Wayne State University

Wayne State University receives $2.6 million National Institutes of Health grant to investigate stress resiliency of Iraqi refugees

DETROIT — A Wayne State University School of Medicine researcher will conduct one of the largest studies ever on stress resiliency and the social programs designed to ease post-traumatic stress disorder among Iraqi war refugees.

Using a five-year, $2,641,244 grant from the National Institutes of Health’s National Institute of Mental Health, Bengt Arnetz, M.D., Ph.D., M.P.H., will track Iraqi refugees in metropolitan Detroit who have been exposed to war in their home country to determine the effect of post-migration factors such as employment, language classes, and mental and social health services in mitigating stress and post-traumatic stress disorder.

Dr. Arnetz, a professor in WSU’s Department of Family Medicine and Public Health Sciences and director of the Division of Occupational and Environmental Health, said he believes this will be the largest controlled study to date that investigates stress resiliency and risk factors in Iraqi refugees who have experienced war as noncombatants. It is also the first study ever of refugees in which there will be a mechanism to study a random sample of immigrants at the time they arrive in their host country.

While the study will focus only on refugees from Iraq, the results are expected to yield valuable information for other refugee groups. “The results will be valuable no matter the ethnicity or nationality, especially whether the post-migration social and institutional support attenuates the mental and behavioral effects from wartime exposure,” Dr. Arnetz said. “If that is the case, it would decrease mental suffering and medical-psychiatric and social costs, as well as enhancing refugee contributions to society.”

Refugees, he said, are at an elevated risk of suffering from post-displacement mental disorders, which increases the demand on and costs of mental health and social services. Increasing scientific evidence points to adverse mental health effects related to post-displacement trauma, including violence and marginalization.

“As a result, there is a need to assess the efficacy of post-displacement institutional resources, such as language and vocational training,” Dr. Arnetz said. While resources are devoted to post-displacement programs, there is a lack of controlled studies examining their effectiveness in promoting refugees' mental health.

The study will follow 250 Iraqi refugees and 250 control immigrants who are from countries in the Middle East and who have not been exposed to war. The health and coping skills of both groups will be assessed at the time of their arrival from overseas and then annually for two years. Potential study subjects will be identified in collaboration with two community partners, the Arab Community Center for Economic and Social Services (ACCESS) and Lutheran Social Services of Michigan. Dr. Arnetz and his team will randomly select from among those Iraqis cleared by the U.S. government for refugee status and ask them whether they wish to participate as they arrive in the country. The control subjects will be identified by the partnering agencies as well as solicited via advertising in targeted media.

The researchers will use standardized measures to assess to what degree a refugee has been exposed to war, including threats to an individual’s life, witnessing death and other exposure to suffering. That data, Dr. Arnetz said, will be related to the mental health of refugees at the point of arrival as well as over time as the refugees settle in their new country.

“We will also measure possible exposure to threats and violence, as well as civil disorders, in the U.S.,” he said. “For example, studies in the inner city of Detroit report a frequency of 11 percent of post-traumatic stress disorder among participating residents.”

The Detroit region is home to one of the largest Arabic populations outside the Middle East. Many Iraqis, including Chaldeans, have settled in the area. Dr. Arnetz said the study will involve both Muslim and Christian refugees.

“We will address whether issues such as social support will mitigate the effects [of exposure to war],” Dr. Arnetz said. “We will also involve both Chaldean and Muslim refugees, although we have no reason to believe religious or ethnic preferences will impact the results.” Moving into existing immigrant communities, he said, might mitigate the stress effects of exposure to war, but “it might slow down the rate at which you learn English or integrate into the mainstream. To what degree such factors act as risk or resiliency for post-migration mental and social health remains to be determined.”

The primary goals of the study include determining the differences in mental health disorders, specifically post-traumatic stress disorder and depression, between newly arrived Iraqi refugees exposed to war and Arab immigrants who have not, and their relationship to pre-displacement trauma. Researchers also will determine the relationship between pre-displacement trauma and post-displacement stressors in terms of mental health, and whether that relationship differs between refugees and immigrants. Finally, the study will examine the effect of post-migration institutional services on mental health.

Launched in 1971, ACCESS assists the Arab immigrant population in adapting to life in America. The organization provides a variety of services, including employment services, youth programs, educational and cultural programs, English language courses, and mental health programs.

In addition to Wayne State University’s Division of Occupational and Environmental Health, Department of Family Medicine and Public Health Sciences, Department of Psychology, and Department of Psychiatry and Behavioral Neurosciences, other research team members include Smith College in Massachusetts. An additional collaborative community partner is the Kurdish Human Rights Watch.

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Wayne State University is one of the nation’s pre-eminent public research universities in an urban setting. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world. For more information about research at Wayne State University, visit http://www.research.wayne.edu.