COVID-19 Healthcare Mental Health

Refugees vulnerable to COVID-19 mental health toll


Refugees’ mental health has been negatively impacted by COVID-19 stressors, a new study by UNSW Sydney psychologists in partnership with the Australian Red Cross, Settlement Services International (SSI) and Phoenix Australia at the University of Melbourne has shown. COVID-related worries were linked to higher levels of PTSD, depression, health anxiety symptoms, and poorer daily functioning.

The findings, published in the European Journal of Psychotraumatology, suggest refugees may be particularly vulnerable to the adverse effects of the COVID-19 pandemic.

“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,” says lead author Dr Belinda Liddell from UNSW Science’s School of Psychology.

“Refugees are in a really unique situation. We hypothesised refugee communities were particularly vulnerable to the adverse effects of the COVID-19 pandemic on mental health due to traumatic events they have experienced, and the challenges of the postmigration environment, but no one has studied this in the Australian context,” says Dr Liddell.

“That’s why we set out to look at how common these stressors were in refugee communities, and how they related to key mental health and functioning outcomes. Understanding these dynamics could help practitioners and service providers who are responding to the specific needs of refugees during the pandemic,” Dr Liddell says.

In June 2020, scientists ran a COVID-19 survey for refugees and asylum seekers who participated in the Refugee Adjustment Study, a large online study of refugee mental health and adjustment. 656 participants completed the survey, providing information about their mental health (PTSD, depression, health anxiety and disability) and COVID-19 experiences.

“Worry about being infected by COVID-19 – reported by 66.5% of participants – was related to more severe PTSD symptoms and health anxiety symptoms. That’s not surprising, given these concerns reflect fear of being harmed or harming others with COVID-19,” says Dr Liddell.

Social-related difficulties such as lockdown and isolating at home were linked to increased depression. Fears relating to the future, such as concerns about visa application processes, were associated with increased disability and health anxiety.

“This is something resettled refugees may be particularly vulnerable to. They already often experience significant isolation and loneliness, which diminishes mental wellbeing,” Dr Liddell says. “We found the experience of COVID-19 really reminded people of their past difficulties – 41.1% reported this stressor.”

“For example, a heightened role of government-mandated restrictions, social isolation strategies and quarantine measures that are common during COVID-19 might trigger memories of living in situations of political terror or in immigration detention. Problems sourcing basic supplies or accessing services during the COVID-19 lockdown could remind refugees of previous difficulties accessing essential goods during situations of conflict or civil unrest,” Dr Liddell says.

The researchers reached these findings after accounting for other factors that could affect mental health, e.g. degree of past trauma exposure and visa insecurity. “This means our findings of adverse mental health outcomes were strongly associated with COVID-19 experiences,” Dr Liddell says.

The researchers also found some surprising findings in this study.

“We found that difficulties accessing everyday items or emergency support, and difficulties trusting authorities, were reported less frequently, and were also not related to mental health symptoms,” says Dr Liddell. “This is a welcome finding, as it suggests a good public health engagement in Australia for refugees, and is supported by other reports that indicate high levels of trust in authorities amongst refugee communities in Australia.”

The researchers say the flipside of vulnerability is increased resilience. Previous studies reported how refugees’ past experience had made them more resilient and able to use coping strategies they’d developed over the years.

Twenty-three-year-old refugee Sarah Salam Mezban says that while her family has been concerned about COVID-19, they are not strangers to lockdowns due to experience living through war. “For my family, we are worried about getting infected or transferring the disease to others, but at the same time, we are trying our best to adjust our day-to-day life with the situation and follow government advice.”

“As refugees, it’s not too hard for us to isolate ourselves. We are used to practising similar lockdowns during the war back home.”

Vicki Mau, Head of Migration Programs, Australian Red Cross, says it has been an extremely difficult time for people who arrived in Australia as refugees.

“Many have faced additional barriers and stressors during COVID-19 seeking support, information and help in a largely English digital environment. They are also often separated from family, and, as so many Australians, are worrying about loved ones overseas in vulnerable situations. Despite this, communities have shown extraordinary resilience, including working as first responders at the front lines, and by helping to address COVID-19 vaccine concerns across Australia.”

The researchers say COVID-19 responses need to accommodate the specific needs of refugees.

“During a time where resources are stretched, it is important to make sure that information and support are available to those who are vulnerable to the impact of the COVID-19 pandemic,” says senior study author, UNSW Professor Angela Nickerson.

“A lot of the people who participated in the survey have lived through war, poverty, hunger and persecution – a situation like the one we’re currently in can really push those buttons again, so we need to make sure there’s adequate support available.”

The researchers say the findings underscore the importance of practitioners and service providers being aware of the significance of COVID-19 for refugees, and its impact on mental health.

“Access to mental health services is critical to ensure these effects are mitigated and that refugees are psychologically supported to cope with the current pandemic,” Prof. Nickerson says.

“Like other Australians, refugees also need access to a wide spectrum of support, including income support when they lose employment, connection to local services and opportunities to maintain social and community connections during COVID-19.”

These findings also highlight the importance of public health messages that specifically target culturally and linguistically diverse members of the community, as well as those with limited literacy, to strengthen participation in COVID-19 public health responses, including vaccination.

The study was funded by an Australian Research Council Linkage project with Phoenix Australia at the University of Melbourne, Settlement Services International and The Australian Red Cross, as well as funding from UNSW Sydney.



Original story and information found on the Third Sector Australia website. Note: Content has been edited for style and length.

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Nina Alvarez is a Content Producer for Healthcare Channel. Her interests include writing, particularly about the healthcare sector and the many ways it can improve to further benefit people from all walks of life.


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