The impact of the refugee decision on the trajectory of PTSD, anxiety, and depressive symptoms among asylum seekers: a longitudinal study.

OBJECTIVE: To examine prospectively the trajectory of trauma-related psychiatric symptoms and disability amongst asylum seekers over the course of the refugee determination process. To identify the direct impact of the refugee decision on psychiatric symptoms by adjusting for other variables, namely sociodemographic characteristics, past trauma, and ongoing postmigration stresses. DESIGN: A prospective cohort study of asylum seekers recruited from a random sample of immigration agents in Sydney, Australia. SETTING: Consecutive asylum seekers were referred for interview by immigration agents. Interviews were undertaken after the initial application and on average, 3.8 months after the refugee decision. MEASURES: Measures assessed premigration trauma and postmigration stressors. Mental health status was assessed using the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25. Functional impairment was assessed with the Medical Outcomes Study-Short Form 12. RESULTS: Sixty-two of 73 asylum seekers were retained at follow-up. The accepted (16) and rejected (46) groups did not differ on premigration trauma or baseline psychiatric symptoms. Postdecision, the accepted group showed substantial improvements in posttraumatic stress disorder, anxiety, depression, and in mental health functioning, whereas the rejected group maintained high levels of symptoms on all psychiatric indices. CONCLUSIONS: Establishing secure residency status for asylum seekers may be important to their recovery from trauma-related psychiatric symptoms. The practical and theoretical implications are discussed.

Impact of immigration detention and temporary protection on the mental health of refugees.

BACKGROUND: Over the past decade, developed Western countries have supplied increasingly stringent measures to discourage those seeking asylum. AIMS: To investigate the longer-term mental health effects of mandatory detention and subsequent temporary protection on refugees. METHOD: Lists of names provided by community leaders were supplemented by snowball sampling to recruit 241 Arabic-speaking Mandaean refugees in Sydney (60% of the total adult Mandaean population). Interviews assessed post-traumatic stress disorder (PTSD), major depressive episodes, and indices of stress related to past trauma, detention and temporary protection. RESULTS: A multilevel model which included age, gender, family clustering, pre-migration trauma and length of residency revealed that past immigration detention and ongoing temporary protection each contributed independently to risk of ongoing PTSD, depression and mental health-related disability. Longer detention was associated with more severe mental disturbance, an effect that persisted for an average of 3 years after release. CONCLUSIONS: Policies of detention and temporary protection appear to be detrimental to the longer-term mental health of refugees.