European Child & Adolescent Psychiatry

, Volume 27, Issue 4, pp 411–422 | Cite as

The impact of detention on the social–emotional wellbeing of children seeking asylum: a comparison with community-based children

  • Karen Zwi
  • Sarah Mares
  • Dania Nathanson
  • Alvin Kuowei Tay
  • Derrick Silove
Original Contribution


Accumulating literature demonstrates that immigration detention is harmful to children. However, there is a scarcity of scientifically rigorous and reliable data about the health of children held in detention facilities. The aim of the study was to compare a community-based population of recently arrived refugee children flown into Australia, not detained, resettled in a non-urban area, with a population of children who arrived by boat seeking asylum, detained since arrival. The parent-version of the strength and difficulties questionnaire (SDQ) of children aged 4–15 years was compared in children living in the community with those held in detention. We compared 86 children who had a parent-completed SDQ performed, 38 (44%) in the community group and 48 (56%) in the detention group. The community sample had been living in Australia for 325 days, with no time in detention. The detention sample had been living in detention for a mean of 221 days. The mean age was similar for the community and detention sample at 8.4 years (P = 0.18). In the total sample, children in the detention group had significantly higher SDQ total difficulties scores than children in the community group (P < 0.0001). There was no difference between age groups (P = 0.82). The children in the detention group had, on average, an SDQ total difficulties score that was 12 points higher than children in the community group. Four of the five SDQ subscale scores indicated greater disturbance amongst children in detention (< 0.0001) compared to children living in the community. The detention group had significantly higher scores (P < 0.001) for all except Pro-social scores as compared to Australian norms for the 4–6 and 7–15 years age group. This study presents a rare opportunity to compare the wellbeing of displaced children who were detained following arrival in Australia with those settled in the Australian community since arrival. The community children’s scores approximated data from the general Australian childhood population. Children held in detention had significantly more social, emotional and behavioural difficulties than children living in the community, and at levels resembling a clinical cohort. Despite the small sample size, data restrictions and other limitations of the data, statistical significance in differences between the community and detention children is marked and arguably demonstrates the negative impact of post-arrival detention in children who are presumed to have similar levels of pre-arrival adversity. If the objective is to optimise the health and wellbeing of children seeking asylum, removal of post-arrival detention is one of the most powerful interventions available to host countries.


Refugee Asylum seeker Children Detention Social–emotional wellbeing Strengths and difficulties questionnaire (SDQ) 



The authors acknowledge participating families and children involved in the community study, Refugee Health Nurses Jenny Lane, Colleen Allen and Lisa Atkins, and Statistician Jenny Peat. The analysis of the detention sample is possible because the Australian Human Rights Commission (AHRC) collected the primary data from families seeking asylum and detained on Christmas Island. This was subsequently released under Freedom of Information legislation (FOI). Any errors or omissions are the sole responsibility of the authors.

Compliance with ethical standards

Conflict of interest

The authors received no financial support for the research, authorship, and/or publication of this article and have no conflict of interest.


The community study was funded by Financial Markets Foundation for Children (AUD$158 000 July 2009–June 2011). The funders had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.


The research involving the community sample in this study and the comparison with the detention sample was granted by the Human Research Ethics Committee Northern Hospitals Network, South Eastern Sydney (SES) Illawarra Area Health Service/SES Local Health District (HREC Ref No 09/163). The research involving the detention sample in this study was assessed by the South Western Sydney Local Health District Human Research Ethics Committee (HREC/15/LPOOL/556), which was satisfied with provisions to protect the rights of participants. All participants gave their informed consent prior to their inclusion in the study.


