The Impact of Family Separation and Worry About Family on Psychological Adjustment in Refugees Resettled in Australia

Trajectories of posttraumatic stress symptoms following collective violence: A systematic review and meta-analyses

Although collective violence represents a significant public health concern, a limited number of longitudinal studies have addressed this topic, with no systematic reviews focusing on posttraumatic stress symptom (PTSS) trajectories. The present systematic review and meta-analyses examined PTSS prevalence and trajectories after exposure to collective violence. A systematic literature search across six databases (APA PsycInfo, APA PsycArticles, PSYINDEX, MEDLINE, ERIC, and PubMed) identified 771 studies that were screened for the following eligibility criteria: exposure to collective violence, adult sample, longitudinal design, PTSS assessment using validated measures, PTSS trajectories estimated using latent growth modeling, and report sample prevalence rate for each trajectory. Ten studies met the criteria, and five meta-analyses were performed to assess the overall prevalence of each trajectory. Most included studies (63.6%) identified four trajectories, characterized as low-stable, high-stable, decreasing, and delayed-worsening. The low-stable trajectory was the modal response, with a pooled prevalence of 58.0%, 95% CI [51.0, 65.0]. The high-stable prevalence was 7.0%, 95% CI [4.0, 19.0]; the decreasing trajectory was 13%, 95% CI [9.0, 17.0]; and the delayed-worsening trajectory was 8.0%, 95% CI [5.0, 10.0]. A fifth trajectory, moderately stable, had a prevalence of 19.0%, 95% CI [9.0, 29.0]. The trajectory models robustly identified clinically relevant patterns of response to collective violence, offering a contribution to the literature and a starting point for future research. Further studies are needed, as a better comprehension of symptom trajectories after collective violence events has important clinical and public health implications.

Trends and determinants of mental illness in humanitarian migrants resettled in Australia: Analysis of longitudinal data

Given the frequent exposure of humanitarian migrants to traumatic or stressful circumstances, there exists a potential predisposition to mental illness. Our objective was to pinpoint the trends and determinants of mental illness among humanitarian migrants resettled in Australia. This study considered five waves of longitudinal data involving humanitarian migrants resettled in Australia. Post-traumatic stress disorder (PTSD) and psychological distress were assessed using PTSD-8 and Kessler-6 screening tools. Through a Generalised Linear Mixed model (GLMM), variables displaying a 95% CI that excluded the value of 1.0 for the odds ratio were identified as associated factors for both PTSD and elevated psychological distress. The selection of multivariable covariates was guided by causal loop diagrams and least absolute shrinkage and selection operators methods. At baseline, there were 2399 humanitarian migrants with 1881 retained and at the fifth yearly wave; the response rate was 78.4%. PTSD prevalence decreased from 33.3% (95% CI: 31.4-35.3) at baseline to 28.3% (95% CI: 26.2-30.5) at year 5. Elevated psychological distress persisted across all waves: 17.1% (95% CI: 15.5-18.6) at baseline and 17.1% (95% CI: 15.3-18.9) at year 5. Across the five waves, 34.0% of humanitarian migrants met screening criteria for mental illness, either PTSD or elevated psychological distress. In the multivariate model, factors associated with PTSD were loneliness (AOR 1.5, 95% CI: 1.3-1.8), discrimination (AOR 1.6: 1.2-2.1), temporary housing contract (AOR 3.7: 2.1-6.7), financial hardship (AOR 2.2:1.4-3.6) and chronic health conditions (AOR 1.3: 1.1-1.5), whereas the associated factors for elevated psychological distress were loneliness (AOR 1.8: 1.5-2.2), discrimination (AOR 1.7: 1.3-2.2) and short-term lease housing (AOR 1.6: 1.0-1.7). The prevalence, persistence and consequential burden of mental illness within this demographic underscore the urgent need for targeted social and healthcare policies. These policies should aim to mitigate modifiable risk factors, thereby alleviating the significant impact of mental health challenges on this population.

