For many fleeing the violence of war, the most profound scars are invisible. While physical injuries are immediate and obvious, the psychological toll of displacement often remains hidden, making it difficult for healthcare providers to identify who needs the most urgent support. New research suggests that the answer may lie not in what a patient says, but in their hair.
Researchers recently reported at the annual meeting of the American Association of Biological Anthropologists in Denver that hair cortisol can be a more accurate indicator of chronic stress in war refugees than traditional psychological questionnaires. The study focused on approximately 300 women and children who sought refuge in Poland after the Russian invasion of Ukraine in February 2022.
The findings highlight a critical gap in humanitarian aid: the reliance on self-reported data. In high-stress environments, standard questionnaires often fail to distinguish between those experiencing general anxiety and those suffering from the profound, systemic trauma of direct combat exposure. By measuring the biological accumulation of stress hormones, scientists believe they can more effectively triage mental health resources for the most vulnerable.
The biological record of trauma
Cortisol, often called the “stress hormone,” is produced by the adrenal glands in response to pressure or danger. While blood or saliva tests provide a snapshot of a person’s stress level at a single moment, hair acts as a long-term ledger. Given that cortisol is incorporated into the hair shaft as it grows, a small sample can reveal a person’s average stress levels over the preceding three months.
This longitudinal data is vital because of the prevalence of long-term mental health struggles in conflict zones. Estimates suggest that roughly a quarter of people exposed to conflict and violence experience enduring problems, including depression, anxiety, and post-traumatic stress disorder (PTSD).
Grazyna Jasienska, a human biologist at Jagiellonian University in Kraków, Poland, noted that identifying those at the highest risk has been elusive. She observed that standard questionnaires are often not specific enough to the unique experiences of refugee populations, leading to a potential underestimation of the trauma experienced by those who have fled active war zones.
When questionnaires fail to capture the truth
In the study, Jasienska and her team administered questionnaires to adults, older children, and parents of younger children. The surveys were designed to assess the degree of stress experienced during unpredictable and overwhelming situations. However, the results were surprisingly uniform.
The survey data suggested that stress levels were almost identical between two very different groups: those who had been directly exposed to combat or fled Russian-controlled areas, and those who had only been indirectly exposed to the war or lived in Ukrainian-controlled areas.
The biological data told a different story. When the researchers analyzed hair samples, they found that cortisol levels were significantly higher in those with direct exposure to the conflict. This discrepancy suggests that refugees may under-report their stress or that the trauma is so internalized that standard questions cannot trigger an accurate response.
| Exposure Group | Average Cortisol (pg/mg) | Percentage Difference |
|---|---|---|
| Indirect Exposure | 8.6 | Baseline |
| Direct Exposure | 12.5 | +46% |
For children between the ages of 6 and 17, the difference was stark. The direct exposure group showed cortisol levels 46 percent higher than those in the indirect group. As Jasienska stated, “Questionnaires don’t capture this [difference].”
Challenges in biological screening
Despite the promise of hair cortisol testing, the researchers acknowledge that it is not a perfect diagnostic tool. Biological sampling in refugee camps or temporary shelters presents significant logistical hurdles, from maintaining a sterile chain of custody to the high cost of laboratory analysis.
cortisol is not exclusively triggered by psychological trauma. The body releases this hormone during various forms of energy expenditure, including intense physical exercise or systemic illness. This means a high cortisol reading does not automatically equal a diagnosis of PTSD or chronic stress; it indicates a physiological state that requires further clinical investigation.
The goal for the research team is not to replace psychological evaluations but to augment them. By combining biological markers with more refined, refugee-specific questionnaires, clinicians can create a more holistic “picture” of a patient’s health. This dual approach could allow aid organizations to prioritize the most severe cases of chronic stress for immediate therapeutic intervention.
The path toward specialized diagnostics
The next steps for this research involve the development and validation of questionnaires specifically targeted toward the nuances of war refugee experiences. Jasienska has expressed a desire to witness cortisol levels measured among the newly displaced to understand how stress spikes in the immediate aftermath of flight versus the long-term adaptation period in a host country.
As the conflict in Ukraine continues to displace thousands, the ability to rapidly and accurately screen for chronic stress could prevent the long-term degradation of mental health in an entire generation of children. The integration of biological anthropology into humanitarian medicine represents a shift toward “precision” public health, where treatment is tailored to the physiological reality of the patient.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Individuals experiencing symptoms of stress, anxiety, or PTSD should seek professional help from a licensed healthcare provider.
For those currently affected by conflict or experiencing a mental health crisis, support is available through the UNHCR and local mental health services in host countries.
The research team continues to refine their methodology as they seek to publish these findings in peer-reviewed journals. Further updates on the validation of refugee-specific stress tools are expected as the study expands its cohort.
We invite readers to share their thoughts on the use of biological markers in mental health screening in the comments below.
