The Development of Posttraumatic Stress Disorder and Depression Symptoms in Iraqi Refugees: Associations with Acculturation and C-reactive Protein.

ABSTRACT: Refugees experience distress from premigration trauma, often exacerbated by postmigration difficulties. To develop effective interventions, risk factors for mental health symptoms need to be determined. Male Iraqi refugees (N = 53) to the United States provided background information and reported predisplacement trauma and psychological health within 1 month of their arrival. An inflammatory biomarker-C-reactive protein (CRP) was assessed approximately 1.5 years after arrival, and a contextual factor-acculturation-and psychological health were assessed 2 years after arrival. We tested whether acculturation and CRP were associated with posttraumatic stress disorder (PTSD) and depression symptoms at the 2-year follow-up, controlling for baseline symptoms, age, body mass index, and predisplacement trauma. Acculturation was inversely related to depression, and CRP was positively related to both PTSD and depression at the 2-year follow-up. Interventions targeting acculturation could help reduce the development of depression symptoms in refugees. The role of CRP in the development of PTSD and depression symptoms warrants further research.

IL-10: A possible immunobiological component of positive mental health in refugees.

Objective: As the number of refugees continues to rise, there is growing concern about the impact from trauma exposures on their mental health. However, there is a limited understanding of possible biological mechanisms contributing to the substantial inter-individual differences in trauma-related outcomes, especially as it relates to positive mental health. Only sparse work has focused on the biology of positive mental health, including energy and sleep, in trauma-exposed persons. In this study, we analyzed cytokines in blood from newly arrived refugees with differential trauma exposures in relationship to self-reported energy, as a key marker of positive mental health. Methods: Within the first month of arrival in the USA, 64 refugees from Iraq and Syria were interviewed. Refugees completed the clinical DSM-IV PTSD-Checklist Civilian Version (PCL-C), the Beck Anxiety Inventory (BAI), and the Hospital Anxiety and Depression Scale (HADS). Ten psychiatrically healthy non-refugee persons were used as healthy controls to compare levels of cytokines. Blood samples were collected at the time of the interview and subsequently analyzed for IL-1ß, IL-6, IL-8, IL-10, and TNF-α concentrations. Results: Energy correlated positively with current concentration ability and sleep quality, and negatively with stress, PCL-C, BAI and HADS scores (Spearman correlations, all p<0.05). Refugees had lower levels of IL-10 compared to controls (p<0.05). IL-10 levels in refugees correlated with higher energy levels (p<0.01). Conclusions: Results suggest that self-reported energy is a key component of positive mental health in newly arrived traumatized refugees. Additionally, the anti-inflammatory cytokine IL-10 could be a marker of, or causally associated with positive mental health. A better understanding of the balance between pro- and anti-inflammatory states in highly traumatized individuals has the potential to create more targeted and effective treatments with implications for long-term health outcomes.

Perception of Discrimination in Employment and Health in Refugees and Immigrants.

Unemployment is associated with poor health among refugees and immigrants; however, the degree to which discrimination in employment contributes to poor health remains unclear because of methodological limitations. This cross-sectional study aims to investigate factors associated with perceived discrimination, ethnicity and migration status, and their implication on health (self-rated health & depression). Perceived discrimination was investigated in 273 Iraqi skilled-workers, refugees and immigrants, who are members of a professional scientific organization. It was hypothesized that unemployment, ethnicity (Arab), and migration status (refugee) would be associated with perceived discrimination. Additionally, it was hypothesized that participants who endorse discrimination are more likely to report poor health. Results reveal that more individuals who were unemployed (46.4%), reported perceived discrimination (X2 (1, N=273) =6.63, p<.05), however, when linear regression modeling was applied, age [OR=1.36], gender [OR=2.13], and ethnicity [OR=2.15], not migration status became significant predictors of discrimination. With respect to health, age [OR=2.25], length of residency [OR.93], language skills [OR=3.00], and perception of discrimination [OR=2.12] were predictors of SRH, while ethnicity [OR=3.93], age [OR=1.39], and discrimination [OR=3.26] were significant predictors of depression. Notably, perceived discrimination was a predictor in both health variables. In conclusion, there appears to be a link between discrimination and health in a homogenous refugee and immigrant sample.

Unemployment in Iraqi refugees: The interaction of pre and post-displacement trauma.

Previous refugee research has been unable to link pre-displacement trauma with unemployment in the host country. The current study assessed the role of pre-displacement trauma, post-displacement trauma, and the interaction of both trauma types to prospectively examine unemployment in a random sample of newly-arrived Iraqi refugees. Participants (N = 286) were interviewed three times over the first two years post-arrival. Refugees were assessed for pre-displacement trauma exposure, post-displacement trauma exposure, a history of unemployment in the country of origin and host country, and symptoms of posttraumatic stress disorder (PTSD) and depression. Analyses found that neither pre-displacement nor post-displacement trauma independently predicted unemployment 2 years post-arrival; however, the interaction of pre and post-displacement trauma predicted 2-year unemployment. Refugees with high levels of both pre and post-displacement trauma had a 91% predicted probability of unemployment, whereas those with low levels of both traumas had a 20% predicted probability. This interaction remained significant after controlling for sociodemographic variables and mental health upon arrival to the US. Resettlement agencies and community organizations should consider the interactive effect of encountering additional trauma after escaping the hardships of the refugee's country of origin.