Pre-migration and post-migration factors associated with mental health in humanitarian migrants in Australia and the moderation eff ect of post-migration stressors: findings from the first wave data of the BNLA cohort study
The process of becoming a humanitarian migrant is potentially damaging to mental health. We examined the association between pre-migration and post-migration potentially traumatic events and stressors and mental health, and assessed the moderating eff ect of post-migration stressors in humanitarian migrants in Australia.
In this study, we used the first wave of data between 2013 and 2014 from the Building a New Life in Australia survey. The survey included 2399 migrants who had arrived in Australia holding a permanent humanitarian visa three to six months preceding the survey, with 77 percent and 23 percent of participants being granted visas through off shore and onshore humanitarian programmes, respectively. Post-traumatic stress disorder (PTSD) was measured with the Posttraumatic Stress Disorder 8 items (PTSD-8) and severe mental illness was measured with the Kessler Screening Scale for Psychological Distress (K6). Pre-migration potentially traumatic events and post-migration stressors related to asylum process and resettlement were measured with a self-reported questionnaire.
Of the 2399 participants, 762 (31 percent; 95 percent CI 29·4–33·2) had PTSD and 394 (16 percent; 95 percent CI 14·2–17·2) had severe mental illness. The mean number of pre-migration potentially traumatic events was 2·1 (SD 1·4). 64, 59, 49, and 18 percent of participants reported poor social integration, economic problems, worrying about family or friends overseas, and loneliness as post-migration stressors. Pre-migration potentially traumatic events and post-migration stressors were positively associated with PTSD and severe mental illness. Factors signifi cantly modifying the association between pre-migration potentially traumatic events and mental health after controlling for confounding factors were resettlement related stressors, including loneliness (odds ratio 1·17, 95 percent CI 1·05–1·28 for PTSD and 1·28, 1·16–1·41 for severe mental illness) and the number of social integration stressors (1·10, 1·05–1·16 for PTSD).
Our data suggest that post-migration resettlement-related stressors were the most important correlates
of mental health in humanitarian migrants, accounting for both direct and indirect associations. Targeting resettlement-related stressors through augmenting psychosocial care programmes and social integration would be a key approach to improve humanitarian migrants’ mental health.