What Biological Factors Influence Mental Health Resilience in Refugee Children?

What you need to know

• Higher levels of the stress hormone cortisol in hair samples were associated with reduced mental health resilience in Syrian refugee children.
• Genetic factors linked to depression risk interacted with cortisol levels to predict resilience.
• Measuring biological factors like cortisol may help identify refugee children at higher risk for mental health problems.

The mental health challenges faced by refugee children

Refugee children often experience significant trauma and adversity that can impact their mental health and development. The Syrian civil war has displaced millions of people, with about half of Syrian refugees being children under 18 years old. Many refugee children have been exposed to violence, family separation, disrupted education, and harsh living conditions. These experiences put them at increased risk for mental health issues like post-traumatic stress disorder (PTSD), depression, and behavioral problems.

However, not all refugee children develop mental health problems, even after experiencing severe trauma. This ability to maintain good mental health and functioning in the face of adversity is known as resilience. Understanding what factors contribute to resilience in refugee children is important for identifying those at highest risk and developing interventions to support their wellbeing.

A multisystem view of resilience

Resilience is not just an individual trait, but emerges from the interaction of many different systems that impact a child’s life. These include biological factors, family relationships, community support, cultural practices, and broader societal influences. Researchers are increasingly taking a “multisystem” approach to studying resilience - looking at how these various levels work together to shape a child’s response to adversity.

At the most basic biological level, genes and physiological stress responses play a role in resilience. But these biological factors don’t operate in isolation. A child’s genetic predisposition interacts with their experiences and environment to influence mental health outcomes. By examining biological markers alongside other psychosocial factors, researchers hope to gain a more complete picture of the pathways to resilience in refugee children.

Studying biological markers of resilience

This study aimed to investigate two types of biological factors that may be associated with mental health resilience in Syrian refugee children:

1. Hair cortisol levels: Cortisol is a hormone released as part of the body’s stress response. Measuring cortisol in hair samples provides an indicator of cumulative stress exposure over the past few months.

2. Polygenic scores: These are scores that summarize the combined influence of many genetic variants associated with traits like depression risk or neuroticism (the tendency to experience negative emotions).

The researchers examined whether these biological factors predicted which children showed resilience - defined as not meeting clinical thresholds for PTSD, depression, or behavioral problems despite significant trauma exposure.

Key findings on cortisol and resilience

The study found that higher levels of cortisol in hair samples were significantly associated with reduced resilience in refugee children. Children with elevated hair cortisol were less likely to be classified as resilient, even after accounting for their level of war exposure and other factors.

This suggests that chronically elevated stress responses, as indicated by higher cortisol, may make it more difficult for children to maintain good mental health in the face of trauma. Measuring cortisol levels in hair could potentially help identify refugee children who are at higher biological risk for developing mental health problems.

Limited evidence for genetic influences

The researchers also looked at whether genetic risk scores for traits like depression were associated with resilience in refugee children. Overall, they found limited evidence that these genetic factors directly predicted resilience.

There are a few potential reasons for this:

1. The genetic risk scores were developed based on studies of European adults, so they may not be as applicable to Syrian children.

2. Genetic influences on complex traits like resilience tend to be small, especially compared to the impact of major environmental factors like war exposure.

3. Genetic predisposition may play a larger role later in development. The researchers found slightly stronger genetic associations when looking only at older children/adolescents in the study.

Interaction between genetic risk and cortisol levels

While genetic factors alone did not strongly predict resilience, the researchers did find evidence that genetic risk for depression interacted with cortisol levels to influence resilience.

Specifically, children with a higher genetic risk score for depression showed a stronger relationship between cortisol levels and resilience outcomes. At low cortisol levels, these children were actually more likely to be resilient. But as cortisol levels increased, their probability of being resilient dropped more steeply compared to children with lower genetic risk scores.

This illustrates how biological risk factors may work together to shape resilience. A genetic predisposition alone may not determine outcomes, but it could make a child more sensitive to the effects of chronic stress exposure.

Implications for identifying at-risk children

The findings suggest that biological markers, particularly hair cortisol levels, could potentially help identify refugee children who are at higher risk for mental health problems. Measuring these markers alongside other psychosocial risk factors may allow for earlier and more targeted interventions.

However, the researchers caution that more work is needed before biological tests could be used as reliable screening tools in refugee populations. Factors like cortisol dysregulation in response to chronic trauma make interpreting these markers complex.

The importance of a multisystem approach

While this study focused on biological factors, the researchers emphasize that resilience emerges from the interaction of many different systems in a child’s life. Supportive families, communities, and cultural practices all play crucial roles in fostering resilience.

Biological markers should be considered alongside other psychosocial factors to get a full picture of a child’s risk and resilience. The goal is to identify children who may need additional support, while also recognizing and bolstering the strengths and resources that many refugee families and communities already possess.

Limitations and future directions

Some key limitations of this study include:

• The cross-sectional design, which limits the ability to determine cause-and-effect relationships
• Defining resilience based only on the absence of mental health problems, rather than more positive measures of wellbeing
• Potential issues with applying genetic risk scores developed in European adult populations to Syrian refugee children

Future research directions could include:

• Longitudinal studies to track how biological markers and resilience change over time
• Developing genetic risk scores specifically for childhood resilience in diverse populations
• Examining how biological factors interact with family and community-level protective factors

Conclusions

• Hair cortisol levels were associated with mental health resilience in Syrian refugee children, with higher cortisol linked to lower resilience.
• There was limited evidence for direct effects of genetic risk factors, but some indication that genetic predisposition may interact with stress exposure to influence resilience.
• Measuring biological markers like cortisol may help identify refugee children at higher risk for mental health problems, but should be considered alongside other psychosocial factors.
• A multisystem approach considering biological, family, community, and cultural influences is crucial for understanding and supporting resilience in refugee children.