Refugee health and physiological profiles in transitional settlements in Serbia and Kenya: Comparative evidence for effects of gender and social support.

When armed conflict compels people to flee from their homelands, they embark on protracted journeys during which they experience wide ranging physical, social, and psychological challenges. Few studies have focused on refugee psychosocial and physiological profiles during the transitional phase of forced migration that often involves temporary sheltering. Transient refugees' experiences can vary substantially based on local socio-ecological conditions in temporary settlements, including the length of stay, living conditions, as well as the availability and accessibility of physical and social resources. In this study, we compared physiological and psychosocial data from refugees (N=365; 406 observations) in Serbia and Kenya, respectively, with divergent temporal (length of stay) and socio-ecological conditions. In Serbia, refugees resided in asylum centers (mean stay: 0.9 y); in Kenya they were living in Kakuma Refugee Camp (mean stay: 8.8 y), one of the world's largest camps at the time. We had limited ability to directly compare psychosocial measures and used meta-analytic techniques to evaluate predictors of refugee mental and physical health at the two sites, including based on perceived social support. Refugees in Serbia had higher fingernail cortisol (p < 0.001) and were less likely to have elevated C-reactive protein (CRP) levels (p < 0.01) than refugees in Kakuma. We found common gender differences in both settings; women had lower cortisol but higher EBV antibody titers and higher likelihood of having elevated CRP compared to men (all p < 0.01). Woman also reported poorer mental and physical health (p < 0.001). These physiological and health differences may reflect variation between men and women in their psychosocial and physical experiences of factors such as stress, violence, and trauma during their journeys and as transitional refugees. Finally, we also found that refugees with lower levels of perceived social support reported poorer physical and mental health (p < 0.001). Although our results are cross-sectional, they suggest that this intermittent phase of the refugee experience is a key window for helping enhance refugee well-being through an emphasis on interpersonal and community support systems.

Transient refugees' social support, mental health, and physiological markers: Evidence from Serbian asylum centers.

OBJECTIVES: Refugees seeking safety across international borders are often exposed to a wide breadth of psychosocially stressful experiences that may fracture existing sources of social support and impair the generation of new social relationships, with implications for their long-term health and resilience. Using data from recently settled refugees in two asylum centers in Serbia, we examined the associations between social support, mental health, and physiological markers. METHODS: In this mixed-method study of refugees (age 18-50 years, n = 76), we collected key socio-demographic information and conducted semi-structured interviews about refugees' journey and stay in Serbia, trauma/loss, and their sources of social support. We also collected self-reported measures of mental well-being as well as physiological markers relevant to repeated exposure to chronic psychosocial stress (fingernail cortisol and dried blood spots for analysis of Epstein-Barr virus [EBV] antibody titers). RESULTS: We found that refugees with longer journeys reported lower social support than those with shorter journeys. Refugees with lower social support reported poorer mental well-being, greater PTSD-related symptoms, and higher recent perceived stress than those with higher social support. We also observed that refugees with lower social support and higher recent stress, respectively, tended to exhibit higher fingernail cortisol levels. However, we did not observe comparable patterns linking EBV antibodies with psychosocial functioning. CONCLUSION: Our cross-sectional findings are consistent with the notion that social support is likely to be a critical component in effective interventions aimed at mitigating the adverse health effects of relocation-related illnesses and poor social functioning as they await resettlement.

Forced migration experiences, mental well-being, and nail cortisol among recently settled refugees in Serbia.

Refugees are exposed to a wide breadth of traumatic and psychosocially stressful experiences that have long-term implications for their health and resilience. Most prior research on this topic has focused on long-settled refugee populations, as opposed to those who find themselves in more intermittent transitional stages of the forced migration process. Specifically, few studies have explored how refugees' experiences during their recently completed journeys correlate with their mental well-being or physiological profiles that are responsive to psychosocial stress and trauma. Using data from recently settled refugees in Serbia (n = 111), our study helps address this existing gap by examining the associations between refugees' experiences during their arduous journeys, fingernail cortisol concentrations (CORT), and self-reports of psychosocial stress and PTSD symptomology. We found that refugees who reported experiencing longer journeys had higher recent perceived stress as well as poorer well-being and physical health. Refugees who experienced trauma during their journeys also reported higher recent perceived stress and tended to have higher CORT than those who did not experience trauma. In addition, we also observed sex differences in mental health and CORT profiles. Women tended to report poorer mental well-being and physical health and also had lower CORT compared to men. While longitudinal research is needed, our correlative findings are consistent with the notion that reducing exposure to extreme trauma and stress by establishing safe migration pathways for people fleeing hardship could potentially help attenuate forced relocation-related illnesses and improve health outcomes among refugees as they await resettlement.

