Change in visa status amongst Mandaean refugees: Relationship to psychological symptoms and living difficulties Angela Nickerson a, ⁎, Zachary Steel b , Richard Bryant a , Robert Brooks b , Derrick Silove b a School of Psychology, University of New South Wales, Sydney, NSW Australia b School of Psychiatry, University of New South Wales, Sydney, NSW Australia abstract article info Article history: Received 28 May 2010 Received in revised form 24 November 2010 Accepted 5 December 2010 Keywords: Migration policy Temporary protection Mental health Trauma Depression PTSD Quality of life Policies of deterrence, including the use of detention and temporary visas, have been widely implemented to dissuade asylum seekers from seeking protection in Western countries. The present study examined the impact of visa status change on the mental health of 97 Mandaean refugees resettled in Australia. At the time of the first survey (2004), 68 (70%) participants held temporary protection visas (TPVs) and 29 (30%) held permanent residency (PR) status, whereas by the second survey (2007), 97 (100%) participants held PR status. We tested a meditational model to determine whether the relationship between change in visa status and change in psychological symptoms was mediated by change in living difficulties associated with the visa categories. The conversion of visa status from TPV to PR status was associated with significant improvements in PTSD and depression symptoms, and increases in mental health-related quality of life (MHR-QOL). The relationship between change in visa status and reduced PTSD and depression symptoms was mediated by reductions in living difficulties. In contrast, the relationship between change in visa status and increased MHR-QOL was not mediated by changes in living difficulties. These results suggest that restriction of rights and access to services related to visa status negatively affect the mental health of refugees. Implications for government policies regarding refugees are discussed. © 2010 Published by Elsevier Ireland Ltd. 1. Introduction There has been a recent trend internationally to limit the inflow of asylum seekers into developed countries by implementing restrictive immigration policies. Strategies have included mandatory detention of asylum seekers (Silove et al., 2000; McLoughlin, 2006) and the issuing of temporary protection visas in lieu of offering refugees permanent protection (Steel et al., 2006), policies that have attracted widespread criticism from human rights organisations (Refugee Council of Australia, 2003; Amnesty International Australia, 2007). Although the harmful psychological effects of prolonged detention have been documented (e.g., Keller et al., 2003; Steel et al., 2004; Ichikawa et al., 2006; Robjant et al., 2009; Tucci et al., 2010), less attention has been paid to the impact of temporary protection on the mental health of refugees. Theoretical considerations supported by clinical observations suggest that policies of deterrence may cause ongoing distress by extending the uncertainty and fear generated by experiences of past persecution amongst asylum seekers (Silove et al., 2001). Hence, asylum seekers may be confronted with a “continuum of stress” in which traumatic events experienced in the past merge with ongoing post-migration environmental stressors and fear for the future (Silove et al., 1991; Silove, 2003). Such conditions may hamper psychological recovery from the effects of past psychological trauma by creating a climate of anxiety, fear and uncertainty rather than conditions of safety, support and predictability that would aid recuperation (Silove, 1999; Silove and Steel, 2006). A growing body of research points to the negative effects of policies of deterrence, suggesting that asylum seekers facing protracted periods without definitive decisions being reached regarding their refugee status may suffer from poorer mental health (Laban et al., 2004, 2008; Silove et al., 2007). Silove and colleagues have documented that asylum seekers who successfully obtained refugee status in Australia showed significant reductions in psychiatric morbidity, in contrast to those whose applications were rejected who continued to manifest high symptom levels (Silove et al., 2007). Australia's recent changes in immigration policies allow examina- tion of the impact of temporary protection on the mental health of asylum seekers. As a signatory to the United Nations' Convention Relating to the Status of Refugees (United Nations High Commissioner for Refugees (UNHCR) (1951, 1967)), Australia has an obligation to offer protection to persons who are outside their home country and who face the threat of persecution should they return. Individuals fleeing persecution who arrive in Australia with valid travel docu- ments are eligible to apply for Permanent Residency (PR). If PR is denied on the basis that the individual does not have a “well-founded Psychiatry Research 187 (2011) 267–274 ⁎ Corresponding author. School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia. Tel.: +61 2 93853640; fax: +61 2 93853641. E-mail address: anickerson@psy.unsw.edu.au (A. Nickerson). 0165-1781/$ – see front matter © 2010 Published by Elsevier Ireland Ltd. doi:10.1016/j.psychres.2010.12.015 Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres