ucsdhealthsciences:

The number of people forced to flee their homes has become a global crisis. Worldwide, there are 68.5 million forcibly displaced people, 25.4 million of whom are refugees. We often hear about the torture, violence and instability faced by refugees in their home countries and en route to their resettlement locations. And yet, even when refugees reach their resettlement locations, their hardship continues.

Public policy leaders and health professionals have only recently started to think about the enduring consequences of refugee trauma and its effect post resettlement. The effects are felt not only by the refugees themselves, but also by their children. But it is unclear whether traumatic events experienced by refugees affect their children. Can children be affected even if they were born in resettlement locations and never experienced trauma themselves?

Wael Al-Delaimy, MD, PhD, in the Department of Family Medicine and Public Health, Sheila Gahagan, MD, and Patricia East, PhD, both in the Department of Pediatrics, all at UC San Diego School of Medicine, studied the intergenerational effects of trauma in a sample of Somali refugee mothers who had resettled in San Diego. In their work, they studied how refugee trauma could possibly be transmitted to their children.  

Harms of Trauma to Unexposed Refugee Children

Sudanese refugees await medical care. Centers for Disease Control and Prevention’s Public Health Image Library

In 1991, the Somali civil war began, and Somalis were forced to flee their country. Many spent years in Kenyan refugee camps, where they experienced a lack of sanitation, food, clean water and access to medical care. By 2015, 150,000 Somalis lived in the United States, with San Diego housing the second largest population of Somalis in the U.S.

As Somali refugees experienced traumatic events, and in some cases torture, some of them resettled in the U.S. with serious mental health complications stemming from their past trauma. Though it was clear that their experiences as refugees affected their quality of life post resettlement, there was little understanding of the effects of those experiences on their children.

Al-Delaimy, East, and Gahagan surveyed 198 Somali refugee mothers in San Diego and 198 of their children. Mothers reported on the traumatic events and torture they experienced as refugees, as well as on the amount of current post-traumatic stress symptoms, such as withdrawal-detachment, volatility-panic and depressive symptoms. Their children reported on traumatic events that they had experienced, witnessed or heard about, and on their current experience of racism, bullying/victimization and depressive symptoms.

Mothers had experienced on average 24 traumatic events, most commonly murder or violent death of a family member (77 percent) and, on average, one torture event prior to entering the U.S. A large majority (76 percent) of the children in the study were born in the U.S., and very few had experienced traumatic events themselves.

Despite the fact that most children had not experienced trauma themselves, they were significantly impacted by their mothers’ experiences. This was manifested by children’s increased perceptions of racism, experiences of bullying victimization and depressive symptoms. Their mothers’ depressive symptoms were the reason they experienced all three of these child outcomes, and their mothers’ volatility-panic was the reason for the amount of bullying victimization children experienced.

What Does All This Mean?

Trauma has long-lasting effects. The people who directly experience trauma are not the only ones affected by those events; instead, the repercussions of trauma are experienced across generations and are passed on through manifestations of mental health issues. Intergenerational traumatization applies not only to the children of refugees, but also to the children of other populations that experience trauma, including military personnel, fire and rescue teams and other medical staff.

Conceptual framework of the pathway of intergenerational traumatization. Trauma and torture experienced by refugee mothers predicted their mental health outcomes, and their mental health outcomes predicted their children’s adjustment. However, mothers’ past trauma did not consistently predict their children’s adjustment. Adapted from the Journal of Immigrant and Minority Health.

These findings also have implications for policy interventions that address the psychosocial difficulties faced by both adult refugees and their children and include family-centered mental health services. Countries of resettlement of refugees should seek early prevention and treatment of mental illness among both those affected and their families. Refugee trauma, at the levels we see today, will deeply affect society globally and for generations to come, impacting worldwide health and wellness, educational success and economic output. Thus, as millions of people flee violence, persecution and famine, it is imperative that steps are taken to minimize additional traumatic experiences and protect current and future affected persons.

— Marya Rana, research intern with the Department of Pediatrics at UC San Diego School of Medicine

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