For family members who have missing relatives who may have died on dangerous journeys, not knowing the fate of loved ones can have profound psychological and social consequences, especially if they are displaced themselves.

Forced migrants face innumerable challenges and risks that can include going missing while undertaking dangerous migration journeys in search of safety from war, humanitarian crisis and persecution. Their families and communities carry the psychological burden of not knowing what has happened to their loved ones and can require significant support, both in seeking their missing family and in managing uncertainty and the tension between hope and despair during the search process. This is especially true if they themselves have been forcibly displaced. Yet, there has been very little systematic research into the psychological repercussions of having missing family under such circumstances. We know even less about how these psychological and social impacts may evolve over time, nor about the processes that enable families to cope.

What existing research tells us

Most psychological research has focused on the mental health symptoms associated with having a missing family member. These studies have been conducted with a wide range of participant groups, including both non-refugee and refugee and asylum seeker populations. Collectively, studies observe that people with missing family report elevated rates of posttraumatic stress disorder (PTSD), depression, anxiety or complicated (that is, severe and persistent) grief.[1] [2] [3] Refugees with missing loved ones may also experience physical symptoms, such as poor health or pain, due to the stress this causes.[3] These conditions typically occur following experiences of trauma, such as the unexpected death of a loved one or other traumatic experiences involving threat to life or injury. However, the traumatic loss that occurs when a loved one is missing may have distinct repercussions compared to these other trauma types.[4] For instance, traumatic stress responses typically relate to past events, yet the impact of having a missing family member continues in the present and often over a long timeframe. As such, the psychological response to a missing loved one may reflect chronic trauma – a traumatic event that does not end, which carries sustained psychological and physical symptoms.[4]

The impact of having a missing loved one also appears to go beyond increased risk of mental health disorders and affect broader psychological processes and social functions[5]. One study conducted with forcibly displaced people settled in Australia found that in comparison to the experience of being separated from family whose whereabouts remain known, having a missing loved one was associated with more intense feelings of grief, including yearning for the lost person, emotional pain, a sense of meaninglessness and grief reactions that interfered with daily life.[5] Practice-based insights accumulated by the Red Cross and Red Crescent Movement highlight the enduring impact of missing family on psychological states, including feelings of guilt, and self-blame, difficulties with self-regulation, emotional withdrawal and irritability and cognitive changes, including preoccupying worries about the missing person.[6] Having a missing family member can also affect how an individual relates socially, including within their family and with the wider community [4] [5], as well as their capacity to work, study or care for others.[6]

Ambiguous loss as a useful framework

Ambiguous loss describes experiencing the psychological presence but physical absence of a loved one, and could be a useful framework to consider the psychological impact of having missing family.[7] It reflects the lack of resolution that flows from not knowing the fate of a loved one, which may limit a person’s ability to move through the natural and cultural rituals of bereavement.[7] This can lead to a life lived in limbo and an inability to engage in everyday activities. The psychological impact can therefore be even more severe than that experienced with the death of a family member. For instance, forcibly displaced people from Syria, Iraq, Iran and Afghanistan resettled in Germany and experiencing ambiguous loss because a family member was missing displayed greater symptoms of prolonged grief disorder than refugees whose family member had died.[2] Ambiguous loss has also been described as a form of chronic trauma.[4]

Physical distance or ongoing instability and conflict in countries of origin can make it difficult to search directly for or enquire about missing loved ones. Consequently, families commonly have a low sense of control over their situation, and research has shown that they report feeling helpless and guilty for not being able to do more.[5] While displaced families can use services such as the Red Cross and Red Crescent Restoring Family Links programme to help trace their family members, answers can take years to arrive or might never come. Therefore, families face the challenge of making decisions about their future without knowing the whereabouts or fate of their loved ones.[3]

The impact of ‘double ambiguity’