  1. 1.
    UNHRC (2017) United Nation Refugee Agency. Figures at a glance Accessed 17 May 2017
  2. 2.
    Measham T, Guzder J, Rousseau C, Nadeau L (2014) Refugee children and their families: supporting psychological wellbeing and positive adaptation following migration. Curr Probl Pediatr Adolesc Health Care 44(7):208–215CrossRefPubMedGoogle Scholar
  3. 3.
    Edge S, Newbold B (2013) Discrimination and the health of immigrants and refugees: exploring Canada’s evidence base and directions for future research in newcomer receiving countries. J Immigr Minor Health 15(1):141–148CrossRefPubMedGoogle Scholar
  4. 4.
    Fazel M, Reed RV, Panter-Brick C, Stein A (2012) Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet 379:266–282CrossRefPubMedGoogle Scholar
  5. 5.
    Warfa N, Curtis S, Watters C, Carswell K, Ingleby D, Bhui K (2012) Migration experiences, employment status and psychological distress among Somali immigrants: a mixed-method international study. BMC Public Health 12:749. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Sanders-Phillips K, Settles-Reaves B, Walker D, Brownlow J (2009) Social inequality and racial discrimination: risk factors for health disparities in children of color. Pediatrics 124(Suppl 3):S176–S186CrossRefPubMedGoogle Scholar
  7. 7.
    Montgomery E (2008) Long-term effects of organized violence on young Middle Eastern refugees’ mental health. Soc Sci Med 67:1596–1603. CrossRefPubMedGoogle Scholar
  8. 8.
    Porter M, Haslam N (2005) Pre-displacement and post-displacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA 294(5):602–612. CrossRefPubMedGoogle Scholar
  9. 9.
    Hjern A, Angel B (2000) Organized violence and mental health of refugee children in exile: a 6-year follow-up. Acta Paediatr 89(6):722–727CrossRefPubMedGoogle Scholar
  10. 10.
    Almqvist K, Broberg AG (1999) Mental health and social adjustment in young refugee children 3½ years after their arrival in Sweden. J Am Acad Child Adolesc Psychiatry 38(6):723–730CrossRefPubMedGoogle Scholar
  11. 11.
    Mares S (2016) Fifteen years of detaining children who seek asylum in Australia—evidence and consequences. Australas Psychiatry 24(1):11–14CrossRefPubMedGoogle Scholar
  12. 12.
    Fazel M, Karunakara U, Newnham EA (2014) Detention, denial, and death: migration hazards for refugee children. Lancet Glob Health 2(6):e313–e314CrossRefPubMedGoogle Scholar
  13. 13.
    Dudley M, Steel Z, Mares S, Newman L (2012) Children and young people in immigration detention. Curr Opin Psychiatry 25(4):285–292CrossRefPubMedGoogle Scholar
  14. 14.
    Robjant K, Hassan R, Katona C (2009) Mental health implications of detaining asylum seekers: systematic review. Br J Psychiatry 194(4):306–312CrossRefPubMedGoogle Scholar
  15. 15.
    Newman L, Steel Z (2008) The child asylum seeker: psychological and developmental impact of immigration detention. Child Adolesc Psychiatr Clin N Am 17(3):665–683CrossRefPubMedGoogle Scholar
  16. 16.
    Royal Australasian College of Physicians (2017) Accessed 17 May 2017
  17. 17.
    Zwi K, Chaney G (2013) Refugee children: rights and wrongs. J Paediatr Child Health 49:87–93. CrossRefPubMedGoogle Scholar
  18. 18.
    Mares S (2016) The mental health of children and parents detained on Christmas Island: secondary analysis of an Australian human rights commission data set. Health Hum Rights 18(2):219–232PubMedPubMedCentralGoogle Scholar
  19. 19.
    Kronick R, Rousseau C, Cleveland J (2015) Asylum-seeking children’s experiences of detention in Canada: a qualitative study. Am J Orthopsychiatr 85(3):287–294CrossRefGoogle Scholar
  20. 20.
    Paxton G, Tosif S, Graham H, Smith A, Reveley C, Standish J, McCloskey K, Ferguson G, Isaacs D, Gunasekera H, Marais B, Britton P, Khatami A, Zwi K, Raman S, Elliot E, Levitt D, Francis J, Bauert P, Morris P, Whybourne A, Cherian S, Mutch R, Forbes D, Rutherford D, Packer S (2015) Perspective: the forgotten children: national inquiry into children in immigration detention (2014). J Paediatr Child Health 51(4):365–368CrossRefPubMedGoogle Scholar
