Projects
Please click on the tabs below to find out more about each of the projects.
See here for a list of all the people involved in these projects.
Refugee children are at increased risk of developing mental health problems due to war-related traumatic experiences and the often significant challenge of living in humanitarian settings.
However, some refugee children show remarkable psychological resilience despite exposure to war and displacement. Such individual differences in risk and resilience are most likely the result of the complex and dynamic interplay between biological (e.g., genetic, epigenetic, hormonal) and psychosocial (e.g., housing conditions, social support, family relationships) factors over time.
The BIOPATH study aims to advance our understanding of how psychosocial and biological factors influence risk and resilience in a large sample of 1,595 Syrian refugee children (aged 6-19 years) and their primary caregivers living in informal tented settlements in the Beqaa region, Lebanon. Data collection for the longitudinal study was conducted from 2017 until 2019 across two time points. The specific objectives of the BIOPATH study are to:
- Examine biological differences between resilient and vulnerable Syrian refugee children
- Investigate genetic moderation of trauma exposure on psychological and biological outcomes
- Examine associations between environmental factors and DNA methylation (epigenetics)
- Investigate the effects of protective factors on the development of adaptive outcomes in refugee children
- Examine the development of refugee children's psychological resilience over time
Research Partners:
- Queen Mary University of London (PI: Prof Michael Pluess; Dr Fiona McEwen; Prof Vardhman Rakyan)
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC; Co-PI: Prof Elie Karam; Dr John Fayyad)
- Médecins du Monde (MdM; Patricia Moghames)
- University College London (Prof Stephan Beck)
- University of Western Ontario (Prof Stan van Uum; Prof Michael Rieder)
Funding
- The BIOPATH study is funded by a grant from the Eunice Shriver National Institute of Child Health and Human Development (NICHD; R01HD083387)
See here, for a detailed description of the study and measures used.
This is a PhD project based on data from the BIOPATH study, and aims to extend the general resilience literature by exploring novel operationalisations of the concept, and apply these methods to assess resilience and mental health needs in a specific group of Syrian refugee children. There are three main objectives to the project:
- Identify trajectories of risk and resilience in Syrian refugee children.
- Explore the individual, social, and wider environmental factors that predict resilience.
- Investigate how children’s mental health develops within the family environment.
Team and Collaborators
- Queen Mary University of London (Cassandra M. Popham, Dr Fiona McEwen, Prof Michael Pluess)
- All of the BIOPATH research partners (see above)
Funding
- This PhD project is funded by a grant from the Eunice Shriver National Institute of Child Health and Human Development (NICHD; R01HD083387) as well as institutional funding from Queen Mary University of London.
The environment can leave long-term changes to the human body, which in turn can impact function and dysfunction throughout the lifespan.
This includes biological systems which underpin mental health outcomes and psychological resilience. This biological embedding of the environment can be visible in multiple biological systems, including DNA methylation and the endocrine system. DNA methylation ultimately impacts gene expression, while changes to the endocrine system have multi-systemic consequences.
Within the BIOPATH project we aim to understand:
- Whether endocrinological markers and DNA methylation are associated with mental health outcomes
- Whether severe adverse events (e.g., war exposure) can impact long-term endocrinological markers and DNA methylation
- How more immediate and chronic aspects of the environment (e.g., parenting quality, peer bullying) contribute to endocrinological markers and DNA methylation
- Whether endocrinological markers and DNA methylation mediate the impact of the environment on mental health outcomes
Team and Collaborators
- Queen Mary University of London (Dr Demelza Smeeth, Prof Michael Pluess)
- All of the BIOPATH research partners (see above)
Funding
- This project is funded by a grant from the Eunice Shriver National Institute of Child Health and Human Development (NICHD; R01HD083387).
Locally validated instruments are essential to accurately assess mental health in refugee children. The VAST study focused on validating common mental health screening tools in a subsample of the BIOPATH study through clinical interviews conducted by a local clinical psychologist. The aims of the study were to:
- Explore the reliability and validity of screening tools for emotional and behavioural disorders when used with Syrian children in a humanitarian context
- Identify the main challenges in conducting clinical interviews and assigning diagnosis
- Discuss the wider implications of mental health diagnoses in refugee children
Team and Collaborators:
- Queen Mary University of London (PI: Dr Fiona McEwen, Prof Michael Pluess)
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC; Prof Elie Karam)
- Médecins du Monde (MdM; Patricia Moghames)
- American University of Beirut (AUB; Dr Tania Bosqui)
Funding
- The VAST study was funded by TIES/NYU as part of the 3EA | MENAT Measurement Consortium (Subaward: S4323-04).
See here, for a report of the study results.
See here, for copies of the culturally adapted and validated measures.
