Abstract
Early life stress is an important factor in later psychopathology, including symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety. The purpose of the present study was to investigate the effect of early life stress on psychiatric symptoms within a sample of Syrian refugees. In this model, the use of cognitive emotion regulation strategies was assessed as a potential mediator of the relationship between early life stress and current symptoms of PTSD, depression, and anxiety. Bootstrap analyses were generated to test the indirect effect of emotion regulation (Cognitive Emotion Regulation Questionnaire) on the relationship between early life stress (Childhood Trauma Questionnaire), PTSD (Harvard Trauma Questionnaire), depressive (PHQ-9) and anxiety (GAD-7) symptoms in eighty-nine Syrian refugees resided in Germany (n = 49) and Jordan (n = 40). The indirect effect of maladaptive strategies was significant between early life stress and psychopathology, whereas the mediation effect of adaptive strategies was not significant. The findings provide an evidence that emotional dysregulation is an underlying factor affecting psychological symptoms in refugees with adverse childhood experiences. These results suggest targeting cognitive emotion regulation in prospective prevention and treatment strategies.
Highlights
There is extensive evidence for interdependencies between stress in early childhood and physical[1] as well as mental illnesses such as posttraumatic stress disorder (PTSD), depression, generalised anxiety, panic disorder, social phobia, substance use, and personality disorders across the lifespan[2,3,4,5,6,7].Early life stress is the exposure to single or multiple events during childhood that threaten emotional or physical well-being to the extent, that exceeds the child’sDemir et al Translational Psychiatry (2020)10:371 maltreatment and current depression[11,12]
The mean Generalized Anxiety Disorder-7 (GAD-7) score was 8.75 (±5.02), indicating, on average, mild anxiety in the study sample. 27% of respondents were above the cut-offs for mild, 36% for moderate, and 34.8% for severe generalized anxiety disorder
The mean Childhood Trauma Questionnaire (CTQ) score was 35.31 (±9.76), indicating that participants reported moderate to severe childhood traumatic experiences. 29.5% of respondents reported no history of early life stress, 6.8% reported mild, 22.7% moderate, and 40.9% severe level of early life stress. 26.1% (±2.9) of subjects indicated having experienced emotional abuse, another 20.5% (±2.74) reported physical abuse, and 29.5% (±2.15) sexual abuse. 36.4% (±3.33) of participants reported emotional neglect, and 34.1% (±2.45) experienced physical neglect
Summary
There is extensive evidence for interdependencies between stress in early childhood and physical[1] as well as mental illnesses such as posttraumatic stress disorder (PTSD), depression, generalised anxiety, panic disorder, social phobia, substance use, and personality disorders across the lifespan[2,3,4,5,6,7].Early life stress is the exposure to single or multiple events during childhood that threaten emotional or physical well-being to the extent, that exceeds the child’sDemir et al Translational Psychiatry (2020)10:371 maltreatment and current depression[11,12]. Life stress is the exposure to single or multiple events during childhood that threaten emotional or physical well-being to the extent, that exceeds the child’s. Even though several potential mediators have been identified in the literature so far, research focusing on cognitive emotion regulation as a mediator of the relationship between early life stress and adult symptom presentations is still scarce. Cognitive processes may help us to regulate the emotions, and not to get overwhelmed by them during or after the experience of threatening or stressful events[17]. Previous research showed that trauma, especially enduring or repeated traumatic experiences such as early life stress, seems to compromise the acquisition of appropriate emotion regulation skills[21]. A related study confirms that children who have experienced neglect present less adaptive emotion regulation skills[23]
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