The mental health of child refugees from the Middle-East & their parents: refugee status and...
Transcript of The mental health of child refugees from the Middle-East & their parents: refugee status and...
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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 from http://www.abc.net.au/news/australia/2002/07/item20020703071032_1.htm
(Woomera)
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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
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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
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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
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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
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Measures
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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.
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Stressors Parents’ Psychological Distress
• Self-report– Hopkins Symptom Checklist-25
• Depression and Anxiety
• Single score (mean)• Cronbach alpha=.93 (n=56)
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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
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Outcomes Children’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
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Results
Description
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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
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Stressful events: Detained children
Journey to Australia Chased by guards or police 54.3%Separated from parents/ family 28.6%Shipwreck 74.3%
In detentionLiving 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)
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Stressors
Parents’ Psychological Distress
Refugees Refugees NotHopkins score detained not detained refugees_____________________________________________________________________________
Mean 2.1*** 1.6 1.4 (S.D.) (0.6) (0.4) (0.4)
In clinical range 60%*** 29% 17%_____________________________________________________________________________
*** Detained > not detained, p<.001
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OutcomesChild emotional and behavioural problems
(CBCL: High scores = more problems) Refugees Refugees Not detained not detainedrefugees
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)
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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
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Outcomes Children’s adaptation
(Ratings: high scores = better adaptation)
Refugees Refugees Notdetained 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)
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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)
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Results
Explanation
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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
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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
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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***
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• ratings of children’s adaptation
R2change
_________________________
Parent Childreport self-
report____________________________________________________
Happy/sad .140*** n.s.Safety .054* .071**Health .137*** .075**Schoolwork .192*** .167***Friendship .114*** .047*Relationship with parents .194*** .119***____________________________________________________
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• 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**)
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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-reported Self-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
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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%*
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Conclusions
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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
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• 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
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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
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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
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• 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
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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 from http://www.hreoc.gov.au/human_rights/children_detention_report/report/chap09.htm
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