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Principal Investigator: Catherine Panter-Brick (Yale University)


This research assessed the health impact of Advancing Adolescents, a psychosocial intervention of structured, group-based activities for youth affected by the Syria and Iraq crises. This programme is a brief, scalable intervention, implemented by Mercy Corps in Jordan, Lebanon, Iraq, Syria, and Turkey as part of the No Lost Generation initiative.  It is strategic in focusing on adolescence, a key time for protecting the next generation and building its future, and innovative in serving both refugee & host communities.

The  impact evaluation was a randomised controlled trial, measuring the impacts of profound stress attunement for 11-15 year old Syrian refugee and Jordanian youth, living in five urban centers in northern Jordan.  It examined psychosocial, physiological and cognitive outcomes – stress in the mind, the body, and the brain – as well as levels of resilience, at three time-points (pre-intervention, post-intervention, 1-year follow-up).

Youth-focused interventions in humanitarian crises had never previously measured stress alleviation in ways that go beyond subjective self-reports, through measuring ‘stress under the skin’ or ‘toxic stress’ in the brain.  This mixed-method study was the first to do so, including measures of stress biomarkers and tablet-based tests of cognitive function.  Robust scientific assessments are essential in order to inform potential scale up strategies.

Want to know more?

Visit Yale University’s project website to learn more.


The study evaluated two iterations of the Advancing Adolescents programme and assessed:

  • psychosocial outcomes, including mental health, stress, and insecurity
  • biological outcomes, including hair cortisol and immune function;
  • cognitive outcomes, using tablet-based tests of inhibitory control and working memory;
  • levels of individual, relational, and cultural resilience
  • genetic signatures of exposure to war-related trauma

Key Findings

  • A structured approach to stress attunement, implemented by trained community workers can be effective in reducing psychosocial stress and insecurity for war-affected youth;
  • A brief intervention is also effective in regulating stress physiology: cortisol levels were reduced hair cortisol by a third;
  • Culturally-relevant tools such as the Human Insecurity Scale and the Child Youth Resilience Measure are among the most useful for evaluating risk and resilience in humanitarian contexts;
  • A strong partnership between local and international actors is essential to overcome challenges in the field and deliver a robust, ethical, and multi-disciplinary impact evaluation.

The study demonstrated the effectiveness of methods of assessment that go beyond self-reports.  The use of hair cortisol, as a marker of chronic physiological stress, is a compelling indicator of stress regulation, which is an important outcome for crisis-affected populations.

As a result of the study, Mercy Corps has incorporated the key study findings into regional programming, and expanded the inclusion of psychosocial support as part of larger livelihoods interventions in Lebanon, Iraq, Jordan and Palestine.

Mercy Corps has also adopted three Arabic-language tools – the Child Youth Resilience Measure, the Human Insecurity scale and the Strength and Difficulties Questionnaire – in ongoing programming in the Middle East Region, as this study demonstrated their relevance for research monitoring and impact evaluations.

Key Outputs

Play video


Peer Reviewed Mental Health and Psychosocial Support

Measuring the psychosocial, biological, and cognitive signatures of profound stress in humanitarian settings: impacts, challenges, and strategies in the field

Peer Reviewed Mental Health and Psychosocial Support

C-reactive protein, Epstein-Barr virus, and cortisol trajectories in refugee and non-refugee youth: Links with stress, mental health, and cognitive function during a randomised controlled trial

Peer Reviewed Mental Health and Psychosocial Support

Hair cortisol concentrations in war-affected adolescents: A prospective intervention trial

Peer Reviewed Mental Health and Psychosocial Support

Insecurity, distress and mental health: experimental and randomized controlled trials of a psychosocial intervention for youth affected by the Syrian crisis

Peer Reviewed Mental Health and Psychosocial Support

Resilience in Context: A Brief and Culturally Grounded Measure for Syrian Refugee and Jordanian Host-Community Adolescents

Peer Reviewed Mental Health and Psychosocial Support

Association of MAOA genetic variants and resilience with psychosocial stress: A longitudinal study of Syrian refugees

Article Mental Health and Psychosocial Support

What strong partnerships achieve: innovations in research and practice

Article Mental Health and Psychosocial Support

FAAH, SLC6A4, and BDNF variants are not associated with psychosocial stress and mental health outcomes in a population of Syrian refugee youth

Peer Reviewed Mental Health and Psychosocial Support

Minds Under Siege: Cognitive Signatures of Poverty and Trauma in Refugee and Non‐Refugee Adolescents

Team Photo

Latest Updates

Publication in Conflict and Health

Jun 2020

Findings published in Conflict and Health


A Documentary Film by Ron Bourke

Mar 2020

Terror and Hope: The Science of Resilience is a story about children and war.


Yale News

Oct 2019

Study: Poverty, not trauma, affects cognitive function in refugee youth


National Public Radio

Oct 2019

A teen refugee's brain may be disrupted more by poverty than past trauma


Yale News

Jul 2019

Study examines effects of genes and resilience on Syrian refugee youth


Challenges of implementing a rigorous, innovative research methodology in a humanitarian setting: national partner perspectives

Mar 2016

It is one thing to design a research project in a series of meetings between collaborators; it is quite another to implement the resulting program of work in the field


Measuring resilience in Syrian refugee youth

Feb 2016

The youth and community centre in Mafraq we were visiting bore all the familiar hallmarks of facility serving contemporary global youth: poster-bedecked rooms depicting preoccupations with cute animals, music idols…


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