The mental health of child refugees from the Middle-East & their

parents: refugee status and immigration detention

Julie Robinson

Soheyla Farhadi School of Psychology

Flinders University

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(Woomera)

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Background

• 2184 children in immigration detention between 1 July 1999 and 30 June 2003.

• 92.8% of them were eventually recognized as refugees, granted TPVs and released into the Australian community

• Little is known about their well-being or their need for services.

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Past research

• “A last resort”. The national inquiry into children in immigration detention– Qualitative data

– from children and families– case notes of professionals (only those referred)

– Quantitative– no comparison groups

• Steel, Silove, Newman et al. (2004)– Quantitative

• Telephone interviews, in detention– No comparison groups

Objectives

• Compare 3 groups– detained refugee children (unauthorised arrivals)– refugee children not detained (authorised arrivals)– Australian-born children of refugee parents Whose parents were born in Iraq, Iran or Afghanistan

• Assess 2 outcomes– Mental health – Adjustment

• educational performance, physical health, feelings of safety, quality of peer and family relationships

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Participants• Mean age 10.2 years (range 4.1 to 18.0 years)

• 3 groups:– Refugees detained on arrival (n=35)

• Duration of detention, M = 5.7 months • Time since release, M = 28.0 months

– Refugees not detained on arrival (n=35)– Australian-born children of refugee parents (n=35)

• Snowball recruitment

• 56 families

Measures

StressorsChildren’s exposure to stressful events

• Parental report• Exposure to Traumatic Events Scale (McCallin,

1992)

– Designed for refugees

• In homeland (e.g., home raid)

• En-route to Australia (e.g., shipwreck) • In detention (e.g., ransacked, tear gas)

All parents asked to report on all events regardless of location

Score = number of different types of events directly experienced, witnessed, first hand accounts.

Stressors Parents’ Psychological Distress

• Self-report– Hopkins Symptom Checklist-25

• Depression and Anxiety

• Single score (mean)• Cronbach alpha=.93 (n=56)

OutcomesChild emotional and behavioural problems

• Parental report • Child Behaviour Checklist (CBCL) in Farsi or

English• Internalising problems (alpha = .86)• Externalising problems (alpha = .85)• Total problems (alpha = .90-.92)

Interview format if low literacy

Outcomes Children’s adjustment

• Ratings by parents and children• Sad/happy• feelings of safety • physical health • school performance • friendships• relationship with parents

– 5-point scale• alternatives marked by both verbal and visual cues

Results

Description

StressorsChildren’s exposure to stressful events

Refugees Refugees Not

detained not detained refugees

M (SD) M (SD) M (SD)

_____________________________________

In homeland 1.0 (1.8) 1.3 (1.4) 0.3 (0.7)

On the way 4.0*** (1.6) 0.7 (1.0) 0.1 (0.2)

In detention 5.8*** (2.7) 0.0 - 0.0 -

Total trauma 10.8***(3.5) 2.0 (2.0) 0.4 (0.7)

______________________________________*** Detained > not detained, p<.001

Stressful events: Detained children

Journey to Australia Chased by guards or police 54.3%Separated from parents/ family 28.6%Shipwreck 74.3%

In detentionLiving quarters “ransacked” 80.0%Witnessed self-harm 77.1%Riot 74.3%

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Stressors

Parents’ Psychological Distress

Refugees Refugees NotHopkins score detained not detained refugees_____________________________________________________________________________

Mean 2.1*** 1.6 1.4 (S.D.) (0.6) (0.4) (0.4)

In clinical range 60%*** 29% 17%_____________________________________________________________________________

*** Detained > not detained, p<.001

OutcomesChild emotional and behavioural problems

(CBCL: High scores = more problems) Refugees Refugees Not detained not detainedrefugees

T scores M (SD) M (SD) M (SD)________________________________________________________________________________

Total 64.1*** (7.2) 50.8 (9.1) 48.7 (6.5)

Internalizing 64.3*** (9.7) 53.5 (9.7) 51.9 (6.3)

Externalizing 57.8*** (9.0) 46.9 (8.1) 45.3 (8.2)________________________________________________________________________________

*** Detained > not detained, p<.001 Covaried for relevant extraneous variables (parental education, time in Australia) No sig. differences between “refugees not detained” and “not refugees” (p>.05)

Children in CBCL “clinical range”

Refugees Refugees Not

detained not detained refugees

__________________________________________________________________________________

Total score 49%** 11% 3%

Internalising 54%** 14% 3%

Externalising 26%** 3% 6%___________________________________________________________

** Detained > not detained, p<.01

Outcomes Children’s adaptation

(Ratings: high scores = better adaptation)

Refugees Refugees Notdetained not detained refugees

Domain M (SD) M (SD) M (SD)________________________________________________________________________

