International Journal of Epidemiology
Volume 43 Issue 1 February 2014
http://ije.oxfordjournals.org/content/current

Frequent relocations between asylum-seeker centres are associated with mental distress in asylum-seeking children: a longitudinal medical record study
Simone Goosen1,2,*, Karien Stronks1 and Anton E Kunst1
Author Affiliations
1Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands and 2Netherlands Association for Community Health Services, Utrecht, The Netherlands
↵*Corresponding author. Netherlands Association for Community Health Services, P.O. Box 85300, 3508 AH Utrecht, The Netherlands. E-mail: sgoosen@ggd.nl
Accepted October 14, 2013.
http://ije.oxfordjournals.org/content/43/1/94.abstract

Abstract
Background
There are concerns about negative effects of relocations between asylum-seeker centres on the mental health of asylum-seeking children. However, empirical evidence comes from cross-sectional studies only. In this longitudinal medical record study, we aimed to assess: (i) whether relocations during the asylum process are associated with the incidence of newly recorded mental distress in asylum-seeking children; and (ii) whether this association is stronger among vulnerable children.

Methods
Data were extracted from the electronic medical records database of the Community Health Services for Asylum Seekers in The Netherlands (study period: 1 January 2000–31 December 2008). Included were 8047 children aged 4 to 17 years. Case attribution was done using International Classification of Primary Care codes for mental, behavioural or psychosocial problems. The association between annual relocation rate and incidence of mental distress was measured using relative risks (RR) estimated with multivariate Cox regression models.

Results
A high annual relocation rate (>1 relocation/year) was associated with increased incidence of mental distress [RR = 2.70; 95% confidence interval (CI) 2.30–3.17]. The relative risk associated with a high annual relocation rate was larger in children who had experienced violence (RR = 3.87; 95% CI 2.79–5.37) and in children whose mothers had been diagnosed with post-traumatic stress disorder or depression (RR = 3.40; 95% CI 2.50–4.63).

Conclusions
The risk of mental distress was greater in asylum-seeking children who had undergone a high annual relocation rate. This risk increase was stronger in vulnerable children. These findings contribute to the appeal for policies that minimize the relocation of asylum seekers.

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Commentary: Reducing further harm to asylum-seeking children. The global human rights context
Karen Zwi1, and Sarah Mares2
Author Affiliations
1Sydney Children’s Hospital Network, Sydney Children’s Community Health Centre, Randwick, Australia and 2Consultant Infant Child and Family Psychiatrist in Private Practice, Sydney, Australia
Accepted December 5, 2013.
http://ije.oxfordjournals.org/content/43/1/104.extract

Extract
Increasing numbers of adults and children are seeking asylum across the globe. Many Western nations, unlike The Netherlands, have responded to asylum seekers with incarceration and other harsh immigration practices, and there is mounting evidence of the psychological harm associated with detention of already vulnerable children and the adults who care for them.1

Australia (the country of residence of the authors) presents a good example of an increase in the ‘policies of deterrence’,2 with diversion of processing responsibility to poorer neighbouring countries, involuntary relocation between detention centres, reduced rights to family reunification and reintroduction of temporary protection visas, which reduce the length of protection offered and provide no long-term certainty. The shifting of responsibility offshore means involuntary relocations and substandard conditions for detainees (including children and unaccompanied minors), despite well-documented evidence of harm. Political leadership on the issue has led the voting public to view racism and xenophobia as acceptable and in the national interest, exemplified by the recent nomenclature change in Australia of asylum seekers to ‘illegals’, in addition to the long-held policies of mandatory detention (often indefinite) for all asylum seekers arriving by boat, including unaccompanied minors and children.