Postmigration stress and sleep disturbances mediate the relationship between trauma exposure and posttraumatic stress symptoms among Syrian and Iraqi refugees

Abstract

Study Objectives: Sleep disturbance is common in those who experience trauma. In a sample of nontreatment-seeking refugees, we examined the associations between trauma exposure, postmigration stress, sleep symptoms, and posttraumatic psychological symptoms. Methods: Syrian and Iraqi refugees (n = 86; 51% female; mean age = 45 years) residing in Australia were recruited from the local community. Cross-sectional descriptive design, multinominal regression analyses, and mediation analyses were used. Participants completed measures in Arabic assessing premigration trauma exposure, postmigration stress, sleep symptoms, and mental health. They also completed 7 days of sleep diaries and actigraphy. Results: We identified 34.9% of the participants as normal sleepers, 32.6% as probably having insomnia, and 32.6% as likely having insomnia. Variables associated with greater sleep disturbance (McFadden's R 2 = 0.57) included greater trauma exposure, increased time of resettlement, greater postmigration stress, and greater presleep arousal. The association of premigration trauma exposure to current posttraumatic symptoms was mediated sequentially by postmigration stress and sleep symptoms. Conclusions: Our findings highlight the extent of sleep disturbance in refugees. We found evidence for an indirect pathway between trauma exposure and posttraumatic symptoms through premigration stress and sleep (particularly presleep arousal). In the current global refugee crisis, improving the existing system of care in countries experiencing increased migration is critical. Because sleep disturbance is a modifiable condition associated with mental health, targeting sleep could be an important component of psychological interventions for refugees.

Longitudinal investigation of the relationships between trauma exposure, post-migration stress, sleep disturbance, and mental health in Syrian refugees

“…This current study aimed to examine theoretical models that account for the relationships between trauma exposure, post-migration stress, sleep symptoms, and mental health problems. These current longitudinal findings support our baseline findings (Lies et al, 2020); post-migration stress and sleep symptoms (insomnia, pre-sleep arousal) sequentially mediated the relationship between trauma exposure and mental health (PTSD, anxiety/depression symptoms).…”

“…Third, only presleep arousal at Time 1 was a unique significant predictor of PTSD, anxiety/depression symptoms at Time 2. Finally, current post-migration stress and sleep symptoms (insomnia, pre-sleep arousal) mediated the relationship between trauma exposure and current mental health (PTSD, anxiety/depression) symptoms, replicating findings from the baseline study (Lies et al, 2020).…”

“…Recently, we conducted a cross-sectional study investigating a) sleep disturbance amongst newlyarrived Syrian (n = 75) and Iraqi (n = 11) refugees living in Melbourne, Australia, b) psychosocial factors associated with greater sleep disturbance, and c) whether the relationship between trauma exposure and PTSD symptoms was mediated by postmigration stress and sleep symptoms in a sequential manner. We found that 65% of the sample had moderate to high levels of sleep disturbance, and pre-sleep arousal was the only factor predicting sleep disturbance (Lies, Jobson, Mascaro, Whyman, & Drummond, 2020). We also found the association between trauma exposure and PTSD symptoms was mediated by postmigration stress and sleep symptoms in a sequential order.…”

“…Accumulating research demonstrates that mental health and psychosocial problems are significantly associated with levels of sleep disturbance in refugees (Lies et al, 2020;2019). The current study found, however, that over time sleep disturbance may reduce.…”

“…Therefore, the current study examined the associations between post-migration life stress, pre-sleep arousal/sleep disturbance, and PTSD. Examining this relationship is of particular importance given sleep disturbance is common among refugees and associated with PTSD symptoms (Lies, Mellor, Jobson, & Drummond, 2019). Recently, we conducted a cross-sectional study investigating a) sleep disturbance amongst newlyarrived Syrian (n = 75) and Iraqi (n = 11) refugees living in Melbourne, Australia, b) psychosocial factors associated with greater sleep disturbance, and c) whether the relationship between trauma exposure and PTSD symptoms was mediated by postmigration stress and sleep symptoms in a sequential manner.…”