target moral injury, collective steps are needed to diminish deterioration of refugee mental health. Our results highlight the potentially deleterious mental health impact of experiencing multiple subtle and substantial transgressions of one’s moral frameworks. Policy makers should incorporate moral injury considerations to prevent eroding refugee mental health.

HIGHLIGHTS

We retrospectively investigated moral injury and mental health related to immigration detention on Nauru.
Participants conveyed the impact of deprivation, lack of agency, violence, and dehumanization.
Evaluations of their experiences fit with conceptualizations of moral injury.

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Tho’ Much is Taken, Much Abides: Asylum Seekers’ Subjective Wellbeing

Development and validation of a mental health screening tool....

Social factors ameliorate psychiatric disorders in community-based...

Demoralisation syndrome does not explain the psychological profile of...

Demoralisation syndrome does not explain the psychological profile of community-based asylum-seekers

Abstract

Background: Demoralisation syndrome (DS) has been advanced as a construct that features hopelessness, meaninglessness, and existential distress. Demoralisation and DS have predominantly been considered secondary only to illness; hence there is scant research on demoralisation or DS in populations affected by extreme environmental stress.
Aims: The current study aimed to determine the prevalence of demoralisation, its predictors, and the relevance of DS in a community-based forced-migrant population.
Method: A convenience sample of 131 adult asylum-seekers (n = 98) and refugees (n = 33) without recognised mental disorders in Melbourne, Australia, were assessed cross-sectionally on posttraumatic stress, anxiety, depression, post-migration stress, and demoralisation. Socio-demographic data were analysed with relevant clinical data. Predictive aims were investigated using bivariate statistical tests and exploratory aims were investigated using correlational and linear regression analyses.
Results: Seventy nine percent of the sample met criteria for demoralisation (asylum-seekers = 83%; refugees = 66%), with asylum-seekers being 2.55 (95% C.I. = 1.03 6.32, Z = 2.03, p = .04) times more likely to be demoralised than refugees. No relationship between demoralisation and time in the refugee determination process emerged. The regression model explained 47.5% of variance in demoralisation scores for the total sample F(9,111) = 13.07, p b .0001, with MDD and anxiety score making unique significant contributions.
Conclusions: Demoralisation was widespread through the asylum-seeker and refugee population and its prevalence was attributable to a range of social and psychiatric factors. However, DS had little explanatory power for psychiatric morbidity, which was more suggestive of a pan-distress symptom complex.

Find out more about the paper (906 KB pdf).

To strive, to seek, to find, and not to yield: Narratives on the road to asylum

Mental Disorders in Asylum Seekers

Age and environmental factors predict psychological symptoms in...

Age and environmental factors predict psychological symptoms in adolescent refugees during the initial post-resettlement phase

Background

Adolescent refugees are at high risk of developing mental disorders but are often not recognised early. This pilot study aimed to identify early putative risk factors associated with psychological symptoms in newly resettled refugee youth at potential risk of subsequently developing mental disorders.

Methods

Newly resettled adolescent refugees were recruited through English language schools in Melbourne, Australia. Participants were assessed with the MINI-Kid, Achenbach Youth Self-Report and Reaction of Adolescents to Traumatic Stress scale. Parents completed a mental health screening separately. Linear regression models were used to identify predictive factors associated with symptom ratings.

Results

Seventy-eight, ostensibly well, refugee adolescents (mean age = 15.0 ± 1.6 years) resettled in Australia for 6.1 ± 4.2 months were assessed. Levels of anxiety, depression and post-traumatic stress symptoms were considerably lower than in mainstream population data. Prior displacement was a key determinant of symptomatology. Transitory displacement, irrespective of duration, was associated with elevated scores for depression (t (47) = -4.05, p < 0.0001), avoidance/numbing (U = 466, p < .05) and total trauma (U = 506, p < .05) symptoms. Older age was a unique predictor of depression (F (1,74) = 8.98, p < .01), internalising (F(1,74) = 6.28, p < .05) and total (F(1,74) = 4.10, p < .05) symptoms, whilst parental depression symptoms (t = 2.01, p < 0.05), displacement (t = 3.35, p < 0.01) and, expectedly, trauma exposure (t = 3.94, p < 0.001) were unique predictors of post-traumatic stress symptoms.

Conclusions

Displaced status, older age, and parental symptoms predicted psychological symptoms in adolescent refugees in an initial relatively asymptomatic post-resettlement phase. The early recognition of at-risk refugee youth may provide an opportunity for preventative mental health interventions.

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Clinical Sciences at Monash Health

Medicine, Nursing and Health Sciences