  21. 21.
    Robjant K, Robbins I, Senior V (2009) Psychological distress amongst immigration detainees: a cross-sectional questionnaire study. Br J Clin Psychol 48:275–286CrossRefPubMedGoogle Scholar
  22. 22.
    Steel Z, Silove D (2004) Science and the common good: indefinite, non-reviewable mandatory detention of asylum seekers and the research imperative. Monash Bioeth Rev 23(4):93–103CrossRefPubMedGoogle Scholar
  23. 23.
    Cohen J (2008) Safe in our hands?: a study of suicide and self-harm in asylum seekers. J Forensic Leg Med 15(4):235–244CrossRefPubMedGoogle Scholar
  24. 24.
    Young P, Gordon M (2016) Mental health screening in immigration detention: a fresh look at Australian government data. Australas Psychiatry 24(1):19–22CrossRefPubMedGoogle Scholar
  25. 25.
    Lorek A, Ehntholt K, Nesbitt A, Wey E, Githinji C, Rossor E, Wickramasinghe R (2009) The mental and physical health difficulties of children held within a British immigration detention center: a pilot study. Child Abuse Negl 33(9):573–585CrossRefPubMedGoogle Scholar
  26. 26.
    Cleveland J, Rousseau C (2012) Mental health impact of detention and temporary status for refugee claimants under Bill C-31. CMAJ 184(15):1663–1664CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ichikawa M, Nakahara S, Wakai S (2006) Effect of post-migration detention on mental health among Afghan asylum seekers in Japan. Aust N Z J Psychiatry 40(4):341–346CrossRefPubMedGoogle Scholar
  28. 28.
    Puthoopparambil S, Bjerneld M, Kallestal C (2015) Quality of life among immigrants in Swedish immigration detention centres: a cross-sectional questionnaire study. Glob Health Action 8:28321CrossRefPubMedGoogle Scholar
  29. 29.
    Graf M, Wermuth P, Hafeli D, Weisert A, Reagu S, Pfluger M, Taylor P, Dittmann V, Jones R (2013) Prevalence of mental disorders among detained asylum seekers in deportation arrest in Switzerland and validation of the Brief Jail Mental Health Screen BJMHS. Int J Law Psychiatry 36(3–4):201–206CrossRefPubMedGoogle Scholar
  30. 30.
    Hodes M (2010) The mental health of detained asylum seeking children. Eur Child Adolesc Psychiatry 19(7):621–623CrossRefPubMedGoogle Scholar
  31. 31.
    Shields L, Stathis S, Mohay H, van Haeringen A, Williams H, Wood D, Bennett E (2004) The health of children in immigration detention: how does Australia compare? Aust N Z J Public Health 28(6):513–519CrossRefPubMedGoogle Scholar
  32. 32.
    Mares S, Jureidini J (2004) Psychiatric assessment of children and families in immigration detention—clinical, administrative and ethical issues. Aust N Z J Public Health 28(6):520–526CrossRefPubMedGoogle Scholar
  33. 33.
    Green J, Eagar K (2010) The health of people in Australian immigration detention centres. MJA 192(2):65–70PubMedGoogle Scholar
  34. 34.
    Steel Z, Silove D (2000) The mental health implications of detaining asylum seekers. MJA 175(11–12):596–599Google Scholar
  35. 35.
    Zwi K, Rungan S, Woolfenden S, Williams K, Woodland L (2016) Methods for a longitudinal cohort of refugee children in a regional community in Australia. BMJ Open 6:e011387CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Zwi K, Rungan S, Woolfenden S, Woodland L, Palasanthiran P, Williams K (2017) Refugee children and their health, development and well-being over the first year of settlement: a longitudinal study. J Paediatr Child Health. Google Scholar
  37. 37.
    Zwi K, Woolfenden S, Williams K, Rungan S, Woodland L, Jaffe A (2017) Protective factors for social-emotional well-being of refugee children in the first 3 years of settlement in Australia. Arch Dis Child. Google Scholar
  38. 38.
    Australian Human Rights Commission (2015) The forgotten children: national inquiry into children in immigration detention 2014. ISBN 978-1-921449-56-7Google Scholar
  39. 39.
    Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40(11):1337–1345CrossRefPubMedGoogle Scholar
  40. 40.
    Vostanis P (2006) Strengths and difficulties questionnaire: research and clinical applications. Curr Opin Psychiatry 19(4):367–372CrossRefPubMedGoogle Scholar
