Understanding and treating mental ill-health in asylum seekers
Demoralisation is variously conceptualized as a harbinger of Major Depressive Disorder (MDE) (Rickelman, 2002) and as distinct from MDE (Gutkovich, 1999). However, it has long been considered ’emotional and somatic distress’, rather than a clinical disorder (Frank, 1973). Demoralisation has been discussed as a consequence of unremitting, unavoidable stress in a range of adverse situations (Gutkovich, 1999) and is thought to result from an imbalance between personal coping capacity and environmental stress (Murphy, 1986). Frank (1974) believed that anxiety and depression symptoms were expressions of demoralisation and that accurate diagnosis was crucial to ascertain which symptoms were modifiable by psychotherapy, including the modifiability of environmental stressors contributing to demoralisation.
The current study explores whether ‘demoralisation-syndrome’ (Kissane, 2001) is a characteristic of the asylum-seeker population. 131 adult asylum-seekers living in the Melbourne community were recruited; 25% had been granted permanent protection (PR) while the remainder (non-PR) was awaiting the outcome of their applications. It was predicted that rates of demoralisation would increase both as a function of time and number of ‘rejections’ in the Refugee Determination Process. The relationship between demoralisation and other clinical measures (MDE & PTSD) was also explored. Demoralisation was not predicted by time or number of rejections but was predicted by a diagnosis of MDE (F= 25.6, p<.0001) in the PRgroup and a diagnosis of PTSD (F= 12.5 p<.0001) in the non-PR group. These aetiological differences point to the heterogeneity of demoralization and have important implications for its treatment in the asylum seeking population
