Refugees Experience Gender- and Time-Specific Psychological Stressors During Resettlement

Immigrants walking before sunset
By understanding the time-varying association of pre-migration and post-migration stressors in the mental health of refugees, tailored health promotion services could be designed for different resettlement stages thus improving the efficiency of resource allocation.

Gender-specific and time-sensitive services were needed for the improvement of mental health among refugees who were being resettled. These results, from a longitudinal study, were published in the Lancet Psychiatry.

Data from the Building a New Life in Australia (BNLA) project collected between 2013 and 2017 in 4 waves were used for this study. Recently resettled migrants (N=2399) in Australia were assessed by computer-assisted self-interview or computer-assisted telephone interview in 19 different languages. Participants were assessed by the post-traumatic stress disorder (PTSD)-8 scale, high risk of severe mental illness (HR-SMI), and the Kessler Screening Scale for Psychological Distress (K6).

The participants were 45.5% women, who tended to be younger, have a lower level of education, lower incomes, and fewer were married compared with the men.

Among women, PTSD and HR-SMI were observed to decrease over time from 36.6% (95% CI, 33.6%-39.5%) and 20.1% (95% CI, 17.7%-22.5%) during wave 1 to 22.8% (95% CI, 20.0%-25.7%) and 15.3% (95% CI, 12.9%-17.7%) during wave 4, respectively. Similarly, among men, decreases of PTSD and HR-SMI were observed.

The motivators for PTSD and HR-SMI symptoms differed by wave and among genders. During wave 1 the top factors were loneliness, concerns for family in Australia, and difficulties adjusting to Australian life. Wave 2 found economic stressors, problems adjusting to Australia, and family conflicts in Australia to be predictors. The wave 3 factors were discrimination, difficulties adjusting to Australia, and traumatic events. During wave 4, refugees cited loneliness, discrimination, and language barriers to be the most problematic features.

Economic concerns were consistently important factors for PTSD and HR-SMI among women and difficulties adjusting to life in Australia was consistently associated with PTSD among men.

Economic stressors were associated with PTSD during the second wave (adjusted odds ratio [AOR], 1.60; 95% CI, 1.26-2.03; P =.0001) among men and (AOR, 1.81; 95% CI, 1.27-2.57; P =.0009) among women and with HR-SMI among women (AOR, 2.24; 95% CI, 1.49-3.38; P =.0001).

Loneliness was observed to fluctuate over time. Among women loneliness was associated with PTSD during waves 2 (P <.0001) and 4 (P <.0001) and with HR-SMI during waves 1 (P =.0012), 2 (P <.0001), and 4 (P <.0001).

Among men, difficulty adjusting to Australian life increased continually. The AOR for PTSD increased to 2.79 (95% CI, 1.49-5.21; P =.0013) at the study conclusion and to 3.87 (95% CI, 1.92-7.82; P =.0002) for HR-SMI.

The major limitation of these results was that the BNLA survey did not include information on how long the participants had been living in Australia, and data from individuals who had been resettled more recently may not be consistent with individuals who had been residing in Australia for longer periods of time.

These data indicated that stressors which impacted the psychological health of refugees were heterogeneous and fluctuated over time and affected men and women differently. The study authors assert that a tailored mental health promotion plan was needed for assisting individuals during the difficult relocation period.


Wu S, Renzaho AMN, Hall B J, Shi L, Ling Li, Chen W. Time-varying associations of pre-migration and post-migration stressors in refugees’ mental health during resettlement: a longitudinal study in Australia. Lancet Psychiatry. 2020;S2215-0366(20)30422-3. doi: 10.1016/S2215-0366(20)30422-3