Understanding factors of risk and resilience in Syrian refugee children

Background

Displacement places refugee children at risk but not all are affected equally

Millions of children worldwide are displaced due to war and conflict, facing a multitude of challenges including exposure to violence, separation from family and limited access to education and healthcare. These early and repeated adversities can disrupt development and increase vulnerability to mental health difficulties. Some demonstrate remarkable psychological resilience despite overwhelming circumstances. Understanding why certain children are more resilient that others is crucial for designing effective mental health interventions.

 

What were the aims of this study?

Exploring whether biological measures can predict resilience in young refugees

This multi-system analysis aimed to assess two biological factors:

1. Long-term stress hormone levels measured through hair cortisol
2. Genetic predispositions for mental illness measured using polygenic scores

Through assessing such factors researchers explored whether they could predict psychological resilience or risk of mental health difficulties in Syrian refugee children.

 

How was this study carried out?

Syrian refugee children and adolescents were assessed for psychological, hormonal and genetic data

The research conducted as part of the BIOPATH study included 1,359 Syrian refugee children and adolescents (aged 6-18 years) living in informal settlements in Lebanon and their caregivers. They participated in structured interviews assessing trauma exposure, living conditions and their current mental health.

Children were categorised as “resilient” if they scored below clinical thresholds for post-traumatic stress disorder (PTSD), depression and externalising behaviours. Those scoring above any threshold were classified as “at risk”. 

Biological data were collected via:

• Hair cortisol concentration (HCC): a non-invasive marker reflecting cumulative stress exposure over ~2 months.
• Polygenic scores (PGS): scores based on common genetic variants linked to mental health conditions such as depression and neuroticism.

Variables such as age, gender and war exposure were controlled for during analysis.

 

What were the key findings?

Elevated stress hormone levels predicted lower resilience while genetic predispositions showed limited predictive value.

The study revealed 3 main findings:

1. Higher levels of hair cortisol were significantly associated with a reduced likelihood of resilience. This relationship held even after controlling for exposure to war-related trauma.
2. Polygenic scores, which represent an individual’s inherited vulnerability to psychiatric conditions, did not show significantly predict resilience. However, one significant finding emerged: children with high genetic predisposition to depression were more likely to show mental health problems if they also had elevated cortisol levels. In contrast, children with a lower genetic risk for depression showed a weaker or no relationship between cortisol and resilience.
3. Only 19% of children were classified resilient. Most had experienced multiple types of trauma, and more than half met criteria for PTSD.

The study findings suggest that chronic psychological scores, as reflected in cortisol levels, may be a useful biological marker for identifying children who are more likely to develop mental health difficulties

 

What are the implications of this research?

Stress biomarkers could support early identification of at-risk refugee children

The findings suggest that hair cortisol concentration could be a practical and non-invasive biomarker to identify refugee children at higher risk of mental health difficulties. This could support earlier and more targeted mental health interventions, particularly in settings where psychological assessments are difficult to administer or where language barriers exist.

In contrast, polygenic scores currently appear to have limited utility for predicting resilience in displaced child populations. Most genetic risk scores were developed using data from adults of European ancestry, which may not translated effectively to young people from Middle Eastern backgrounds. More inclusive research is required to develop polygenic tools that are accurate across age groups and ethnicities.

Overall, this study underscores the importance of considering biological as well as psychosocial factors in resilience. Biological markers may help reveal the hidden psychological toll of displacement and trauma, offering a complementary approach to conventional mental health screening methods. As the global refugee crisis continues, such tools could play a key role in informing timely and effective support for vulnerable children.

 

About the study group

This research was carried out by a team of experts in psychology including Demelza Smeeth (Queen Mary University of London), Andrew K. May (Queen Mary University of London), Elie G. Karam (St Georges Hospital University Medical Center, Lebanon), Michael J. Rieder (University of Western Ontario), Abdelbaset A. Elzagallai (University of Western Ontario), Stan van Uum (University of Western Ontario)and Michael Pluess (University of Surrey).