Refugees are exposed to multiple traumatic events and postmigration stressors, elevating risk for posttraumatic stress disorder (PTSD), but there is limited research into how these factors affect emotional neural systems. Here, resettled refugees in Australia (N = 85) completed a functional magnetic resonance imaging scan while viewing fear and neutral faces. We examined the influence of PTSD symptoms, cumulative trauma, and recent postmigration stress on neural reactivity and regional coupling within the refugee sample. Cumulative trauma and postmigration stress but not PTSD symptoms correlated with fear-related brain activity and connectivity. Trauma exposure correlated with stronger activity but overall decreased connectivity in the bilateral posterior insula/rolandic operculum, postcentral gyrus, ventral anterior cingulate cortex, and posterior cingulate gyrus. Postmigration stress correlated with fusiform gyrus hyperactivity and increased connectivity in face-processing networks. Findings highlight the impact of past trauma and recent postmigration stress on fear-related neural responses within refugees over and above PTSD symptoms.
AbbottA. (2016). The troubled minds of migrants. Nature, 538, 158–161.
2.
AdenauerH.PinöschS.CataniC.GolaH.KeilJ.KißlerJ.NeunerF. (2010). Early processing of threat cues in posttraumatic stress disorder—Evidence for a cortical vigilance-avoidance reaction. Biological Psychiatry, 68, 451–458.
3.
AkdenizC.TostH.StreitF.HaddadL.WustS.SchaferA.. . . Meyer-LindenbergA. (2014). Neuroimaging evidence for a role of neural social stress processing in ethnic minority-associated environmental risk. JAMA Psychiatry, 71, 672–680. doi:10.1001/jamapsychiatry.2014.35
4.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
5.
AupperleR. L.AllardC. B.GrimesE. M.SimmonsA. N.FlaganT.BehroozniaM.. . . SteinM. B. (2012). Dorsolateral prefrontal cortex activation during emotional anticipation and neuropsychological performance in posttraumatic stress disorder. Archives of General Psychiatry, 69, 360–371.
6.
BeaupréM. G.HessU. (2005). Cross-cultural emotional recognition among Canadian ethnic groups. Journal of Cross-Cultural Psychology, 36, 355–370.
7.
BryantR. A.KempA. H.FelminghamK. L.LiddellB.OlivieriG.PedutoA.. . . WilliamsL. M. (2008). Enhanced amygdala and medial prefrontal activation during nonconscious processing of fear in posttraumatic stress disorder: An fMRI study. Human Brain Mapping, 29, 517–523.
8.
CarlssonJ. M.SonneC.SiloveD. (2014). From pioneers to scientists: Challenges in establishing evidence-gathering models in torture and trauma mental health services for refugees. Journal of Nervous and Mental Disease, 202, 630–637.
9.
CraigA. D. (2009). How do you feel now? The anterior insula and human awareness. Nature Neuroscience, 10, 59–70.
10.
DerogatisL. R.LipmanL. S.RickelsK.UhlenhuthE. H.CoviL. (1974). The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behavioral Science, 19, 1–15.
11.
FelminghamK.WilliamsL. M.KempA. H.LiddellB.FalconerE.PedutoA.BryantR. (2010). Neural responses to masked fear faces: Sex differences and trauma exposure in posttraumatic stress disorder. Journal of Abnormal Psychology, 119, 241–247.
12.
FoaE.RiggsD.DancuC.RothbaumB. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 6, 459–474.
13.
FoaE.TolinD. F. (2000). Comparison of the PTSD Symptom Scale-Interview Version and the Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 13, 181–191.
14.
FonzoG. A.SimmonsA. N.ThorpS. R.NormanS. B.PaulusM. P.SteinM. B. (2010). Exaggerated and disconnected insular-amygdalar blood oxygenation level-dependent response to threat-related emotional faces in women with intimate-partner violence posttraumatic stress disorder. Biological Psychiatry, 68, 433–441.
15.
HartA. J.WhalenP. J.ShinL. M.McInerneyS. C.FischerH.RauchS. L. (2000). Differential response in the human amygdala to racial outgroup vs ingroup face stimuli. NeuroReport, 11, 2351–2355.
16.
