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Anxiety, depression and PTSD in asylum-seekers: Assocations with pre-migration trauma and post-migration stressors

Published online by Cambridge University Press:  03 January 2018

Derrick Silove*
Affiliation:
School of Psychiatry, University of New South Wales, Liverpool Hospital, Australia
Ingrid Sinnerbrink
Affiliation:
School of Psychiatry, University of New South Wales, Liverpool Hospital, Australia
Annette Field
Affiliation:
Asylum Seekers Centre, Surry Hills, Australia
Vijaya Manicavasagar
Affiliation:
Psychiatry Research and Teaching Unit, Liverpool Hospital, Australia
Zachary Steel
Affiliation:
Psychiatry Research and Teaching Unit, Liverpool Hospital, Australia
*
Professor Derrick Silove, Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, Level 4 Health Services Building, Liverpool Hospital, Liverpool, NSW 2170, Australia

Abstract

Background

Research into the mental health of refugees has burgeoned in recent times, but there is a dearth of studies focusing specifically on the factors associated with psychiatric distress in asylum-seekers who have not been accorded residency status.

Method

Forty consecutive asylum-seekers attending a community resource centre in Sydney, Australia, were interviewed using structured instruments and questionnaires.

Results

Anxiety scores were associated with female gender, poverty, and conflict with immigration officials, while loneliness and boredom were linked with both anxiety and depression. Thirty subjects (79%) had experienced atraumatic event such as witnessing killings, being assaulted, or suffering torture and captivity, and 14 subjects (37%) met full criteria for PTSD. A diagnosis of PTSD was associated with greater exposure to pre-migration trauma, delays in processing refugee applications, difficulties in dealing with immigration officials, obstacles to employment, racial discrimination, and loneliness and boredom.

Conclusions

Although based on correlational data derived from a convenient'sample, our findings raise the possibility that current procedures for dealing with asylum-seekers may contribute to high levels of stress and psychiatric symptoms in those who have been previously traumatised.

