ESPIRE: The measurement and predictors of Environmental Sensitivity in Syrian refugee children
Lead Research Organisation:
University of Surrey
Department Name: Psychology
Abstract
The Syrian civil war has exacted a heavy toll on the mental health of affected individuals, especially refugee children. Estimates suggest that 45% of refugee children present with post-traumatic stress disorder, and 44% exhibit symptoms of depression. However, not all children exposed to the traumatic experiences of war and forced displacement develop mental illness. The Environmental Sensitivity (ES) metaframework proposes that children differ in their level of sensitivity, rendering them more or less susceptible to their environmental experiences. Low sensitivity children are robust against contextual adversity, but also benefit less from psychosocial support. Meanwhile, high sensitivity children are vulnerable to mental illness following experiences of adversity, but benefit disproportionately from protective factors in their environment. Individual differences in ES are the product of genetic, physiological and environmental factors, but these factors have yet to be explored in refugee populations of a Middle Eastern genetic background. In collaboration with colleagues in Lebanon, Italy, and Germany, the Experienced Researcher, Dr Andrew May, aims to investigate cross-sectional and longitudinal predictors of sensitivity in Syrian refugee children using pre-existing psychological, physiological and genetic data. In a sample of approximately 1500 Syrian refugee children from Lebanon, the ER will psychometrically analyse responses from the Highly Sensitive Child Scale. These responses will be correlated with hormone levels associated with stress sensitivity, as well as genome-wide genotyping data. Polygenic scores will be assessed as a tool for accurately inferring sensitivity in Middle Eastern refugee children. The ER will then explore how these sensitivity levels moderate children's mental health and well- being outcomes to both traumatic and beneficial experiences. Study results are anticipated to inform future care practices for refugee children.
Organisations
Related Projects
| Project Reference | Relationship | Related To | Start | End | Award Value |
|---|---|---|---|---|---|
| EP/X028690/1 | 01/11/2022 | 29/06/2023 | £190,380 | ||
| EP/X028690/2 | Transfer | EP/X028690/1 | 30/06/2023 | 31/10/2024 | £126,920 |
| Description | In the first publication attributed to this award, we examined the ability of hair cortisol concentrations and polygenic scores for mental health to predict risk and resilience in a sample of Syrian refugee children (n = 1,359). Children were categorized as either at-risk or resilient depending on clinical thresholds for posttraumatic stress disorder, depression, and externalising behaviour problems. Using a series of logistic regression models, we discovered that elevated hair cortisol concentrations were significantly associated with reduced resilience, even when controlling for differences in war exposure among children. Although polygenic scores for depression, self-harm, and neuroticism were not found to predict either risk or resilience, a significant interaction emerged between hair cortisol and a polygenic score for depression, suggesting that children predisposed to depression were more at risk for mental health problems when hair cortisol concentrations were high. This novel study provided the first ever examination of the interaction between hair cortisol and polygenic scores in predicting risk and resilience, using the largest known cohort of refugee children to date, and produced findings that suggest that biomarkers (both physiological and genetic) might help with the early identification of refugee children at risk for mental health problems. In our second publication, we investigated how refugee children's levels of environmental sensitivity influenced their mental health. Children with high environmental sensitivity have nervous systems that are more receptive to both protective and threatening aspects of the environment, suggesting that their mental health may be significantly affected by the traumatic events typically experienced by forcefully displaced refugees. In a sample of 1,591 refugee children, we used Bayesian linear mixed modelling to test the association between environmental sensitivity and anxiety, depression, post-traumatic stress disorder (PTSD), and externalising behaviour. Results suggested that refugee children who report high levels of sensitivity have significantly higher burdens of all forms of mental illness, implying that the measurement of environmental sensitivity may be beneficial for identifying children with greater vulnerability to mental illness following trauma. As the second part of our investigation, we also explored how strongly biomarkers of sensitivity, including hormones and genetic variation, were associated with self-reported levels of sensitivity, along with how predictive these biomarkers were of mental health. There were no biomarkers that appeared to fully correlate with self-reported sensitivity, nor predict mental health burden to the same extent. However, we did verify previously published evidence that the hormone dehydroepiandrosterone (DHEA) is a strong marker of acute mental illness. In the third publication, we provided detailed perspectives on our experience collecting hair hormone data from refugee children. Scalp hair is an accessible source for measuring multiple hormones (which are potential biomarkers of sensitivity), and hair samples are substantially easier to collect and transport compared to samples of bodily fluids. Additionally, single hair samples can provide an assessment of