Self-compassion and self-coldness and their relationship with psychological distress and subjective well-being among community-based Hazaras in Australia

Hazaras are a newly emerging community in Australia and limited research has explored their mental health. The first aim of this study was to explore levels of psychological distress and subjective well-being reported by Hazaras in Australia, and whether scores on psychosocial variables (self-compassion, self-coldness, acculturation, resilience, spirituality), psychological distress and domains of subjective well-being differed by sociodemographic groups. The second aim had two parts: (a) to examine bivariate relationships between the psychosocial variables, psychological distress and subjective well-being; and (b) to examine whether the psychosocial predictor variables independently contributed to subjective well-being and psychological distress when controlling for sociodemographic characteristics. Seventy-two Hazaras (58 men and 14 women), with a mean age of 28.82 years (SD = 8.84) and average length of time residing in Australia of 10.17 years (SD = 4.11), completed an online survey. There were sociodemographic differences in relation to key variables of interest; for example, participants who did not have family members in Australia reported lower levels of global life satisfaction. Moderate negative relationships were found between self-compassion and psychological distress and between self-coldness and subjective well-being. Self-coldness, self-compassion, resilience and acculturation contributed uniquely to psychological distress and subjective well-being when controlling for sociodemographic variables. Although migration programmes that provide permanent residency and allow family members to join refugees in Australia are limited, they appear important. Many of the difficulties facing Hazaras are ongoing, external and beyond their control (e.g. visa status); however, there is a possibility that self-compassion can play a role as a protective factor.

Group Belonging and Social Identities in the Transition of Asylum-Seekers in Greece: Longitudinal Pathways to Adjustment

Millions of forced migrants settling in host countries often struggle to adjust to their new life. As their inclusion and adjustment within receiving societies has become a global social challenge, studying the factors that support their successful transition is an important topic of research inquiry. The present three-wave longitudinal study examined the role of group belonging and social identification in facilitating the transition of 60 sub-Saharan African asylum-seekers to Greece. Drawing upon the Social Identity Model of Identity Change (SIMIC), we investigated how multiple group memberships before migration, social identity continuity, and social identity gain related to their adjustment over 8 months. On the between-person level, multiple group belonging before migration indirectly contributed to better person-average levels of sociocultural adjustment, physical health functioning and satisfaction, psychological distress, and life satisfaction, by way of higher person-average levels of social identity continuity and/or social identity gain. However, multiple groups before migration also had a direct negative effect on the overall levels of psychological distress. On the within-person level, positive changes in social identity continuity and gain were related to positive changes in different adjustment-related outcomes over time. Our findings are consistent with SIMIC and highlight the importance of group belonging and associated social identities in forced migrants' transition, in ways that may pave the way for the development of social identity interventions to promote their health, well-being, and successful integration. Future longitudinal and experimental evidence with larger and more diverse samples of forced migrants is needed to establish the generalizability and causality of the observed associations.

Understanding the relationship between social support and mental health of humanitarian migrants resettled in Australia

Background

Forced migration can lead to loss of social support and increased vulnerability to psychological distress of displaced individuals. The aims were to ascertain the associations of sociodemographic characteristics and social support received by resettled adult humanitarian migrants in Australia; determine the relationship between social support and mental health at different intervals following humanitarian migration; and examine the modification effects of gender, age and migration pathway on that relationship.

Methods

A secondary analysis was conducted of data generated in Waves One (three to six months after resettlement), Three (three years after resettlement) and Five (five years after resettlement) of the Building a New Life in Australia prospective cohort study. The association between sociodemographic characteristics and mental health were examined at each timepoint using a multivariate regression model. Exploratory factor analysis was used to develop a two-factor social support scale (emotional/instrumental and informational support) from a larger set of items collected in the BNLA. Psychological distress was measured by the Kessler-6 scale. Path analysis was used to analyse the relationships between social support and psychological distress among the three time points considering socio-demographic characteristics simultaneously.

Results

A total of 2264 participants were included in the analyses. Age, gender, birth region, migration pathway, education level and English proficiency were significantly associated with both social support types. Main source of income was only significantly associated with informational support. Remoteness area was only significantly associated with emotional/instrumental support. As emotional/instrumental support increased by one standard deviation (SD) at Wave One, psychological distress at Wave Three decreased by 0.34 score [95% CI (− 0.61; − 0.08)]. As informational support at Wave Three increased by one SD, psychological distress at Wave Five decreased by 0.35 score [95% CI (− 0.69; − 0.01)]. The relationships between social support and psychological distress varied between genders, age groups and migration pathways.

Conclusion

Findings demonstrate the importance of emotional/instrumental support and informational support for the medium and long-term mental health of humanitarian migrants. This study also highlights the important of extending current social support provisions and tailoring programs to enhance support received by humanitarian migrant subgroups years after resettlement to improve mental health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14082-z.

