Evidence map›Paper›PMID 36385169›Full record

Observational studyMolecular psychiatry2023

War exposure, post-traumatic stress symptoms and hair cortisol concentrations in Syrian refugee children.

Demelza Smeeth, Fiona S McEwen, Cassandra M Popham, Elie G Karam, John Fayyad, Dahlia Saab, Michael J Rieder, Abdelbaset A Elzagallaai, Stan van Uum, Michael Pluess

Open access · hybridAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Molecular psychiatry, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 1 pooled it
3.6field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.

  1. Pooled it
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  7. From Screens to Scars: Understanding the Association Between Social Media Engagement and Trauma During Crises and Emergency Situations.Stress and health : journal of the International Society for the Investigation of Stress · 2025
    Article
  8. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 3 countries.

Demelza SmeethDepartment of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK.ORCID 0000-0001-5631-367X
Fiona S McEwenDepartment of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK.ORCID 0000-0002-5562-481X
Cassandra M PophamDepartment of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK.
Elie G KaramDepartment of Psychiatry and Clinical Psychology, Balamand University, St George Hospital University Medical Center, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
John FayyadDepartment of Psychiatry and Clinical Psychology, Balamand University, St George Hospital University Medical Center, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
Dahlia SaabDepartment of Psychiatry and Clinical Psychology, Balamand University, St George Hospital University Medical Center, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
Michael J RiederDepartment of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
Abdelbaset A ElzagallaaiDepartment of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
Stan van UumDivision of Endocrinology and Metabolism, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
Michael PluessDepartment of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK. m.pluess@qmul.ac.uk.ORCID 0000-0001-5071-2047
Queen Mary University of London · GBInstitute for Development, Research, Advocacy and Applied Care · LBWestern University · CA

Funding

Biological Pathways of Risk and Resilience in Syrian Refugee ChildrenR01HD083387 · NICHD · UNIV/LONDON-QUEEN MARY& WESTFIELD COLL · PI KARAM, ELIE GEORGES, PLUESS, MICHAEL · 2015 to 2019
$2.2M
NICHD NIH HHS R01 HD083387U.S. Department of Health & Human Services | NIH | Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) R01HD083387
6 · The paper itself

Abstract

Altered secretion of cortisol, the primary effector of the hypothalamus-pituitary-adrenal axis, has been proposed as a means by which traumatic experiences compromise later mental health. However, despite the popularity of cortisol as a potential biomarker for stress and adversity, findings are inconsistent, and little is known about the impact of war-related trauma on stress physiology of children and adolescents. Here we aimed to evaluate the relationships between war exposure, current living conditions, hair cortisol concentrations (HCC) and post-traumatic stress disorder (PTSD) symptoms in a large cohort of Syrian refugee children and adolescents (6-18 years) and their caregiver. This longitudinal observational study assessed Syrian refugee children and adolescents in two waves, 1 year apart, within informal tented settlements in Lebanon. The relationships between war exposure, time since leaving Syria, PTSD symptoms and HCC were investigated using linear mixed-model regression utilising both waves of data collected (Y1: N = 1574, Y2: N = 923). Hair cortisol concentration was positively, but weakly associated with the number of war-related events experienced. This was limited to those who were at least 12 years old at the time of war exposure. Conversely, HCC decreased with time since leaving Syria. HCC was also associated with PTSD symptoms but not with the quality of their current living conditions. This study revealed that changes to hypothalamic-pituitary-adrenal axis activity may accompany both earlier war exposure and current PTSD symptoms in children and adolescents. Additionally, early adolescence may be a particularly sensitive time in terms of trauma-related changes to the hypothalamic-pituitary-adrenal axis.

Indexed as

RefugeesStress Disorders, Post-TraumaticAdolescentChildHairHumansHydrocortisoneHypothalamo-Hypophyseal SystemPituitary-Adrenal SystemSyriaWar ExposureHydrocortisone

Identifiers

PMID36385169
PMCPMC9908541
OpenAlexW4309330910

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.