Transcript for
The mental health of refugee children in Australia

Narrator [00:00:02] Welcome to the Emerging Minds podcast.

Sophie Guy [00:00:08] You’re with Sophie Guy, and today I’m speaking with Dr Sonia Terhaag from the Australian Institute of Family Studies or AIFS. Sonia has worked in research for ten years across Canada and Australia. Her research focus is on mental health, in particular following potentially traumatic experiences such as injury, human-made and natural disasters, and occupational exposure. In her current role at AIFS, her work across various national longitudinal research studies, including Building a New Life in Australia: The Longitudinal Study of Humanitarian Migrants, Ten to Men: The Australian Longitudinal Study on Male Health, and Growing Up in Australia: The Longitudinal Study of Australian Children. In today’s episode, we discuss findings from the Building A New Life in Australia Study on the wellbeing of refugee children and the impact of pre and post migration experiences.

[00:01:02] Thank you very much, Sonia, for joining me today to have a conversation about this longitudinal study that you’ve been working on. I wonder if you could start by just telling me a little bit about yourself and how you came to be working on the Building a New Life in Australia study.

Sonia Terhaag [00:01:20] Yeah. So thank you very much for having me. It’s really great to be here. I started working on the Building a New Life in Australia Study in a previous role I had at the University of Melbourne. I am a mental health researcher, so I did my PhD in that area as well. And recently started working here in the Longitudinal Lifecourse Studies Team for research and analysis. So the BNLA study, as we usually refer to it, is one of the studies that I work on.

Sophie Guy [00:01:57] Could you tell us about the Building a New Life in Australia Study? I’ll start calling it the BNLA study as well. Could you tell us about that?

Sonia Terhaag [00:02:05] The BNLA study is currently the largest of its kind in Australia in that it’s a longitudinal study of humanitarian migrants here in Australia. It was conducted by the Australian Institute of Family Studies with funding from the Department of Social Services and the Department of Immigration. So it’s a study of humanitarian migrants that arrived in Australia from 2013. Humanitarian migrants might be helpful to just clarify that are migrants who come to Australia either as refugees under a special protection or who are already in Australia and then apply for humanitarian migrant visa. So the majority were offshore when they applied for these visas, but about a tenth of them were already in Australia when they applied. The study encompasses around two-thousand four-hundred respondents in total, of which there were around one and a half thousand primary applicants and then their family members. So spouses, other family members, older children and almost seven hundred younger children who were assessed at the third wave of data collection. So in total, there’s five waves of data collection, which means that they were assessed once a year for five years after the first time they completed a survey. But the child data was only collected at wave three, so most of the families had been here for two to three years by the time the children actually completed any questionnaires and required parental consent to participate. Most of them were from, they came from Iraq and Afghanistan, but they also had other migration experiences in countries of origin. So in total, the study actually had migrants from thirty-five countries and spoke over fifty languages. So a very diverse group, the children were all accompanied, so I think that’s important to keep in mind when talking about the BNLA study. And what we found is that all of the children had at least one family member with them when they came to Australia.

Sophie Guy [00:04:29] So what can the BNLA study tell us about the social and emotional wellbeing of children who come here through the humanitarian program?

Sonia Terhaag [00:04:38] Well, there’s actually, I think quite a bit that it can tell us, especially because there’s not that much research that has been done with refugee children, it’s increasing lately. But the BNLA study is quite unique, both in the Australian context but also generally around the globe in that it assessed a lot of different domains in the children’s lives and in the family’s lives. So the questions include bits about their pre-migration experiences, so where they were before they came to Australia, what kind of experiences they had before coming here, their country of origin, what their family unit looks like. So if they’re living with their mother and father or just one parent, if they had siblings, other family members that might be included, then their migration experience itself, so how they came to Australia, how long they spent in different places, what countries they were in before coming here, how many countries they had, any traumatic experiences, pre-migration or during their migration. And then also a lot of questions, post-migration. So how are they adjusting? Do they have any emotional symptoms? Do they have any physical health problems? How are they adjusting at school with their peers, their community? So it’s quite comprehensive in that sense. So in terms of what the study can tell us about the social and emotional wellbeing of humanitarian migrant children in Australia.

Sophie Guy [00:06:19] Particularly under twelve years, if you know about that group.

Sonia Terhaag [00:06:22] The sample of children in that age range in the BNLA study was relatively small, but what the research so far has found in terms of their adjustment and their wellbeing, it’s found that compared to their Australian counterparts, they’re actually generally well-adjusted. Now, there are obviously some differences by age and by gender, but generally on a whole, they were very comparable in some instances actually better adjusted than their Australian counterparts. So in domains of prosociality, for example, so being helpful and kind to others in those kinds of things, they actually scored higher.

