Risk of psychological distress among recently arrived humanitarian migrants
Risk of psychological distress among recently arrived humanitarian migrants
John De Maio, Liliya Gatina-Bhote, Pilar Rioseco and Ben Edwards
Many humanitarian migrants have experienced torture and trauma prior to arrival in Australia and these experiences can have serious long-term mental health impacts (Settlement Council of Australia, 2014).
This Research Summary explores Building a New Life in Australia (BNLA) participants' risk of psychological distress - shortly after arrival in Australia (3-6 months, Wave 1 of the study), and at annual interviews after that (at Wave 2 and Wave 3).Differences in risk of psychological distress between men and women and by age group are also explored.
Psychological distress was assessed in the study using the Kessler Psychological Distress Scale, which screens for general mental health in an adult population.This measure provides information on the likely presence of mental health problems. How these results changed over the first three years of settlement (over three waves of data collection) for the whole cohort are also reported.
Recently arrived humanitarian migrants had a risk of psychological distress at much higher rates than the general Australian population. Between 31-46% were classified as having moderate or high risk of psychological distress in the first three waves of the study. For the Australian population, 7% of men and 11% of women had these levels of difficulties.
For some study participants, risk of psychological distress persisted over time, with 16% of the sample being classified at moderate or high risk of psychological distress at each of the first three waves of data collection.
Differences were found by gender and age, with women having greater levels of psychological distress (between 39-46% classified as moderate or high risk across waves) compared to men (31-39%). Older participants were also more often at moderate or high risk of psychological distress compared to younger migrants.
A higher proportion of those reporting to have experienced discrimination was classified as having moderate or high psychological distress compared to those that did not experience discrimination.
Risk of psychological distress
Humanitarian migrants fare poorly on a range of health outcomes when compared to the general population in their resettlement country, including having poorer physical health and heightened levels of psychological distress (Davidson & Carr, 2010). This section investigates levels of psychological distress among BNLA participants, whether these change over time (across waves), and differences between men and women.
Measuring psychological distress
Levels of psychological distress at each wave were measured using the Kessler 6 Psychological Distress Scale. This scale includes six questions about anxiety and depressive symptoms experienced during the previous four weeks and screens for general mental health in an adult population (Kessler et al., 2003). Based on participants' responses to each item, they were classified into one of the following three groups: low, moderate or high risk of psychological distress.This information was collected from all participants aged 15 years and older.
Risk of psychological distress outcomes for recently arrived humanitarian migrants
Overall, 42% of humanitarian migrants were classified as being at moderate or high risk of psychological distress at Wave 1. The corresponding rate at Wave 2 was 35% (significantly lower than at Wave 1) and 40% at Wave 3. At Wave 2 data were collected by telephone interview, with Wave 1 and Wave 3 data collected via a home interview. This different survey methodology may have influenced participants' willingness to disclose mental health problems, resulting in the lower percentage classified as moderate or high risk of psychological distress at Wave 2. This will be explored with further waves of data.
To further explore the timing of risk of psychological distress since settlement in Australia, analysis was also undertaken to describe at which time-points over the first three waves participants were classified as being at moderate or high risk of psychological distress. These results are described in Table 1 and show that overall one third (34%) of participants were not classified as moderate or high risk of psychological distress in any of the first three waves of BNLA. Conversely, 16% of participants had elevated risk of psychological distress (moderate or high) at all waves. For some participants (18% of the sample) risk of psychological distress was present earlier on in their settlement journey (either Wave 1 only, or Wave 1 and 2) and low risk was evident at Wave 3. A similar proportion (16%) of participants were at risk of psychological distress after some time in Australia (low risk at Wave 1, moderate or high risk at Wave 2 and 3, or Wave 3 only).
There were no differences in the pattern of timing of risk of psychological distress by gender, with the exception of a higher proportion of females reporting moderate or high risk of psychological distress at all waves compared to males (19% of women compared to 13% of males).
