Trajectories of post-traumatic stress disorder symptoms and risk-protective factors in recently resettled refugees in the United States

Abstract

Background:

Refugees face elevated risks of post-traumatic stress disorder (PTSD) due to exposure to acute and chronic potentially traumatic events (PTEs) pre-, during, and post-migration. Early resettlement is a period of profound transition, marked by reduced acute trauma exposures but heightened chronic and daily stressors. Despite this, limited longitudinal research has examined PTSD symptom trajectories during the initial years of resettlement.

Purpose:

This study aimed to: (1) identify PTSD symptom trajectory subgroups using latent class trajectory modeling (LCTM), and (2) examine sociodemographic (e.g., age, sex, nationality) and psychosocial (e.g., social support, quality of life) factors influencing trajectory group membership through multilevel multinomial logistic regression (MMLR).

Method:

Data were drawn from a longitudinal randomized controlled trial (RCT) evaluating a mental health intervention for 290 refugees (143 households) from Afghanistan, Iraq, Syria, and the Great Lakes region of Africa. LCTM analyzed PTSD symptoms across four timepoints (TP), and MMLR analyses utilized the R package mclogit.

Results:

A five-class cubic latent model best fit the data. The reference group (n = 205) demonstrated low PTSD symptom levels over time. The remaining groups were: Group 2: Decreasing slope of PTSD symptoms over time (starting high) (n = 28); Group 3: High PTSD symptoms maintained over time (n = 21); Group 4: Inverse U-shape with moderate-to-high-to-low PTSD symptoms (n = 11); Group 5: Low-to-moderate PTSD symptoms with slight increase at TP3 (n = 25). MMLR revealed that social support, quality of life, culturally-specific distress, depression symptoms, age, and sex were key predictors of trajectory group membership.

Conclusion:

Distinct PTSD symptom trajectories were identified, with 18% of participants exhibiting concerning patterns. These findings underscore the importance of targeted interventions addressing social support, mental health, and contextual factors at individual, clinical, and policy levels to aid refugee resettlement.