Type
Papers
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). Washington, DC: APA.Google Scholar
Baker, R. (1992) Psychosocial consequences for tortured refugees seeking asylum and refugee status in Europe. In Torture and its Consequences (ed. Basoglu, M.). pp. 83106. Cambridge: Cambridge University Press Google Scholar
Basoglu, M., Paker, M., Ozmen, E., et al(1994) Factors related to long-term traumatic stress response in survivors of torture in Turkey, Journal of the American Medical Association, 272, 357363.CrossRefGoogle ScholarPubMed
Becker, R. & Silove, D. (1993) Psychiatric and psychosocial effects of prolonged detention on asylum-seekers. In Protection or Punishment: The Detention of Asylum-Seekers in Australia (ed. Crock, M.), pp. 8190. Sydney: Federation Press.Google ScholarPubMed
Butcher, J. N. (1991) Psychological evaluation. In Mental Health Services for Refugees (eds J. Westermeyer, C. L. Williams & A. N. Nguyen), pp. III 1122. Washington. DC: Government Printing Office Google Scholar
Carlson, E. B. & Rosser-Hogan, R. (1991) Trauma experiences, posttraumatic stress, dissociation, and depression in Cambodian refugees. American Journal of Psychiatry, 148, 15481551.Google ScholarPubMed
Carlson, E. B. & Rosser-Hogan, R. (1993) Mental health status of Cambodian refugees ten years after leaving their homes. American Journal of Orthopsychiatry, 63, 223231.CrossRefGoogle ScholarPubMed
Carlson, E. B. & Rosser-Hogan, R. (1994) Cross-cultural response to trauma: a study of traumatic experiences and posttraumatic symptoms in Cambodian refugees, Journal of Traumatic Stress, 7, 4358.Google ScholarPubMed
Cox, D. R. & Amelsvoort, A. V. (1994) The Wellbeing of Asylum Seekers in Australia: A Study of Policies and Practice with Identification and Discussion of the Key Issues. Melbourne: Centre for Regional Social Development, La Trobe University Google Scholar
Cunningham, M. & Silove, D. (1993) Principles of treatment and service development for refugee survivors of torture and trauma. In International Handbook of Traumatic Stress Syndromes (eds J. Wilson & B. Raphael), pp. 751762. New York: Plenum.CrossRefGoogle Scholar
Davidson, J., Hughes, D., Blazer, D. G., et al (1991) Post-traumatic stress disorder in the community: an epidemiological survey Psychological Medicine, 21, 713721.CrossRefGoogle Scholar
Goldfeld, A. E., Mollica, R., Pesavento, B. H., et al(1988) The physical and psychological sequelae of torture: symptomatology and diagnosis. Journal of the American Medical Association, 259, 27252729.CrossRefGoogle ScholarPubMed
Hauff, E. & Vaglum, P. (1994) Chronic posttraumatic stress disorder in Vietnamese refugees: a prospective community study of prevalence, course, psychopathology and stressors. Journal of Nervous and Mental Disease, 182, 8590.Google Scholar
Hinton, W. L., Yung-Chang, J. C., Nang, D., et al (1993) DSM – III – R disorders in Vietnamese refugees: prevalence and correlates. Journal of Nervous and Mental Disease, 181, 113122.CrossRefGoogle ScholarPubMed
Hougen, H. P. & Jacobsen, P. (1988) Physical and psychological sequelae to torture: a controlled clinical study of exiled asylum applicants. Forensic Science International. 39, 511.CrossRefGoogle ScholarPubMed
Jupp, J. (1994) Australian immigration and settlement: history and current trends. In Migration and Mental Health. Responsibilities and Opportunities (eds I. H. Minas & C. L. Hayes), pp. 311. Melbourne: Victorian Transcultural Psychiatry Unit.Google Scholar
Kinzia, J. D. & Manson, S. M. (1987) The use of self-rating scales in cross-cultural psychiatry Hospital and Community Psychiatry, 38, 190196.Google Scholar
Kilmidis, S., Minas, I. H., Stuart, G., et al (1994) A Comparative Study of Health Among Elderly Persons from Diffèrent Ethnic Backgrounds. Victorian Transcultural Psychiatry Unit Research report. Melbourne: Victorian Transcultural Psychiatry Unit Google Scholar
Kos, A., Perron-Klinger, G., Groenenberg, M., et al(1993) Draft Guidelines on the Evaluation and Core of Victims of Trauma and Violence. Geneva: United Nations High Commissioner for Refugees.Google Scholar
Kroll, J., Habenicht, M., Mackenzie, T., et al(1989) Depression and posttraumatic stress disorder in Southeast Asian refugees. American Journal of Psychiatry 148, 15921597.Google Scholar
Landgraf, J. M. & Nelson, E. C. (1992) Summary of the WONCA/COOP International Health Assessment Field Trial. Australian Family Physician, 21, 255269.Google Scholar
Lin, E. H. B., Ihle, L. J. & Tazuma, L. (1985) Depression among Vietnamese refugees in a primary care clinic. American Journal of Medicine. 78, 4144.CrossRefGoogle Scholar
McIvor, R. J. & Turner, S. W. (1995) Assessment and treatment approaches for survivors of torture. British Journal of Psychiatry, 188, 705711.Google Scholar
Mollica, R. F., Wyshak, G. & Lavelle, J. (1987) Psychosocial impact of war trauma and torture on Southeast Asian refugees. American Journal of Psychiatry, 144, 15671572.Google Scholar
Mollica, R. F., Wyshak, G. & Lavelle, J., de-Marneffe, D., et al (1987) Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. American Journal of Psychiatry, 144, 497500.Google ScholarPubMed
Mollica, R. F., Wyshak, G. & Lavelle, J., Caspi-Yavin, Y., Bollini, P., et al(1992) The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disease, 180, 111116.Google Scholar
Moore, L. J. A Boehnleln, J. K. (1991) Posttraumatic stress disorder, depression, and somatic symptoms in US Mien patients. Journal of Nervous and Mental Disease, 179, 728733.Google Scholar
Moss, I. (1993) Refugees and asylum seekers. In State of the Nation: A Report on People of Non-English Speaking Bock-ground, pp. 173222. Australia: Human Rights and Equal Opportunity Commission Google Scholar
Murray, B. (1990) Australia's new refugee policies: a practitioners point of view. International Journal of Refugee Law, 2, 260264.CrossRefGoogle Scholar
Nelson, E., Wasson, J., Kirk, , (1987) Assessment of function in routine clinical practice: a description of the COOP chart method and preliminary findings. Journal of Chronic Disease, 40, 55S69S.CrossRefGoogle ScholarPubMed
Parloff, M. B., Kelman, H. C. & Frank, J. D. (1954) Comfort, effectiveness, and self-awareness as criteria of improvement in psychotherapy. American Journal of Psychiatry 3, 343351.Google Scholar
Pernice, R. A Brook, J. (1994) Relationship of migrant status (refugee or immigrant) to mental health. International Journal of Social Psychiatry. 40, 177188.Google Scholar
Ramsay, R., Gorst-Unsworth, C. & Turner, S. (1993) Psychiatric morbidity in survivors of organised state violence including torture. British Journal of Psychiatry 162, 5559.CrossRefGoogle ScholarPubMed
Reid, J., Silove, D. & Tarn, R. (1990) The development of the New South Wales Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS): the first year. Australian and New Zealand Journal of Psychiatry 24, 486495.CrossRefGoogle ScholarPubMed
Shore, J. H., Taturn, E. & Vollmer, W. M. (1988) Psychiatric reactions to disaster: the Mt St Helens experience. American Journal of Psychiatry 143, 590595.Google Scholar
Silove, D., Tarn, R., Bowles, R., et al (1991) Psychosocial needs of torture survivors. Australian and New Zealand Journal of Psychiatry, 25, 481490.Google Scholar
Silove, D., Tarn, R., Bowles, R., McIntosh, P. A Backer, R. (1993) Risk of retraumatisation of asylum-seekers in Australia. Australian and New Zealand Journal of Psychiatry 27, 606612.CrossRefGoogle ScholarPubMed
Silove, D., Tarn, R., Bowles, R., Chang, R. & Manicavasagar, V. (1995) Impact of recounting their trauma stories on the emotional state of Cambodian refugees. Psychiatric Services, 46, 12871288.Google Scholar
United Nations (1951) United Nations Convention Relating to the Status of Refugees. New York: United Nations Publications.Google Scholar
Van Velsen, C., Gorst-Unsworth, C. & Turner, S. (1996) Survivors of torture and organized violence: demography and diagnosis. Journal of Traumatic Stress, 9, 181193.Google Scholar
Westermeyer, J. (1988) DSM – III psychiatric disorders among the Hmong refugees in the United States: a point prevalence study. American Journal of Psychiatry 145, 197202.Google Scholar
Winokur, A., Winokur, D F. & Rickals, K. (1984) Symptoms of emotional distress in a family planning service: stability over a four-week period. British Journal of Psychiatry 144, 395399.Google Scholar
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