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The mental health of child refugees from the Middle-East & their parents: refugee status and immigration detention

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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The mental health of child refugees from the Middle-East & their parents: refugee status and immigration detention

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  1. 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 Image downloaded June 22, 2004 fromhttp://www.abc.net.au/news/australia/2002/07/item20020703071032_1.htm (Woomera) Copyright image deleted

  2. 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. Image from http://www.smh.com.au/articles/2002/06/05/1022982721514.html Copyright image deleted

  3. 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

  4. Copyright image deleted 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 Image downloaded 21st July, 2004 from http://images.google.com.au/images?q=woomera+detention&hl=en&lr=&ie=UTF-8&start=40&sa=N

  5. 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

  6. Measures

  7. 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.

  8. StressorsParents’ Psychological Distress • Self-report • Hopkins Symptom Checklist-25 • Depression and Anxiety • Single score (mean) • Cronbach alpha=.93 (n=56)

  9. 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

  10. OutcomesChildren’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

  11. Results Description

  12. 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

  13. Stressful events: Detained children Journey to Australia Chased by guards or police 54.3% Separated from parents/ family 28.6% Shipwreck 74.3% In detention Living quarters “ransacked” 80.0% Witnessed self-harm 77.1% Riot 74.3% Images downloaded June 22, 2004 from http://news.bbc.co.uk/1/hi/world/asia-pacific/1646366.stm (top); http://www.worldpress.org/asia/0402smh.htm (2nd);www.accessnews.skatv.org.au/ site/realvideos/ (3,4) Copyright images deleted

  14. StressorsParents’ Psychological Distress Refugees Refugees Not Hopkins score detained not detained refugees _____________________________________________________________________________ Mean 2.1*** 1.6 1.4 (S.D.) (0.6) (0.4) (0.4) In clinical range60%*** 29% 17% _____________________________________________________________________________ *** Detained > not detained, p<.001

  15. OutcomesChild emotional and behavioural problems(CBCL: High scores = more problems) Refugees Refugees Not detained not detained refugees 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)

  16. 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

  17. OutcomesChildren’s adaptation(Ratings: high scores = better adaptation) Refugees Refugees Not detained 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)

  18. 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)

  19. Results Explanation

  20. 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

  21. 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

  22. 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***

  23. ratings of children’s adaptation R2change_________________________ Parent Child report self-report ____________________________________________________ Happy/sad .140*** n.s. Safety .054* .071** Health .137*** .075** Schoolwork .192*** .167*** Friendship .114*** .047* Relationship with parents .194*** .119*** ____________________________________________________

  24. 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**)

  25. 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-reportedSelf-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

  26. 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%*

  27. Conclusions

  28. 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

  29. 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

  30. 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

  31. 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

  32. 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

  33. No policy to protect children from exposure to stressful events Children in playground at Woomera with hunger strike in background, January 2002. Downloaded 21 June, 2004 fromhttp://www.hreoc.gov.au/human_rights/children_detention_report/report/chap09.htm Copyright image deleted

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