Pre-migration and post-migration factors associated with mental health in humanitarian migrants in Australia and the moderation effect 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 effect 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 3-6 months preceding the survey, with 77% and 23% of participants being granted visas through offshore and onshore humanitarian programmes, respectively. Post-traumatic stress disorder (PTSD) was measured with the Post-traumatic 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%; 95% CI 29·4-33·2) had PTSD and 394 (16%; 95% 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% 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 significantly 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% 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.



None.
Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China; Humanitarian and Development Research Initiative, School of Social Science and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW, Australia. Electronic address: chenwen200485@163.com.
Wen
W
Chen
Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China; Global and Community Mental Health Research Group, Faculty of Social Sciences, Department of Psychology, University of Macau, Macau, China; Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Brian J
BJ
Hall
Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China; Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China.
Li
L
Ling
Humanitarian and Development Research Initiative, School of Social Science and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW, Australia.
Andre Mn
AM
Renzaho
D000328:Adult; D001315:Australia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D008603:Mental Health / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D012036:Refugees / Q000523:psychology* / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000523:psychology*