Happy/sad Parent 3.4* (1.2) 4.3 (0.9) 4.5 (0.7) Child 3.7 (1.1) 4.0 (0.9) 4.3 (0.8)

Feelings of safety Parent 3.2* (1.3) 4.3^ (1.0) 4.0 (1.1) Child 3.6* (1.1) 4.4^ (0.6) 4.2 (8.4)________________________________________________________________________

• Detained < not detained;

^ Refugees not detained > or < not refugees (p<.05)

Refugees Refugees Not detained not detained refugees

Domain M (SD) M (SD) M (SD)________________________________________________________________________

Physical health Parent 3.6* (1.3) 4.5 (0.8) 4.5 (0.7) Child 3.9* (0.9) 4.4 (0.7) 4.2 (1.0)

School performance Parent 3.5* (1.2) 4.5 (0.7) 4.6 (0.6) Child 3.6 (0.9) 4.1 (0.9) 4.4 (0.6)

Friendships Parent 3.6* (1.4) 4.7^ (0.7) 4.5 (0.7)

Child 3.9 (1.0) 4.2^ (0.9) 4.7 (0.5)

Relationship with parents Parent 3.6* (1.3) 4.5 (0.8) 4.5 (0.6)

Child 4.0 (1.1) 4.3^ (0.7) 4.3 (0.7)

Results

Explanation

What accounts for group differences in outcomes: artifact of parental distress?

• When covary for parental distress, poorer outcomes for detained refugees remain– All CBCL scores– All parental ratings of adjustment– Both sig. child ratings of adjustment

What accounts for group differences in outcomes: detention per se?

• Duration of detention – NOT related to any CBCL score

• Time since release from detention – related to 1 CBCL score

• Externalising problems r (33) = -.57, p<.001

What accounts for group differences in outcomes: exposure to stressful events?

When covaried for extraneous variables associated with group, stressful events continue to show associations with

• CBCL measures• Total score R2change=.205***• Internalising problems R2change=.128***• Externalising problems R2change=.148***

• ratings of children’s adaptation

R2change

_________________________

Parent Childreport self-

report____________________________________________________

Happy/sad .140*** n.s.Safety .054* .071**Health .137*** .075**Schoolwork .192*** .167***Friendship .114*** .047*Relationship with parents .194*** .119***____________________________________________________

• When extraneous variables and exposure to stressful events were entered first, group explained additional variance on only 3/15 outcome variables– externalising problems (R2change=.059**)– parent-reported safety (R2change=.033* )– parent-reported friendships

(R2change=.051**)

Across groups, how much variance in outcomes accounted for by exposure to stressful events alone (Step 1 of regression)?

• CBCL Total T score 40.9% p<.001

Internalizing 26.3% p<.001

Externalizing 23.8% p<.001

• Child adaptation Parent-reported Self-reported

Happy/sad 27.7% p<.001 8.1% p<.01

Safety 15.2% p<.001 13.1% p<.001

Health 23.7% p<.001 7.5% p<.01

Schoolwork 25.4% p<.001 18.6% p<.001

Friendships 24.7% p<.001 13.7% p<.001

Family relationships 26.5% p<.001 11.1% p=.001

Parental distress & children’s exposure to stressful events

• Correlation between parental distress and child exposure to stressful events, r(103)

= .56***

• Regression analysis– Step 1: Exposure to stressful events– Step 2: Parental distress accounted for additional

variance in• Total score CBCL 3.8%*• Internalising problems CBCL 5.2%**• Child report happy/sad 4.3%*• Child report relationship with parents 4.4%*

Conclusions

Causation• No random assignment• No pre-/post design

• Groups– Confounded with measured demographic

variables (nationality, child age, time in Australia)--statistical control only

– Differ in exposure to trauma prior to detention– Differ in current status (TPVs) – Likely confounded with unmeasured variables past

and present

• 4 possibilities– Psychological problems predate detention

but were not effectively addressed in detention or since release

– Psychological problems originated with detention and were not effectively addressed in detention or since release

– Psychological problems originated after release, and have not yet been effectively addressed

– Some combination of above

Action

• Prevention: Plausible explanations– Exposure to stressful events– Parental distress

• Intervention– Parents– Children

• Reports by distressed parents– Covary for parental distress: all group differences remain

• Parent’s poor mental health a risk factor

Poor outcomes for detained refugee children

• Not due to cultural norms (not seen in Australian-born

children of refugees) • Not due to being refugee (greater than for refugees

who did not experience detention)

• Associated with parental distress and exposure to stressful events, both of which associated with being in detention

• Problems present 2 yrs after release

• Not going away: – Children remain in detention (Dec 2003 M = 1 yr 8 mo 11 days)– They are now us– Unlikely to be the last

• Decisions– Detain or not detain– What model of detention– Policies and procedures within chosen

model

No policy to protect children from exposure to stressful events

Children in playground at Woomera with hunger strike in background, January 2002.

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