Testosterone moderates the effects of social support on cardiovascular disease risk factors among older US men.

OBJECTIVES: Social support positively affects health through pathways such as shaping intrapersonal emotional and psychological well-being. Lower testosterone often interrelates with psychological and behavioral orientations that are beneficial to participation in emotionally supportive relationships. Yet, little research has considered the ways in which testosterone may contribute to health outcomes related to emotional support. METHODS: We draw on testosterone, social support data, and cardiovascular disease (CVD)-relevant indicators (inflammatory markers; blood pressure [BP]) from older men (n = 366) enrolled in the National Health and Nutrition Examination Survey, a US nationally representative study. We test whether men's testosterone moderates associations between emotional social support and markers related to CVD risk. RESULTS: For men with relatively lower testosterone, higher levels of social support predicted lower white blood cell (WBC) counts, consistent with reduced inflammation. In contrast, men with higher testosterone exhibited elevated WBC counts with greater support. In a diverging pattern, men with lower testosterone had higher systolic and diastolic BP with higher support, whereas the slopes for systolic and diastolic BP, respectively, were comparatively flatter for men with higher levels of testosterone. CONCLUSIONS: We suggest that our findings are theoretically consistent with the idea that testosterone helps shape intrapersonal and interpersonal experiences and perceptions of men's emotional support networks, thereby affecting the health implications of that support. The somewhat divergent results for WBC count vs BP highlight the need for inclusion of other neuroendocrine markers alongside testosterone as well as refined measures of perceived and received support.

Positive effects of refugee presence on host community nutritional status in Turkana County, Kenya.

OBJECTIVES: Refugee camps are often assumed to negatively impact local host communities through resource competition and conflict. We ask instead whether economic resources and trade networks associated with refugees have benefits for host community health and nutrition. To address this question we assess the impacts of Kakuma Refugee Camp in northwest Kenya, comparing anthropometric indicators of nutritional status between Turkana communities in the region. METHODS: Participants were recruited at four sites in Turkana County (N = 586): Kakuma Town, adjacent to Kakuma Refugee Camp; Lorugum, an area with sustained economic development; Lokichoggio, formerly host to international NGOs, and now underdeveloped; and Lorengo, an undeveloped, rural community. We evaluated nutritional status using summed skinfold thickness and body mass index (BMI). Structured interviews provided contextual data. RESULTS: Age-controlled multiple regression models reveal two distinct skinfold thickness profiles for both sexes: comparatively elevated values in Kakuma and Lorugum, and significantly lower values in Lorengo and Lokichoggio. BMI did not vary significantly by location. Despite better nutritional status, a large proportion of Kakuma residents still report worries about basic needs, including hunger, health, and economic security. CONCLUSIONS: Kakuma Refugee Camp is associated with better host community energetic status indicators, compared to other relevant, regional sites varying in development and resources. Based on global nutritional standards, observed differences likely represent meaningful disparities in overall health. We suggest that access to cereals via refugee trade networks and employment might mediate this relationship. However, perceptions of refugees as illegitimate interlopers maintain a high psychological burden.

Population is the main driver of war group size and conflict casualties.

The proportions of individuals involved in intergroup coalitional conflict, measured by war group size (W), conflict casualties (C), and overall group conflict deaths (G), have declined with respect to growing populations, implying that states are less violent than small-scale societies. We argue that these trends are better explained by scaling laws shared by both past and contemporary societies regardless of social organization, where group population (P) directly determines W and indirectly determines C and G. W is shown to be a power law function of P with scaling exponent X [demographic conflict investment (DCI)]. C is shown to be a power law function of W with scaling exponent Y [conflict lethality (CL)]. G is shown to be a power law function of P with scaling exponent Z [group conflict mortality (GCM)]. Results show that, while W/P and G/P decrease as expected with increasing P, C/W increases with growing W. Small-scale societies show higher but more variance in DCI and CL than contemporary states. We find no significant differences in DCI or CL between small-scale societies and contemporary states undergoing drafts or conflict, after accounting for variance and scale. We calculate relative measures of DCI and CL applicable to all societies that can be tracked over time for one or multiple actors. In light of the recent global emergence of populist, nationalist, and sectarian violence, our comparison-focused approach to DCI and CL will enable better models and analysis of the landscapes of violence in the 21st century.

Adiposity, CVD risk factors and testosterone: Variation by partnering status and residence with children in US men.

