Altered secretion of cortisol, the primary effector of the hypothalamus–pituitary–adrenal axis, has been proposed as a means by which traumatic experiences compromise later mental health.

Children’s responses to war and displacement are varied; many struggle, while others appear resilient. However, research into these outcomes disproportionately focuses on crosssectional data in high-income countries.

The BIOPATH cohort was established to explore the interplay of psychosocial and biological factors in the development of resilience and mental health problems in Syrian refugee children.

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There is substantial variation in people’s responses to adversity, with a considerable proportion of individuals displaying psychological resilience. Epigenetic mechanisms are hypothesised to be one molecular pathway of how adverse and traumatic events can become biologically embedded and contribute to individual differences in resilience.

More than 5.4 million Syrian refugees are registered in countries surrounding Syria, including an estimated 1.5m in Lebanon. Psychological and social distress among refugees is common, resulting in a wide range of emotional, cognitive, physical and behavioural problems.