The impact of age-related differences in emotion dysregulation on refugee mental health and social outcomes.

The refugee experience is typically characterized by exposure to numerous premigration traumatic events and postmigration stress in the resettlement environment. Refugees' experiences can lead to elevated rates of psychopathology, including posttraumatic stress disorder (PTSD) and depression. Emotion regulation is a key mechanism contributing to mental health outcomes among refugees. This study examined the impact of age on the association between emotion regulation and critical social outcomes relevant to refugee resettlement, such as social engagement and functional impairment. Participants were 1,081 Arabic-, Farsi-, Tamil- and English-speaking adult refugees. Premigration trauma exposure, postmigration stressors, PTSD symptoms, depressive symptoms, emotion regulation, social engagement, and functional impairment were measured. A series of hierarchical regression and Poisson regression analyses revealed emotion dysregulation as a significant predictor of functional impairment, ß = .36, p < .001, and social engagement, Exp B = 0.99, p = .002. A significant interaction between age and emotion dysregulation was associated with both PTSD, ß = .05, p = .048 and depressive symptoms, ß = .06, p = .010, suggesting a stronger positive association between emotion dysregulation and both PTSD and depressive symptom severity for older individuals. Postmigration stressor exposure, emotion dysregulation, and older age are important factors that may negatively impact social engagement and functional impairment in the resettlement environment. Additionally, higher levels of trauma exposure may negatively impact social engagement. These findings have implications for public health and social services in the context of resettled refugee communities.

The mental health effects of changing from insecure to secure visas for refugees.

OBJECTIVE: In response to growing numbers of refugees worldwide, host governments are increasingly implementing temporary protection policies; however, little is known regarding the mental health impact of these policies. This online longitudinal study investigated whether refugees who transitioned from low visa security (e.g. short-term transient visas) to medium (e.g. temporary protection visas) or high visa (e.g. permanent visas) security showed changes in depression symptoms, social difficulties and immigration-related fears. METHODS: Participants were 1,201 refugees and asylum-seekers from Arabic, Farsi, Tamil or English-speaking backgrounds. Study variables were measured prior to and after change in visa status (6 months apart). RESULTS: Refugees who transitioned from low to medium security visas showed reduced immigration-related fear (B = -0.09, 95% confidence interval = -0.29 to -0.06), but no change in depression symptoms or social difficulties compared to those who retained low visa security. Refugees who transitioned from low to high security visas showed reduced depression symptoms (B = -0.02, 95% confidence interval = -0.04 to -0.01), social difficulties (B = -0.04, 95% confidence interval = -0.05 to -0.01) and immigration-related fear (B = -0.03, 95% confidence interval = -0.06 to -0.01) compared to those who retained low visa security. CONCLUSION: Findings indicate that the increased security afforded by temporary protection policies (vs short-term transient visas) did not translate into improved mental health and social outcomes for refugees. In contrast, permanent protection was associated with significant improvements in psychological and social functioning. These results have important policy implications for countries who have committed to protect and facilitate improved mental health among refugees.

The longitudinal association between moral injury appraisals and psychological outcomes in refugees.

BACKGROUND: Refugees report a diverse array of psychological responses following persecution and displacement. Little is known, however, regarding the mechanisms that underlie differential psychological reactions in refugees. This study investigated the longitudinal impact of negative moral appraisals about one's own actions [i.e. moral injury-self (MI-self) appraisals] and others' actions [i.e. moral injury-other (MI-others) appraisals] on a variety of psychological symptoms over a period of 6 months. METHODS: Participants were 1085 Arabic, Farsi, Tamil, or English-speaking refugees who completed a survey at baseline and 6 months later either on-line or via pen-and-paper. The survey indexed demographic factors, exposure to potentially traumatic events (PTEs), exposure to ongoing stressors, MI-other appraisals, MI-self appraisals, re-experiencing and arousal symptoms, and feelings of sadness, anger and shame. RESULTS: Findings indicated that, after controlling for demographics, PTE exposure and ongoing stressors, MI-other appraisals predicted increased re-experiencing and hyperarousal symptoms, and feelings of sadness and shame. MI-self appraisals predicted decreased feelings of shame, and decreased re-experiencing symptoms. In contrast, psychological symptoms at baseline did not as strongly influence MI appraisals 6 months later. CONCLUSIONS: These findings highlight the important role that cognitive appraisals of adverse events play in the longitudinal course of psychological symptoms. These results thus have important implications for the development of tailored psychological interventions to alleviate the mental health burden held by refugees.

