What impacts refugee and asylum seeker children’s mental health?

Children from refugee and asylum seeker backgrounds are likely to have been exposed to significant adversity during crucial phases of their development. These children may be impacted by war/conflict, displacement and separation from parents or traditional carers, leading to a higher risk of poor mental health (Allotey & Reidpath, 2019). Experiences during pre-migration, migration and post-migration can have significant effects on their mental health and leave them vulnerable to a range of mental health difficulties (Mares, 2016; Ziaian, de Anstiss, Antoniou, Baghurst, & Sawyer, 2013).

Pre-migration factors

Child mental health outcomes are influenced by various pre-migration factors and experiences including, for example, the level and duration of a child’s education in their home country (Scharpf et al., 2021). A longer period of schooling in a child’s home country has been found to be associated with fewer post-traumatic stress disorder (PTSD) symptoms, as well as fewer self- and parent-reported emotional, behavioural and anxiety symptoms (Scharpf et al., 2021). In contrast, fewer years of schooling prior to leaving their home country has been associated with higher levels of depression in refugee children (Scharpf et al., 2021).

Pre-migration trauma, particularly exposure to war-related traumatic events, is associated with various mental health problems including depression, anxiety and PTSD (Scharpf et al., 2021). Family separation and displacement pre-migration are also associated with increased long-term psychological distress, depression and PTSD symptoms (Liddell et al., 2021; Nickerson et al., 2022). Furthermore, parental experiences of trauma can have an adverse effect on parents’ mental health, parenting practices and child adjustment (Kara & Stuart, 2021). Evidence suggests that understanding the impacts of pre-migration experiences on the post-settlement mental health of refugee parents, and how they might relate to parenting practices and child adjustment, can encourage positive outcomes (Kara & Stuart, 2021).

Migration factors

The migration experiences of children and their families can have significant effects on children’s mental health and wellbeing (Australian Human Rights Commission, 2014). In particular, immigration detention is associated with poor social and emotional wellbeing outcomes in children (Zwi, Mares, Nathanson, Tay, & Silove, 2018).

An Australian study of 277 children exposed to immigration detention found a high prevalence of pre-arrival trauma, medical, mental health and developmental concerns (Tosif et al., 2023). Specifically, 62% of children had a mental health concern, including PTSD (30%), anxiety (44%) and depression (32%), and 75% had a concern relating to development (Tosif et al., 2023). Children who had been detained for longer periods and those in more remote facilities had higher rates of all mental health challenges.

Child responses to moving country are also associated with their mental health outcomes. In particular, acculturation style (i.e. being engaged in both the host and heritage cultures), is associated with higher levels of mental wellbeing (Scharpf et al., 2021). Our practice paper offers more detail on how different levels of acculturation can affect child mental health.

Post-migration factors

Evidence indicates that post-migration stressors also have a significant impact on long-term mental health and wellbeing among children. These stressors include:

• experiences of discrimination and racism
• experiences related to seeking asylum or refugee status – for example, having to live in mandatory immigration or community detention
• lack of social connection and social support, particularly separation from loved ones
• low levels of supervision and support with resettlement – for instance, having to live independently (De Maio, Gatina-Bhote, Rioseco, & Edwards, 2017; Fazel, Reed, Panter-Brick, & Stein, 2012; Lamb, 2018; Reed et al., 2012; Scharpf et al., 2021; Zwi et al., 2020).

On the other hand, factors that have a positive or protective effect on child mental health include:

• better physical health
• higher levels of resilience
• school achievement and a supportive school environment
• social connection and social support; and
• low levels of negative parenting behaviours (Doma, Tran, Rioseco, & Fisher, 2022; Fazel et al., 2012; Lau et al., 2018; Liddell et al., 2021; Reed et al., 2012; Scharpf et al., 2021).

Conclusion

The mental health of children from refugee and asylum seeker backgrounds is influenced by various factors including:

• their experiences prior to migration (e.g. trauma events)
• their migration experiences (e.g. asylum processes and exposure to immigration detention); and
• post-migration and resettlement experiences and circumstances (e.g. discrimination, cultural adjustment).

