Bengt B. Arnetz
Researchers have gained new insight into the mechanisms behind the adverse mental health impact of war trauma, particularly among refugees, according to study findings published in PLOS One.
“Clinicians assessing mental health in trauma-exposed individuals, including refugees but also those exposed to severe psychological trauma with adverse mental health outcomes (eg, depression and PTSD), should consider adding neuroplasticity-related biomarkers, as well as blood levels of heavy metals — foremost lead — to the diagnostic workup plan,” Bengt B. Arnetz, MD, PhD, MPH, chair of the department of family medicine at Michigan State University’s College of Human Medicine, told Healio Psychiatry.
According to Arnetz and colleagues, trauma-induced disorders are associated with heightened neuroplastic restructuring of brain areas, including the amygdala and hippocampus, which play critical roles in PTSD pathophysiology. During war, civilians are exposed to both psychological trauma and environmental hazards, such as metals. However, research is sparse regarding the potential mental health impact of these environmental exposures alone or in combination with trauma. Further, war exposures may contribute to dysfunctional neuroplasticity.
The researchers sought to determine the relationships among environmental exposures and predisplacement trauma, the nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) neurotrophins, which may mediate neuroplasticity responses to stress-related exposures, and mental health.
To do so, they administered a semi-structured survey in Arabic to Middle Eastern refugees from Syria (n = 40) or Iraq (n = 24) 1 month after arrival to Michigan. Specifically, they assessed predisplacement trauma and environmental exposure, anxiety, PTSD, depression and self-rated mental health. Further, they determined concentration levels of BDNF and NGF, as well as six heavy metals, through whole blood collection.
The researchers created a neuroplasticity index by combining the two neurotrophins, because of their similar functions in neuroplasticity, and used linear regression to test whether biomarkers, psychosocial trauma and environmental exposures were associated with mental health symptoms.
Results showed an association between the neuroplasticity index and PTSD (standardized beta = 0.25, P < .05), depression (0.26, P < .05) and anxiety (0.32, P < .01), after controlling for predisplacement trauma exposure. Moreover, predisplacement environmental exposure was associated with anxiety (0.32, P < .05) and PTSD (0.28, P < .05).
Syrian refugees and women were more likely to have higher scores on depression (0.25, P < .05; 0.3, P < .05) and anxiety scales (0.35, P < .01; 0.27, P < .05), and lower scores on self-rated mental health (0.32, P < .05; 0.34, P < .05). The neuroplasticity index was related to blood lead levels (P < .01) in bivariate analysis.
“I was surprised to find that neuroplasticity might become overactive and result in mental health problems,” Arnetz said. “Most of the time, we view neuroplasticity as a desired process. However, if the neuroplasticity results in consolidation of negative memories of trauma, reliving the situations and depression, we need to develop a better and more personalized intervention based on patient’s psychological and biological reactions to trauma.” – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.