Refugees and asylum seekers with missing family live with a ‘double ambiguity’, that is the ambiguity associated with having a missing loved one and the uncertainty that arises from forced displacement and resettlement itself. Globally, the high levels of mental health difficulties reported by refugees have been attributed to multiple and cumulative trauma exposure pre-migration, including mass violence, deprivation and human rights violations such as torture; the distress of displacement around the time of migration; and ongoing stress and uncertainty experienced post-migration. The combination of past trauma and ongoing stress can make it challenging for refugees to adjust to life in their new country of residence. These difficulties may be compounded by the experience of having missing family. For example, displaced families may also be vulnerable to economic stressors if the missing family member provided income for the family.[5] Ambiguous loss also affects the family unit, increasing family stress and anxiety. Members may shift to different roles in the family due to the absence of loved ones (for example, work to provide an income, or become the caregiver and emotional support person), which may add to the pressures of navigating settlement in a host country.[4] [5]

The vast majority of displaced people live with temporary status, lacking access to permanent settlement pathways and facing uncertainty about their future. Visa insecurity on its own is associated with increased levels of PTSD, depression and suicidality. However, the effects of insecure residency may be compounded by ongoing fears for the safety of missing loved ones.[5] Temporary visa status is also commonly associated with restricted access to formal family reunification migration pathways. If missing family members are found, resettled refugees with temporary status may be unable to access sponsorship programmes or even travel across borders to visit them. Even for refugees with permanent and secure visas in high-income countries such as Australia or in Europe, applying for family reunification is a long, expensive and convoluted process. For forcibly displaced people who do regain contact with their missing family, the joy and relief can be tempered by new pressure to provide significant emotional and financial support to loved ones.[5]

Resilience and coping mechanisms

Families of the missing may be coping with significant daily stress and pressure, yet few studies have examined their resilience or the coping mechanisms they use. One study conducted with forcibly displaced people now living in Australia who had missing family or were separated from their family found that engaging in activities such as work or household jobs helped to distract them from worrying about their absent family member.[5] Study participants reported that social engagement, religious practices, and other forms of emotion-focused coping (for example, acceptance of the situation) were useful strategies. Formal support services provided by government, non-government, community or health services also helped with practical problems. However, there were often barriers to accessing these services, such as low English proficiency, social isolation and temporary visa status – another effect of ‘double ambiguity’. Taking action to find missing family members by connecting with agencies that provide family tracing services and using informal, personal channels was reported as a coping strategy as it helped people gain some agency over their situation.[5]

Despite this evidence of resilience, psychological and neuroscience research has shown that the psychological impact of ongoing absence may limit people’s ability to use these strategies. For example, humans naturally develop an attachment system based on caregiver relationships during infancy, which manages threat and stress responses throughout life. This attachment system may be compromised for refugees separated from missing loved ones who are often important attachment figures in their lives – such as parents, spouses and siblings. A brain imaging study involving displaced refugees and asylum seekers living in Australia provides evidence for this.[8] In the study, participants viewed pictures of attachment (for example, a mother with a child) to activate the attachment system before viewing threat-related (for example, a conflict scene) and neutral (for example, a street corner) pictures, while undergoing functional magnetic resonance imaging (fMRI) brain scanning. The study found that for participants with PTSD, their attachment system was less effective in managing strong emotional reactions to both threat and neutral pictures, depending on how much grief they reported in relation to their separated family. This was demonstrated in the brain by a pattern of heightened activity in the amygdala (the core region for facilitating fear and emotion responses) and less activity in the medial prefrontal cortex (which controls behaviour and thoughts and regulates emotions). This study provides preliminary neurobiological evidence that separation grief interferes with intrinsic attachment-related stress coping systems for refugees and asylum seekers. How the attachment system specifically affects forcibly displaced people with missing family is unknown, but it is likely to involve the compounding effect of ambiguous loss.

An evidence base for better support

Despite this evidence on the impact of missing family, gaps in our knowledge remain and further research is needed to improve our understanding of how to help people cope.

