Cohort profile: intimate partner violence and mental health among women from refugee background and a comparison group of Australian-born – the WATCH cohort study

Abstract

PurposeThe Women Aware with Their Children study was created because prospective data are required to accurately guide prevention programmes for intimate partner violence (IPV) and to improve the mental health and resettlement trajectories of women from refugee backgrounds in Australia.Participants1335 women (685 consecutively enrolled from refugee backgrounds and 650 randomly selected Australian-born) recruited during pregnancy from three public antenatal clinics in Sydney and Melbourne, Australia. The mean age was 29.7 years among women from refugee backgrounds and 29.0 years among women born in the host nation. Main measures include IPV, mood, panic, post-traumatic stress disorder, disability and living difficulties.Findings to datePrevalence of IPV at all three time points is significantly higher for refugee-background women. The trend data showed that reported IPV rates among Australian-born women increased from 25.8% at time 1 to 30.1% at time 3, while for refugee-background women this rate declined from 44.4% at time 1 to 42.6% at time 3. Prevalence of major depressive disorder (MDD) at all three time points is higher for refugee-background women. MDD among Australian-born women significantly declined from 14.5% at time 1 to 9.9% at time 3, while for refugee-background women it fluctuated from 25.1% at time 1 to 17.3% at time 2 and to 19.1% at time 3.Future plansWe are currently examining trajectories of IPV and mental disorder across four time points. Time 4 occurred during the COVID-19 pandemic, enabling a unique opportunity to examine the impacts of the pandemic over time. Time 5 started in August 2021 and time 6 will begin approximately 12 months later. The children at time 5 are in the early school years, providing the capacity to examine behaviour, development and well-being of the index child.

COVID-19 stressors and mental health problems amongst women who arrived as refugees and those born in Australia

“…This study followed Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. The study protocol is published [ 21 ].…”

“…Women’s mental health may be at particular risk during COVID-19 because of factors unique to their gender, including a higher vulnerability to CMDs in general, the impact of pregnancy and early child-rearing, greater socio-economic deprivation, and significantly higher exposure to traumatic events [ 20 , 21 ]. All these factors may exacerbate the impact of COVID-19 related stressors including women’s greater representation in insecure employment and having a disproportionate responsibility for domestic and caring tasks [ 13 , 22 , 23 ].…”

Invisible wounds of the Israel–Gaza war in Australia

“…Health professionals may expect to see a higher number of presentations with acute traumatic disturbance, re‐emergence of previously controlled mental illness, and presentations for somatic and unexplained illnesses. On watching news of the Israel–Gaza conflict, a participant from our WATCH study, 6 from Lebanon, spontaneously remembered Israeli attacks on her village and said: “This made me recall exactly where I was sitting at that time we were bombed, as a child, wondering why this is happening to us, and why can other people have a normal life. It is like I know what they feel.” Other spontaneous descriptions from the study include “that deep feeling of fear when we could hear the explosions, then the bomb hit the side of our shelter, we ran barefoot into the street to escape”, and “remembering my child's face and seeing children of the same age now, I feel frozen with helplessness”.…”

“…Mental distress in these populations can be severe, and trauma of this nature can have deleterious impacts for years to come 5 . It is instructive to draw on some concrete examples of the immediate stress reactions from our current longitudinal mental health study of 1335 women from refugee background (the WATCH cohort) and its research assistants, more than half of whom are from the Middle East, including from Lebanon and Palestine 6,7 . All quotes below from study participants have been deidentified and approved by the person who shared it with us.…”

The Psychosocial Impacts of Intimate Partner Violence against Women in LMIC Contexts: Toward a Holistic Approach

“…As armed conflicts and political turmoil increase worldwide, increasing numbers of people are refugees and migrants to other countries who experience increased stressors and reduced social controls that may contribute to IPVAW. Current evidence indicates that being a refugee increases the risks of IPVAW [ 107 , 120 ]; makes the IPVAW impacts more severe [ 121 , 122 , 123 ] and decreases the likelihood that survivors will receive the services and supports they need and are entitled to [ 107 ]. Further, the perpetrators may worsen the psychosocial impact on the survivors by threatening to report them to the immigration authorities [ 121 , 123 ].…”