Prevalence of sleep disturbance and its relationships with mental health and psychosocial issues in refugees and asylum seekers attending psychological services in Australia

Background: Worldwide, 68.5 million individuals are refugees, asylum seekers, or internally displaced. Although many studies have examined mental health concerns in this population, few studies have assessed sleep or examined the relationship between sleep and mental health or psychosocial functioning. Objectives: The objectives were to (1) examine the prevalence of sleep disturbance within refugees and asylum seekers from diverse backgrounds, (2) examine mental health and psychosocial factors associated with sleep disturbance, and (3) explore whether symptoms cluster together in unique subsets of individuals. Methods: Clinician-administered interview data (N = 2703) were obtained from a large mental health service in greater Melbourne, Australia. Data included patient demographics, sleep disturbance, mental health (anxiety, depression, traumatic stress symptoms), and psychosocial concerns (family dysfunctions, interpersonal difficulties, social isolation). Results: A total of 75.5% of the sample reported moderate or severe sleep disturbance. Severity of sleep disturbance was positively correlated with severity of mental health symptoms, psychosocial concerns, age, and migration status. This was true in both refugee and asylum seeker populations and in both adults and children. Cluster analyses revealed 3 subsets of individuals: those with “severe sleep and anxiety symptoms,” “mild to moderate symptoms,” and “mild symptoms.” Using “mild symptoms” as the comparator, being a refugee and increasing age were associated with a 1.57- and 1.02-fold increase, respectively, in the likelihood of classification as “severe sleep and anxiety problems” and 1.70- and 1.02-fold increase, respectively, in the likelihood of classification as “mild to moderate symptoms.” Conclusion: These findings suggest that systematic screening of sleep disturbance among refugees and asylum seekers during health-related visits is needed.