Comorbidities, both physical and mental, are quite common with PTSD and CPTSD (van der Kolk & McFarlane, 1996). This is especially so among those who have been exposed to significant trauma, including from community violence and war. Hoppen and Morina (2019) conducted a meta-analysis on the comorbidity between PTSD and depression in war survivors worldwide and found that nearly half of those with PTSD also had major depression.
Al-Smadi et al. (2016) found that among Syrian refugees in Jordan, in more than half the participants, chronic diseases were comorbid with PTSD and depression. Chung et al. (2020) found that participants with lower physical health and social health scores had significantly higher rates of posttraumatic stress. Kizilhan (2017) discusses how people from Syria and other collectivistic cultures typically express PTSD through somatic symptoms and chronic pain. Grasser et al. (2020) noted co-morbidities in their sample of Syrian and Iraqi refugees between PTSD, anxiety, and depression. Furthermore, they collected saliva samples from participants and were able to find a correlation between these psychological disorders with higher rates of inflammatory responses, lower immunity, and increased susceptibility to diseases.
Middle Eastern cultures, such as those from Syria, are collectivistic and highly tied to their family groups (Chung et al., 2020; Kizilhan, 2017). As such, an “occurrence of trauma to a family member means trauma to the whole family. In other words, PTSD is a within-and-between-individuals phenomenon for an Arabic family” (Chung et al., 2020 p.6). In most peoples, but especially in those in collectivistic cultures, rely heavily on social networks, which buffer against both physical and mental health problems (Powell et al., 2020). Oppression as experienced by Syrian refugees and internally displaced persons is both individual and collective, and is linked with higher rates of PTSD, CPTSD, poor physical health, higher suicidality, and existential annihilation anxiety (Ibraheem et al., 2017).
References
Al-Smadi, A. M., Halaseh, H. J., Gammoh, O. S., Ashour, A. F., Gharaibeh, B., & Khoury, L. S. (2016). Do chronic diseases and availability of medications predict post-traumatic stress disorder (PTSD) among Syrian refugees in Jordan. Pak J Nutr, 15(10), 936-941.
Chung, M. C., AlQarni, N., AlMazrouei, M., Al Muhairi, S., Shakra, M., Mitchell, B., Al Mazrouei, S., & Al Hashimi, S. (2020). Posttraumatic stress disorder and psychiatric co-morbidity among Syrian refugees: the role of trauma exposure, trauma centrality, self-efficacy and emotional suppression. Journal of mental health (Abingdon, England), 1–9. https://doi.org/10.1080/09638237.2020.1755023
Grasser, L. R., Burghardt, P., Daugherty, A. M., Amirsadri, A., & Javanbakht, A. (2020). Inflammation and Trauma-Related Psychopathology in Syrian and Iraqi Refugees. Behavioral Sciences, 10(4), 75. doi:10.3390/bs10040075
Hoppen, T. H., & Morina, N. (2019). The prevalence of PTSD and major depression in the global population of adult war survivors: a meta-analytically informed estimate in absolute numbers. European journal of psychotraumatology, 10(1), 1578637. https://doi.org/10.1080/20008198.2019.1578637
Al Ibraheem, B., Kira, I. A., Aljakoub, J., & Al Ibraheem, A. (2017). The health effect of the Syrian conflict on IDPs and refugees. Peace and Conflict: Journal of Peace Psychology, 23(2), 140. https://doi.org/10.1037/pac0000247
Kizilhan, J. I. (2018). Trauma and pain in family-orientated societies. International journal of environmental research and public health, 15(1), 44.
Powell, T. M., Shin, O. J., Li, S. J., & Hsiao, Y. (2020). Post-traumatic stress, social, and physical health: A mediation and moderation analysis of Syrian refugees and Jordanians in a border community. PloS one, 15(10), e0241036. https://doi.org/10.1371/journal.pone.0241036
Van der Kolk, B.A. & McFarlane, A.C. (1996). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New York, NY: The Guilford Press.