The association between visa insecurity and mental health, disability and social engagement in refugees living in Australia

Figures & data

Table 1. Participant characteristics.

	All participants	Secure visa status (n = 826)	Insecure visa status (n = 259)
Age	38.11 (11.79)	38.96 (12.52)	35.40 (8.58)	t(625.08) = 5.14, p < .001
Gender (Female)	465 (42.9%)	384 (46.6%)	81 (31.4%)	χ^2(1) = 18.54, p < .001
Language				χ^2 (3) = 488.73, p < .001
Arabic	741 (68.3%)	698 (84.5%)	43 (16.6%)
Farsi	186 (17.1%)	60 (7.3%)	126 (48.6%)
English	104 (9.6%)	65 (7.9%)	39 (15.1%)
Tamil	54 (5.0%)	3 (0.4%)	51 (19.7%)
Country of birth				χ^2 (5) = 574.88, p < .001
Iraq	589 (54.3%)	557 (67.4%)	32 (12.4%)
Iran	174 (16.0%)	50 (6.1%)	124 (47.9%)
Syria	162 (14.9%)	161 (19.5%)	1 (0.4%)
Sri Lanka	58 (5.3%)	2 (0.2%)	56 (21.6%)
Afghanistan	37 (3.4%)	26 (3.1%)	11 (4.2%)
Other	65 (6.0%)	30 (3.6%)	35 (13.5%)
Mode of travel to Australia
Boat	243 (22.4%)	35 (4.2%)	208 (80.3%)	χ^2 (1) = 653.52, p < .001
Plane	842 (77.6%)	791 (93.8%)	51 (6.1%)
Held in immigration detention in Australia or offshore	211 (19.4%)	41 (5.3%)	170 (75.6%)	χ^2 (1) = 512.73, p < .001
No immediate family in Australia	251 (23.2%)	122 (14.8%)	129 (50.2%)	χ^2 (1) = 137.35, p < .001
Marital Status				χ^2 (1) = 23.36, p < .001
Married or in a relationship	773 (71.2%)	619 (75.0%)	154 (59.2%)
Not married or in a relationship	311 (28.7%)	206 (25.0%)	105 (40.5%)
Education
Little/no formal education	48 (4.5%)	38 (4.7%)	10 (3.9%)	χ^2 (4) = 15.19, p = .004
Completed primary school	122 (11.4%)	100 (12.3%)	22 (8.6%)
Completed high school	378 (35.3%)	266 (32.6%)	112 (43.8%)
Completed university	428 (39.9%)	329 (40.3%)	99 (38.7%)
Completed other training (vocational, apprenticeship)	96 (8.8%)	83 (10.2%)	13 (5.1%)
Time in Australia	1.98 (1.65)	1.44 (1.37)	3.65 (1.32)	t(1025) = 22.39, p < .001

Table 2. Linear regression analyses predicting PTSD symptoms, depression symptoms and disability in refugees with secure and insecure visa status.

	PTSD Symptoms				Depression Symptoms				Disability
	R^2 = 0.35, F (10, 943) = 50.94, p < .001				R^2 = 0.27, F (10, 976) = 36.13, p < .001				R^2 = 0.08, F (10, 966) = 8.76, p < .001
	B (SE)	β	sig	95% CI	B (SE)	β	sig	95% CI	B (SE)	β	sig	95% CI
Age	0.01 (0.01)	0.03	0.322	[−0.01, 0.01]	0.01 (0.01)	0.01	0.779	[−0.01, 0.01]	0.06 (0.03)	0.07	0.038	[0.01, 0.12]
Gender (female)	0.14 (0.04)	0.10	<.001	[0.07, 0.22]	0.13 (0.05)	0.08	0.004	[0.04, 0.22]	1.44 (0.66)	0.07	0.030	[0.14, 2.74]
Married/in relationship	0.03 (0.04)	0.02	0.497	[−0.06, 0.12]	0.01 (0.05)	0.01	0.854	[−0.09, 0.11]	−1.03 (0.75)	−0.05	0.169	[−2.51, 0.41]
Education
Little or no education	-	-	-	-	-	-	-	-
Primary school	0.12 (0.11)	0.05	0.282	[−0.10, 0.33]	0.08 (0.13)	0.03	0.555	[−0.17, 0.32]	0.69 (1.84)	0.02	0.708	[−2.92, 4.29]
High school	0.10 (0.10)	0.06	0.334	[−1.00, 0.29]	0.11 (0.12)	0.07	0.338	[−0.11, 0.34]	0.16 (1.67)	0.01	0.922	[−3.11, 3.43]
Other training	0.15 (0.10)	0.10	0.126	[−0.04, 0.34]	0.15 (0.11)	0.09	0.183	[−0.07, 0.37]	−0.06 (1.64)	−0.01	0.969	[−3.27, 3.15]
University	0.20 (0.11)	0.08	0.068	[−0.02, 0.42]	0.24 (0.13)	0.09	0.064	[−0.02, .50]	0.70 (1.89)	0.02	0.710	[−3.00, 4.40]
Time in Australia (yrs)	0.03 (0.01)	0.07	0.026	[0.01, 0.06]	0.06 (0.02)	0.12	<.001	[0.03, 0.09]	−0.05 (0.24)	−0.01	0.844	[−0.52, 0.43]
PTE Exposure	0.08 (0.01)	0.52	<.001	[0.07, 0.09]	0.07 (0.01)	0.40	<.001	[0.06, 0.08]	0.70 (0.08)	0.30	<.001	[0.54, 0.86]
Visa insecurity*	0.15 (0.05)	0.09	0.005	[0.05, 0.26]	0.22 (0.06)	0.12	0.001	[0.09, 0.34]	−1.08 (0.94)	−0.04	0.252	[−2.92, 0.77]

*Reference category: Secure visa

Table 3. Multinomial logistic regression analysis predicting thoughts of being better off dead and suicidal intent in refugees with secure and insecure visa status.

