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Review
. 2023 Feb 16:3:1066158.
doi: 10.3389/fepid.2023.1066158. eCollection 2023.

Exposure to war and conflict: The individual and inherited epigenetic effects on health, with a focus on post-traumatic stress disorder

Zara Raza  1   2   3 , Syeda F Hussain  1   2 , Victoria S Foster  1   2   4 , Joseph Wall  3   5 , Peter J Coffey  6 , John F Martin  7 , Renata S M Gomes  1   2   8
Affiliations
Review

Exposure to war and conflict: The individual and inherited epigenetic effects on health, with a focus on post-traumatic stress disorder

Zara Raza et al. Front Epidemiol. .

Abstract

War and conflict are global phenomena, identified as stress-inducing triggers for epigenetic modifications. In this state-of-the-science narrative review based on systematic principles, we summarise existing data to explore the outcomes of these exposures especially in veterans and show that they may result in an increased likelihood of developing gastrointestinal, auditory, metabolic and circadian issues, as well as post-traumatic stress disorder (PTSD). We also note that, despite a potential "healthy soldier effect", both veterans and civilians with PTSD exhibit the altered DNA methylation status in hypothalamic-pituitary-adrenal (HPA) axis regulatory genes such as NR3C1. Genes associated with sleep (PAX8; LHX1) are seen to be differentially methylated in veterans. A limited number of studies also revealed hereditary effects of war exposure across groups: decreased cortisol levels and a heightened (sex-linked) mortality risk in offspring. Future large-scale studies further identifying the heritable risks of war, as well as any potential differences between military and civilian populations, would be valuable to inform future healthcare directives.

Keywords: PTSD; conflict; epigenetics; healthy soldier effect; inherited epigenetics; stress; trauma; war.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Epigenetic effects from exposure to war and conflict. Upon the individual: decreased cortisol, mortality* and sleep quality/quantity; increased mortality, PTSD, noradrenaline**, tinnitus, immune dysfunction, Alzheimer's disease**, obesity, anxiety, depression, gastrointestinal ulcers and IBS in children exposed to war. Inherited: decreased cortisol and mortality*, and increased risk of PTSD but also resilience. Noted are genes (and the microRNA miR-125a where expression is altered) that are associated with these pathologies and may occur differentially methylated and/or expressed. *Decreased mortality, potentially as a confounding “healthy solider effect”. **Increased risk only in individuals with PTSD. IBS, irritable bowel syndrome; PTSD, post-traumatic stress disorder.
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