The longitudinal impact of war exposure on psychopathology in Syrian and Iraqi refugee youth.

BACKGROUND: War and natural disasters lead to forced migration - and increased risk of adverse psychological outcomes - in approximately 1% of the global population. Though recent years have brought a greater understanding of the consequences of war exposure on mental health outcomes for refugee children, little is known about the longitudinal and developmental impact of these experiences on youth. AIMS: The aim of this study was to assess the effect of direct exposure to war and/or combat on trajectories of symptoms related to anxiety and post-traumatic stress disorder (PTSD) in Syrian and Iraqi refugee youth following resettlement. Prevalence of possible anxiety disorders and PTSD was also assessed. METHOD: Participants included accompanied refugee youth resettled in the state of Michigan in the U.S. (n = 74). Youth filled out self-report measures of trauma exposure, anxiety symptoms, and PTSD symptoms upon arrival and 2 years later. Linear mixed-effects modeling was used to assess the effect of war exposure over time. RESULTS: Upon arrival, 38% screened positive for an anxiety disorder and 4.1% met diagnostic thresholds for PTSD. While war exposure did not predict changes to PTSD symptom trajectories (p = .481), anxiety symptoms increased over time among children reporting war exposure (B = 10.13, SE = 4.22, t = 2.40, p = .019). CONCLUSIONS: Our findings suggest that without appropriate interventions, anxiety- and trauma-related symptoms often do not decrease. Further, exposure to war trauma may lead to progressive worsening of symptoms. These findings suggest that assessing for type of trauma exposure, rather than focusing solely on migration status, may inform focused attention and interventions among trauma-exposed children resettling as refugees.

The fear that remains: Associations between trauma, related psychopathology, and fear-potentiated startle in youth resettled as refugees.

Fear-potentiated startle (FPS) can be used to measure fear and safety learning-behaviors affected by trauma that may map onto posttraumatic stress disorder (PTSD). Therefore, FPS could be a candidate biomarker of trauma-related psychopathology and a potential identifier of trauma-exposed youth in need of focused treatment. We enrolled n = 71 (35 females, Mage  = 12.7 years) Syrian youth exposed to civilian war trauma. Eyeblink electromyogram (EMG) data from a differential conditioning FPS paradigm were obtained 2.5 years after resettlement. Youth provided self-report of trauma exposure (Harvard Trauma Questionnaire) and PTSD symptoms (UCLA PTSD Reaction Index). While FPS during conditioning was not associated with symptoms, associations with psychopathology emerged in fear extinction. Probable PTSD was associated with FPS in the last block of extinction, such that FPS to threat cue was significantly greater in the PTSD+ group compared to the PTSD- group at the end of extinction (F = 6.25, p = .015). As with adults, we observed a deficit in extinction learning but not fear conditioning in youth with PTSD. These results support the use of trauma-informed cognitive behavioral therapy based on the learning principles of extinction in youth with PTSD.

Skin conductance response to trauma interview as a candidate biomarker of trauma and related psychopathology in youth resettled as refugees.

Background: Posttraumatic stress symptoms (PTSS) include a constellation of physical and emotional profiles that youth exposed to trauma may experience. An estimated 20% of youth are exposed to trauma, and in refugee populations, up to 54% experience posttraumatic stress. Given the physical and mental health consequences associated with trauma exposure and subsequent psychopathology, identifying biomarkers of symptom severity is a top research priority.Objective: Previous research in adults found that skin conductance responses to trauma interview predicted current and future PTSS. We extended this method to refugee youth exposed to civilian war trauma and forced migration, to examine associations between PTSS and skin conductance in this uniquely vulnerable child and adolescent population.Methods: 86 refugee youth ages 7-17 years completed a trauma interview and assessment of self-reported PTSS. The mobile eSense app on a iPad was used to obtain continuous recordings of skin conductance level (SCL) during a trauma interview (trauma SCL). Skin conductance response (SCR) was calculated by subtracting the baseline SCL from the maximum amplitude of the trauma SCL.Results: SCL during trauma was significantly greater than baseline SCL, Trauma exposure was significantly associated with SCR to trauma interview, R2 = .084, p = .042. SCR to trauma interview was positively correlated with reexperiencing (R2 = .127, p = .028), and hyperarousal symptoms (R 2 = .123, p = .048).Conclusions: The present study provides evidence for feasibility of SCR to trauma interview as a candidate biomarker of PTSS in youth. This is the first study to look at SCR to trauma interview in youth resettled as refugees and is part of the limited but growing body of research to look at biomarkers in refugee cohorts more broadly. As the number of forcibly displaced persons surges, early detection and prevention of trauma-related psychology is becoming more important than ever. HIGHLIGHTS: Using the mobile eSense app, we demonstrate that skin conductance is measurable in a variety of research settings and that skin conductance response may be a biological indicator of trauma and related psychopathology - namely re-experiencing symptoms - in youth resettled as refugees.

Research With Refugees and Vulnerable Populations in a Post-COVID World: Challenges and Opportunities.

At the Stress, Trauma and Anxiety Research Clinic (STARC) at Wayne State University in Detroit, we are currently amid data collection for a longitudinal prospective study of Syrian refugee children and their parents. Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, our goal is to understand the impact of exposure to war trauma and the stress of migration on symptoms of posttraumatic stress disorder, anxiety, and depression, as well as the neurobiological, epigenetic, and environmental correlates of risk and resilience. Like many research groups around the world, the COVID-19 pandemic brought our work to a screeching halt. Researchers who, like us, were engaged in human subjects research were left grappling with the question of how to continue their work while ensuring the safety of both research staff and participants, and while maintaining scientific integrity. In March 2020, our institution halted all in-person human subjects research that did not have direct benefits to participants, which continued until October, when research activity was resumed subject to implementation of modified procedures. Over the past 2 years, we have pivoted, adapted, and flexed, ultimately making changes that have allowed us to continue successful data collection throughout the pandemic. This article will discuss the specific challenges of working with ethnically minoritized and immigrant populations during the pandemic, the adaptations that we implemented to enable safe and effective data collection, as well as the new knowledge that we can apply to future research protocols.