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Supporting Documentation for grant funding request:
Implementing an electronic version of the Screening Tool for Asylum-seeker Mental Health
(STAMH)
Hocking, D. and S. Sundram (2015). "Demoralisation syndrome does not explain the psychological profile of
community based asylum-seekers." Comprehensive Psychiatry 63: 55–64.
Background: Demoralisation syndrome (DS) has been advanced as a construct that features
hopelessness, meaninglessness, and existential distress. Demoralisation and DS have
predominantly been considered secondary only to illness; hence there is scant research on
demoralisation or DS in populations affected by extreme environmental stress.
Aims: The current study aimed to determine the prevalence of demoralisation, its predictors, and
the relevance of DS in a community-based forced-migrant population.
Method: A convenience sample of 131 adult asylum-seekers (n = 98) and refugees (n = 33) without
recognised mental disorders in Melbourne, Australia, were assessed cross-sectionally on
posttraumatic stress, anxiety, depression, post-migration stress, and demoralisation. Sociodemographic data were analysed with relevant clinical data. Predictive aims were investigated
using bivariate statistical tests and exploratory aims were investigated using correlational and
linear regression analyses.
Results: Seventy nine percent of the sample met criteria for demoralisation (asylum-seekers = 83%;
refugees = 66%), with asylum-seekers being 2.55 (95% C.I. = 1.03–6.32, Z = 2.03, p = .04) times
more likely to be demoralised than refugees. No relationship between demoralisation and time in
the refugee determination process emerged. The regression model explained 47.5% of variance in
demoralisation scores for the total sample F(9,111) = 13.07, p b .0001, with MDD and anxiety score
making unique significant contributions.
Conclusions: Demoralisation was widespread through the asylum-seeker and refugee population
and its prevalence was attributable to a range of social and psychiatric factors. However, DS had
little explanatory power for psychiatric morbidity, which was more suggestive of a pan-distress
symptom complex.
Hocking, D. C., et al. (2015). "Mental Disorders in Asylum Seekers: The Role of the Refugee Determination
Process and Employment." The Journal of Nervous and Mental Disease 203(1): 28-32.
The refugee determination process (RDP) and social factors putatively impact on the psychiatric
morbidity of adult asylum seekers (ASs) living in the community. Clinical and sociodemographic
data relevant to AS experience in the RDP were collected using self-report measures to assess
posttraumatic stress (Harvard Trauma Questionnaire–Revised) and depressive and anxiety
symptoms (25-item Hopkins Symptom Checklist), and the Mini-International Neuropsychiatric
Interview 6.0 psychiatric interview was used to establish a cutoff for caseness. The prevalence of
major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) was 61% and 52%,
respectively. Unemployment and greater numbers of both potentially traumatic events and RDP
rejections were predictors of symptom severity. Unemployed ASs were more than twice as likely to
have MDD (odds ratio, 2.61; 95% confidence interval [CI], 1.11– 6.13; p = 0.03), and ASs with at
least one RDP rejection were 1.35 times more likely to develop PTSD for each additional rejection
(95% CI, 1.00–1.84; p = 0.05). Reducing the asylum claim rejection rate and granting work rights are
likely to reduce the rate of PTSD and MDD in communitybased ASs.
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Hocking, D. C., et al. (2015). "Social factors ameliorate psychiatric disorders in community-based asylum
seekers independent of visa status." Psychiatry Research 230(2): 628-636.
The impact of industrialised host nations’ deterrent immigration policies on the mental health of
forced migrants has not been well characterised. The present study investigated the impact of
Australia’s refugee determination process (RDP) on psychiatric morbidity in community-based
asylum-seekers (AS) and refugees. Psychiatric morbidity was predicted to be greater in AS than
refugees, and to persist or increase as a function of time in the RDP. The effect on mental health of
demographic and socio-political factors such as health cover and work rights were also
investigated. Psychiatric morbidity was measured prospectively on five mental health indices at
baseline (T1, n=131) and an average of 15.7 months later (T2, n=56). Psychiatric morbidity in AS
significantly decreased between time points such that it was no longer greater than that of
refugees at T2. Caseness of PTSD and demoralisation reduced in AS who gained protection;
however, those who maintained asylum-seeker status at T2 also had a significant reduction in PTS
and depression symptom severity. Reduced PTS and demoralisation symptoms were associated
with securing work rights and health cover. Living in the community with work rights and access to
health cover significantly improves psychiatric symptoms in forced migrants irrespective of their
protection status.
(Hocking and Sundram 2015, Hocking, Kennedy et al. 2015, Hocking, Kennedy et al. 2015)
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