Trends and Impact Factors of Mental Health Service Utilization among Resettled Humanitarian Migrants in Australia: Findings from the BNLA Cohort Study

Resettled humanitarian migrants (HMs) have high levels of mental disorders, but factors associated with the utilization of mental health services (MHS) are poorly understood. We aimed to explore trends and impact factors of MHS utilization among HMs in the process of resettlement in Australia. A total of 2311 HMs from the 1st (2013), 3rd, and 5th (2018) waves of a national cohort study were included. MHS utilization in the past year was assessed by two indicators: having MHS contacts and the frequency of MHS contacts. Trends were identified by Cochran-Armitage tests, and generalized linear mixed models and ordered logistic models were fitted to explore impact factors of MHS utilization. The proportion of having MHS contacts significantly rose from 13.0% to 29.4% over the five years. MHS utilization was mainly driven by perceived needs, such as post-traumatic stress disorders and the degree of post-migration stress. Unemployment and strong belongingness to the local community were also associated with having MHS contacts. No significant gender difference was found in having MHS contacts but females tended to contact MHS more frequently. Resettled HMs have a persistent dilemma of high mental illness prevalence and MHS underutilization. Sustainable mental health education and long-term resettlement services targeted at social integration that consider gender difference are urgently needed in host countries.

Association between unmet post-arrival expectations and psychological symptoms in recently arrived refugees

Thwarted expectations regarding one's post-settlement life may challenge the mental health of refugees. The present study aimed to investigate the relationship between pre-arrival expectations and the course of psychological symptoms across time. A secondary analysis of 1,496 principal visa applicants across five waves of the Building a New Life in Australia (BNLA) study was conducted. The cross-sectional associations between expectations on the one hand, and post-traumatic stress (PTSD-8) symptoms and psychological distress (Kessler-6; K6) on the other, were assessed using multiple regression. Latent class growth analysis (LCGA) was used to identify discrete symptom trajectories of psychological symptoms across five years following settlement, and multinomial regressions were used to determine if violated expectations predicted membership of identified PTSD-8 and K6 class trajectories. LCGA supported a four-class solution for the PTSD-8 "Resilient Post Traumatic Stress (PTS)" (54.1%), "Improving PTS" (15.0%), "Deteriorating PTS" (17.3%), and "Persistently High PTS" (13.6%). For the K6, three classes were identified: "Persistently Mild K6" (60.4%), "Resilient K6" (9.4%), and "Persistently High K6" (30.2%). Thwarted expectations were found to significantly predict membership of less favourable symptom trajectories classes in the context of other established predictors. Post-settlement expectations may thus have weak but unique predictive value for the course of psychological symptoms alongside other factors such as older age and financial stress. Implications of these findings for service provision and policy are discussed.

Distinct trajectories of psychological distress among resettled refugees: Community acceptance predicts resilience while low ingroup social support predicts clinical distress

Refugees can experience elevated levels of psychological distress upon resettlement, although disparate outcomes over time are expected. The current study modeled trajectories of changes in distress over a 5-year period among resettled refugees and sought to explicate post-settlement factors that influence distress over time. A large-scale sample of refugees resettled in Australia (2,399) was tracked over a 5-year period, completing measures of psychological distress at each wave and initial risk and protective factors immediately after resettlement. A latent class growth analysis conducted on distress found four unique classes characterized by (1) resilient levels of distress, (2) consistent clinical distress, (3) recovering levels of distress, and (4) deteriorating distress. Lower perceived discrimination and greater positive context of reception predicted membership to the resilient group and differentiated the recovering and deteriorating groups. Further, lower ingroup social support predicted membership to the clinically distressed group relative to all others. We conclude by echoing calls to strengthen community support for refugees and promote ingroup ties, particularly among those who are the most vulnerable.

Understanding the effects of being separated from family on refugees in Australia: a qualitative study

OBJECTIVE

To understand the impact of family separation on refugees living in Australia.

METHOD

Thirteen participants with a refugee background and experiencing separation from family participated in a semi-structured qualitative interview. Interviews were coded and a thematic analysis was conducted using NVivo software.

