The Association Between Trauma Centrality and Posttraumatic Stress Among Syrian Refugees: The Impact of Cognitive Distortions and Trauma-Coping Self-Efficacy

Abstract

While research suggests that the war in Syria has led to a drastic re-evaluation of oneself and elevated psychiatric symptoms among Syrian refugees, little is known whether these psychological reactions might be influenced by maladaptive beliefs about oneself and the world and their ability to cope with the effect of the trauma. This study aimed to provide further evidence on the association between trauma centrality, posttraumatic stress, and psychiatric comorbidity, and examine whether cognitive distortions and trauma-coping self-efficacy would mediate the impact of trauma centrality on distress among Syrian refugees residing in Sweden. Four-hundred seventy-five Syrian refugees completed a demographic page, the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale, Cognitive Distortion Scales, and trauma-coping self-efficacy. Results showed that trauma centrality was significantly correlated with posttraumatic stress disorder (PTSD) and psychiatric comorbidity after adjusting the effects of trauma exposure characteristics. Cognitive distortions mediated the impact of trauma centrality on the two distress outcomes; trauma-coping self-efficacy did not but was negatively correlated with outcomes. To conclude, the war in Syria changed self-perception, outlook on life, and identity among Syrian refugees. These changes were related to increased psychological symptoms especially for those who had distorted beliefs about themselves and the world. Refugees’ belief in the lack of ability to cope with the effect of the trauma impacted psychological distress independently of changes in self-perception.

Mental health outcomes in Syrian refugees: A systematic review

“…Forty-two studies assessed PTSD and trauma-related disorders (Acarturk et al, 2018, 2021; Alpak et al, 2015; Al-Smadi et al, 2016; Aoun et al, 2019; Basheti et al, 2019; Böge et al, 2020; Borho et al, 2020; Cengiz et al, 2018; Cheung Chung et al, 2018; Chung & Shakra, 2022; Chung et al, 2017, 2021; Chung, AlQarni et al, 2018; Chung, Shakra et al, 2018; Demir et al, 2020; Ersahin, 2022; Fuhr et al, 2019; Georgiadou et al, 2018, 2020; Gottvall et al, 2019; Hendaus et al, 2021; Ibrahim & Hassan, 2017; Javanbakht et al, 2019; Jefee-Bahloul et al, 2014; Kazour et al, 2017; Mahmood et al, 2019; Marwa, 2016; McGrath et al, 2020; M’zah et al, 2019; Oda et al, 2021; Powell et al, 2020; Rizkalla & Segal, 2018, 2019; Röhr et al, 2020; Sagaltici et al, 2020; Sengoelge et al, 2019; Sim et al, 2018, 2019; Tekeli-Yesil et al, 2018; Tinghög et al, 2017; Uygun, 2021). The most preferred instrument to evaluate PTSD was the Harvard Trauma Questionnaire (HTQ).…”

“…Only one study in this review assessed psychosis, and it reported a positive screening of 7.6% for psychotic disorders using the Mini International Neuropsychiatric Interview (MINI) instrument (Rizkalla & Segal, 2018). Other mental disorders or psychiatric symptoms investigated were psychological distress (Basheti et al, 2015; Borho et al, 2020; Bridekirk & Hynie, 2021; Hendaus et al, 2021; Khamis, 2022; M’zah et al, 2019; Oda et al, 2021; Saab et al, 2020; Schlechter et al, 2021; Sim et al, 2018, 2019), somatization problems (Braun-Lewensohn et al, 2019; Cheung Chung et al, 2018; Chung & Shakra, 2022; Chung et al, 2017, 2021; Chung, AlQarni et al, 2018; Chung, Shakra et al, 2018; McGrath et al, 2020), substance use disorders (Kazour et al, 2017; Oda et al, 2021), and eating disorder (Aoun et al, 2019).…”

“…Forty-two studies focused on major depressive disorder or depressive symptoms (Acarturk et al, 2018, 2021; Ahmad et al, 2021; Böge et al, 2020; Borho et al, 2020; Braun-Lewensohn et al, 2019; Cheung Chung et al, 2018; Chung & Shakra, 2022; Chung et al, 2017, 2021; Chung, AlQarni et al, 2018; Chung, Shakra et al, 2018; Demir et al, 2020; Euteneuer & Schäfer, 2018; Fuhr et al, 2019; Gammouh et al, 2015; Georgiadou et al, 2018, 2020; Javanbakht et al, 2019; Mahmood et al, 2019; Marwa, 2016; McGrath et al, 2020; Mohammad et al, 2018; M’zah et al, 2019; Naal et al, 2021; Naja et al, 2016; Oda et al, 2021; Okenwa-Emegwa et al, 2019; Poole et al, 2018; Rizkalla & Segal, 2018, 2019; Röhr et al, 2020; Schlechter et al, 2021; Sengoelge et al, 2019; Sevinc et al, 2021; Sim et al, 2018; Stevenson et al, 2019; Tekeli-Yesil et al, 2018; Tinghög et al, 2017; Uygun, 2021; Woltin et al, 2018; Yalim, 2021). The most used instrument was the Hopkins Symptom Checklist 25-items (HSCL-25), and the prevalence of positive screening results ranged from 34.7% to 59.4%.…”

“…Other mental disorders or psychiatric symptoms investigated were psychological distress (Basheti et al, 2015;Borho et al, 2020;Hendaus et al, 2021;Khamis, 2022;M'zah et al, 2019;Oda et al, 2021;Saab et al, 2020;Schlechter et al, 2021;Sim et al, 2018Sim et al, , 2019, somatization problems (Braun-Lewensohn et al, 2019;Cheung Chung et al, 2018;Chung & Shakra, 2022;Chung et al, 2017Chung et al, , 2021McGrath et al, 2020), substance use disorders (Kazour et al, 2017;Oda et al, 2021), and eating disorder (Aoun et al, 2019).…”

The Persian version of the centrality of event scale (CES): Assessment of validity and reliability among Iranian university students

“…Event centrality has been evidenced as one of the significant correlates of post‐traumatic stress symptoms (PTSS) in populations with different traumatic events, including survivors of childhood maltreatment (Watts et al., 2021), individuals diagnosed with PTSD (Uzer et al., 2020), survivors of natural disasters (Mordeno et al., 2018), refugees (Chung & Shakra, 2020), and bereaved undergraduates (Bellet et al., 2018). Research has shown that event centrality positively correlates with PTSD symptoms, even when controlling for event severity, depression, anxiety, dissociation, self‐consciousness, and personality traits (Berntse & Rubin, 2007; Ogle et al., 2013; Vermeulen et al., 2020).…”