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 (Woomera) Copyright image deleted

Background 2184 children in immigration detention between 1 July 1999 and 30 June % 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 Copyright image deleted

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

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 Copyright image deleted

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

Measures

Stressors Children’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.

Stressors Parents’ Psychological Distress Self-report –Hopkins Symptom Checklist-25 Depression and Anxiety Single score (mean) Cronbach alpha=.93 (n=56)

Outcomes Child 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 = ) Interview format if low literacy

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

Results Description

Stressors Children’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) Total trauma10.8 ***(3.5) 2.0 (2.0) 0.4 (0.7) ______________________________________ *** Detained > not detained, p<.001

Stressful events: Detained children Journey to Australia Chased by guards or police54.3% Separated from parents/ family28.6% Shipwreck74.3% In detention Living quarters “ransacked” 80.0% Witnessed self-harm 77.1% Riot 74.3% Images downloaded June 22, 2004 from pacific/ stm (top); (2nd); site/realvideos/ (3,4) pacific/ stmhttp:// (2nd); Copyright images deleted

Stressors Parents’ Psychological Distress Refugees Refugees Not Hopkins score detained not detained refugees _____________________________________________________________________________ Mean 2.1*** (S.D.) (0.6) (0.4)(0.4) In clinical range60%***29%17% _____________________________________________________________________________ *** Detained > not detained, p<.001

Outcomes Child emotional and behavioural problems (CBCL: High scores = more problems) Refugees RefugeesNot detained not detainedrefugees T scoresM (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)

Children in CBCL “clinical range” RefugeesRefugees Not detainednot detained refugees __________________________________________________________________________________ Total score49%**11%3% Internalising54%**14%3% Externalising26%** 3%6% ___________________________________________________________ ** Detained > not detained, p<.01

Outcomes Children’s adaptation (Ratings: high scores = better adaptation) RefugeesRefugeesNot detainednot detainedrefugees Domain M (SD) M (SD) M (SD) ________________________________________________________________________ Happy/sad Parent3.4* (1.2)4.3 (0.9)4.5 (0.7) Child3.7 (1.1)4.0 (0.9)4.3 (0.8) Feelings of safety Parent3.2* (1.3)4.3^ (1.0)4.0 (1.1) Child3.6* (1.1)4.4^ (0.6)4.2 (8.4) ________________________________________________________________________ Detained < not detained; ^ Refugees not detained > or < not refugees (p<.05)

Refugees RefugeesNot detained not detainedrefugees Domain M (SD) M (SD) M (SD) ________________________________________________________________________ Physical health Parent3.6* (1.3)4.5 (0.8)4.5 (0.7) Child3.9* (0.9)4.4 (0.7)4.2 (1.0) School performance Parent3.5* (1.2)4.5 (0.7)4.6 (0.6) Child3.6 (0.9)4.1 (0.9)4.4 (0.6) Friendships Parent3.6* (1.4)4.7 ^ (0.7)4.5 (0.7) Child3.9 (1.0)4.2 ^ (0.9)4.7 (0.5) Relationship with parents Parent3.6* (1.3)4.5 (0.8)4.5 (0.6) Child4.0 (1.1)4.3 ^ (0.7)4.3 (0.7)

Results Explanation

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

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

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 R 2 change=.205*** Internalising problems R 2 change=.128*** Externalising problems R 2 change=.148***

ratings of children’s adaptation R 2 change _________________________ Parent Child reportself-report ____________________________________________________ Happy/sad.140***n.s. Safety.054*.071** Health.137***.075** Schoolwork.192***.167*** Friendship.114***.047* Relationship with parents.194***.119*** ____________________________________________________

When extraneous variables and exposure to stressful events were entered first, group explained additional variance on only 3/15 outcome variables –externalising problems (R 2 change=.059**) –parent-reported safety (R 2 change=.033* ) –parent-reported friendships (R 2 change=.051**)

Across groups, how much variance in outcomes accounted for by exposure to stressful events alone (Step 1 of regression)? CBCLTotal 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< % p<.01 Safety 15.2% p< % p<.001 Health 23.7% p< % p<.01 Schoolwork 25.4% p< % p<.001 Friendships 24.7% p< % p<.001 Family relationships 26.5% p< % p=.001

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/sad4.3%* Child report relationship with parents4.4%*

Conclusions

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

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

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

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

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

No policy to protect children from exposure to stressful events Children in playground at Woomera with hunger strike in background, January Downloaded 21 June, 2004 from Copyright image deleted