Effects of War Exposure on Pubertal Development in Refugee Children

• Published in: Developmental psychology 2023-09, Vol.59 (9), p.1559-1572
• Main Authors: Black, Candace J., McEwen, Fiona S., Smeeth, Demelza, Popham, Cassandra M., Karam, Elie, Pluess, Michael
• Format: Article
• Language: English
• Subjects: Adolescent; Bombing; Caregivers; Child; Child Development; Childhood Development; Children; Children & youth; Deprivation; Early Experience; Exposure; Female; Females; Foreign Countries; Gender Differences; Human; Humans; Male; Medical screening; Menarche; Mental Health; Morbidity; Physiology; Psychological assessment; Puberty; Refugees; Refugees - psychology; Resilience; Resilience (Psychology); Risk Factors; Stress; Stress Variables; Threats; Trauma; Traumatic life events; War; War Exposure
• ISSN: 0012-1649; 1939-0599; 1939-0599
• DOI: 10.1037/dev0001569

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. Public Significance StatementExposure to war and displacement in childhood is a known risk factor for poor health outcomes; however, few studies characterize how these experiences impact pubertal development. We investigated how exposure to war impacts pubertal development in Syrian refugee children living in temporary camps in Lebanon. Energetic stress, or nutrition deprivation, can attenuate effects of war exposure on pubertal development, which limits the utility of solely screening for pubertal development to identify trauma-exposed youth. Puberty research conducted in low-resource settings must account for energetic stress when investigating how adverse exposures impact puberty. Findings from this study highlight a critical need for longitudinal research on pubertal d