Sophie Guy [00:07:10] When you say it was a small group, do you know the number of children?

Sonia Terhaag [00:07:13] The way it was broken down for the analysis was five to ten and then eleven to thirteen. So we’ll match up exactly. [Sure]. But the numbers were around two-hundred, two-hundred and fifty who were in that age range.

Sophie Guy [00:07:30] So the five to thirteen age range.

Sonia Terhaag [00:07:33] Yeah.

Sophie Guy [00:07:34] Okay. I’m interested to explore a couple of different things, it sounds like the study was pretty comprehensive in the information it gathered about experiences before coming to Australia, and you talked about trauma and things like that. How is trauma defined? What sorts of things were measured on those variables?

Sonia Terhaag [00:07:52] So it did differ by the parents and by the children. So in terms of defining trauma, this can be a bit broad, but it’s an adverse experience, basically, that has a lasting impact on a person or it can have a lasting impact on a person’s wellbeing, usually where that individual’s life or wellbeing is at risk or is being threatened. So in terms of the experiences of the sample in BNLA, the parents reported on this in more detail. [Okay]. Most of the parents had experienced at least one traumatic event and about a third had experienced three or more traumatic experiences both prior to their migration and during migration. It wasn’t differentiated in the way the questions were asked, but this included witnessing family members being hurt or killed. Violence, war and conflict, which was actually the most common traumatic experience. A small subset had experienced torture. For the children, it was a little bit different. The children were just asked whether they had experienced something traumatic, but no specifics about what that was. And if they had experienced anything where they felt their life was at threat or they felt like there was threat of injury and parents and children reported on that, but not about specifics of what that entailed.

Sophie Guy [00:09:30] And what proportion of children said that they experienced a traumatic event?

Sonia Terhaag [00:09:34] So it was very comparable, the parent and the child report of this about that, just over twenty percent, so twenty-two percent of children said that they had been exposed to something traumatic, although again, it wasn’t clear when that was. And nineteen percent had reported that at any point in time, their safety, their life had been threatened with the child self-report. It’s important to keep in mind that this primarily pertains to the older children because the younger children actually weren’t asked those questions. So that eleven to seventeen year olds were asked about their traumatic experience. What has been of us investigated a bit more using the BNLA data is the experiences of parents and how that impacts the children’s mental health. So that includes the parents’ mental health and wellbeing, the parents’ traumatic experiences and how that impacts their parenting behaviour in the family or family unit as a whole. So there’ve been a few papers published using the BNLA child data in particular that have looked at this. [Okay], and for example, some of the researchers found that parents with PTSD were more likely to use hostile parenting styles, which then affected the children’s mental health. But also the parents’ mental health had a direct impact on the child’s mental health. So parents had PTSD symptoms. The children’s mental health and wellbeing was also lower. Parents who have experienced torture, their children are at a greater risk of having mental health issues. And if the parents were experiencing prolonged grief, often in association with loss of a family member as part of the pre or migration experience. So this is sort of ongoing grief symptoms and behaviours that last for several weeks or months. [Mm-hmm]. The children of parents who experienced that also had lower mental health. So I think that’s a, that’s an important thing to highlight, given that they came here as families and they came here with their parents and siblings and sometimes other family members, that you can’t just look at the children, but you have to consider them sort of in the context of their family.

Sophie Guy [00:12:12] Yeah. Yeah. So you said parents’ mental health had quite a direct effect on children’s mental health and then PTSD perhaps affected parenting. Some things are sort of affecting them in, maybe a bit more indirectly through parenting styles or the I guess the ability that parent has to to show up and parent their child perhaps in the way that they would like to if they weren’t facing these challenges.

Sonia Terhaag [00:12:37] Yeah, I think in many ways really it’s very comparable to what the literature in general suggests about the impact of parents’ wellbeing and their experiences on children. So yeah, parents with mental health difficulties, their children are just slightly higher risk of also having mental health issues or lower wellbeing. [Yeah] And that’s also in part mediated by things like changes in parenting styles, particular experiences, just by the nature of them can have a bigger impact on the parent, which then will impact their family as well. So things like grief, torture, those kinds of things.

Sophie Guy [00:13:24] Yeah. Okay. Yeah, I was interested in the results of the study that was published in BMC Medicine that indicated that boys from a refugee background, some measures in quite a few, they seemed to have better social and emotional wellbeing than boys who grew up in Australia. Do you have any observations or ideas about why that might be?

Sonia Terhaag [00:13:49] I think that’s really hard to say without having tested it. But I think it’s important to keep what the gender differences, like you said in mind, but also the age differences. So as a few of the particular domains, like the prosocial behaviour, the conduct problems, where there were some differences between boys and girls. But as to why that might be. It’s difficult to say, I think,.