Mechanisms underlying the mental health impact of family separation on resettled refugees.

OBJECTIVE: Many refugees experience prolonged separation from family members, which research suggests has adverse effects on mental health and post-displacement outcomes in refugee populations. We examine mental health differences in refugees separated and not separated from their families, and key post-migration factors and cultural mechanisms that may underlie this impact. METHODS: A sample of 1085 refugees resettled in Australia, of which 23.3% were separated from all of their immediate family, took part in an online battery of survey measures indexing pre- and post-migration refugee experiences, mental health symptoms, disability and individualistic/collectivistic self-identity. Family separation was used as a predictor of mental health outcomes in a series of linear regressions, and the separated and non-separated groups were compared in multigroup path analysis models to examine group-specific indirect effects. RESULTS: The separated group reported greater exposure to pre-migration potentially traumatic events and higher levels of post-migration living difficulties compared to the non-separated group. Family separation predicted higher post-traumatic stress and depression symptoms, but not disability, after controlling for potentially traumatic event exposure, age and sex. Path analyses revealed distinct indirect effects for separated and non-separated groups. Principally, higher collectivistic self-identity was associated with elevated post-traumatic stress, depression and disability symptoms via social-related post-migration living difficulties such as isolation and loneliness in the separated group; whereas collectivism was linked with increased depression symptoms via economic-related post-migration living difficulties in the non-separated group. CONCLUSION: These findings indicate that family separation powerfully influences mental health outcomes, but that its effect may be mediated by the type of post-migration stress experienced in the settlement environment and culturally bound differences in how the sense of self is interconnected with family.

Moral injury appraisals and complex PTSD in refugees: A longitudinal study.

OBJECTIVE: Refugees show elevated rates of complex posttraumatic stress disorder (CPTSD). However, relatively little is known regarding the psychological mechanisms that underlie the association between exposure to potentially traumatic events (PTEs) and CPTSD following exposure to war, persecution and displacement. In this study, we investigated the potential mediating role of moral injury appraisals (cognitive appraisals regarding the experience and consequences of morally transgressive events) in the association between PTE exposure, posttraumatic stress disorder (PTSD), and disturbances in self-organization (DSO) symptoms. METHOD: Participants were 889 refugees from Arabic-, Farsi-, Tamil-, and English-speaking backgrounds who completed an online survey in their own language at two time points 12 months apart. We assessed PTE exposure, moral injury-other appraisals (appraising moral transgressions as enacted by others), moral injury-self appraisals (appraising moral transgressions as enacted by the self), PTSD symptoms, and DSO symptoms. RESULTS: Longitudinal structural equation modeling indicated that moral injury-other appraisals mediated the association between PTE exposure and both PTSD and DSO symptoms. In contrast, moral injury-self appraisals only mediated the association between PTE exposure and DSO symptoms. CONCLUSIONS: Findings highlight the role of moral injury appraisals in exacerbating traditional PTSD symptoms, as well as the broader symptoms characteristic of CPTSD. Further, results indicate that specific types of moral injury appraisals (relating to one's own and others' perceived moral transgressions) may lead to differential psychological reactions, raising important implications for clinical practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Staff Perspectives of Safety Planning as a Suicide Prevention Intervention for People of Refugee and Asylum-Seeker Background.