Differences by age and gender
As can be seen in Figure 1, women reported higher rates of psychological distress compared to men. Differences by gender were significant in each of the first three waves. Between 39-46% of women were classified as being at moderate or high risk of psychological distress in the first three waves. The corresponding rates for men at each wave were significantly lower: between 31-39%. Rates of psychological distress were also significantly higher when compared to the general Australian population (7% of men and 11% of women had these levels of difficulties).
Age differences were also evident with older humanitarian migrants more frequently at moderate or high levels of psychological distress than younger respondents at all three waves. Psychological distress peaked among 55-64 year olds with 58% of respondents in this age group classified as moderate or high psychological distress in Wave 1, significantly higher than the 33% of respondents aged 15-24 years old who were classified as being at moderate or high risk of psychological distress (see Table 2). The relationship found between age and psychological distress for recently arrived humanitarian migrants is in contrast to the general population where other studies have found psychological distress peaks in younger ages and then declines (ABS, 2008).
Psychological distress and experience of traumatic events
Previous research suggests a link between prior experience of trauma and humanitarian migrants' mental health (Davidson & Carr, 2010). The relationship between experiences of trauma prior to arrival in Australia and risk of psychological distress is investigated next. Jenkinson and colleagues (2016) reported that almost all BNLA respondents reported that they, or their families, had experienced one or more traumatic events prior to migrating to Australia. The relationship between number of traumatic events experienced before arrival and risk of psychological distress at each wave is described in Figure 2.
Those who had experienced or witnessed four or more traumatic events before arrival were significantly more likely to be at risk of psychological distress than those who had experienced fewer events. These differences were statistically significant at Waves 2 and 3 but not Wave 1. For example, at Wave 2, 49% of those who had reported four or more traumatic events were classified at moderate or high risk of psychological distress compared to 30% who reported one traumatic event. There was a similar difference in the proportion at risk of psychological distress at Wave 3 between those who reported four or more traumatic events (56%) and one traumatic event (42%).
Note: Analysis is restricted to participants who completed Wave 1, Wave 2 and Wave 3 surveys.
Psychological distress and experiences of discrimination
The relationship between experiences of discrimination and mental health was also explored. Overall, a small proportion of adult study participants reported an experience of discrimination at Wave 1 (5%). At Waves 2 and 3, 10% and 8% respectively had experienced discrimination since the previous wave. A higher proportion of those reporting discrimination was classified in the moderate or high psychological distress category in each wave compared to those who reported no discrimination. Around six-in-ten (61%) of the respondents who reported an experience of discrimination in Wave 1 were in the moderate or high psychological distress category compared with 41% of those who did not report discrimination.7
It is not possible to determine the direction of effects from this analysis (whether discrimination causes psychological distress or psychological distress leads to the experience of, or perception of, discrimination, or whether they are directly related at all). These results show only an association between psychological distress and experiences of discrimination. However, other research (e.g. Gee, 2002) has shown that discrimination influences the health of minority group members.
This Research Summary provides an overview of the risk of psychological distress of BNLA participants based on analysis of participants' responses to the Kessler 6 Psychological distress scale - a six question scale that screens for general mental health in an adult population. The analyses reported here use the first three waves of the BNLA data.
Overall, 4 in 10 humanitarian migrants were classified as being at moderate or high risk of psychological distress at Wave 1. These rates were significantly higher than the corresponding rates in the general Australian population (around one-in-ten reported this level of psychological distress). For some, risk of psychological distress persisted over time with 16% of BNLA participants being classified at moderate or high risk of psychological distress at each of the first three waves of the study.
Differences in the risk of psychological distress were also found by gender, with women in the BNLA sample having higher rates of psychological distress compared to men. Between 39-46% of women were classified at moderate/high risk of psychological distress over the first three waves, significantly higher than the corresponding proportion of men (31-39%). Differences by age were also evident with older respondents more frequently classified at risk of psychological distress than younger respondents at all three waves (between 53-61% of those aged 55-64 years compared to 22-33% of those 15-24 years). This pattern of findings is in contrast to the general population where other studies have found psychological distress peaks in younger ages and then declines. An association was also found between experiences of discrimination and higher levels of psychological distress in all three waves.
