Background: Significant sex differences in mental health have been observed among resettled refugees, yet how these disparities and their determinants evolve over time remains unclear. This study sought to unravel determinants and changes in mental health disparities by sex in a quantitative way.
Methods: Data were drawn from Waves 1 [2013–2014], 5 [2017–2018], and 6 [2023] of the 10-year Building a New Life in Australia (BNLA) cohort. Post-traumatic stress disorder (PTSD) and high-risk of severe mental illness (HR-SMI) were measured using the PTSD-8 and Kessler-6 scales. Fairlie decomposition was used to quantify the disparity (total predicted probability difference) and the contribution proportion of individual determinants (explained difference/total predicted probability difference × 100%).
Results: A total of 2,261 refugees were included at Wave 1, with 1,833 (81.1%) and 905 (40.0%) followed up at Waves 5 and 6. Female refugees consistently experienced poor mental health, with a total predicted probability difference decreasing from the initial (Wave 1, 8.33%) to middle stage (Wave 5, 4.61%), then increasing in the long term (Wave 6, 6.31%). Determinants varied across waves, but poor status of physical health-related factors was a persistent contributor (e.g., total contribution of predicted probability difference: PTSD 57.42%, 70.95%, 60.05%). Family conflict contributed at the initial (contribution proportion: HR-SMI 4.53%) and long-term stages (PTSD 8.68%), while financial hardship (PTSD 13.41%; HR-SMI 24.07%), marital status (HR-SMI 25.82%), and family concerns (PTSD 8.39%) were key at the middle stage. Unmet support or help during coronavirus disease 2019 (COVID-19) was a major contributor at Wave 6 (PTSD 23.93%; HR-SMI 8.39%).
Conclusions: Sex disparities in refugee mental health require sustained attention and tailored, stage-specific strategies. Providing necessary physical health care and addressing family conflict (initial/long-term stage), financial hardship (middle stage), and female- specific needs during crises like COVID-19 is essential for promoting mental health equity.
