# Longitudinal Associations Between Sources of Uncertainty and Mental Health Amongst Resettled Refugees During the COVID-19 Pandemic

## TL;DR

This study shows how different types of uncertainty, like visa status and family separation, uniquely affect the mental health of resettled refugees during the pandemic.

## Contribution

The study identifies specific pathways linking distinct uncertainty sources to mental health outcomes in refugees during the pandemic.

## Key findings

- Visa status and family separation stress at T1 predicted increased depression and PTS symptoms at T2.
- Visa uncertainty at T1 was linked to higher stress about family separation and the pandemic at T2.
- Intolerance of uncertainty had limited associations with mental health symptoms and stressors.

## Abstract

The COVID-19 pandemic may have disproportionately affected forcibly displaced people due to parallel uncertainties such as visa insecurity and family separation. This study explicitly examined whether different sources of uncertainty contributed in specific ways to increased psychological symptoms for refugees during the pandemic. A large cohort of 733 refugees and asylum seekers settled in Australia completed a mental health survey in June 2020 (T1) and 12 months later in June 2021 (T2). Using cross-lagged panel modelling, we tested changes in post-traumatic stress (PTS), depression and anxiety symptoms, visa status, family separation and COVID-19 uncertainty stress, and the contribution of intolerance of uncertainty (trait prospective and inhibitory), controlling for age, sex, trauma exposure, language, and time in Australia. Visa status and family separation stress at T1 predicted increased depression (bidirectional pathways) and PTS symptoms at T2 (unidirectional pathways), respectively. Visa status uncertainty at T1 was also associated with increases in COVID-19 and family separation stress at T2. Intolerance of uncertainty showed limited associations with symptoms and stressors. Findings demonstrate that different forms of refugee uncertainty had specific impacts on psychopathology during the first year of the COVID-19 pandemic. Refugees facing diverse kinds of stress may benefit from individual, community, and policy level support targeted to their specific circumstances and mental health needs during future crises.