circulating hormone levels over several months, which would otherwise require repeated (and expensive) sampling of body fluids. However, there are still many challenges to hair sampling and working with hair hormone data, including cultural issues surrounding hair, biological mechanisms of hair hormone deposition, and standardisation in reference ranges of hormone levels, amongst others. Based on our extensive experience sampling hair in children at two different time points (spaced 12 months apart) in the difficult context of an informal refugee settlement, we provided a detailed review of hair sampling and analysis, and offered various guidance and recommendations based on the lessons we learnt through our own unique study. We also offered comprehensive analysis of our hair hormone data, highlighting how hair hormones related to sex, age, hair colour, and pubertal timing. This publication serves as a useful guide for other researchers wishing to embark on hair sampling for research studies, and also provided valuable reference data for hair hormone concentrations, and how these were impacted by various individual and environmental factors. In our fourth publication, we examined the impact of father separation on refugee children. Fathers play an important role in the attachment of young children, providing a secure base from which children can trial activities such as risk-taking and exploration. Father involvement can be an important component of sensitive parenting, which can in turn influence the sensitivity of children. Using structural equation modelling, we compared two groups of refugee children, namely those living with their fathers (n = 1,133) and those separated from their fathers for various reasons (n = 337). Findings indicated that separated children were subjected to more war-related events, lived in worse refugee environments, and had less access to education. Additionally, they had increased levels of depression and PTSD, as well as lower self-efficacy and self-esteem compared to children still living with their fathers. Father separation appeared to uniquely contribute to depression, lowered self-efficacy, and reduced self-esteem, but not anxiety, PTSD, or externalising behaviour. This study helped to confirm that father separation is a unique stressor that can worsen the outcomes for refugee children growing up in the aftermath of war and forced displacement. |
| Exploitation Route | The outcomes of this funding can be taken forward in numerous ways, across multiple disciplines: - At the psychological level, we have provided further evidence of how high self-reported levels of environmental sensitivity can place children at disproportionate risk to mental illness following traumatic experiences. This knowledge can be taken forward towards possible intervention strategies and/or policy changes aimed at enhancing the care of refugee children, especially through earmarking those children higher in sensitivity. We have also highlighted the unique impacts of fathers on the well-being of refugee children. Fathers provide a critical component to sensitive parenting and child attachment, the lack of which appears to substantially worsen mental illness and self-esteem in children. These results could also be taken forward to intervention approaches and/or policy adjustments aimed at encouraging father-child attachment and offering additional care to children separated from their fathers. - At the physiological level, we have further highlighted the nuances of hair hormone sampling, and the role of hormones such as cortisol and DHEA in signalling differences in risk and resilience in refugee children, as wells as acute levels of mental distress. Our work provides a comprehensive guide for future researchers wishing to leverage hair hormone analysis in their investigations, and encourages further investigation into hormones as objective biomarkers that could be used to support the care of refugee children. - At the genetic level, we have discovered some evidence for the interaction between hair hormone levels and genetic predisposition towards depression. The relationship between hair hormones and polygenic scores in the psychological study of risk and resilience is a recent line of investigation, with our findings encouraging further examination along this path. We also contribute to the debate surrounding the applicability of European-derived polygenic scores to non-European individuals, as well as the larger question regarding the utility of polygenic scores in behavioural science. |
| Sectors | Communities and Social Services/Policy Healthcare |
| URL | http://www.globalmentalhealthresearch.com |
| Description | This award is contributing to an emerging academic and societal impact. The investigations aided by this award form a substantial part of the foundational content integral to the www.globalmentalhealthresearch.com website. This website, which launches shortly, will serve as a publicly accessible hub on research relating to global mental health, especially in traditionally underserved populations. Our work on Syrian refugee children forms the cornerstone of this website, which will help to disseminate our findings to the widest possible audience. We also provide all of our research publications and anonymised data, inviting collaborations from other interested researchers. In doing so, we aim to further foster the nascent research area of global mental health, and encourage the exploration of this field in diverse populations, at all levels of analysis, including psychological, physiological, and genetic. |
| First Year Of Impact | 2025 |
| Sector | Communities and Social Services/Policy,Healthcare |
| Impact Types | Policy & public services |