  41. 41.
    Achenbach TM, Becker A, Döpfner M, Heiervang E, Roessner V, Steinhausen HC, Rothenberger A (2008) Multicultural assessment of child and adolescent psychopathology with ASEBA and SDQ instruments: research findings, applications, and future directions. J Child Psychol Psychiatry 49(3):251–275CrossRefPubMedGoogle Scholar
  42. 42.
    Leavey G, Hollins K, King MB, Grayson K (2004) Psychological disorder amongst refugee and migrant schoolchildren in London. Soc Psychiatry Psychiatr Epidemiol 39(3):191–195CrossRefPubMedGoogle Scholar
  43. 43.
    Youthinmind (2017) Strengths and difficulties questionnaire: normative SDQ data from Australia. Accessed 17 May 2017
  44. 44.
    Mellor D (2005) Normative data for the strengths and difficulties questionnaire in Australia. Aust Psychol 40(3):215–222CrossRefGoogle Scholar
  45. 45.
    Sawyer MG, Arney FM, Baghurst PA, Clark JJ, Graetz BW, Kosky RJ, Nurcombe B, Patton GC, Prior MR, Raphael B, Rey JM, Whaites LC, Zubrick SR (2001) The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being. Aust New Z J Psychiatry 35(6):806–814CrossRefGoogle Scholar
  46. 46.
    Australian Human Rights Commission (2014) Handout for hearing: National Inquiry into Children in Immigration Detention 2014. Accessed 12 May 2017
  47. 47.
    Kremer P, de Silva A, Cleary J, Santoro G, Weston K, Steele E, Nolan T, Waters E (2015) Normative data for the strengths and difficulties questionnaire for young children in Australia. J Paediatr Child Health 51(10):970–975. CrossRefPubMedGoogle Scholar
  48. 48.
    Ziaian T, Anstiss H, Antoniou G, Baghurst P, Sawyer M (2011) Emotional and Behavioural Problems Among Refugee Children and Adolescents Living in South Australia. Aust Psychol. Google Scholar
  49. 49.
    Nielsen S, Norredam M, Christiansen K, Obel C, Hilden J, Krasnik A (2008) Mental Health Among children seeking asylum in Denmark—the effect of length of stay and number of relocations: a cross sectional study. BMC Public Health 8:293CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Wiegersma PA, Stellinga-Boelen A, Reijneveld SA (2011) Psychosocial problems in asylum seekers’ children: the parent, child, and teacher perspective using the strengths and difficulties questionnaire. J Nerv Ment Dis 199:85–90CrossRefPubMedGoogle Scholar
  51. 51.
    Maybery D, Reupert A, Goodyear M, Ritchie R, Brann P (2009) Investigating the strengths and difficulties of children from families with a parental mental illness. Aust E J Adv Mental Health 8(2):165–174CrossRefGoogle Scholar
  52. 52.
    Richter J, Sagatun Å, Heyerdahl S, Oppedal B, Røysamb E (2011) The strengths and difficulties questionnaire (SDQ)—self-report. An analysis of its structure in a multiethnic urban adolescent sample. J Child Psychol Psychiatry 52:1002–1011CrossRefPubMedGoogle Scholar
  53. 53.
    Mieloo CL, Bevaart F, Donker MC, van Oort FV, Raat H, Jansen W (2014) Validation of the SDQ in a multi-ethnic population of young children. Eur J Public Health 24(1):26–32CrossRefPubMedGoogle Scholar
  54. 54.
    Derluyn I, Broekaer E (2007) Different perspectives on emotional and behavioural problems in unaccompanied refugee children and adolescents. Ethn Health 12:141–162CrossRefPubMedGoogle Scholar
  55. 55.
    Zwi K, Mares S (2015) Stories from unaccompanied children in immigration detention: a composite account. J Paediatr Child Health 51(7):658–662. CrossRefPubMedGoogle Scholar
  56. 56.
    Mares S, Zwi K (2015) Sadness and fear: the experiences of children and families in remote Australian immigration detention. J Paediatr Child Health 51:663–669CrossRefPubMedGoogle Scholar
  57. 57.
    Lovejoy MC, Graczyk PA, O’Hare E, Neuman G (2000) Maternal depression and parenting behavior: a meta-analytic review. Clin Psychol Rev 20(5):561–592CrossRefPubMedGoogle Scholar
  58. 58.
    Murray L, Halligan SL, Cooper PJ (2010) Effects of postnatal depression on mother–infant interactions, and child development. In: Wachs T, Bremner G (eds) Handbook of infant development. Wiley-Blackwell, MaldenGoogle Scholar
