Association between unmet post-arrival expectations and psychological symptoms in recently arrived refugees

Abstract

Thwarted expectations regarding one's post-settlement life may challenge the mental health of refugees. The present study aimed to investigate the relationship between pre-arrival expectations and the course of psychological symptoms across time. A secondary analysis of 1,496 principal visa applicants across five waves of the Building a New Life in Australia (BNLA) study was conducted. The cross-sectional associations between expectations on the one hand, and post-traumatic stress (PTSD-8) symptoms and psychological distress (Kessler-6; K6) on the other, were assessed using multiple regression. Latent class growth analysis (LCGA) was used to identify discrete symptom trajectories of psychological symptoms across five years following settlement, and multinomial regressions were used to determine if violated expectations predicted membership of identified PTSD-8 and K6 class trajectories. LCGA supported a four-class solution for the PTSD-8 "Resilient Post Traumatic Stress (PTS)" (54.1%), "Improving PTS" (15.0%), "Deteriorating PTS" (17.3%), and "Persistently High PTS" (13.6%). For the K6, three classes were identified: "Persistently Mild K6" (60.4%), "Resilient K6" (9.4%), and "Persistently High K6" (30.2%). Thwarted expectations were found to significantly predict membership of less favourable symptom trajectories classes in the context of other established predictors. Post-settlement expectations may thus have weak but unique predictive value for the course of psychological symptoms alongside other factors such as older age and financial stress. Implications of these findings for service provision and policy are discussed.

Keywords: PTSD; expectations; post-traumatic stress; pre-migration; psychological distress; refugee.