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

Abstract

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.

Progressive worsening of posttraumatic stress symptoms in Syrian and Iraqi refugees associated with cumulative and victimization trauma: A longitudinal study.

“…Most commonly, these include variations upon the following trajectories: resilience (i.e., few to no symptoms following trauma exposure), recovery (i.e., clinically relevant symptoms decreasing over time), chronic (i.e., stable, high levels of symptoms over time), and delayedonset (i.e., subclinical symptoms worsening over time to severe; Armenta et al, 2019;Galatzer-Levy et al, 2018). Distinct symptom trajectories have been documented in relation to posttraumatic stress disorder (PTSD) in particular (Armenta et al, 2019;, though similar patterns have also been observed in depression and anxiety symptoms (Armenta et al, 2019;Bachem et al, 2021;L. M.-E. Hinchey, Nashef, et al, 2023).…”

What happened matters: Trauma type and cumulative trauma exposure in refugee youth psychopathology.

“…Despite the promising implications for improving risk assessment and prediction of symptomatology, these findings may not generalize to refugee youth. Developmentally, the effects of trauma may vary widely between youth and adults (De Bellis & Zisk, 2014): for instance, anxiety may be a more likely outcome for trauma-exposed refugee children than PTSD, which is common in their adult counterparts (Hinchey, Nashef, et al, 2023; Javanbakht et al, 2018). In general populations, the differential impact of trauma exposure on factors such as fear/safety learning, neurobiology, and psychopathology development for adults and youth has also been demonstrated (Grasser & Jovanovic, 2021).…”