Environmental Sensitivity and Mental Health in Syrian Refugee Children

Background

The rising child refugee crisis

As a result of escalating armed conflict, the number of forcibly displaced people continues to rise worldwide, over 40% of whom are children and adolescents. Experiences of war and displacement can cause substantial trauma, raising the risk for mental illness which can disrupt development. With the least access to mental healthcare, many refugee children are robbed of opportunities to reach their full potential in adulthood.  

However, not all children are equally affected by forced displacement. Individual differences in environmental sensitivity may explain why some children cope well with trauma, while others are deeply impacted.  

 

What were the aims of this study?

Investigating the different sensitivities of young refugees

The main aim of this study was to look at how inter-individual differences in environmental sensitivity influenced the mental health outcomes of Syrian refugee children. We also explored the measurement of sensitivity at different levels of analysis (psychological, physiological, and genetic) to see how well these measurements overlapped in both their prediction of sensitivity and mental health.

 

How was this study carried out?

A multi-level cross-disciplinary study

We analysed the BIOPATH dataset which comprises mental health (anxiety, depression, post-traumatic stress disorder) and other psychosocial information on 1,591 Syrian refugee children at two time points spaced one year apart. As part of the psychological information, children self-reported their levels of environmental sensitivity using the 12 item Highly Sensitive Child scale. Children also supplied hair and saliva samples, allowing us to explore sensitivity using biological markers (hormone concentrations and polygenic scores), and how these markers associated with mental health outcomes. Statistical linear regression techniques, such as Bayesian univariate and multivariate linear mixed models, were fitted to help understand the relationships between self-reported sensitivity, biological markers, and mental health. Cross-lagged panel models were used to investigate the relationships between sensitivity and mental health across both time points. 

 

What were the key findings?

Sensitive refugee children face more mental health challenges

We discovered that self-reported highly sensitive children scored significantly higher on anxiety, depression, and post-traumatic stress disorder. To ensure that our measure of sensitivity was not biased by existing mental illness, we generated cross-lagged panel models to explore our data across both waves. Self-reported sensitivity at wave 1 was not correlated with mental health outcomes at wave 2, or vice versa, suggesting that children reported their sensitivity and mental health as separate aspects, not allowing one to influence the other.   

Because self-report data are prone to many issues, we aimed to identify a biological marker correlating well with self-report sensitivity that might serve as a more objective indicator. We examined hormone concentrations of hair cortisol, dehydroepiandrosterone (DHEA), and testosterone, as well as many different polygenic scores for personality traits such as neuroticism, extraversion, and general sensitivity to stress and socioemotional influences. However, none of these biological metrics seemed to track well with self-reported environmental sensitivity.   

Similarly, our selection of biological markers did not appear to be good indicators of mental health. One possible exception was the concentration of DHEA, which was significantly associated with anxiety and depression.

 

What are the implications of this research?

Environmental sensitivity is a context-dependent predictor of mental health

Our study provides one of the first examinations of environmental sensitivity and its relation to mental health in refugee children. In addition to self-reported sensitivity, we also simultaneously explored numerous possible biological markers of sensitivity, which has rarely been done within the same cohort of participants, or within individuals of Middle-Eastern ancestry.  

Our findings confirm that, when sensitive children are situated in stressful and traumatic contexts, such as an informal refugee camp, they are significantly more at risk to mental illness than less sensitive children. This suggests that assessing environmental sensitivity (through the 12-item Highly Sensitive Child scale) may provide clinicians and health professionals with a convenient indication of the temperament of young patients, and how easily their mental health is affected by the quality of their surroundings. Although we found limited evidence for a relationship between our selection of biological markers and refugee sensitivity or mental health, there remain other markers and contexts which need to be investigated in future research. 

 

About the study team

Our multidisciplinary research team comprises experts in psychology, physiology, molecular biology, and psychiatry. Together, we collaborate on investigations into the many ways in which children are at risk, and resilient to, challenges and hardships experienced during childhood, with a focus on Syrian refugee children living in Lebanon. The study team included; Andrew May, Demelza Smeeth, Fiona McEwen, Elie Karam, Michael J. Rieder, Abdelbaset A. Elzagallaai, Stan van Uum, Francesca Lionetti and Michael Pluess.