Sophie Guy [00:14:22] Okay. You said that children started to be interviewed as part of the study, as part of wave three. So maybe you can’t answer this. But I was wondering if you know anything about the social emotional wellbeing of these children over time?

Sonia Terhaag [00:14:36] It’s a bit difficult to answer that. Drawing on BNLA in particular, given that they were only asked at that one point in time. I think there’s some other research being done in Australia with smaller groups of refugee children that might be able to speak to early experiences a bit better. But I think what’s interesting with the wave three data on sort of what’s been done with that so far is that it looks like by the time these children have been here for a few years, so an average wave three meant they’d been here for two to three years. Most of them had adjusted relatively well, which I think indicates are comparable to their Australian-born peers.

Sophie Guy [00:15:28] And do you have any sense with the ones that aren’t doing so well, perhaps don’t have good social and emotional wellbeing, do you know what sorts of factors are influencing that? Does the study tell you anything about that?

Sonia Terhaag [00:15:40] So I think that kind of comes back to what we talked about earlier in terms of there being age and gender differences. So it looks like in BNLA, for example, the older girls struggled a little bit more, so the fourteen to seventeen-year-old girls had slightly higher emotional symptoms than their Australian peers. So in terms of the factors associated with the wellbeing overall, which includes the emotional but also other things like their peer relationships, [yeah] everything, it was things like age and gender that affected that, like mentioned the parenting styles of there was more hostility in the parent child relationship that was usually associated with lower wellbeing. And then also school kind of matters. So school achievement and days absent from school were associated with the children’s wellbeing. So if they’re, if they were comparable in terms of achievement at school, then their wellbeing was comparable to their peers. But if their school achievement was lower, then that was also associated with lower wellbeing. And if they were more absent from school for more days, that was also associated with lower wellbeing.

Sophie Guy [00:16:59] Okay. Could you talk a little bit about what might be important for practitioners to understand about these findings?

Sonia Terhaag [00:17:06] So I think one thing that might be a bit surprising, especially given everything that we’ve learned so far about migration experiences and the various things that factor into that, is that it’s important to keep in mind that not everyone is going to struggle. So the BNLA data, at least in part, suggests that a good adjustment is definitely possible, and most of the children at least seem to be doing relatively well after a couple of years. So it sort of challenges one of those perceptions of refugees that everyone is going to really struggle and have a hard time and have high symptoms of mental health difficulties. And this, at least in part, suggests that that isn’t going to apply to everyone. That’s important to keep in mind. In terms of, I guess, working with refugee children and keeping some of these things in mind, I think it’s, it’s general messages like the, their migration experience as a whole needs to be considered and their family’s migration experience. So, who did they migrate with? What kind of path did they take? What was involved with that? Traumatic experiences as part of that. Their family structure and support plays a big role, especially for the, the younger children, because they rely on, on parents for support and very basic needs. So if those things aren’t in place, that’s going to make it more difficult for the children to adjust as well. So kind of considering family structure and support and what might be missing in that I think is important to consider, so not just looking at the child, but considering them in the context of their family unit. And then the child’s cultural background, I guess, is always going to play into how they might express some things or how comfortable they feel talking about these things. So I think keeping those things in mind, if you’re working with refugee children, is really important.

Sophie Guy [00:19:22] And has the study looked at all, like you’re talking about? So family support, support within the family. Has there been any results around that?

Sonia Terhaag [00:19:29] One of the things that’s come out of BNLA is that parents who have unemployment for a prolonged period of time when they come here as refugees, that’s going to, that’s associated with greater risk of difficulties in the children. So those kinds of supports, just very basic adjustment and integration of not just the child into poverty, usually school settings, but the integration of the family as a whole into the community and the economic system is important for the family, but in relation also the child.

Sonia Terhaag [00:20:06] Yeah. Okay. What about where the BNLA study might go next in looking at particularly children’s wellbeing. Are you able to tell us anything about future research in that area?

Sonia Terhaag [00:20:18] At this stage, I don’t know, but in terms of future work from BNLA, obviously, you know, the more this data can get used and to answer different questions and to help inform the the knowledge base in Australia around the wellbeing of this group and their children is encouraged and access to the, to the data can be requested.

Sophie Guy [00:20:46] Okay, from researchers outside of the Australian Institute of Family Studies?

Sonia Terhaag [00:20:50] Yeah. So the data is available through the Australian dataverse. So if people, or if researchers want to access this data, they can request to do that. And yeah, I guess just the research that’s already been done using this data has been really informative and we’re hoping that that will continue.

Sophie Guy [00:21:11] We might wrap it up and leave it there. And thank you very much for your time, Sonia, I really appreciate you coming in to talk about it.

Sonia Terhaag [00:21:17] Thanks.

Sophie Guy [00:21:17] Thank you.

Narrator [00:21:20] Visit our website www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.