Knowledge and understanding of the various factors that impact mental health can help facilitate early intervention for mental health challenges in children from refugee and asylum seeker backgrounds.

References

Allotey, P., & Reidpath, D. D. (2019). The health of refugees: Public health perspectives from crisis to settlement (2^nd ed.). Oxford: Oxford University Press.

Australian Human Rights Commission. (2014). The Forgotten Children: National Inquiry into Children in Immigration Detention. Sydney: Australian Human Rights Commission.

De Maio, J., Gatina-Bhote, L., Rioseco, P., & Edwards, B. (2017). Risk of psychological distress among recently arrived humanitarian migrants (Building a New Life in Australia research summary). Melbourne: Australian Institute of Family Studies.

Doma, H., Tran, T., Rioseco, P., & Fisher, J. (2022).  Understanding the relationship between social support and mental health of humanitarian migrants resettled in Australia. BMC Public Health 22, 1739.

Fazel, M., Reed, R. V., Panter-Brick, C., & Stein, A. (2012). Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. The Lancet, 379(9812), 266-282.

Kara, B. H., & Stuart, J. (2021). The direct and indirect effects of parental trauma on child adjustment for resettled refugees in Australia. International Journal of Migration, Health & Social Care, 17(4), 474-486.

Lamb, C. (2018). Breaking the cycle of violence for child refugees who display aggressive behaviour. Educating Young Children, 24(3).

Lau, W., Silove, D., Edwards, B., Forbes, D., Bryant, R., McFarlane, A., … Felmingham, K. (2018). Adjustment of refugee children and adolescents in Australia: outcomes from wave three of the Building a New Life in Australia study. BMC Medicine, 16(1), 1-17.

Liddell, B.J., Byrow, Y., O’Donnell, M., Mau, V., Batch, N., McMahon, T., … Nickerson, A. (2021). Mechanisms underlying the mental health impact of family separation on resettled refugees. Australian & New Zealand Journal of Psychiatry, 55(7), 699-710.

Mares, S. (2016). Fifteen years of detaining children who seek asylum in Australia–evidence and consequences. Australasian Psychiatry, 24(1), 11-14.

Nickerson, A., Kashyap, S., Keegan, D., Edwards, B., Forrest, W., Bryant, R., … Liddell, B. (2022). Impact of displacement context on psychological distress in refugees resettled in Australia: A longitudinal population-based study. Epidemiology and Psychiatric Sciences, 31, E51.

Reed, R. V., Fazel, M., Jones, L., Panter-Brick, C., & Stein, A. (2012). Mental health of displaced and refugee children resettled in low-income and middle-income countries: risk and protective factors. Lancet, 379(9812), 250-265.

Scharpf, F., Kaltenbach, E., Nickerson, A., & Hecker, T. (2021). A systematic review of socio-ecological factors contributing to risk and protection of the mental health of refugee children and adolescents. Clinical Psychology Review, 83.

Tosif, S., Graham, H., Kiang, K., Laemmle-Ruff, I., Heenan, R., Smith, A., … Paxton, G. (2023). Health of children who experienced Australian immigration detention. PLoS ONE, 18(3).

UN General Assembly. (1951). Convention Relating to the Status of Refugees. United Nations, Treaty Series, vol. 189, p. 137. Geneva: United Nations.

UN General Assembly. (1967). Protocol Relating to the Status of Refugees. United Nations, Treaty Series, vol. 606, p. 267. Geneva: United Nations.

Ziaian, T., de Anstiss, H., Antoniou, G., Baghurst, P., & Sawyer, M. (2013). Emotional and behavioural problems among refugee children and adolescents living in South Australia. Australian Psychologist, 48(2), 139-148.

Zwi, K., Mares, S., Nathanson, D., Tay, A. K., & Silove, D. (2018). The impact of detention on the social–emotional wellbeing of children seeking asylum: a comparison with community-based children. European Child & Adolescent Psychiatry, 27, 411-422.

Zwi, K., Sealy, L., Samir, N., Hu, N., Rostami, R., Agrawal, R., … Lingam, R. (2020). Asylum seeking children and adolescents in Australian immigration detention on Nauru: a longitudinal cohort study. BMJ Paediatrics Open, 4(1).