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Recently Resettled Refugees Show Hormonal Reactions Accompanying Life Events Related To Integration

January 13, 2003

Two Swedish investigators have explored which events or living conditions in daily life were of importance for the well-being of refugees during the first nine months after resettlement, in order to improve the understanding of which factors are of importance for the development of health and for successful integration of refugees.

Life events can be studied with qualitative interviews, open-ended written responses, or with checklists. The present study combines open-ended responses and checklists. In stress research there is a tradition of measuring hormonal changes after stressful events -such as loss of work- in order to by-pass interpretation difficulties caused social desirability issues.

In the present study, the following hormones were studied: cortisol, thyroxine, and prolactin. These are etablished markers in stress research. Serum cortisol increases in situations where energy mobilisation is necessary. Also the serum concentrations of the thyroid hormone thyroxine has been shown to change with severe stress. Serum cortisol can also decline in association with exhaustion, which has been shown in fibromyalgia or chronic fatigue. Prolactin often decreases in distress.
Another substance, the anabolic steroid hormone dehydroepiandrosterone sulphate (DHEA-s) was included in the study because its serum concentration was hypothesized to increase after positive life events and to be associated with improved self-perceived health.

The results of the study suggest that the following types of events influenced stress-responsive hormones: Negative situations involving next-of-kin, distress, too high demands, and perceptions of racism were associated with increased serum cortisol. The thyroid hormone thyroxine also reacted when a close relative was ill. Prolactin diminished when subjects experienced conflict with authorities or other persons to which the subjects were in a position of dependency.

Many stressful events reported by participants concerned close relatives in the home country, and the general picture was consistent with such events playing an important role for the health of refugees.
Subjects who reported more than once that the demands in language school were too high, developed higher cortisol, and increased symptoms of post-traumatic stress disorder (PTSD).

More than one third of the participants in the study suffered from PTSD.
It turned out that subjects with PTSD -compared to those without PTSD- often showed a different pattern in changes of blood levels of DHEA-s. Contrary to expectations, they reacted with increased levels of DHEA-s after specific negative events, where non-PTSD cases showed the expected decrease.

A general conclusion of the study is that it seems important to identify PTSD in refugees and to develop alternative introduction programmes for these in order to avoid worsening of PTSD. For instance, alternative pathways to the labour market -not requiring language proficiency before the symptoms of PTSD are reduced- could be of importance, as well as the development of alternative methods of language training. The study has also demonstrated that refugees are going though very stressful events even after resettlement, events that influence their health considerably.

Psychotherapy and Psychosomatics, Journal of