COVID-19 and refugees: The toll on mental health

• A recent study considers the mental health effects of COVID-19 anxiety among international refugees resettled in Australia.
• The team found that the most vulnerable people are those for whom COVID-19 brings back memories of past difficulties.
• The authors nevertheless note that resettled refugees are often a resilient group of people.

According to the United Nations (UN) High Commissioner for Refugees, the UN’s refugee agency, 1 in 95 people in the world have fled from their homes.

A new study investigates the mental health effects of COVID-19 on refugees resettled in Australia.

The study finds that resettled refugees are especially sensitive to COVID-19 stressors when these bring back difficult memories.

According to lead author Dr. Belinda Liddell, of the University of New South Wales (UNSW), in Sydney, “To our knowledge, this is one of the first studies anywhere in the world that documents the mental health impact of COVID-19 on refugee communities.”

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“Refugees are in a really unique situation. We hypothesized [that] refugee communities were particularly vulnerable to the adverse effects of the COVID-19 pandemic on mental health due to traumatic events they have experienced in the past and the challenges of the post-migration environment.”

– Dr. Belinda Liddell

The study appears in the European Journal of Psychotraumatology.

An unwelcome reminder

The survey of refugees’ mental health was conducted in June 2020 with 656 individuals who participated in the UNSW’s online Refugee Adjustment Study.

“A situation like the one we’re currently in can really push those buttons again,” notes senior study author Prof. Angela Nickerson, “so we need to make sure there’s adequate support available.”

Dr. Liddell adds, “Understanding these dynamics could help practitioners and service providers who are responding to the specific needs of refugees during the pandemic.”

She told Medical News Today, “The strongest predictor of poor mental health and daily functioning was the degree to which the COVID-19 pandemic reminded refugees of their traumatic pasts, which typically involve exposure to war, conflict, violence, and forced displacement.”

The study found that 41.1% of participants reported that COVID-19 reminded them of their experiences.

MNT also spoke with Prof. Robert Schweitzer, from Queensland University of Technology, in Brisbane. He was not involved in the current research but was the senior author of another study investigating mental health interventions for resettled refugees.

He described to MNT some experiences common among women who had resettled in Australia under the country’s general humanitarian visa or Women at Risk program:

“In terms of the general category, we have reported that something like 13% of women from Sudan and a similar [number of] women from Burma/Myanmar evidenced symptoms associated with post-traumatic stress disorder [PTSD], while 20% of women who entered Australia under the Women at Risk [program] evidenced such symptoms in the pre-COVID period.”

“Similarly, the rates for depression were up to 33% in women from Sudan and closer to 41% in [those involved in] Women at Risk.”

“These figures are all pre-COVID, so we may expect the current figures to be even higher today.”

When asked about specific COVID-19 stressors in the current study, 66.5% of participants reported worrying about SARS-CoV-2 infections. These tended to be people with more severe PTSD and health-related anxiety symptoms. “That’s not surprising,” says Dr. Liddell, “given these concerns reflect fear of being harmed or harming others with COVID-19.”

Resilience

“This study and our other research studies indicate, however, that refugees are a highly resilient population — even though they have been exposed to war, persecution, and other forms of adversity, only a minority go on to develop psychological disorders,” Dr. Liddell explained to MNT.

According to Violet Roumeliotis, of Australia’s Settlement Services International (SSI), “At SSI, we witness the resilience of refugees who have fled war-torn countries, with some reporting these past experiences as preparation for the uncertainties of the pandemic.”

Dr. Liddell added, “Refugee support services in Australia also observe that many people with refugee backgrounds are saying that they are well-equipped to deal with the uncertainty of the pandemic.”

Prof. Schweitzer pointed out that a refugee’s experience of resettlement may have to do with risk or protective factors that vary from person to person.

“We know that having a family and/or close community are protective factors. With this in mind, people who experience isolation, and there are many, would be at highest risk. Many asylum seekers fit this category and are not allowed to work, again a risk factor in not feeling part of a community, and thus at greater risk.”

“Connection with others and leading a meaningful life are probably the most important protective factors for people from refugee backgrounds,” Prof. Schweitzer told MNT.

Trust in local authorities

One of the study’s surprising findings was a high level of trust in Australian authorities among resettled refugees, a phenomenon that is supported by other research.

Just 11.7% of the participants reported difficulty trusting authorities’ information about COVID-19 and related public health advice. These reports were not linked with mental health conditions.

“We can only speculate as to what might drive this,” said Dr. Liddell. “It may be that those who have permanent protection in Australia […] place trust in Australian authorities to uphold their security and safety, in contrast to authorities in their home countries or transition countries.”

Broader implications

Considering that the study reflects the experiences of participants in Australia, its findings may not be applicable elsewhere.

Moreover, 86.2% of the surveyed population held secure visa status, and the average time to acquire this in Australia is 4.64 years. A survey of very newly arrived refugees without secure visa status may arrive at different findings.

In addition, “It may be that factors influencing refugee mental health during the COVID-19 pandemic are different in settings where case numbers are higher,” Dr. Liddell pointed out, “or in the context of widespread vaccination, as we are seeing in other countries.”

Moreover, “The survey was conducted in June 2020, at a time when Australia was emerging from its first wave of COVID-19, and case numbers were decreasing.”

The researchers are currently collecting 12-month follow-up survey data to track the effect of the now-prolonged pandemic.

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