Fleeing one's homeland due to violence and political upheaval is, of course, a harrowing experience, but the discrimination refugees face in their new communities often prolongs and intensifies the trauma, said psychologist Heidi Ellis, PhD, at APA's Annual Convention.

Ellis, who works with refugees at Children's Hospital in Boston, shared her recent study of 144 Somali refugees, age 11 to 20, living in New England. Seventy-eight percent said they had experienced discrimination since coming to the United States, and nearly two-thirds reported post-traumatic stress disorder symptoms. Ellis wanted to find out if these findings were somehow connected.

When she interviewed the teens about their traumatic experiences before and after settling in the United States, several contributing factors showed up: prior exposure to trauma, the stress of resettling, the stress of acclimating and perceived discrimination.

But most surprising, the teens' feelings of discrimination accounted for nearly as much stress as their traumatic experiences.

Some teens reported such verbal taunts as "You are Osama bin Laden" and "Go back to your country." Others reported worse harassment: One 17-year-old described how a group of men showed up at his house, took his father outside and ridiculed and intimidated him. The teen was terrified and reported he didn't know if he'd ever see his father again.

"This would be horrible for anyone, but in the context of someone who has been through a war, where in fact it might be commonplace for people to disappear and never come back, what might this experience be like?" Ellis asked.

Such events can contribute to PTSD symptoms, she explained.

"Refugees, in essence, have fled discrimination that rose to the level of atrocity," Ellis said.

It's important for therapists working with refugees to understand discrimination in that context, Ellis said. Also, while psychologists can't do anything about refugees' pasts, they can help to reduce the stress of resettling and acculturating.

"Trauma exposure can't be undone," Ellis said. "But the social context in which these kids are living can be changed."

Ellis's study was funded by the National Institute of Mental Health and the National Institutes of Health Fogarty International Center. Ellis was invited to speak as part of APA President Alan E. Kazdin's presidential initiative to help treat and prevent PTSD and trauma in children and adolescents.