  59. 59.
    Murray L, Arteche A, Fearon P, Halligan S, Goodyer I, Cooper P (2011) Maternal postnatal depression and the development of depression in offspring up to 16 years of age. J Am Acad Child Adolesc Psychiatry 50(5):460–470CrossRefPubMedGoogle Scholar
  60. 60.
    Cunningham J, Harris G, Vostanis P, Oyebode F, Blissett J (2004) Children of mothers with mental illness: attachment, emotional and behavioural problems. Early Child Dev Care 174(7–8):639–650CrossRefGoogle Scholar
  61. 61.
    Cowling V, Luk E, Mileshkin C, Birleson P (2004) Children of adults with severe mental illness: mental health, help seeking and service use. Psychiatr Bull 28:43–46CrossRefGoogle Scholar
  62. 62.
    Mathai J, Jespersen S, Bourne A, Donegan T, Akinbiyi A, Gray K (2008) Use of the strengths and difficulties questionnaire in identifying emotional and behavioural problems in children of parents with a mental illness in Australia. Aust E J Adv Mental Health. Google Scholar
  63. 63.
    Najman JM, Williams GM, Nikles JMB, Spence S, Bor W, O’Callaghan M, LeBrocque R, Andersen MJ (2000) Mothers’ mental illness and child behaviour problems: cause-effect association or observation bias? J Am Acad Child Adolesc Psychiatry 39:592–602CrossRefPubMedGoogle Scholar
  64. 64.
    Bronstein I, Montgomery P (2011) Psychological distress in refugee children: a systematic review. Clin Child Fam Psychol Rev 14:44–56CrossRefPubMedGoogle Scholar
  65. 65.
    Kersten P, Dudley M, Nayar S, Elder H, Robertson H, Tauroa R, McPherson KM (2016) Cross-cultural acceptability and utility of the strengths and difficulties questionnaire: views of families. BMC Psychiatry 16:347CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Zwi K, Kalowski J, Parmeter J, Woodland L (2017) The impact of health perceptions and beliefs on access to care for migrants and refugees. J Cult Divers 24(3):63–72Google Scholar
  67. 67.
    Hodes M, Jagdev D, Chandra N, Cunniff A (2008) Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. J Child Psychol Psychiatry 49(7):723–732CrossRefPubMedGoogle Scholar
  68. 68.
    Dudley M (2016) Helping professionals and Border Force secrecy: effective asylum-seeker healthcare requires independence from callous policies. Aust Psychiatry 24(1):5–18CrossRefGoogle Scholar
  69. 69.
    Isaacs D (2015) Nauru and detention of children. J Paediatr Child Health 51(4):353–354CrossRefPubMedGoogle Scholar
  70. 70.
    Booth A (2016) Health workers exempt from immigration detention secrecy provisions, SBS News. Accessed 12 May 2017
  71. 71.
    Talley N, Zwi K (2015) Let the children go—advocacy for children in detention by the Royal Australasian College of Physicians. MJA 202(11):555–557PubMedGoogle Scholar
  72. 72.
    Triggs G (2015) The forgotten children: national inquiry into children in immigration detention 2014. MJA 202(11):553–555PubMedGoogle Scholar
  73. 73.
    Isaacs D (2016) Are healthcare professionals working in Australia’s immigration detention centres condoning torture? J Med Ethics 42:413–415CrossRefPubMedGoogle Scholar
  74. 74.
    Corbett EJ, Gunasekera H, Maycock A, Isaacs D (2014) Australia’s treatment of refugee and asylum seeker children: the views of Australian paediatricians. MJA 201(7):393–398PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Karen Zwi
    • 1
    • 2
  • Sarah Mares
    • 3
    • 4
  • Dania Nathanson
    • 2
  • Alvin Kuowei Tay
    • 3
    • 5
  • Derrick Silove
    • 3
    • 6
  1. 1.School of Women’s and Children’s HealthUniversity of New South WalesSydneyAustralia
  2. 2.Sydney Children’s Hospitals NetworkSydneyAustralia
  3. 3.School of PsychiatryUniversity of New South WalesSydneyAustralia
  4. 4.Menzies School of Health ResearchDarwinAustralia
  5. 5.Psychiatry Research and Teaching Unit, Ingham Applied Medical InstituteLiverpool HospitalLiverpoolAustralia
  6. 6.Psychiatry Research and Teaching UnitSouth West Sydney Local Health DistrictSydneyAustralia

Personalised recommendations