Many commentators have criticised trends toward (over-)medicalising trauma responses in cross-cultural populations (P. J. Bracken, et al., 1995; Steel, Bateman
Steel, et al., 2009; Summerfield, 1999; Watters, 2001). Furthermore, focusing on
psychiatric symptomatology may lead to a failure in understanding what factors may
protect survivors of violence from subsequent dysfunction (Ehrenreich, 2003). The
protective factors that emerged have also been well-documented in the literature. In particular, the results from this study suggest that being granted the right to work, securing employment and having access to subsided health care, contributes
significantly to reduced psychiatric morbidity and post-migration stress.
Data gathered in relation to the most commonly cited negative changes that had taken place at the follow-up interview were unemployment/job loss (n=10) and nil
contact with/worry about family in home country (n=15). The most commonly cited
positive changes were employment/increased work hours (n=12), connectivity to
support network/community linkages (n=13) and getting PR (n=15).
5.3.1 Social support and connectivity
The theme of support was salient in relation of its presence or absence for almost all participants. For asylum-seekers coming from collectivist cultures into an individualistic society, the separation from family, culture and community can magnify feelings of isolation. As aforementioned (see 5.1.4), support offered by both
professionals and community members played a significant role in ameliorating
loneliness and emotional suffering. Further to this, Kramer and Bala (2004)
commented that social support can help people to share their experience and
perception of their situation, and receive validation. In particular they recommended that refugee centres engage workers with whom refugees can build relationships
In various ways, many participants expressed gratitude to friends, neighbours,
church communities and other “surrogate family” whose support enabled them to
keep their “sanity”. In some cases communities played a direct role in participants’
legal cases, writing letters to advocate for the granting of permanent protection.
Hence, the qualitative data points to support – in whatever form – as a kind of
lifeline for asylum-seekers burdened by the stress of living in limbo for protracted periods away from their usual support networks. Variables measuring support a priori were unfortunately absent and subsequent data was not gathered in a uniform
way. Yet, based on a solid body of research (Clarke & Kissane, 2002; Flaherty et al.,
1986; Gerritsen et al., 2006; Renner et al., 2007; Schweitzer et al., 2002), the most likely explanation for the decrease in symptom scores at follow-up, (in addition to gaining work rights, Medicare and employment) was the presence of significant
social support.
Contrary to the experiences of most participants was that of the only
participant living in community detention at the time of interview. He felt that the broader community was “deaf and blind” to his plight. Although there may be a number of factors which contributed to his feeling of alienation (such as not being
able to speak English), it does raise questions about the psychosocial impact of
community detention on asylum-seekers and the potential for discrimination which
may compound pre-existing mental health problems. Findings to this end have been documented in the literature. Most notably the controversial ‘dispersal policy’ in
the UK is believed to undermine informal support networks and impede integration (Watters & Ingleby, 2004).
5.3.2 Gainful employment
As expected, there was a significant difference in employment status between asylum-seekers and refugees, with approximately one quarter of all asylum-seekers
not having work rights at baseline. This translated to a greater level of post-
migration stress for those without work rights, even when compared with those who had work rights but were unemployed. In spite of more than one third of the sample having worked in a professional capacity prior to arriving in Australia, those who
were permitted to work were almost exclusively employed in unskilled positions. At follow-up an additional five of the AS-AS cohort were granted work rights.
A reduction in trauma and post-migration stress for this cohort was associated with changes to work status over time, with lawful paid work being associated with lower trauma post-migration stress scores. Previous research has also found that
employment mitigates against psychological distress and psychiatric symptoms (Begley et al., 1999; Dupont et al., 2005; Gorst-Unsworth & Goldenberg, 1998;
Laban et al., 2005; Lavik et al., 1996; Ryan, benson, et al., 2008). A strong negative
relationship emerged between work rights status and PTSD, refugee trauma, demoralisation and post-migration stress. A strong negative relationship also
emerged between Medicare status and both anxiety and demoralisation. briggs
(2011) found employment had a reductive impact on both major depression and demoralisation. While the present study found no difference between the non- demoralised sub-group and the rest of the sample on employment status, it is likely that residency status was masking an effect for asylum-seekers (i.e., asylum-seekers
and refugee participants being conflated in these analyses).
The quantitative data did not reflect depressive symptomatology (in particular) as strongly as did the qualitative data regarding the issue of work rights and
employment. However, a similar discrepancy was reported in an Austrian study (Renner et al., 2007) of asylum-seekers in three ethnic groups. The study stressed the emotional impact of participants being denied work rights in spite of a non-
significant relationship between work permits and ability to cope with trauma. The qualitative thematic content regarding work in Renner et al.’s (2007) study closely resembled that expressed by participants in the present study, including work providing distraction from pernicious worry in addition to increased self-efficacy
and being able to provide for family. 5.3.3 Religion
Religion was not specifically explored in the quantitative analyses and did not emerge as a significant demographic variable in any of the exploratory analyses (e.g., predictors of demoralisation). The one exception was its role in distinguishing between residency status, with Christians’ being more likely to be granted PR at both time points – itself an interesting finding. However, the most enlightening data pertaining to religion was of a qualitative nature. For 16 participants, religion
was spontaneously cited as a buffer against feelings of hopelessness. Adherence to a religious faith was cited by some as a protective factor against depression (and
for some, suicide). Reading the Qur’an, having pastoral counselling and interacting
with faith communities provided a means of coping with mental health symptoms. Religion has been found to help individuals cope with trauma and demoralisation
(Kaplan et al., 2008; S. b. Kleinman, 1990; Levav, et al., 2008; Renner et al., 2007). Other investigators have found that a belief that one’s fate is in the hands of God or is predetermined in some way may relieve anxiety and help individuals accept
and tolerate difficult conditions, including long-term uncertainty (Kramer & bala, 2004). This was certainly the case for some participants. For example, for some
Muslim participants, the belief that their future was left to the will of Allah relieved them of worry and anguish, while others had faith that their prayers for permanent protection would be answered.