In recent years, evidence has been accumulating for the serious detrimental impact of childhood trauma
exposure on child and adult physical and mental health. This evidence is mostly based on retrospective studies
of traumatized adults. Prospective longitudinal studies in children are necessary to determine the impacts of
trauma on neurobiological development. Furthermore, effects of trauma are not static, and may oscillate based
on environmental factors affecting neurobiology of traumatic stress. Examining the longitudinal course in
trauma-related symptoms in children will help in identification of biological and environmental factors
contributing to vulnerability and resilience. While parental and environmental factors have an impact on stress
in traumatized populations, the biological mechanisms of this transmission are not yet clear. Exploring these
factors is vital in determination of the most important modifiable factors affecting childhood mental health
following trauma exposure in order to inform future interventions.
We will leverage an existing cohort of Syrian and Iraqi refugee children ages 7-17 and their parents who settled
in the United States starting in 2016. We will explore longitudinal changes in symptoms of anxiety, depression,
and posttraumatic stress disorder (PTSD) post war-zone trauma in Syria, as well as resettlement, and their
epigenetic, autonomic, and environmental correlates. We have already established the impact of exposure to
war trauma and stress of migration in this cohort and their parents within one month of their arrival in the
United States. This initial assessment (Wave 1) showed high rates of anxiety in the children, and high rates of
PTSD and anxiety in their parents. We propose to follow this cohort (Wave 2, 12-24 months, and Wave 3, 24-
36 months), with collection of self-report measures of anxiety, depression and PTSD, saliva DNA samples, and
skin conductance response as peripheral marker of sympathetic arousal. [We will also do a cross sectional
comparison of above symptoms and biomarkers with Arab immigrant children without war trauma exposure].
This proposal represents the first study to examine course of illness, epigenetic, autonomic, and environmental
correlates of stress and trauma among Syrian refugee children and their parents. A strength of the study is
the known developmental timing of trauma exposure and availability of assessments immediately upon
arrival, as well as the ability to follow-up the children longitudinally during development. The possibility
of finding potential unique epigenetic changes, as well as most important environmental and parenting risk
factors, promises to advance efforts to improve child outcomes and reduce risk for later mental and physical
health problems associated with childhood trauma and stress. This knowledge will not only be useful in
providing better health services to this specific population in need, but also in increasing our more general
understanding of trauma and environmental impact on child development and psychopathology.