RESULTS

Identified themes were organised under four domains. Domain 1 focused on the personal impact of family separation. Themes were the effects on mental health and functioning, driven by incessant worrying about the safety of family and the absence of key attachment figures, the specific effects of having missing family, alterations to self-identity and family dynamics. Domain 2 focused on themes relating to actions taken to find missing family, connect or reunite with separated family. Domain 3 highlighted the coping strategies, support mechanisms and protective factors used by participants. Domain 4 identified core beliefs about the importance of family unity, focusing on security, settlement and a happy future.

CONCLUSIONS

Family separation has an enduring effect on the wellbeing of refugees, with key pathways being ongoing fear and insecurity, disrupted social attachments and identity shifts in relation to the future self.

IMPLICATIONS FOR PUBLIC HEALTH

Refugees separated from or missing family struggle with ongoing stress and adjustment issues.

Factors associated with posttraumatic growth among North Korean defectors in South Korea

Refugees experience various kinds of trauma during the migration process, which can cause psychiatric problems such as posttraumatic stress disorder. However, in the process of overcoming traumatic experiences, they may also experience posttraumatic growth (PTG). This study examined the level of PTG and its associated factors among North Korean defectors, including posttraumatic stress symptoms (PTSS). In total, 212 North Korean defectors completed self-report questionnaires measuring PTG (PTG inventory), PTSS (Posttraumatic Stress Disorder Checklist, PCL-5), quality of life (WHOQOL-BREF), and various sociodemographic variables. Participants completed the survey online, from July 27 to August 4, 2020. Participants reported a moderate level of PTG scores (51.7 ± 15.4, range 0–80). To determine the impact of PTSS on PTG among North Korean defectors, we conducted a hierarchical multiple regression analysis. In the final model, several sociodemographic factors (years in South Korea, education in North Korea, religion, and employment status), overall quality of life (β = 0.321, p < 0.001), and PTSS (β = 0.162, p = 0.035) were positively associated with PTG, whereas living with family (β = − 0.1261, p = 0.040) and loneliness (β = − 0.401, p < 0.001) were negatively associated with PTG, accounting for 36.6% of the variance in PTG scores (p < 0.001). This is the first large-scale study describing the level of PTG and its associated factors among North Korean defectors residing in South Korea. Further, our study provides suggestions for future research in this area, and interventions for improving PTG among this group.

Sick and Tired-Sociodemographic and Psychosocial Characteristics of Asylum Seekers Awaiting an Appointment for Psychotherapy

Background: An EU directive holds the EU member states responsible for implementing the provision of health care for asylum seekers. However, current literature indicates insufficient care for asylum seekers in the German health system. This article aims to characterize the situation of the client population on the waiting list of a psychosocial center (PSZ). Methods: We conducted a retrospective observational study based on client files in Halle (Saale), Germany. We included 437 adults who were on the PSZ waiting list between 2016 and 2019. Questionnaires that collected information on the clientele at two different times were analyzed. Results: The average waiting time for psychotherapy was 50 weeks. In total, 85.6% of the 188 respondents reported sleep disorders (n = 161), 65.4% of clients reported pain (n = 123) and 54.8% suicide attempts/suicidal thoughts (n = 54). In the 16-week waiting period in which the clients waited for an initial appointment with a psychologist, the residence status deteriorated in 21.3% (n = 40). Conclusion: Improving asylum seekers’ access to the German health system is urgently needed in order to prevent unnecessary suffering in the future and to comply with EU law.

Impact of Family Separation on Subjective Time Pressure and Mental Health in Refugees from the Middle East and Africa Resettled in North Rhine-Westphalia, Germany: A Cross-Sectional Study

Little is known about social determinants among refugees resettled in Germany. This study aims to examine the impact of family separation on refugees' subjective time pressure and mental health. Data come from the FlueGe Health Study (n = 208), a cross-sectional study administered by Bielefeld University. We used logistic regression analysis to investigate the effect of family separation on (i) being time-stressed and (ii) having a high risk for adverse mental health, considering sociodemographic and postmigration factors. As a result, more than 30% of participants with a spouse or partner and about 18% with a child or children reported separation. Multiple logistic regression showed that family separation was not associated with being time-stressed, but separation from at least one child was associated with adverse mental health (OR = 3.53, 95% CI = [1.23, 10.11]). In conclusion, family separation primarily contributes to adverse mental health among refugees from the Middle East and Africa resettled in North Rhine-Westphalia, Germany. Therefore, policies and practices that facilitate family reunification can contribute significantly to the promotion of refugees' mental health and well-being.