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The Predictive Utility of Trauma Subtypes in the Assessment of Mental Health Outcomes for Persons Resettled as Refugees

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Pre-migration trauma, a psychological risk factor for refugees, is often measured using cumulative indices. However, recent research suggests that trauma subtypes, rather than cumulative trauma, may better predict psychological outcomes. This study investigated the predictive utility of trauma subtypes in the assessment of refugee mental health. Multiple regression was used to determine whether cumulative trauma or trauma subtypes explained more variance in depression, anxiety, and post-traumatic stress disorder (PTSD) symptom scores in 70 Syrian and Iraqi refugees. Subtype models performed better than cumulative trauma models for PTSD (cumulative R2 = 0.138; subtype R2 = 0.32), anxiety (cumulative R2 = 0.061; subtype R2 = 0.246), and depression (cumulative R2 = 0.041; subtype R2 = 0.184). Victimization was the only subtype significantly associated with PTSD (p < 0.001; r2 = 0.210), anxiety (p < 0.001; r2 = 0.162), and depression (p = 0.002; r2 = 0.140). Cumulative trauma was predictive of PTSD symptoms only (p = 0.003; r2 = 0.125). Trauma subtypes were more informative than cumulative trauma, indicating their utility for improving predictive efforts in research and clinical contexts.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.


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The authors would like to thank all the participants who engaged in this research, contributed their data, and shared their stories. The authors would also like to thank Tarek Almasaddi, Heba Al-Saghir, Mohammed Alsaud, Michael Kabbash, Suzanne Manji, Luna Nasry, Dalya Saleem, Safa Sankari, Rajaa Shoukfeh, and Samantha Sonderman for their assistance with data collection and data entry. Many thanks as well to Dr. Alireza Amirsadri and Dr. Luay Haddad. Finally, thank you to the organizations and institutions who have provided financial support for this research—including the State of Michigan Lycaki/Young Foundation and the Department of Psychiatry and Behavioral Neuroscience. Ms. Grasser’s effort is supported by F31MH120927 (PI: Grasser) and Dr. Javanbakht’s effort is supported by R01HD099178 (PI: Javanbakht).


This work was supported by the National Institute of Health (Grant No. R01HD099178) and the National Institute of Mental Health (Grant No. F31MH120927). The funding sources had no involvement in the collection, analysis and interpretation of data; in the writing of the report; nor in the decision to submit the article for publication.

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Authors and Affiliations



LH: Conceptualization, Methodology, Writing—Original draft, Formal analysis; LRG: Writing—Reviewing and Editing, Conceptualization, Investigation, Funding Acquisition; BS: Investigation, Data Curation, Project Administration; KG: Data Curation, Project Administration; FP: Supervision, Writing—Reviewing and Editing; AJ: Conceptualization, Writing—Reviewing and Editing, Funding Acquisition, Investigation, Supervision.

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Correspondence to Liza Marie-Emilie Hinchey.

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The authors have no financial disclosures nor conflicts of interest to report.

Ethical Approval

All study procedures were carried out in accordance with the latest version of the Declaration of Helsinki and approved by the Institutional Review Board at Wayne State University—IRB #012416B3F.

Consent to Participate

Participants were given the opportunity to join a paid, voluntary research study during health screenings at primary care clinics during their first month of resettlement. Interested parties were introduced to the research group by their physician and provided with informed consent documents. All participants included in this analysis provided informed consent prior to any study procedures.

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Hinchey, L.ME., Grasser, L.R., Saad, B. et al. The Predictive Utility of Trauma Subtypes in the Assessment of Mental Health Outcomes for Persons Resettled as Refugees. J Immigrant Minority Health 25, 274–281 (2023).

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