HerringaR.PhillipsM.AlmeidaJ.InsanaS.GermainA. (2012). Post-traumatic stress symptoms correlate with smaller subgenual cingulate, caudate, and insula volumes in unmedicated combat veterans. Psychiatry Research, 203, 139–145. doi:10.1016/j.pscychresns.2012.02.005
17.
LaniusR. A.FrewenP. A.TursichM.JetlyR.McKinnonM. C. (2014). Restoring large-scale brain networks in PTSD and related disorders: A proposal for neuroscientifically-informed treatment interventions. European Journal of Psychotraumatology, 6, 27313. doi:10.3402/ejpt.v6.27313
18.
LaniusR. A.RabellinoD.BoydJ. E.HarricharanS.FrewenP. A.McKinnonM. C. (2017). The innate alarm system in PTSD: conscious and subconscious processing of threat. Current Opinion in Psychology, 14, 109–115.
19.
LapateR. C.RokersB.TrompD. P.OrfaliN. S.OlerJ. A.DoranS. T.. . . DavidsonR. J. (2016). Awareness of emotional stimuli determines the behavioral consequences of amygdala activation and amygdala-prefrontal connectivity. Scientific Reports, 6, 25826. doi:10.1038/srep25826
20.
LiS. S.LiddellB. J.NickersonA. (2016). The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Current Psychiatry Reports, 18(9), 82. doi:10.1007/s11920-016-0723-0
21.
LiberzonI.AlbelsonJ. L. (2016). Context processing and the neurobiology of post-traumatic stress disorder. Neuron, 92, 14–30.
22.
LiddellB. J.NickersonA.BryantR. A. (2018). Clinical science and torture survivors’ right to rehabilitation. Lancet Psychiatry, 5, 102–103.
23.
MazaikaP.HoeftF.GloverG. H.ReissA. L. (2009, June). Methods and software for fMRI analysis for clinical subjects. Paper presented at the 15th Annual Meeting of the Organization for Human Brain Mapping, San Francisco, CA.
24.
McDonnellM.RobjantK.KatonaC. (2013). Complex posttraumatic stress disorder and survivors of human rights violationsCurrent Opinion in Psychiatry, 26, 1–6. doi:10.1097/YCO.0b013e32835aea9d
25.
MillerK. E.RasmussenA. (2010). War exposure, daily stressors and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworksSocial Science & Medicine, 70, 7–16.
26.
MillerK. E.RasmussenA. (2017). The mental health of civilians displaced by armed conflict: An ecological model of refugee distress. Epidemiology and Psychiatric Sciences, 26, 129–138. doi:10.1017/S2045796016000172
27.
MollicaR.Caspi-YavinY.BolliniP.TruongT.TorS.LavelleJ. (1992). The Harvard Trauma Questionnaire; validating a cross cultural instrument for measuring torture, trauma, and post-traumatic stress disorder in Indochina refugees. Journal of Nervous and Mental Disease, 180, 111–116.
28.
MoserD. A.AueT.SuardiF.KutlikovaH.CorderoM. I.RossignolA. S.. . . SchechterD. S. (2015). Violence-related PTSD and neural activation when seeing emotionally charged male–female interactions. Social Cognitive and Affective Neuroscience, 10, 645–653.
29.
NickersonA.GarberB.LiddellB. J.LitzB. T.HofmannS. G.AsnaaniA.. . . BryantR. A. (2017). Impact of cognitive reappraisal and emotion suppression on affect, heart rate and intrusive memories in traumatized refugeesClinical Psychological Science, 5, 497–512.
PorgesS. W. (2007). The polyvagal perspective. Biological Psychology, 74, 116–143.
32.
RauchS. L.WhalenP. J.ShinL. M.McInerneyS. C.MacklinM. L.LaskoN. B.. . . PitmanR. K. (2000). Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: A functional MRI study. Biological Psychiatry, 47, 769–776.
33.
SchweitzerR.MelvilleF.SteelZ.LacherezP. (2006). Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Australian and New Zealand Journal of Psychiatry, 40, 179–188. doi:10.1111/j.1440-1614.2006.01766.x
34.
SethA. K.FristonK. J. (2016). Active interoceptive inference and the emotional brain. Philosophical Transactions of the Royal Society B: Biological Sciences, 371(1708). doi:10.1098/rstb.2016.0007
35.
SiloveD.VentevogelP.ReesS. (2017). The contemporary refugee crisis: An overview of mental health challenges. World Psychiatry, 16, 130–139.
