Kajeen H. Jasim MSc a
Suad Y. Alkass PhD b
Daniele S. Persike PhD b
The Yazidis, an ethnoreligious group living in the Kurdistan Region of Iraq, Syria, Turkey, Azerbaijan, and Armenia, have faced ongoing marginalization and oppression, primarily because of their minority status.1 This mistreatment dates to the time of the Ottoman Empire and has continued into very recent times. One of the most notable events occurred in August 2014, when the Yazidi community in Sinjar, Northern Iraq, was targeted by ISIS.2 The assault by ISIS specifically targeted individuals by gender: men were executed; boys were recruited as child soldiers; and women and girls were subjected to sexual slavery.3, 4, 5 PTSD, the most frequently documented mental health condition among Yazidis, affects an estimated 70%–90% of the population.5 Given their prolonged exposure to numerous traumatic events, many Yazidis are believed to experience complex PTSD.6 The rates of suicide and attempted suicide are alarmingly high within this community.1 However, importantly, these figures are likely to be substantially underestimated because of stigma surrounding mental health.7 In some instances, self-immolation has been reported as a response to the overwhelming feelings of shame associated with sexual violence.8 According to Mann and Marwaha (2020), symptoms of PTSD include flashbacks, nightmares, intrusive thoughts, avoidance of reminders of trauma, and hypervigilance.6,9 The pathophysiology of PTSD is believed to be associated with changes in the brain leading to alterations in the cerebral spinal fluid. PTSD has been shown to alter the coordination of activities such as metabolism, immune response, and stress management by the hypothalamus–pituitary–adrenal (HPA) axis.5 The HPA axis detects stress, releases hormones such as cortisol, and regulates the activities described above.4 In PTSD, the HPA axis may function abnormally, thereby affecting metabolism, the immune response, and stress management, and contributing to PTSD symptoms and health problems. The HPA axis is responsible for the body's stress response, and PTSD is believed to increase HPA axis reactivity.4,7 Several physical symptoms may result, such as headaches, fatigue, and difficulty in concentrating and sleeping.8,9 PTSD can disrupt the brain's regulation of emotions, often because of imbalances in key neurotransmitters such as serotonin and dopamine.9,10 These neurotransmitters play crucial roles in mood and emotion control, and their imbalance can lead to symptoms such as anxiety and depression in individuals with PTSD.4 PTSD exerts profound effects on various physiological and anthropometric parameters.2,6 Anthropometric parameters are frequently used as research tools to assess noncommunicable disease risk factors in populations.11 These parameters include body weight, height, waist circumference (WC), body mass index (BMI), and waist-to-height ratio (WHtR). PTSD is associated with alterations in both physiological and anthropometric measures, thus reflecting the effects of the disorder on the body's stress response system.3,5 Alterations in blood oxygen saturation, heart rate, blood pressure, body weight, height, WC, BMI, and WHtR have been reported to reflect the effects of PTSD on the body's stress response system.[1]

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