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Protective factors for social-emotional well-being of refugee children in the first three years of settlement in Australia
  1. Karen Zwi1,
  2. Lisa Woodland2,
  3. Katrina Williams3,
  4. Pamela Palasanthiran1,
  5. Santuri Rungan4,
  6. Adam Jaffe1,
  7. Susan Woolfenden4
  1. 1 University of New South Wales and Sydney Children’s Hospitals Network, Sydney, New South Wales, Australia
  2. 2 South Eastern Sydney Local Health District, Health Services Research and Development, Sydney, New South Wales, Australia
  3. 3 Royal Children’s Hospital, Melbourne, Victoria, Australia
  4. 4 Sydney Children’s Hospitals Network, Sydney, New South Wales, Australia
  1. Correspondence to Dr Karen Zwi, University of New South Wales and Sydney Children’s Hospitals Network, High Street, Randwick, Sydney, NSW 2031, Australia; Karen.zwi{at}


Aim This longitudinal study investigated protective factors for social-emotional well-being in refugee children in Australia.

Methods Newly arrived refugee children aged 4–15 years were recruited between 2009 and 2013 and assessments were conducted at two points, at years 2 and 3 postarrival. Social-emotional well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ). Protective factors were assessed by structured interview and the Social Readjustment Rating Scale (SRRS); scores <150 reflect fewer stressful life events in the previous year.

Results Forty-three eligible refugee children were recruited. The SDQ was completed by parents in 90% and protective factor data in 80% at years 2 and 3 of follow-up. Protective factors for normal SDQ scores were: originating from Africa (p=0.01), father present on arrival (p=0.019) and family SRRS scores <150 at year 2 (p=0.045). The median number of protective factors was 4 (range 1–8). Better SDQ scores were associated with ≥4 protective factors (p<0.006). Furthermore, more protective factors increased the child’s likelihood of a stable or improved SDQ score over time (p<0.04). Modifiable protective factors likely to promote social-emotional well-being include stability in the child’s school and residence, parental employment, financial and marital stability, proximity to one’s own ethnic community and external community support.

Conclusions Cumulative protective factors, some of which are potentially modifiable, can predict social-emotional well-being in newly arrived refugee children. Children with four or more protective factors are at low risk of poor social-emotional well-being.

  • refugee child
  • risk factors
  • protective factors
  • social-emotional wellbeing
  • strengths and difficulties questionnaire (SDQ)
  • longitudinal cohort
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  • Funding This study was funded by Foundation Markets Foundation for Children ($A158 000 July 2009–June 2011) and the South Eastern Sydney Multicultural Health Service ($A80 000 July 2012–June 2013). The funders had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study received ethical approval from the Human Research Ethics Committee Northern Hospitals Network, South Eastern Sydney Illawarra Area Health Service (HREC Ref No 09/163).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data on this study that may not be published are available from the authors upon request.

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