Trauma-Related Psychopathology in Iraqi Refugee Youth Resettled in the United States, and Comparison With an Ethnically Similar Refugee Sample: A Cross-Sectional Study

Abstract

BackgroundConflict in Iraq has displaced millions of refugee youth. Warzone exposure and forced migration have unique acute and chronic impacts on youth, yet effects of exposure may not be universal across diverse refugee groups. Understanding how youth from various refugee groups are differentially affected by stress and trauma is critical to allocate resources and implement screening measures with the goal of providing early intervention.MethodTo identify the effects of warzone exposure and forced migration, a convenience sample of 48 Iraqi refugee youth ages 6–17 was assessed within the first month of arrival to the United States. Youth provided self-reported severity of posttraumatic stress and anxiety symptoms; symptom severity was then compared with an existing sample of 135 Syrian refugee youth to explore whether refugee youth of different nationalities experience the same effects of warzone exposure and forced migration. These data are the baseline for a longitudinal developmental study of refugee health, which also includes parental data.ResultsSeverity of separation anxiety and negative alterations in cognition and mood were the greatest symptomatic concerns in Iraqi refugee youth. Thirty-eight percent of responding Iraqi youth showed possible indication of an anxiety disorder. Severity of posttraumatic stress symptoms was lower in Iraqi youth compared to Syrian youth. For both Iraqi and Syrian refugee youth, separation anxiety was the most significant concern, with more than 80% of both samples showing a possible indication of clinically significant separation anxiety.ConclusionThe present observational study indicated that Iraqi refugee youth experience a range of anxiety and posttraumatic stress symptoms following warzone exposure and forced migration; posttraumatic stress symptoms were less severe in Iraqi versus Syrian youth. Comparing refugee youth of different nationalities is of particular importance, as our results demonstrate that findings from one refugee population cannot easily be generalized to another. Clinical and research efforts should prioritize interventions to address separation anxiety in refugee youth, which was of concern in both samples.

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

“…86 youth (36 female, mean age = 12.419, +/− 2.737 SD, range = 7-17) were recruited from an existing cohort of persons resettled as refugees of Syria and Iraq in Southeast Michigan (Grasser et al, 2021 ; Javanbakht et al, 2018 ). Participants were initially recruited as families at the Arab American and Chaldean Council Clinic, where all refugees resettling from Middle Eastern nations, received mandatory health screenings within one month of migration to the U. S. Inclusion criteria were as follows: (1) males and females between the ages of 7and 17, (2) refugee status, originating from Syria or Iraq, and (3) willing and able to give oral assent (ages 7–12) or written assent (ages 13–17) with parent/guardian willing and able to give written informed consent.…”

“…The measure also generates subscales for re-experiencing, avoidance, negative cognitions, and hyperarousal symptoms. The UCLA PTSD RI has been recommended for use with refugee populations, including those with non-Western backgrounds (Miller, Brown, Shramko, & Svetaz, 2019 ), and has been found to be reliable in MENA refugee populations (Grasser et al, 2021 ; Javanbakht et al, 2018 ). Cronbach’s alpha in this sample for the full measure was 0.933.…”

“…Traumatic experiences are common in childhood, 1 in 5 youth experience trauma (Saunders & Adams, 2014 ). However, not everyone exposed to trauma develops PTSD – of the 20% of youth exposed, only about 5% develop PTSD (Merikangas et al, 2010 ) although this rate may be higher in higher-risk populations, including youth who resettle as refugees (rates of PTSD range from 9% to 54%) (Grasser et al, 2021 ; Perreira & Ornelas, 2013 ; Solberg et al, 2020 ). Furthermore, there is heterogeneity in symptom presentation (Galatzer-Levy & Bryant, 2013 ).…”

“…being considered a minority group in a host country, discrimination and bullying, language barriers, and sociocultural transitions. As a result, youth who resettle as refugees experience higher rates of PTSD compared to the general United States population (Grasser et al, 2021 ; Javanbakht, Rosenberg, Haddad, & Arfken, 2018 ). This underscores a need for objective assessment of trauma-related psychopathology and pathophysiology in youth who have resettled as refugees.…”

Addressing Mental Health Concerns in Refugees and Displaced Populations: Is Enough Being Done?

“…There has been a growing number of reports regarding trauma exposure and mental health outcomes in persons who resettle as refugees, with most studies being cross-sectional conducted within refugee camps or at the time of initial resettlement. 50 , 58 , 62 , 63 While screening for stress and trauma-related psychopathology at initial arrival is important, continuing to assess and provide resources for persons who resettle long term is equally important, as persons resettling may actually experience an initial “euphoric” phase upon arriving in a safe place and leaving behind traumatic situations. 78 Also, postmigration stress can contribute to poor mental health; 47 , 79 in some cases, it can even result in non-symptomatic individuals developing significant symptoms years following resettlement, especially when discrimination and family separation are experienced.…”