Biological and Environmental Factors Affecting Risk and Resilience Among Syrian Refugee Children

近年来，越来越多的证据表明，童年创伤的严重有害影响 暴露于儿童和成人的身心健康。这些证据大多基于回溯性研究。 精神受创伤的成年人。对儿童进行前瞻性纵向研究是必要的，以确定 创伤对神经生物发育的影响。此外，创伤的影响不是一成不变的，可能会基于 论影响创伤应激神经生物学的环境因素。考察中国的纵向路线 儿童创伤相关症状将有助于识别生物和环境因素 助长了脆弱性和复原力。虽然父母和环境因素对压力有影响 在遭受创伤的人群中，这种传播的生物学机制尚不清楚。探索这些 在确定影响儿童心理健康的最重要的可改变因素时，因素是至关重要的 在创伤暴露之后，以便为未来的干预提供信息。 我们将利用7-17岁的叙利亚和伊拉克难民儿童及其定居的父母的现有队列 从2016年开始在美国。我们将探索焦虑、抑郁、 和创伤后应激障碍(PTSD)在叙利亚战区创伤后，以及重新安置和他们的 表观遗传、自主神经和环境相关。我们已经确定了暴露于 这群人和他们的父母在抵达阿富汗后一个月内受到的战争创伤和移民压力 美国。这一初步评估(第一波)显示，儿童的焦虑率很高， 父母的创伤后应激障碍和焦虑。我们建议遵循这个队列(第2波，12-24个月，以及第3波，24个月- 36个月)，收集焦虑、抑郁和创伤后应激障碍的自我报告测量、唾液DNA样本，以及 皮肤电导反应作为交感觉醒的外周标志。[我们还会做一个横截面 与没有战争创伤暴露的阿拉伯移民儿童的上述症状和生物标志物的比较]。 这项建议代表了第一项检查病程、表观遗传学、自主神经和环境的研究。 叙利亚难民儿童及其父母的压力和创伤的相关性。这项研究的一个优势是 创伤暴露的已知发育时间和立即评估的可用性 在儿童的成长过程中，对儿童进行纵向跟踪的能力也很重要。这种可能性 发现潜在的独特的表观遗传变化，以及最重要的环境和育儿风险 因素，承诺推进改善儿童结局的努力，并降低以后精神和身体上的风险 与童年创伤和压力有关的健康问题。这一知识不仅对 为这些有需要的特定人群提供更好的医疗服务，同时也在增加我们更普遍的 了解创伤和环境对儿童发育和精神病理学的影响。

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.