Background: Safety planning involves the co-development of a personalized list of coping strategies to prevent a suicide crisis. Aims: We explored the perspectives of workers regarding safety planning as a suicide prevention strategy for people of refugee background and those seeking asylum in Australia. Method: Participants attended suicide prevention training, specific to refugees and asylum seekers, at which safety planning was a key component. Semistructured, posttraining interviews (n = 12) were analyzed thematically. Results: Four key themes were identified: safety planning as a co-created, personalized activity for the client; therapeutic benefits of developing a safety plan; barriers to engaging in safety planning; strategies to enhance safety planning engagement. Limitations: First-hand refugee and asylum-seeker experiences were not included. Conclusion: As a relatively low-cost, flexible intervention, safety planning may be valuable and effective for these groups.

Profiles of post-migration stressors and mental health in refugees: A latent class analysis.

Studies have documented the mental health effects of pre-migration trauma on resettled refugees and identified distinct psychological symptom profiles using person centred statistical techniques (e.g., latent class analysis; LCA). These techniques have advanced our understanding of the complex presentation of trauma and psychopathology in refugees. The current study employs LCA to examine patterns of exposure to stressors including post-migration stressors, allowing us to identify patterns of post-migration stress exposure and their association with mental health outcomes. Participants were 1085 Arabic, Farsi, Tamil, or English speaking adult refugees. Pre-migration trauma, post-migration stressors, PTSD, depression, anger, and functional impairment was measured. LCA was conducted to identify distinct classes of post-migration stressors and associations with mental health and adjustment in the resettlement environment. Latent class analysis revealed 5 classes of participants: high difficulties class (7.2%), immigration fear class (14.4%), social disconnection class (17.3%), moderate difficulties class (28.9%) and a low difficulties class (32.3%). Each of the five classes shared commonalities in addition to key differences associated with specific demographic characteristics and psychopathology. Post-migration stressors appear to map onto distinct profiles, which uniquely contribute to functional impairment and mental health outcomes in refugees. These findings have substantial implications for public health and social services working with resettled refugee communities.

Cognitive mechanisms underlying the association between trauma exposure, mental health and social engagement in refugees: A longitudinal investigation.

BACKGROUNDS: Refugees and asylum-seekers are at heightened risk for developing psychological symptoms following exposure to trauma and displacement. Despite this, relatively little is known about the cognitive mechanisms that underlie common mental disorders in refugees. METHODS: In this study, we investigated the associations between self-efficacy, beliefs about others (relating to benevolence and trust) and psychological and social outcomes in 1079 refugees from Arabic, Farsi, Tamil or English-speaking backgrounds who were residing in Australia. Participants completed an online survey assessing exposure to potentially traumatic events (PTEs), at baseline (T1), and self-efficacy, beliefs about others, PTSD symptoms, depression symptoms, anger and social engagement at baseline (T1) and six months later (T2). RESULTS: A path analysis revealed that greater PTE exposure was associated with lower self-efficacy and lower positive beliefs about others at T1. Self-efficacy at T1 was negatively associated with depression and anger at T2, while positive beliefs about others at T1 were positively associated with social engagement and greater depression symptoms at T2. LIMITATIONS: Limitations of this study included the fact that the study sample was not necessarily representative of the broader refugee population, and in particular may have overrepresented those with higher education levels. CONCLUSIONS: Findings point to the critical role that cognitive variables play in the maintenance of psychological symptoms in forcibly displaced persons, and highlight the importance of targeting these in psychological interventions to promote positive posttraumatic mental health.

An Evaluation of Suicide Prevention Education for People Working With Refugees and Asylum Seekers.

Background: There are concerning rates of suicidality among asylum seekers and refugees in Australia, and tailored suicide prevention initiatives are needed. Aims: We aimed to evaluate the impact of a tailored suicide prevention education program for people working with asylum seekers and refugees. Method: Attendees of the education program completed self-report questionnaires at pretraining, posttraining, and 4-6 months follow-up. Results: Over 400 workers, volunteers, and students across Australia took part in the education program. A series of linear mixed-effects models revealed significant improvements in outcome measures from pretraining (n = 247) to posttraining (n = 231). Improvements were maintained at follow-up (n = 75). Limitations: Limitations of this research were the lack of a control group and a low follow-up response rate. Conclusion: Findings suggest that a 2 days tailored suicide prevention education program contributes to significant improvements in workers' attitudes toward suicide prevention, and their confidence and competence in assessing and responding to suicidal distress.

