Psychological and endocrine abnormalities in refugees from East Germany: Part I. Prolonged stress, psychopathology, and hypothalamic-pituitary-thyroid axis activity

Psychiatry Res. 1994 Jan;51(1):61-73. doi: 10.1016/0165-1781(94)90047-7.


The influence of prolonged psychological stress on hormonal secretion was investigated in 84 East Germany refugees suffering from psychiatric disorders within 6 weeks of their arrival in West Berlin shortly before or after the fall of the Berlin Wall. Before leaving the German Democratic Republic, these patients had already experienced prolonged stress, which continued after migration. In most cases, the diagnosis was anxious-depressive syndrome with vegetative complaints and symptoms of increased arousal. Their formal DSM-III-R diagnoses (American Psychiatric Association, 1987) included adjustment disorders, depressive disorders, and anxiety disorders (the latter including posttraumatic stress disorder). Serum levels of thyroid stimulating hormone (TSH) and thyroid hormones (thyroxine, free thyroxine, triiodothyronine, and reverse triiodothyronine) were measured and compared with those of 20 healthy control subjects. TSH and all thyroid hormone concentrations were significantly reduced in the patient group. Fifty-two of the patients (62%) were in the hypothyroid range but did not show any clinical signs of hypothyroidism. These disturbances in hormonal secretion were not correlated to any psychiatric diagnosis or to the severity of acute or chronic stress. The marked abnormalities in the hypothalamic-pituitary-thyroid axis seen in these refugees differ from those reported in depression and would seem to reflect severe chronic stress rather than specific psychiatric disorders. The underlying neurochemical mechanisms remain to be investigated.

Publication types

  • Comparative Study

MeSH terms

  • Adjustment Disorders / blood
  • Adjustment Disorders / physiopathology
  • Anxiety Disorders / blood
  • Anxiety Disorders / physiopathology
  • Depressive Disorder / blood
  • Depressive Disorder / physiopathology
  • Germany
  • Germany, East / ethnology
  • Humans
  • Hypothalamo-Hypophyseal System / physiopathology
  • Mental Disorders / blood*
  • Mental Disorders / physiopathology
  • Pituitary-Adrenal System / physiopathology
  • Psychiatric Status Rating Scales
  • Radioimmunoassay
  • Refugees / psychology*
  • Stress Disorders, Post-Traumatic / blood
  • Stress Disorders, Post-Traumatic / physiopathology
  • Stress, Psychological / blood*
  • Stress, Psychological / physiopathology
  • Thyroid Hormones / blood*
  • Thyroid Hormones / physiology
  • Thyrotropin / blood*
  • Thyrotropin / physiology
  • Thyroxine / blood
  • Thyroxine / physiology


  • Thyroid Hormones
  • Thyrotropin
  • Thyroxine