Abstract
Background: As refugee numbers grow worldwide, understanding prevalence and determinants of mental illness in this population becomes increasingly important. Methods: We used longitudinal data to examine the initial years of resettlement in Australian refugees with a focus on ethnic-like social support. Three annual waves from a longitudinal, nationally representative cohort of 2,399 humanitarian migrants recently resettled in Australia were examined for two mental illness outcomes: post-traumatic stress disorder indicated by positive PTSD-8 screen and “high risk of severe mental illness” (HR-SMI) by Kessler Psychological Distress Scale (K6) ≥19. Generalized linear mixed models examined demographic and resettlement factors. Findings: Contrary to predictions, high prevalence of positive screens for mental illness persisted over 3 years. At baseline, 30.3% (95% CI, 28.5–32.2) screened positive for post-traumatic stress disorder (PTSD), and 15.4% (95% CI, 14.0–16.9) had HR-SMI. Over the 3 years, 52.2% met screening criteria for mental illness. PTSD was associated with older age, females, Middle Eastern birthplace, increasing traumatic events, more financial hardships, having a chronic health condition, and poor self-rated health. HR-SMI was associated with females, Middle Eastern birthplace, unstable housing, more financial hardships, having a chronic health condition, poor self-rated health, and discrimination. Also contrary to predictions, like-ethnic social support was positively associated with PTSD (OR, 1.51; 95% CI, 1.10–2.09). Interpretation: There is high prevalence of positive screens for mental illness throughout initial years of resettlement for refugees migrating to Australia. Our unexpected finding regarding like-ethnic social support raises future avenues for research. Predictors of mental illness in the post-migration context represent tangible opportunities for intervention and are likely relevant to similar resettlement settings globally.
Highlights
The number of forcibly displaced people worldwide has currently reached levels second only to the number shortly after World War II [1]
Our study considers three waves of data from the largest, nationally representative, prospective cohort study of refugees conducted to date (n = 2,399)
We show the predictors of mental illness in this cohort and examine the relationship of like-ethnic social support and mental illness
Summary
The number of forcibly displaced people worldwide has currently reached levels second only to the number shortly after World War II [1]. The United Nations High Commissioner for Refugees (UNHCR) estimates that there were 22.5 million refugees and 2.8 million asylum seekers worldwide at the end of 2016, equating to, on average, 20 people displaced from their homes every minute [1]. Australia’s humanitarian intake represents the third highest rate of UNHCR humanitarian resettlement worldwide, behind the United States and Canada, and is committed to a programme in 2018–2019 aiming to permanently resettle 18,750 humanitarian migrants [1, 2]. Individuals acquiring visas prior to arrival in Australia are considered as offshore humanitarian migrants and individuals acquiring visas after arriving in Australia as onshore humanitarian migrants [2]. The Australian offshore humanitarian migrant programme resettles individuals under a Permanent Protection visa. The Australian onshore humanitarian migrant programme resettles individuals under the “Refugee” or “Special Humanitarian Programme” visa categories [2]. As refugee numbers grow worldwide, understanding prevalence and determinants of mental illness in this population becomes increasingly important
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