International Journal of Public Health

, Volume 64, Issue 5, pp 763–772 | Cite as

The mental health effects of visa insecurity for refugees and people seeking asylum: a latent class analysis

  • Elizabeth A. NewnhamEmail author
  • April Pearman
  • Stephanie Olinga-Shannon
  • Angela Nickerson
Original article



Current regional conflicts are creating a surge in forced migration, and heightened visa restrictions are increasingly being applied. The current study aimed to examine the relationship between visa insecurity and psychological outcomes within a large clinical sample of refugees and people seeking asylum in Australia.


The sample comprised 781 clients (53.9% male, 16–93 years) attending a clinic for trauma survivors. Country of birth was most frequently identified as Afghanistan (18.1%), Iraq (15.3%) and Iran (15.1%). The Hopkins Symptom Checklist was administered at admission.


Latent class analyses identified four groups varying in severity of symptoms, namely very high (16.1%), high (38.1%), moderate (31.5%), and low (14.3%). People with insecure visa status were at least five times more likely to report high (OR = 5.86, p < 0.001) or very high (OR = 5.27, p < 0.01) depression and anxiety symptoms than those with permanent residency. Women were almost twice as likely to report high (OR = 1.96 p < 0.01) or very high (OR = 1.96, p < 0.05) symptoms.


The findings suggest that temporary visas play a significant role in psychological distress and that timely immigration processing has important implications for health outcomes.


Refugee Asylum Migration Depression Anxiety Gender 



We are grateful to the ASeTTS clinical team, coordinators, and clients whose input and experience have informed the study. We thank Grace McKie for her assistance with data management.


The study was funded by a University of Western Australia Collaborative Research Grant and Western Australian Government Department of Health New Independent Researcher Infrastructure Award. The first author was supported by a National Health and Medical Research Council of Australia (NHMRC) Sidney Sax Early Career Fellowship (GNT1035196) and a Curtin Research Fellowship. The funding bodies played no role in the design, analysis, interpretation of findings, or decision to publish the study.

Compliance with ethical standards

Conflict of interest

The second and third authors were employed by an agency that provides psychological services for torture and trauma survivors. The authors declare no other conflicts of interest.

Ethics statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Western Australia Human Research Ethics Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Swiss School of Public Health (SSPH+) 2019

Authors and Affiliations

  • Elizabeth A. Newnham
    • 1
    • 2
    • 3
    Email author
  • April Pearman
    • 4
  • Stephanie Olinga-Shannon
    • 4
  • Angela Nickerson
    • 5
  1. 1.School of PsychologyCurtin UniversityPerthAustralia
  2. 2.FXB Center for Health and Human RightsHarvard T.H. Chan School of Public HealthBostonUSA
  3. 3.School of Psychological ScienceThe University of Western AustraliaPerthAustralia
  4. 4.Association for Services to Torture and Trauma Survivors (ASeTTS)PerthAustralia
  5. 5.School of PsychologyUniversity of New South WalesSydneyAustralia

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