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. 2023 Sep;59(9):1559-1572.
doi: 10.1037/dev0001569. Epub 2023 Jul 6.

Effects of war exposure on pubertal development in refugee children

Candace J Black  1 , Fiona S McEwen  1 , Demelza Smeeth  1 , Cassandra M Popham  1 , Elie Karam  2 , Michael Pluess  1
Affiliations

Effects of war exposure on pubertal development in refugee children

Candace J Black et al. Dev Psychol. 2023 Sep.

Abstract

Increasing research shows pubertal development accelerates following threats while it decelerates following deprivation. Yet, these environmental stressors are unlikely to occur in isolation. We investigated how war exposure and energetic stress impact pubertal development using data from the longitudinal Biological Pathways of Risk and Resilience in Syrian Refugee Children study. Our sample included 1,600 male and female Syrian refugee children and their caregivers who lived in temporary settlements in Lebanon. We hypothesized that (a) energetic stress suppresses pubertal development; (b) war exposure accelerates pubertal timing in boys and increases risk of menarche in girls, but only when energetic stress is low; and (c) when energetic stress is elevated, effects of war exposure on pubertal development will be attenuated. Among boys, we did not find support for Hypothesis 1, but Hypotheses 2 and 3 were supported. Exposure to morbidity/mortality threats accelerated pubertal timing; this effect was attenuated under conditions of elevated energetic stress. Among girls, we found support for Hypothesis 1, but not for Hypotheses 2 and 3. Elevated energetic stress decreased the risk of menarche in girls. Neither war exposure, nor any interactions with energetic stress, predicted risk of menarche. Sensitivity analyses revealed a significant interaction between bombing exposure and the amount of time since leaving Syria. Bombing decreased the risk of menarche, but only for girls who had left Syria four or more years prior to data collection. We discuss implications for translational efforts advocating for puberty screening in medical and mental health settings to identify trauma-exposed youth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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Conflict of interest statement

Disclosures

The authors declare no competing interests or financial support.

Figures

Figure 1.
Figure 1.
Impact of environmental harshness on developmental trajectories. LH = life history. Modified with permission from Ellis et al., 2009.
Figure 2.
Figure 2.
BMI-for-age distributions and baseline descriptive statistics for boys (blue) and girls (red).
Figure 3.
Figure 3.
Final model showing effects of war exposure and energetic stress on pubertal timing in boys.
Figure 4.
Figure 4.
Effect of mortality*BMI-for-age interaction on boys’ pubertal timing in year one.
Figure 5.
Figure 5.
Final model showing effects of war exposure, energetic stress, and time since leaving Syria on risk of menarche in girls.
Figure 6.
Figure 6.
Effect of bombing*time interaction on girls’ risk of menarche.
See this image and copyright information in PMC

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