High Rates of Anxiety in Syrian Kids, Moms Resettled in US

Alicia Ault

May 22, 2017

SAN DIEGO, California – Female Syrian refugees and their children who have been resettled in the United States appear to be disproportionately affected by anxiety and post-traumatic stress disorder (PTSD) compared to fathers, preliminary research suggests. However, it is possible such symptoms are underreported in men.

Results from a large study of Syrian refugee children showed that 61% of children had probable anxiety and that 84.7% had probable separation anxiety. The investigators also found that 60% of Syrian mothers had probable PTSD, compared to one third of the fathers. In addition, 90% of adults with PTSD had depression.

It is likely that the prevalence of anxiety and depression is higher, said study investigator Arash Javanbakht, MD, director of the Stress, Trauma, and Anxiety Research and Clinical Program at Wayne State University School of Medicine, Detroit, Michigan, noting that many of the refugees did not disclose symptoms directly — likely out of fear of jeopardizing their chances of staying in the United States.

The study was presented here at the American Psychiatric Association (APA) 2017 Annual Meeting.

A First Look

The Syrian civil war has exposed millions of civilians to extreme physical and emotional trauma. However, the investigators note, little is known about the effect the war has had on the mental health of refugee children.

To examine this issue, investigators studied 59 children aged 6 years to 17 years from 20 Syrian families that included adults up to age 80. The participants were recruited from primary care clinics in southeastern Michigan, where refugees receive health assessments within the first month of arriving in the United States.

After a mandatory physical examination, the refugees were approached to participate in the study by an Arabic-speaking team of physicians who were themselves refugees from Iraq, said Dr Javanbakht. Being culturally competent likely helped the team recruit 95% of the eligible refugees, he said.

The adults were screened using the PTSD Checklist (PCL), and children were evaluated with the Screen for Child Anxiety Disorder (SCARED).

A higher total anxiety score in children was associated with a PCL score in mothers (P = .05) but not in fathers.

Although the Arabic-speaking physicians were able to understand the language, the culture, and to some degree the mindset of refugees, many questions remain about the impact of trauma on the brain and how to design interventions, said Dr Javanbakht.

The data on the children offer a preliminary perspective on a larger study of 500 Syrian adults and children who were resettled in the Detroit area. The Wayne State researchers are compiling the data on the full cohort and plan to publish a report, study investigator Cynthia Arfken, PhD, professor of psychiatry at Wayne State University, told Medscape Medical News.

The Wayne State researchers collected hair and saliva samples from the refugees, which will help inform the next phase of the study. Cortisol accumulates in hair and can provide a kind of chronologic measure of stress reactions, said Dr Javanbakht.

Saliva will allow the researchers to assess inflammation — PTSD is thought to activate the inflammatory process. The goal is to determine the physiologic and biological vulnerability to PTSD in this Middle Eastern population.

The use of biomarkers could also delineate factors that confer resiliency and help in the development of treatments. The fact that not all the Syrians who were studied had anxiety or PTSD "does show that some of the refugees are resilient, and we want to find out more — how they are resilient," said Dr Arfken.

Higher Risk for Anxiety?

Commenting on the findings, Dr Ranna Parekh, MD, MPH, director of the Division of Diversity and Health Equity at the APA, said the findings were not surprising. All refugees are susceptible to anxiety, depression, and PTSD, said Dr Parekh, who moderated a press briefing on the study.

Dr Ranna Parekh

But for the Syrians, "there's something specific about their history and their migration history that makes them more devastatingly at risk for anxiety," Dr Parekh told Medscape Medical News. "An added risk is lack of empathy for this group," she said.

Dr Parekh said the biomarker aspect of the study is important. "What does the biological vulnerability in this group look like?" is a key question, she said. Even if the refugees do not have any markers indicating a predisposition to PTSD, it is possible the genetics of the population could be shifting, given "this chronic, constant sense of hopelessness or not knowing where you will be tomorrow," said Dr Parekh.

This research, she added, has implications for many populations, including other refugee groups, people living in poverty in the United States, and veterans.

Dr Arfken, Dr Javanbakht, and Dr Parekh have disclosed no relevant financial relationships.

American Psychiatric Association (APA) 2017 Annual Meeting. Abstract 52, presented May 20, 2017.

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