The long-term impact of COVID-19 on mental health and the moderation effect of sex and loneliness amongst resettled refugees: findings from BNLA cohort study

Background: Vulnerability to mental health problems is well-established in refugees, attributed to the interplay between pre-and post-migration stressors. COVID-19 pandemic was recognized as a universal stressor with potential to further impact refugees’ mental health. This longitudinal study sought to investigate the mental health impact of COVID-19 and its moderators in resettled refugees in Australia. Methods: Data from Waves 1 (2013–2014, pre-pandemic), 5 (2017–2018, pre-pandemic) and 6 (2023, post-pandemic) of the Building a New Life in Australia were utilized in this study. High risk of severe mental illness (HR-SMI) and post-traumatic stress disorder (PTSD) were measured by K6 and PTSD-8 scales. Using generalized linear mixed model, we examined the mental health impacts of COVID-19 pandemic and moderation effect of sex and loneliness. The difference in changes in predicted probability of HR-SMI and PTSD across Waves 1 to 5 and Waves 5 to 6 between moderator-based subgroups were calculated. Findings: A total of 2399 resettled refugees participated. The weighted prevalence of HR-SMI (Δ6-5 5.0%) or PTSD (Δ6-5 3.2%) was increased after the pandemic, different from the trend from Waves 1 to 5 (HR-SMI stable trend; PTSD decreased trend). Compared to Wave 5, Wave 6 had a significant effect on HR-SMI (AOR 1.54 [95% CI 1.17–2.04]), especially among females (2.04 [95% CI 1.16–3.56]); causing an additional 8.82% change in predicted probability than males. A significant effect of Wave 6 on PTSD was only found in respondents with loneliness (2.17 [95% CI 1.17–4.05]), causing an additional 14.92% change in predicted probability than those without loneliness. Interpretation: Rates of mental illness increased among resettled refugees in Australia from prepandemic to four years post-COVID-19 and were moderated by loneliness and being female. This highlights the need for ongoing, targeted psycho-social support for specific refugee sub-groups. Funding: Guangdong Basic and Applied Basic Research Foundation ( 2022B1515020094).