Access to the BNLA data
The analyses reported here are based on Waves 1-3. The first three waves of BNLA data are now available to approved researchers from government, academic institutions and non-profit organisations. Details on how to apply for the BNLA data are available on the Department of Social Services website.
1 Weighted data are used in analyses. Analysis was based on 1,704 respondents who completed a Wave 1, Wave 2 and Wave 3 interview.
2 See Kessler et al., 2003, for further details.
3 See Hilton et al. (2008) for further detail on scoring of the Kessler 6 scale.
4 Correspondingly, there was also a significant difference in the proportion of men reporting psychological distress in none of the first three waves (38%) compared to women (30%).
5 See Jenkinson et al. (2016) for further analysis of rates of psychological distress in the humanitarian migrant population and comparison with the wider Australian population. This paper reports analysis of data for the general Australian population from the ABS National Survey of Mental Health and Wellbeing.
6 Follow up questions in Wave 3 were asked and respondents reported if they had experienced traumatic events such as persecution, violence, kidnapping or imprisonment, extreme living conditions. The number of traumatic events reported were grouped into the following categories: 1 traumatic event, 2 or 3 traumatic events, 4 or more traumatic events.
7 62 respondents reported an experience of discrimination in Wave 1, 1,569 respondents did not report an experience of discrimination in Wave 1.
Australian Bureau of Statistics. (2008). National Survey of Mental Health and Wellbeing: Summary of results, 2007. (Publication no. 4326.0). ABS: Canberra.
Davidson, G., & Carr, S. (2010). Forced migration, Social exclusion and poverty: Introduction. Journal of Pacific Rim Psychology, 4(1), 1-6. Retrieved from <search.informit.com.au/documentSummary;dn=413336183034671;res=IELNZC>.
De Maio, J., Silbert, M., Jenkinson, R., & Smart, D. (2014). Building a New Life in Australia: Introducing the Longitudinal Study of Humanitarian Migrants. Family Matters, 94, 5-14. Retrieved from <aifs.gov.au/publications/family-matters/issue-94/building-new-life-australia>
Gee, G. (2002). A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. American Journal of Public Health, 92(4), 615-623.
Hilton, M. F., Whiteford, H. A., Sheridan, J. S., Cleary, C. M., Chant, D. C., Wang, P. S., & Kessler, R. C. (2008). The prevalence of psychological distress in employees and associated occupational risk factors. Journal of Occupational and Environmental Medicine, 50(7), 746-757.
Jenkinson, R., Silbert, M., De Maio, J., & Edwards, B. (2016). Settlement experiences of recently arrived humanitarian migrants (Building a New Life in Australia Fact Sheet). Melbourne: Australian Institute of Family Studies.
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., et al. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184-189.
Settlement Council of Australia. (2014). Position on key settlement issues. Canberra: Settlement Council of Australia. Retrieved from: <www.scoa.org.au/announcements/scoa-position-on-key-settlement-issues>
Authors and Acknowledgements
In 2012, the former Department of Immigration and Citizenship, now the Department of Immigration and Border Protection (DIBP), commissioned the BNLA project. From the end of Wave 1 fieldwork in April 2014, responsibility for the project moved from DIBP to the Department of Social Services. This research summary was commissioned by Settlement Services Branch, DSS. We thank DSS staff for their input into this research.
The Australian Institute of Family Studies (AIFS) was commissioned to manage the design, administration and fieldwork of the BNLA project. AIFS contracted Colmar Brunton Social Research, in conjunction with Multicultural Marketing and Management, to undertake the fieldwork for the project.
We extend special thanks to the humanitarian migrants who participated in this study, especially for their wonderful support and generosity of time. We look forward to continuing to talk with them about their settlement journey in Australia.
Feature image: © iStockphoto/asiseeit
De Maio, J., Gatina-Bhote, L., Rioseco, P., & Edwards, B. (2017). Risk of psychological distress among recently arrived humanitarian migrants. (Building a New Life in Australia Research Summary). Melbourne: Australian Institute of Family Studies.
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