Course and predictors of posttraumatic stress and depression longitudinal symptom profiles in refugees: A latent transition model.

Exposure to potentially traumatic events and post-migration living difficulties (PMLDs) may explain the high rates of posttraumatic stress disorder (PTSD) and depression in resettled refugees. Latent class analyses (LCAs) in refugees have identified subgroups that differ in symptom profiles of PTSD and comorbid symptoms. However, knowledge on longitudinal symptom profiles in refugees is sparse. Examining longitudinal PTSD and depression symptom profiles could provide information on risk factors underlying worsening of symptoms post-resettlement. Self-rated PTSD (Posttraumatic Diagnostic Scale) and depression (Patient Health Questionnaire-9) symptoms were assessed among 613 refugees who had resettled in Australia up to two years previously (W1) and at 6 months follow-up (W2). PTSD and depression symptom profiles were identified using LCAs for W1 and W2 separately. Latent transition analysis was used to examine (predictors of) changes in symptom profiles, including gender, age, trauma exposure, and PMLDs. Four classes were identified that were consistent across timepoints: a No symptoms (W1 61%; W2 68%), Low PTSD/Moderate depression (W1 16%; W2 10%), Moderate PTSD/depression (W1 16%; W2 14%), and High symptoms class (W1 7%; W2 7%). Higher levels of problems with PMLDs, including being discrimination and family separation, predicted movements out of the No symptom class at W1 to classes with psychopathology at W2. To conclude, most participants did not develop PTSD or depression symptoms. The risk of developing these symptoms seems higher when problems with interpersonal PMLDs increased, pointing to the need for considering these stressors when addressing the mental health needs in this population.

The association between COVID-19 related stressors and mental health in refugees living in Australia.

BACKGROUND: Refugees may be particularly vulnerable to the adverse effects of the COVID-19 pandemic on mental health due to their traumatic pasts and the challenges of the postmigration environment. OBJECTIVE: To evaluate the prevalence of COVID-19 related stressors and their relationship to key mental health and functioning outcomes in a resettled refugee sample. METHOD: N = 656 refugees and asylum seekers living in Australia completed a survey in June 2020 to index their mental health (posttraumatic stress disorder (PTSD), depression, health anxiety and disability) and COVID-19 experiences. The relationship between COVID-19 stressors and mental health was examined using a series of hierarchical linear regression models while controlling for other key demographic factors. RESULTS: Refugees' most prevalent stressors related to worries of being infected by COVID-19 or the risk COVID-19 posed to others, which predicted health anxiety and PTSD. Social-related difficulties predicted depression and disability symptoms. Accessing and trusting information from authorities were the least prevalent stressors and were not significantly associated with mental health outcomes; neither was accessing basic supplies and financial support. Fears relating to the future such as concerns about visa application processes predicted health anxiety and disability. Crucially, the strongest predictor of all mental health outcomes was COVID-19 serving as a reminder of difficult past events. CONCLUSIONS: Refugees may be uniquely affected by COVID-19 because the pandemic serves as a reminder of their past conflict and persecution trauma. It is critical that mental health strategies accommodate the specific needs of refugees during the COVID-19 pandemic.

