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

Authors

  • Derrick Silove, MBChB (Hons I), MD, FRANZCP
  • Zachary Steel, MPsych(clinical), BA(Hons)
  • Ina Susljik, BA, PDip(psychol)
  • Naomi Frommer, BA(Hons), LLB
  • Celia Loneragan, BA(Hons)
  • Tien Chey, MAppstat
  • Robert Brooks, PhD
  • Dominique le Touze, BA(Hons), MSc
  • Mariano Ceollo, BA, MPsych
  • Mitchell Smith, MBBS
  • Elizabeth Harris, MPH
  • Richard Bryant, PhD

DOI:

https://doi.org/10.5055/ajdm.2007.0041

Keywords:

refugees, asylum seekers, trauma, PTSD, postmigration stress, migration, policy

Abstract

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.

Author Biographies

Derrick Silove, MBChB (Hons I), MD, FRANZCP

School of Psychiatry, University of New South Wales and Centre for Population Mental Health Research, Sydney South West Area Health Service, Sydney, Australia.

Zachary Steel, MPsych(clinical), BA(Hons)

School of Psychiatry, University of New South Wales and Centre for Population Mental Health Research, Sydney South West Area Health Service, Sydney, Australia.

Ina Susljik, BA, PDip(psychol)

School of Psychiatry, University of New South Wales and Centre for Population Mental Health Research, Sydney South West Area Health Service, Sydney, Australia.

Naomi Frommer, BA(Hons), LLB

Centre for Population Mental Health Research, Sydney South West Area Health Service, Sydney, Australia.

Celia Loneragan, BA(Hons)

Centre for Population Mental Health Research, Sydney South West Area Health Service, Sydney, Australia.

Tien Chey, MAppstat

Centre for Population Mental Health Research, Sydney South West Area Health Service, Sydney, Australia.

Robert Brooks, PhD

Centre for Population Mental Health Research, Sydney South West Area Health Service, Sydney, Australia.

Dominique le Touze, BA(Hons), MSc

Centre for Population Mental Health Research, Sydney South West Area Health Service, Sydney, Australia.

Mariano Ceollo, BA, MPsych

Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), New South Wales, Carramar, Sydney, Australia.

Mitchell Smith, MBBS

NSW Refugee Health Service, Sydney South West Area Health Service, Sydney, Australia.

Elizabeth Harris, MPH

Dlp Social Work, Dip ED, Centre for Health Equity, Training, Research and Evaluation, Sydney South West Area Health Service, Sydney, Australia.

Richard Bryant, PhD

School of Psychology, University of New South Wales, Sydney, Australia.

References

Lie B: A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees. Acta Psychiatr Scand. 2002; 106(6): 415-425.

Hauff E, Vaglum P: Organised violence and the stress of exile. Predictors of mental health in a community cohort of Vietnamese refugees three years after resettlement. Br J Psychiatry. 1995; 166(3): 360-367.

Roth G, Ekblad S: A longitudinal perspective on depression and sense of coherence in a sample of mass-evacuated adults from Kosovo. J Nerv Mental Dis. 2006; 194(5): 378-381.

Silove D, Sinnerbrink I, Field A, et al.: Anxiety, depression and PTSD in asylum seekers: Associations with pre-migration trauma and post-migration stressors. Br J Psychiatry. 1997; 170: 351-357.

Silove D, Steel Z,Watters C: Policies of deterrence and the mental health of asylum seekers in Western Countries. JAMA. 2000; 284: 604-611.

Laban C, Gernaat H, Komproe I, et al.: Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Mental Dis. 2004; 192: 843-851.

Steel Z, Mares S, Newman L, et al.: The politics of asylum and immigration detention: Advocacy, ethics and the professional role of the therapist. In Wilson JP, Drozdek B, (eds.): Broken Spirits:The Treatment of Traumatised Asylum Seekers, Refugees,War and Torture Survivors. New York: Brunner-Routledge, 2004: 659-687.

Steel Z, Silove D, Bird K, et al.: Pathways from war trauma to posttraumatic stress symptoms among Tamil asylum seekers, refugees, and immigrants. J Trauma Stress. 1999; 12(3): 421-435.

United Nations High Commissioner for Refugees: 2005 Global Refugee Trends: Statistical Overview of Populations of Refugees, Asylum Seekers, Internally Displaced Persons, Stateless Persons and Other Persons of Interest to UNHCR. Geneva: UNHCR, 2006.

Glendenning P, Leavey C, Hetherton M, et al.: Deported to Danger: A Study of Australia’s Treatment of 40 Rejected Asylum Seekers. Sydney, Australia: Edmund Rice Centre for Justice & Community Education, 2004.