The CARINGTrauma Study
The CARINGtrauma study aims to advance our understanding of individual differences in the response to war and displacement by investigating and establishing the causal relationships between specific biological, social, and psychological factors and mental health outcomes in Syrian refugee children. The study is based on data from the BIOPATH study and has three objectives:
- Development and testing of statistical procedure to establish causality in the interplay between biological and psychosocial factors on mental health
- Identification of the most relevant social, biological, and psychological causal factors for risk and resilience in mental health
- Investigation of the causal interactions between genetic and environmental factors regarding individual differences in mental health
Team and Collaborators:
- Queen Mary University of London (Dr Claudinei Biazoli and Prof Michael Pluess)
Funding
The CARINGTrauma study is funded by the Horizon 2020 programme of the European Commission (H2020-MSCA-IF 2019; 896021). See here, for more information on the funded project.
Individual Differences in the Biological Embedding of Developmental Origins of Health and Illness in Syrian Refugee Children
This project applies evolutionary-developmental models to explore individual differences in biological embedding of stress among Syrian refugee children.
The overarching goals of the project are to 1) understand individual differences in the developmental origins of health and illness, 2) identify modifiable risk and protective factors that suppress or enhance refugee mental health, and 3) inform individualized interventions to prevent and treat mental illness among Syrian—and other—displaced populations. These aims are achieved with the following Research Objectives:
- Investigate whether childhood adversity and protective factors impact developmental trajectories of Syrian refugee children
- Investigate the relations among developmental trajectories and mental health outcomes, including both adverse and positive outcomes as well as modifiable risk/protective factors that influence those outcomes
- Investigate whether Environmental Sensitivity moderates relations between exposure to adversity and biological embedding of stress via developmental trajectories, as well as relations between developmental timing and mental health outcomes
Team and Collaborators:
- Queen Mary University of London (Dr Candace J. Black and Prof Michael Pluess)
Funding
- This study is funded by the Horizon 2020 programme of the European Commission (H2020-MSCA-IF 2019; 896988). See here, for more information on the funded project.
The following study recruited participants from the BIOPATH cohort study.
Development and Evaluation of Phone-Delivered Psychotherapy for Children in Humanitarian Settings: The t-CETA Study
The study aims to adapt and evaluate the Common Elements Treatment Approach (CETA) for delivery by trained lay counsellors over the phone to Syrian refugee children living in Lebanon.
Empirical studies investigating the mental health of children in humanitarian settings have found that many children in war-affected settings with a need for psychological treatment don’t have access to mental health services.
Humanitarian health organisations working in these settings tend to be confronted with many obstacles, including lack of funding to set up new mental health services, difficulties in recruiting qualified local staff, and restricted access of the refugee population to primary health care centres.
These challenges are difficult to address with conventional mental health services, which tend to be provided by mental health specialists in centralised primary health care centres.
To overcome these hurdles, this study aims to adapt and evaluate the existing transdiagnostic psychological treatment programme called Common Elements Treatment Approach (CETA) for the delivery by trained lay counsellors over phone. The study has been funded by a grant awarded by Elrha.
The project has two objectives:
- Development of telephone-delivered CETA (t-CETA) by adapting the existing face-to-face CETA intervention
- Evaluation of the feasibility of t-CETA with a small mixed-methods pilot trial
If found to be effective, telephone-delivered CETA (t-CETA) will facilitate the provision of psychological intervention for children in humanitarian emergency and other low-resource settings with limited access to mental health services.
For a short summary of preliminary study results, see here t-CETA Preliminary study results [PDF 627KB]
Team and Collaborators:
- Queen Mary University of London (PI: Prof Michael Pluess; Dr Fiona McEwen)
- Médecins du Monde (MdM; Nicolas Chehade, Patricia Moghames)
- Johns Hopkins University (Dr Laura Murray, Stephanie Skavenski, Dr Paul Bolton)
- Medical School Hamburg (Prof Roland Weierstall)
- American University of Beirut (Dr Tania Bosqui)
Funding
- The t-CETA research project is funded by Elrha’s Research for Health in Humanitarian Crises (R2HC) Programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. R2HC is funded by the UK Foreign, Commonwealth and Development Office (FCDO), Wellcome, and the UK National Institute for Health Research (NIHR). Visit Elrha’s website for more information about their work to improve humanitarian outcomes through research, innovation, and partnership.
The COVID-19 pandemic has led to the immediate necessity for many practitioners to deliver psychological treatment through phone or other remote technologies.
Here we provide a guidance document that sets out basic principles for the delivery of psychological therapy to children via telephone, drawing on our recent experience of adapting an existing treatment programme to phone-delivery among Syrian refugee children in Lebanon.
It is aimed at mental health services that are adapting therapies to phone-delivery and is especially relevant for those working in refugee or other low resource settings. Although we propose several specific solutions, each service must adapt these further to create protocols that are appropriate to their specific setting, population, and type of therapy.
Key points covered include:
- Developing safety protocols for managing risk over the phone
- Adapting therapy to maintain child engagement and using alternatives to workbooks or written materials
- Tips to manage specific practical and treatment-related challenges that can arise during therapy
This guidance document was developed by Prof Michael Pluess and Dr Fiona McEwen (Queen Mary University of London), Dr Tania Bosqui (American University of Beirut), Nicolas Chehade (Médecins du Monde), and Dr Laura Murray and Stephanie Skavenski (Johns Hopkins University).
QMUL_Guidance for Delivering Psychological Treatment to Children [PDF 1,544KB]