Antecedentes: Los refugiados pueden ser particularmente vulnerables a los efectos adversos de la pandemia del COVID-19 en la salud mental a consecuencia de sus pasados traumáticos y los desafíos del ambiente post migración.Objetivo: Evaluar la prevalencia de los estresores relacionados al COVID-19 y su relación a resultados claves funcionamiento y salud mental claves en una muestra de refugiados reubicados.Método: N = 656 refugiados y personas en búsqueda de asilo que viven en Australia completaron una encuesta en junio de 2020 para identificar su salud mental (trastorno de estrés postraumático (TEPT), depresión, ansiedad de salud y discapacidad) y las experiencias de COVID-19. Fueron examinadas la relación entre los estresores de COVID-19 y la salud mental usando una serie de modelos de regresión lineal jerárquica mientras se controlaron otros factores demográficos claves.Resultados: Los estresores más prevalentes de los refugiados se relacionaban con la preocupación de infectarse de COVID-19 o el riesgo del COVID-19 hacia otros, lo cual predijo la ansiedad de salud y TEPT. Las dificultades sociales predijeron los síntomas de depresión y discapacidad. Acceder y confiar en la información proporcionada por las autoridades fueron los estresores menos prevalentes y no se asociaron significativamente a los resultados de salud mental; tampoco lo fue el acceder a insumos básicos y apoyo financiero. Los temores asociados al futuro tales como preocupaciones sobre los procesos de aplicación a la visa predijeron la ansiedad de salud y discapacidad. De manera crucial, el predictor más fuerte de todos los resultados de salud mental fue el COVID-19 sirviendo como un recordatorio de los eventos pasados difíciles.Conclusiones: Los refugiados pueden estar afectados de forma única por el COVID-19 porque la pandemia sirve como un recordatorio de sus conflictos pasados y trauma de persecución. Es crítico que las estrategias de salud mental se acomoden a las necesidades específicas de los refugiados durante la pandemia del COVID-19.

Factors associated with COVID-19 vaccine hesitancy amongst refugees in Australia.

Background: Refugees may be especially vulnerable to the adverse effects of COVID-19. Therefore it is critical that refugee communities are supported to access COVID-19 vaccines and for public health responses to address vaccine hesitancy. Objective: To investigate the key demographic factors, barriers and attitudes associated with vaccine hesitancy in a community sample of refugees. Method: Participants in the Refugee Adjustment Study, a cohort of refugees living in Australia, were invited to complete a survey about their COVID-19 vaccine intentions, barriers to access and attitudes relating to the vaccine. Results: Of the 516 participants, 88% were unvaccinated and 28.1% were classed as vaccine hesitant. Key predictors of vaccine hesitancy were younger age, information and trust barriers, lower logistical barriers, and attitudes relating to low control and risk posed by COVID-19. Conclusions: Findings suggest that public health strategies need to address trust, control and risk perception attitudes to increase COVID-19 vaccine uptake in resettled refugee communities.

Antecedentes: Los refugiados pueden ser especialmente vulnerables a los efectos adversos del COVID-19. Por lo tanto, es fundamental que las comunidades de refugiados reciban apoyo para acceder a las vacunas COVID-19 y para que las respuestas de salud pública aborden la indecisión ante las vacunas.Objetivo: Investigar los factores demográficos clave, las barreras y las actitudes asociadas con la indecisión ante las vacunas en una muestra comunitaria de refugiados.Método: Se invitó a los participantes en el Estudio de Adaptación de Refugiados, una cohorte de refugiados que viven en Australia, a completar una encuesta sobre sus intenciones de vacunarse contra el COVID-19, barreras de acceso y actitudes relacionadas con la vacuna.Resultados: De los 516 participantes, el 88% no estaban vacunados y el 28,1% se clasificaron como reacios a vacunarse. Los predictores clave de la vacilación a la vacuna fueron menor edad, las barreras en información y confianza, menores barreras logísticas y las actitudes relacionadas con bajo control y el riesgo que plantea el COVID-19.Conclusiones: Los hallazgos sugieren que las estrategias de salud pública deben abordar las actitudes de confianza, control y percepción del riesgo para aumentar la aceptación de la vacuna COVID-19 en las comunidades de refugiados reasentados.

The association between visa insecurity and mental health, disability and social engagement in refugees living in Australia.