Background and objectives: In many settings, partnered, invested fathers have lower testosterone than single men or fathers who are not involved in caregiving. Reduced testosterone has been identified as a risk factor for multiple chronic diseases, and men's health also commonly varies by life history status. There have been few tests of whether variation in testosterone based on partnering and parenting has implications for men's health. Methodology: We analysed data from a US population-representative sample (NHANES) of young-to-middle aged US men (n = 875; mean age: 29.8 years ± 6.0 [SD]). We tested for life history status differences in testosterone, adiposity levels and biomarkers of cardiovascular disease (CVD)-risk (HDL cholesterol; triglycerides; white blood cell count [WBC]). Results: Partnered men residing with children (RC) had lower testosterone and elevated abdominal adiposity compared to never married men not residing with children. While they did not significantly differ for WBC or triglycerides, partnered RC men also had comparatively lower HDL. Partnered RC males' lower testosterone accounted for their relatively elevated adiposity, but testosterone, adiposity, and health-related covariates did not explain their relatively reduced HDL. Conclusions and implications: Our results linking life history status-based differences in testosterone and adiposity, alongside our complementary HDL findings, indicate that testosterone-related psychobiology might have implications for partnered RC men's CVD risk in the US and other similar societal settings. These types of socially contextualized observations of men's health and physiological function particularly merit incorporation in clinical discussions of fatherhood as a component of men's health.

Are testosterone levels and depression risk linked based on partnering and parenting? Evidence from a large population-representative study of U.S. men and women.

Partnered adults tend to have lower risks of depression than do single individuals, while parents are more commonly depressed than non-parents. Low testosterone men, and possibly women, are also at greater risk of depression. A large body of research has shown that partnered parents have lower testosterone than single non-parents in some cultural settings, including the U.S. Here, we drew on a large (n = 2438), U.S.-population representative cohort of reproductive aged adults (age: 38.1 years ± 11.1 SD) to test hypotheses regarding the intersections between partnering and parenting, testosterone, socio-demographic characteristics, and depression outcomes. Men and women's depression prevalence did not vary based on testosterone. Partnered fathers had lower testosterone than single (never married, divorced) non-fathers, but were less commonly depressed than those single non-fathers. Partnered mothers had reduced testosterone compared to never married and partnered non-mothers. Never married mothers had higher depression prevalence and elevated depressive symptomology compared to partnered mothers; these differences were largely accounted for by key health-related covariates (e.g. cigarette smoking, BMI). We found significant three-way-interactions between socioeconomic status (SES), testosterone, and parenting for adults' depression risks. High testosterone, high SES fathers had the lowest prevalence of mild depression, whereas low testosterone, low SES non-fathers had the highest. Compared to other mothers, low SES, low testosterone mothers had elevated prevalence of mild depression. Overall, low SES, high testosterone non-mothers had substantially elevated depression risks compared to other women. We suggest that psychobiological profiles (e.g. a male with low testosterone) can emerge through variable psychosomatic and psychosocial pathways and the net effect of those profiles for depression are influenced by the social (e.g. partnering and parenting status; socioeconomic gradients), cultural (e.g. gender and family life domains), and ecological (e.g. the lived environment, particularly related to low SES and poverty) contexts in which individuals find themselves.

Aging US males with multiple sources of emotional social support have low testosterone.

Among species expressing bi-parental care, males' testosterone is often low when they cooperate with females to raise offspring. In humans, low testosterone men might have an advantage as nurturant partners and parents because they are less prone to anger and reactive aggression and are more empathetic. However, humans engage in cooperative, supportive relationships beyond the nuclear family, and these prosocial capacities were likely critical to our evolutionary success. Despite the diversity of human prosociality, no prior study has tested whether men's testosterone is also reduced when they participate in emotionally supportive relationships, beyond partnering and parenting. Here, we draw on testosterone and emotional social support data that were collected from older men (n=371; mean: 61.2years of age) enrolled in the National Health and Nutrition Examination Survey, a US nationally-representative study. Men who reported receiving emotional support from two or more sources had lower testosterone than men reporting zero support (all p<0.01). Males with the most support (4+ sources) also had lower testosterone than those with one source of support (p<0.01). Men who reported emotional support from diverse (kin+non-kin or multiple kin) sources had lower testosterone than those with no support (p<0.05). Expanding on research on partnering and parenting, our findings are consistent with the notion that low testosterone is downstream of and/or facilitates an array of supportive social relationships. Our results contribute novel insights on the intersections between health, social support, and physiology.