Steel Z, Frommer N, Silove D: Failing to understand: refugee determination and the traumatized applicant. Int J Law Psychiatry. 2004; 27(6): 511-528.

Herlihy J, Ferstman C, Turner SW: Legal issues in work with asylum seekers. In Wilson J, Drozdek B (eds.): Broken Spirits: The Treatment of Traumatised Asylum Seekers, Refugees, War and Torture Survivors. New York: Brunner-Routledge, 2004: 641-658.

Rousseau C, Crépeau F, Foxen P, et al.: The complexity of determining refugeehood: A multidisciplinary analysis of the decisionmaking process of the Canadian Immigration and Refugee Board. J Refug Stud. 2002; 15(1): 43-70.

Department of Immigration and Multicultural Affairs: Factsheet 61: Seeking asylum within Australia. Canberra: DIMIA, 2003.

Silove D, Steel Z, McGorry P, et al.: Trauma exposure, postmigration stressors, and symptoms of anxiety, depression and posttraumatic stress in Tamil asylum-seekers: Comparison with refugees and immigrants. Acta Psychiatr Scand. 1998; 97(3): 175-181.

Silove D, Coello M,Tang K, et al.: Towards a researcher-advocacy model for asylum seekers: A pilot study amongst East Timorese living in Australia. Transcult Psychiatry. 2002; 39: 452-468.

Silove D, Ekblad S: How well do refugees adapt after resettlement in Western countries? Acta Psychiatr Scand. 2002; 106(6): 401-402.

Steel Z, Silove D, Phan T, et al.: Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: A population-based study. Lancet. 2002; 360: 1056-1062.

Davis R: PTSD Symptom changes in refugees. Torture. 2006; 16(1): 10-19.

Silove D: The psychosocial effects of torture, mass human rights violations, and refugee trauma: Toward an integrated conceptual framework. J Nerv Ment Dis. 1999; 187(4): 200-207.

Silove D, Steel Z, Susljik I, et al.: Torture, mental health status and the outcomes of refugee applications among recently arrived asylum seekers in Australia. Int J Migration Health Social Care. 2006; 2(1): 4-14.

Steel Z, Silove D, Brooks R, et al.: Impact of immigration detention and temporary protection on the mental health of refugees. Br J Psychiatry. 2006; 188: 58-64.

Silove D: Is posttraumatic stress disorder an overlearned survival response? An evolutionary-learning hypothesis. Psychiatry. 1998; 61(2): 181-190.

Sarantakos S: Social Research. 2nd ed. Melbourne, Australia: Macmillan Education, 1998.

Mollica RF, Caspi-Yavin Y, Bollini P, et al.: The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992; 180(2): 111-116.

Mollica RF, McInnes K, Sarajlic N, et al.: Disability associated with psychiatric comorbidity and health status in bosnian refugees living in Croatia. JAMA. 1999; 282: 433-439.

Mollica RF,Wyshak G, de-Marneffe D, et al.: Indochinese versions of the Hopkins Symptom Checklist-25: A screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987; 144: 497-500.

Gandek B, Ware JE, Aaronson NK, et al.: Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: Results from the IQOLA project. J Clin Epidemiol. 1998; 51(11): 1171-1178.

Ware JE, Kosinski M, Keller SD: A 12-item short-form health survey, construction of scales and prelimenery test of validity and reliability. Med Care. 1996; 34: 220-233.

Vickers AJ, Altman DG: Statistics notes: Analysing controlled trials with baseline and follow up measurements. BMJ. 2001; 323: 1123-1124.

Herlihy J, Scragg P, Turner S: Discrepancies in autobiographical memories—Implications for the assessment of asylum seekers: repeated interviews study. BMJ. 2002; 324: 324-327.

Silove D, Steel Z: Understanding community psychosocial needs after disasters: Implications for mental health services. J Postgrad Med. 2006; 52(2): 121-125.

Published

11/01/2007

How to Cite

Silove, MBChB (Hons I), MD, FRANZCP, D., Z. Steel, MPsych(clinical), BA(Hons), I. Susljik, BA, PDip(psychol), N. Frommer, BA(Hons), LLB, C. Loneragan, BA(Hons), T. Chey, MAppstat, R. Brooks, PhD, D. le Touze, BA(Hons), MSc, M. Ceollo, BA, MPsych, M. Smith, MBBS, E. Harris, MPH, and R. Bryant, PhD. “The Impact of the Refugee Decision on the Trajectory of PTSD, Anxiety, and Depressive Symptoms Among Asylum Seekers: A Longitudinal Study”. American Journal of Disaster Medicine, vol. 2, no. 6, Nov. 2007, pp. 321-9, doi:10.5055/ajdm.2007.0041.