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. 2025 Jul-Aug;32(4):e70133.
doi: 10.1002/cpp.70133.

Discrimination-Based Continuous Traumatic Stress, PTSD and Chronic Pain in Syrian Refugees: A Moderated Mediation Analysis

Emre Han Alpay  1 , Ibrahim Aref Kira  2
Affiliations

Discrimination-Based Continuous Traumatic Stress, PTSD and Chronic Pain in Syrian Refugees: A Moderated Mediation Analysis

Emre Han Alpay et al. Clin Psychol Psychother. 2025 Jul-Aug.

Abstract

Purpose: This study aimed to examine the relationships among continuous traumatic stressors (CTS), posttraumatic stress disorder (PTSD), somatic symptoms, and chronic pain in a sample of Syrian refugees. Specifically, we hypothesized that PTSD would mediate the association between discrimination-based CTS and chronic pain and that somatic symptoms would moderate the link between PTSD and chronic pain-such that higher somatic symptom levels would amplify this association.

Materials and methods: A total of 669 Syrian refugees residing in Türkiye participated in the study. Data were collected through face-to-face interviews using validated self-report instruments, including the Patient Health Questionnaire-15 (PHQ-15), the PTSD Checklist for DSM-5 (PCL-5), the Short-Form McGill Pain Questionnaire (SF-MPQ) and the Cumulative Trauma Scale.

Results: PTSD symptoms mediated the relationship between discrimination-based CTS and chronic pain. Additionally, somatic symptoms significantly moderated the association between PTSD and chronic pain, such that individuals with higher levels of somatic symptoms exhibited a stronger link between PTSD symptoms and chronic pain severity.

Conclusion: These findings emphasize the relationship between discrimination-based CTS, psychological distress, and physical complaints among Syrian refugees in Türkiye. While the results provide important insights into trauma-related health outcomes in this group, caution should be exercised in generalizing the findings to all displaced populations. The results highlight the profound impact of prolonged traumatic stress on both psychological and physical health and emphasize the need for trauma-informed, culturally sensitive clinical interventions for displaced individuals.

Keywords: PTSD; chronic pain; continuous traumatic stress; discrimination; somatic symptoms.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Proposed model.
FIGURE 2
FIGURE 2
Moderating effect of somatic symptoms on the PTSD–chronic pain association.
See this image and copyright information in PMC

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