36.
SimmonsA. N.PaulusM. P.ThorpS. R.MatthewsS. C.NormanS. B.SteinM. B. (2008). Functional activation and neural networks in women with posttraumatic stress disorder related to intimate partner violence. Biological Psychiatry, 64, 681–690.
37.
SinnerbrinkI.SiloveD.FieldA.SteelZ.ManicavasagarV. (1997). Compounding of premigration trauma and postmigration stress in asylum seekers. Journal of Psychology, 131, 463–470.
38.
SongX.-W.DongZ.-Y.LongX.-Y.LiS.-L.ZuoX.-N.ZhuC.-X.. . . ZangY.-F. (2011). REST: A toolkit for resting-state functional magnetic resonance imaging data processing. PLOS ONE, 6(9), Article e25031. doi:10.1371/journal.pone.0025031
39.
StarkE. A.ParsonsC. E.Van HarteveltT. J.Charquero-BallesterM.McMannersH.EhlersA.. . . KringelbachM. L. (2015). Post-traumatic stress influences the brain even in the absence of symptoms: A systematic, quantitative meta-analysis of neuroimaging studies. Neuroscience & Biobehavorial Reviews, 56, 207–221. doi:10.1016/j.neubiorev.2015.07.007
40.
SteelZ.CheyT.SiloveD.MarnaneC.BryantR. A.von OmmerenM. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. Journal of the American Medical Association, 302, 537–549.
41.
SteelZ.MomartinS.SiloveD.CoelloM.ArocheJ.TayK. W. (2011). Two year psychosocial and mental health outcomes for refugees subjected to restrictive or supportive immigration policies. Social Science & Medicine, 72, 1149–1156.
42.
SteelZ.SiloveD.BirdK.McGorryP.MohanP. (1999). Pathways from war trauma to posttraumatic stress symptoms among Tamil asylum seekers, refugees, and immigrants. Journal of Traumatic Stress, 12, 421–435. doi:10.1023/A:1024710902534
43.
SteinD.HeY.PhillipsA.SahakianB. J.WilliamsJ.PatelV. (2015). Global mental health and neuroscience: potential synergies. Lancet Psychiatry, 2, 178–185.
44.
StevensJ. S.JovanovicT.FaniN.ElyT. D.GloverE. M.BradleyB.ResslerK. J. (2013). Disrupted amygdala-prefrontal functional connectivity in civilian women with posttraumatic stress disorder. Journal of Psychiatric Research, 47, 1469–1478.
45.
SuvakM. K.BarrettL. F. (2011). Considering PTSD from the perspective of brain processes: A psychological construction approach. Journal of Traumatic Stress, 24, 3–24.
46.
TeicherM. H.SamsonJ. A.AndersonC. M.OhashiK. (2016). The effects of childhood maltreatment on brain structure, function and connectivity. Nature Reviews Neuroscience, 17, 652–666. doi:10.1038/nrn.2016.111
47.
ThomaesK.DorrepaalE.DraijerN.de RuiterM. B.ElzingaB. M.SjoerdsZ.. . . VeltmanD. J. (2013). Increased anterior cingulate cortex and hippocampus activation in complex PTSD during encoding of negative words. Scan, 8, 190–200.
48.
TsakirisM.CritchleyH. (2016). Interoception beyond homeostasis: affect, cognition and mental health. Philosophical Transactions of the Royal Society B: Biological Sciences, 371(1708). doi:10.1098/rstb.2016.0002
49.
Tzourio-MazoyerN.LandeauB.PapathanassiouD.CrivelloF.EtartO.DelcroixN.. . . JoliotM. (2002). Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. NeuroImage, 15, 273–289.
van MarleH. J. F.HermansE. J.QinS.FernándezG. (2009). From specificity to sensitivity: How acute stress affects amygdala processing of biologically salient stimuli. Biological Psychiatry, 66, 649–655.
52.
WagerT. D.GianarosP. J. (2014). The social brain, stress, and psychopathology. JAMA Psychiatry, 71, 622–624. doi:10.1001/jamapsychiatry.2014.288
53.
WilliamsL. M.KempA. H.FelminghamK.BartonM.OlivieriG.PedutoA.. . . BryantR. A. (2006). Trauma modulates amygdala and medial prefrontal responses to consciously attended fear. NeuroImage, 29, 347–357.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