Background: The vast majority of the world's refugees and people seeking asylum live in a state of sustained displacement. Little is known, however, about the mental health impact of prolonged insecurity. Objective: This study aimed to investigate the association between insecure visa status and mental health, suicidality, disability and social engagement in a sample of refugees and asylum-seekers living in Australia Method: Participants were 1,085 refugees with secure (i.e. permanent residency or Australian citizenship, n = 826, 76.1%) and insecure (i.e. asylum-seeker claim, bridging visa, temporary visa, n = 259, 23.9%) visa status who had arrived in Australia since January 2011, and were from Arabic, Farsi, Tamil or English-speaking backgrounds. Participants completed an online survey assessing pre- and post-migration experiences, mental health, disability and social engagement. Results: Results indicated that, after controlling for background factors, refugees with insecure visas had significantly greater PTSD symptoms, depression symptoms, thoughts of being better off dead and suicidal intent compared to those with secure visas. There were no group differences in disability. Refugees with insecure visas received support from significantly more groups in the Australian community than those with secure visas. Further, refugees with insecure visa status who had low group membership showed greater depression symptoms and suicidal intent than those with secure visa status who had low group membership. Conclusion: Findings highlight the negative mental health consequences of living in a state of protracted uncertainty for refugees and people seeking asylum, and the key role of social engagement in influencing mental health amongst insecure visa holders. Results also underscore the importance of designing and implementing policies and services that facilitate improved mental health for those with visa insecurity.

Antecedentes: la mayoría de los refugiados del mundo y las personas que solicitan asilo viven en un estado de desplazamiento sostenido. Sin embargo, se conoce muy poco sobre el impacto en la salud mental de la inseguridad prolongada.Objetivo: este estudio investiga la asociación entre el estatus inseguro de la visa y la salud mental, la suicidalidad, la discapacidad y la participación social en una gran muestra de refugiados y solicitantes de asilo que viven en Australia.Metodología: Los participantes fueron 1.085 refugiados. Un grupo tenía un estatus seguro de la visa (como por ejemplo residencia permanente o ciudadanía australiana n=826, 76.1%) y otro grupo tenía un estatus inseguro de su visa (como por ejemplo solicitantes de asilo, visa puente1, visas temporales, n = 259, 23,9%). Los sujetos llegaron a Australia desde Enero de 2011, y eran de origen árabe, farsi, tamil o angloparlante. Los participantes completaron un cuestionario online que evaluaba las experiencias pre y post migración, salud mental, discapacidad y participación social.Resultados: Los resultados indican que después de controlar factores contextuales importantes, los refugiados con visas inseguras tuvieron síntomas de TEPT significativamente mayores (ß=0.15, 95%; intervalo de confianza (IC) = 0,05-0,26), síntomas depresivos (ß=0.22, 95% CI=0.069-0.34), pensamientos de estar mejor muerto (OR=1.9, 95% CI=1.26-2.89) e intentos suicidas (OR=2.41, 95% CI=1.03-5.62), comparados con aquellos que contaban con visas seguras. No existen diferencias entre grupos para la discapacidad. Los refugiados con visas inseguras recibieron el apoyo de muchos más grupos que aquellos que tenían visas seguras (Chi ­ cuadrado de Wald= 33.01, p <.001). Además, los refugiados con estatus de visa inseguro con baja pertenencia al grupo mostraron mayores síntomas de depresión (B=0.17, t=3.85, p <.001) e intentos suicidas que aquellos que tenían un estatus de visa seguro y una baja pertenencia a un grupo (B=−1.25, OR=0.29, p =0.006).Conclusión: Los resultados destacan las consecuencias negativas para la salud mental de vivir en un estado de incertidumbre prolongada para los refugiados y las personas que solicitan asilo, y el papel clave de la participación social para influir en la salud mental entre los titulares de visas inseguras. Los resultados también subrayan la importancia de diseñar e implementar políticas y servicios que faciliten una mejor salud mental para las personas con visas inseguras.