Armed conflicts in multiple regions of the world have led to international displacement of millions of people during the past few years. Decades of ongoing war and unrest in Iraq, and several years of war in Syria, have exposed millions of people in these 2 countries to chronic and cumulative stress and trauma. The US has been accepting Iraqi refugees, and the former administration planned to welcome 10,000 Syrian refugees to this country.
In addition to a humanitarian crisis, the refugees are now part of the US political discourse. The highlighting of the political implications of accepting refugees has led to involvement of the American people in the conversation through social media and at the dinner table.
Lost in this discussion are the mental health needs of Syrian and other refugees. This is not surprising as the main focus of resettlement has been on security and their immediate housing, finances, and physical health care needs. Moreover, mental health assessment, which requires greater language and cultural proficiency, is more challenging than conducting a physical examination because of language and cultural differences.
PTSD in refugees
Unfortunately, the extant literature is not very helpful in predicting how many of the new refugees will have PTSD or other mental health problems. Across studies on refugee populations settled in different parts of the world, the prevalence of PTSD has been as low as 2% (surprisingly less than the US general population) and as high as 86%.1 Studies restricted to Middle Eastern refugees have not been more consistent.1-4 Besides sampling and measurement differences among the studies, the range in prevalence could well be due to various factors, including:
• Sources of trauma (eg, torture, resource deprivation, exposure to war)
• Distance from the conflict areas prior to departure from the home country
• Extent and duration of exposure to cumulative trauma and number of traumatic events
• Loss of an immediate family member to trauma
• Separation from the family during resettlement
• Time since exposure to trauma
• Difficulties faced prior to and during resettlement in the new environment
Familiarity with the culture and language of the new environment; perception of being welcomed; financial, housing, and health care resources in the new environment; employment; and level of uncertainty can all affect the ongoing level of stress, which in turn can reduce or increase severity of the PTSD/depression symptoms, below or above the diagnostic threshold.
Trauma among Syrian refugees
As home to one of the largest Arab communities in the US, the State of Michigan has welcomed thousands of refugees from Iraq and Syria. During the past year, our research team at the Wayne State University Department of Psychiatry and Behavioral Neurosciences—in collaboration with a well-respected social service agency, the Arab American Chaldean Council—has been assessing trauma and its impact on Syrian refugees. We interview children and adult refugees during the first few weeks of their arrival in the US. We collect demographic data; screen for PTSD, depression, and anxiety; and collect biological samples to examine genetic vulnerability, the role of inflammation, and cumulative level of physiological stress during the few months prior to arrival in the US.
Data have been collected on nearly 500 refugees. Having been able to recruit more than 90% of the eligible refugees, we believe that our findings will be robustly representative of the refugee population. Our team of interviewers consists of bicultural and bilingual doctors, and their experience in clinical work and the level of cultural trust have contributed to our success with recruitment.
Dr. Javanbakht is Assistant Professor, Director of Stress, Trauma, and Anxiety Research Clinic (STARC), Department of Psychiatry and Behavioral Neuroscience, Wayne State University; and Adjunct Assistant Professor, Department of Psychiatry, University of Michigan in Ann Arbor. Dr. Arfken is Professor, Department of Psychiatry and Behavioral Neurosciences, Wayne State University in Detroit, MI.
The authors report no conflicts of interest concerning the subject matter of this article.
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