	Thoughts of being better off dead					Suicidal intent
	χ^2(20) = 175.44, p < .001
	B (SE)	OR	95% CI	Wald χ^2	p	B (SE)	OR	95% CI	Wald χ^2	p
Age	−0.01 (0.01)	1.00	[0.94, 1.01]	0.24	0.623	−0.02 (0.02)	0.98	[0.94, 1.03]	0.73	0.392
Gender (female)	0.24 (0.17)	1.28	[0.92, 1.77]	2.13	0.144	0.79 (0.44)	2.21	[0.94, 5.23]	3.27	0.071
Married/in relationship	0.18 (0.18)	1.19	[0.84, 1.71]	0.95	0.331	1.02 (0.42)	2.77	[1.23, 6.26]	6.03	0.014
Education
Little or no education	0.40 (0.53)	1.49	[0.53, 4.16]	0.57	0.451	−0.59 (1.05)	0.55	[0.07, 4.37]	0.32	0.574
Primary school	0.40 (0.49)	1.49	[0.58, 3.86]	0.67	0.412	−0.82 (0.90)	0.44	[0.08, 2.57]	0.83	0.363
High school	0.16 (0.48)	1.17	[0.45, 3.02]	0.11	0.743	−0.86 (0.91)	0.42	[0.07, 2.53]	0.89	0.345
Other training	0.54 (0.53)	1.72	[0.61, 4.90]	1.04	0.308	−0.24 (1.06)	0.79	[0.10, 6.31]	0.05	0.823
University
Time in Australia (yrs)	0.04 (0.06)	1.04	[0.93, 1.17]	0.51	0.476	0.27 (0.13)	1.32	[1.03, 1.68]	4.71	0.030
PTE Exposure	0.13 (0.02)	1.14	[1.10, 1.18]	45.57	<.001	0.25 (0.05)	1.29	[1.18, 1.41]	29.28	<.001
Visa insecurity*	0.64 (0.21)	1.90	[1.26, 2.88]	9.31	0.002	0.88 (0.43)	2.41	[1.03, 5.62]	4.12	0.042

*Reference category: Secure visa

Table 4. Poisson regression analyses predicting social engagement in refugees with secure and insecure visa status.

	Group Membership				Support from Groups				Support from Individuals
	χ^2(11) = 196.40, p < .001				χ^2(11) = 119.32, p < .001				χ^2(11) = 84.50, p < .001
	B (SE)	95% CI	Wald χ^2	p	B (SE)	95% CI	Wald χ^2	p	B (SE)	95% CI	Wald χ^2	p
Age	−0.01 (0.01)	[−0.02, 0.01]	1.84	0.174	0.01 (0.01)	[−0.01, 0.01]	1.02	0.313	−0.01 (0.01)	[−0.01, 0.01]	0.74	0.389
Gender (female)	0.04 (0.09)	[−0.14, 0.21]	0.17	0.685	0.27 (0.10)	[0.08, 0.47]	7.42	0.006	0.17 (0.07)	[0.03, 0.31]	5.94	0.015
Married/in relationship	0.25 (0.09)	[0.07, 0.43]	7.38	0.007	0.27 (0.11)	[0.06, 0.48]	6.53	0.011	0.07 (0.08)	[−0.08, 0.22]	0.80	0.370
Education
Little or no education	-	-	-	-					-	-	-	-
Primary school	0.36 (0.36)	[−0.34, 1.07]	1.02	0.312	0.50 (0.38)	[−0.24, 1.23]	1.75	0.186	0.21 (0.23)	[−0.24, 0.66]	0.85	0.358
High school	0.58 (0.33)	[−0.06, 1.22]	3.13	0.077	0.41 (0.35)	[−0.28, 1.09]	1.34	0.247	0.19 (0.21)	[−0.23, 0.60]	0.78	0.376
University	1.15 (3.22)	[0.52, 1.78]	12.71	<.001	0.97 (0.34)	[0.29, 1.64]	7.93	0.005	0.56 (0.21)	[0.15, 0.97]	7.27	0.007
Other training	1.01 (0.35)	[0.33, 1.69]	8.55	0.003	0.67 (0.38)	[−0.07, 1.41]	3.12	0.077	0.38 (0.23)	[−0.07, 0.84]	2.70	0.100
PTE Exposure	0.07 (0.01)	[0.05, 0.09]	51.33	<.001	0.08 (0.01)	[0.06, 0.10]	48.85	<.001	0.04 (0.01)	[0.03, 0.06]	27.51	<.001
Time in Australia (years)	0.12 (0.03)	[0.07, 0.18]	19.29	<.001	0.02 (0.03)	[−0.05, 0.09]	0.26	0.607	0.02 (0.02)	[−0.02, 0.07]	0.95	0.330
Depression symptoms	−0.20 (0.06)	[−0.31, −0.08]	11.37	0.001	−0.15 (0.07)	[−0.28, −0.02]	4.75	0.029	−0.09 (0.05)	[−0.18, 0.01]	3.21	0.073
Visa insecurity	0.13(0.10)	[−0.07, 0.33]	1.58	0.209	0.26 (0.13)	[0.02, 0.51]	4.31	0.038	0.17 (0.09)	[−0.01, 0.34]	3.32	0.068