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.
Keywords: COVID-19; PTSD; depression; family separation; intolerance of uncertainty; longitudinal; refugee; trauma; visa insecurity.