Persistent psychological distress in resettled refugee women-at-risk at one-year follow-up: Contributions of trauma, post-migration problems, loss, and trust.

The mental health of women has been largely neglected in the refugee literature, notwithstanding the specific gender-related issues that confront women seeking asylum. Furthermore, a specific category of women, deemed to be women-at-risk, face particular challenges in their journey and resettlement process. This longitudinal study investigated psychological distress in refugee women-at-risk one year after resettlement in Australia. Follow-up survey of 83 women-at-risk (mean age = 33.41 years; SD = 11.93) assessed: trauma events and symptoms; loss events and loss distress; level of post-migration problems; anxiety, depression, and somatic symptoms; and absence of trust in community members. Participants demonstrated no symptom change since initial assessment (p > .05). Substantial proportions of women reported traumatization (39%), PTSD (20%), anxiety (32%), and depression (39%) above clinical cut-offs, and high levels of somatization and loss distress. Post-migration problems, trauma events, and region of birth were associated with all symptoms, with post-migration problems the strongest predictor. Absence of trust in community members was associated with trauma, depression, and somatic symptoms. Initial trauma and somatic symptoms were associated with follow-up traumatic and somatic symptoms. Loss and trauma events were associated with loss distress. Findings underline the role of post-migration problems on psychological distress and the need to consider women's psychological wellbeing in the context of their trauma and loss history, potential impacts of ethnicity, and complex socio-cultural dynamics underpinning issues of trust within communities. Effective service delivery requires that practitioners screen for and address psychological distress in women-at-risk at least up to 18 months after resettlement.

Recently resettled refugee women-at-risk in Australia evidence high levels of psychiatric symptoms: individual, trauma and post-migration factors predict outcomes.

BACKGROUND: Despite increasing numbers of refugee women-at-risk being resettled and their potential vulnerability, there exists no empirical research into the psychiatric health of this unique subgroup with which to guide policy and practice. This research aimed to investigate psychiatric symptom status of a sample of refugee women-at-risk recently resettled in Australia, as well as factors contributing to symptoms of trauma, anxiety, depression, and somatization. The level of psychiatric symptomatology is compared to reference groups of women from Sudan and Burma, who entered Australia under the Humanitarian Entry Programme, and who did not meet criteria as women-at-risk. METHODS: This is a cross-sectional survey of 104 refugee women-at-risk across several ethnic groups including a demographic questionnaire, the Harvard Trauma Questionnaire, Post-migration Living Difficulties Checklist, and Hopkins Symptom Checklist to assess individual factors, traumatic experiences, post-migration problems, and symptoms of trauma, anxiety, depression, and somatization. A series of multiple hierarchical regression analyses examined factors predicting psychiatric symptoms. RESULTS: Substantial proportions of participants reported psychiatric distress in symptomatic ranges, including for traumatization (41%), post-traumatic stress disorder (20%), anxiety (29%), and depression (41%), as well as significant symptoms of somatization (41%). These findings are significantly higher than those derived from reference groups of women from Sudan or Burma, resettled in the same area and utilizing a similar methodology. Higher numbers of trauma events and post-migration living difficulties predicted higher trauma, depression, and somatic (but not anxiety) symptoms. Having children predicted higher trauma, anxiety, and somatic symptoms. Greater English fluency predicted higher anxiety symptoms. Region of birth predicted anxiety and depression symptoms. Age predicted trauma and anxiety symptoms. CONCLUSIONS: Findings suggest that recently arrived refugee women-at-risk are at high risk of psychiatric disorders. The results indicate a need for comprehensive psychiatric assessment to identify women in need of treatment very early after resettlement, with implications for medical practice, service delivery, and policy programs.

Mental health of newly arrived Burmese refugees in Australia: contributions of pre-migration and post-migration experience.

OBJECTIVE: This study documents the mental health status of people from Burmese refugee backgrounds recently arrived in Australia, then examines the contributions of gender, pre-migration and post-migration factors in predicting mental health. METHOD: Structured interviews, including a demographic questionnaire, the Harvard Trauma Questionnaire, the Post-migration Living Difficulties Checklist and Hopkins Symptom Checklist assessed pre-migration trauma, post-migration living difficulties, depression, anxiety, somatization and traumatization symptoms in a sample of 70 adults across five Burmese ethnic groups. RESULTS: Substantial proportions of participants reported psychological distress in symptomatic ranges including: post-traumatic stress disorder (9%), anxiety (20%) and depression (36%), as well as significant symptoms of somatization (37%). Participants reported multiple and severe pre-migration traumas. Post-migration living difficulties of greatest concern included communication problems and worry about family not in Australia. Gender did not predict mental health. Level of exposure to traumatic events and post-migration living difficulties each made unique and relatively equal contributions to traumatization symptoms. Post-migration living difficulties made unique contributions to depression, anxiety and somatization symptoms. CONCLUSIONS: While exposure to traumatic events impacted on participants' mental well-being, post-migration living difficulties had greater salience in predicting mental health outcomes of people from Burmese refugee backgrounds. Reported rates of post-traumatic stress disorder symptoms were consistent with a large review of adults across seven western countries. High levels of somatization point to a nuanced expression of distress. Findings have implications for service provision in terms of implementing appropriate interventions to effectively meet the needs of this newly arrived group in Australia.