A new research programme, the Project Researching the Impact of Separated and Missing (PRISM) Family, is being undertaken to shed light on these issues.[9] PRISM Family is a joint project between the University of New South Wales (UNSW) Sydney, the University of Newcastle, the Australian Red Cross Restoring Family Links programme and the International Committee of the Red Cross’s Central Tracing Agency. PRISM Family is connecting with members of the Australian community who have been forcibly displaced to understand how having missing and separated family affects individuals and families. The study aims to account for how the capabilities and needs of forcibly displaced people with missing family change over time, particularly if families are reconnected, reunited or information regarding the fate of a missing family member comes to light.

Building an evidence base through PRISM Family will provide critical information to develop and direct services that support forcibly displaced people to navigate the painful complexity of having missing family, particularly if they live with double ambiguity. This knowledge will drive advocacy efforts for policies that uphold the protection, health and wellbeing of forcibly displaced people, including optimising reunification pathways if families of the missing are reconnected with their loved ones.

 

Belinda Liddell
Professor and Daphne Keats Chair in Cross-Cultural Psychology
School of Psychological Science, University of Newcastle, and School of Psychology, University of New South Wales (UNSW) Sydney
Belinda.Liddell@newcastle.edu.au

Kimberly Archer
Research Assistant
School of Psychological Science, University of Newcastle, and School of Psychology, UNSW Sydney
K.Archer@unsw.edu.au

Nicole Batch
Head of Migration Development
Australian Red Cross
nbatch@redcross.org.au

Jill Stockwell
Lead of Structural Support & Research, Red Cross and Red Crescent Missing Persons Centre
International Committee of the Red Cross
jstockwell@icrc.org

The authors would like to thank the following contributors to the PRISM Family study: Angela Nickerson, Richard Bryant, Katherine Wright, Melissa Freire, Bhava Poudral, Yulisha Byrow, Natalie Grove, Joanne Golding, Joshua Wong, Stephanie Murphy, Mandy Kamel, Nizar Dakroub, Cassandra Steeth, Isabelle Shaw, Sarah Daniels, Roula Sleiman, Deeman Hameed, Atifa Mohseni and Sibbo Sengabo.

 

[1] Lenferink L I M, de Keijser J, Wessel I, de Vries D, and Boelen P A (2019) ‘Toward a Better Understanding of Psychological Symptoms in People Confronted With the Disappearance of a Loved One: A Systematic Review’, Trauma Violence Abuse, Vol 20 (3): 287-302

[2] Comtesse H, Lechner-Meichsner F, Haneveld J, Vogel A, and Rosner R (2022) ‘Prolonged grief in refugees living in Germany confronted with ambiguous or confirmed loss’, Anxiety Stress Coping, Vol 35 (3): 259-269

[3] Renner A, et al (2021) ‘Traumatized Syrian Refugees with Ambiguous Loss: Predictors of Mental Distress’. International Journal of Environmental Research and Public Health, Vol 18 (8)

[4] Holmes L (2016) ‘Missing Someone: Exploring the Experiences of Family Members’ in Morewitz S J and Sturdy Colls, C  (Eds) Handbook of Missing Persons (pp 105-126), Springer International Publishing AG

[5] Liddell B J, et al (2022) ‘Understanding the effects of being separated from family on refugees in Australia: a qualitative study’, Australian and New Zealand Journal of Public Health, Vol 46 (5): 647-653

[6] British Red Cross, International Committee of the Red Cross, Red Cross EU Office, Swedish Red Cross, Swiss Red Cross (2019) Humanitarian Consequences of Family Separation and People Going Missing

[7] Boss P (2002) ‘Ambiguous Loss: Working with Families of the Missing’, Family Process Vol 41: 14-17

[8] Liddell B J, et al (2022) ‘Activating the attachment system modulates neural responses to threat in refugees with PTSD’, Social Cognitive and Affective Neuroscience, Vol 16 (2): 1244-1255

[9] www.rtrp-research.com/prism-language-selection

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