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

## TL;DR

This study shows that ongoing discrimination-based stress in Syrian refugees leads to PTSD and chronic pain, with somatic symptoms making the pain worse.

## Contribution

The study introduces a moderated mediation model showing how PTSD and somatic symptoms link discrimination-based stress to chronic pain in refugees.

## Key findings

- PTSD symptoms mediate the relationship between discrimination-based CTS and chronic pain.
- Somatic symptoms amplify the link between PTSD and chronic pain severity.
- Cultural sensitivity is crucial for addressing trauma-related health outcomes in displaced populations.

## Abstract

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.

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.

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.

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.

Discrimination‐based continuous traumatic stress (CTS) is a critical yet under‐recognized contributor to PTSD and chronic pain among refugees. Practitioners should assess for chronic identity‐based stressors—including ongoing discrimination—as part of a trauma‐informed clinical evaluation.PTSD symptoms serve as a central mechanism linking CTS to chronic pain. Clinicians must be aware that unaddressed PTSD can manifest in physical symptoms, particularly chronic pain.Somatic symptoms significantly amplify the impact of PTSD on chronic pain. In populations where psychological distress is expressed somatically, elevated somatic symptomatology may indicate more severe underlying trauma and pain dysregulation. Practitioners should interpret somatic complaints not merely as physical issues but as potential markers of unresolved trauma.Cultural and contextual sensitivity is essential in clinical encounters. In refugee populations, stigma surrounding mental health may lead individuals to express emotional suffering through bodily symptoms. Clinicians should adopt culturally attuned communication strategies to explore these complaints empathetically and without pathologizing.Integrated care approaches are necessary. Collaborative models involving mental health professionals, primary care providers and community organizations can help address the intertwined psychological, somatic and social needs of forcibly displaced individuals.

Discrimination‐based continuous traumatic stress (CTS) is a critical yet under‐recognized contributor to PTSD and chronic pain among refugees. Practitioners should assess for chronic identity‐based stressors—including ongoing discrimination—as part of a trauma‐informed clinical evaluation.

PTSD symptoms serve as a central mechanism linking CTS to chronic pain. Clinicians must be aware that unaddressed PTSD can manifest in physical symptoms, particularly chronic pain.

Somatic symptoms significantly amplify the impact of PTSD on chronic pain. In populations where psychological distress is expressed somatically, elevated somatic symptomatology may indicate more severe underlying trauma and pain dysregulation. Practitioners should interpret somatic complaints not merely as physical issues but as potential markers of unresolved trauma.

Cultural and contextual sensitivity is essential in clinical encounters. In refugee populations, stigma surrounding mental health may lead individuals to express emotional suffering through bodily symptoms. Clinicians should adopt culturally attuned communication strategies to explore these complaints empathetically and without pathologizing.

Integrated care approaches are necessary. Collaborative models involving mental health professionals, primary care providers and community organizations can help address the intertwined psychological, somatic and social needs of forcibly displaced individuals.