Psychological distress and coping in breast cancer patients and healthy women whose parents survived the Holocaust

Holocaust centrality, anxiety, and other risk factors associated with terror threat salience among descendants of Holocaust survivors

The study examined risk factors for sensitivity to terror threats among descendants of Holocaust survivors (Holocaust G1) during a significant rise in terrorist attacks in Israel. We examined the association of the number of familial Holocaust G1, trauma exposure, probable posttraumatic stress disorder (PTSD), anxiety symptoms, and Holocaust centrality with terror threat salience (TTS) in children and grandchildren of Holocaust G1 (Holocaust G2; G3). A web-based national sample included 297 Holocaust G2 (Mage=62.95, SD=10.25), 224 comparison G2 (Mage=61.79, SD=10.13), 379 Holocaust G3 (Mage=34.02, SD=8.65) and 171 comparison G3 (Mage=33.55, SD=8.26). Participants completed questionnaires on background characteristics, Holocaust background, trauma exposure, probable PTSD, anxiety symptoms, Holocaust centrality, and TTS. Findings showed that Holocaust G2 and G3 reported higher Holocaust centrality and TTS relative to comparisons, and Holocaust G3 reported higher levels of anxiety than comparison G3. The number of Holocaust G1, background characteristics, Holocaust centrality, and anxiety symptoms were associated with TTS in G2 and G3. Probable PTSD and trauma exposure were also associated with TTS in G2 and G3, respectively. Results highlight Holocaust centrality and anxiety among the factors associated with an increased preoccupation with terror threats in Holocaust descendants. Practitioners should implement interventions focusing on these factors, particularly at times of increased terrorism.

Evil-related threats and mental health concomitants among offspring of Holocaust survivors gay men

OBJECTIVES

In view of the accumulated stress associated with the combination of intergenerational trauma and minority stress, we aimed to examine whether offspring of Holocaust survivors (OHS) reported stronger evil-related threats compared to non-OHS individuals and whether OHS gay men experienced stronger threats. We also examined whether sexual orientation moderated the hypothesized indirect effect of Holocaust background on mental health through evil-related threats.

METHOD

Participants were 346 middle-aged and older Israeli men (mean age = 60.56, SD = 8.42, range 50-86). Among them, 173 identified as gay men, and 81 identified as OHS. Participants completed measures of evil-related threats, depression, and life satisfaction.

RESULTS

Analysis of covariance revealed that OHS men reported stronger evil-related threats compared to non-OHS men. Yet, an interaction between Holocaust background and sexual orientation indicated that OHS gay men reported stronger evil-related threats compared to non-OHS gay men, while no such difference existed among heterosexual counterparts. Conditional indirect effect analysis showed a significant indirect effect, in which Holocaust background related to higher depressive symptoms and lower life satisfaction through evil-related threats among gay men, but not among heterosexual men.

CONCLUSION

This study sheds light on the particular experience of evil-related threats, focusing on older OHS gay men and the mental health vulnerability associated with it. In applied contexts, this might help identify a sexual minority group that is particularly sensitive to adverse mental health and offer it supporting interventions.

Trauma-related and risk factors associated with perceived exacerbation in psychological distress due to the Russo-Ukrainian war

This study examined trauma-related and other potential risk factors associated with perceived exacerbation in psychological distress among Israelis due to the Russo-Ukrainian War. Specifically, we assessed how vulnerability factors such as previous traumatic exposure, having relatives and friends affected by the war, media exposure, having a Holocaust familial background, lower levels of resilience, and probable posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) are associated with perceived exacerbation in psychological distress. A random sample of 845 Israeli Jews aged 18-75 who reported exposure to at least one traumatic event participated in the study. Univariate logistic regression showed that Holocaust familial background, previous exposure to trauma, media exposure to the Russo-Ukrainian War, and probable diagnosis of PTSD or CPTSD are the main factors associated with perceived exacerbation in psychological distress. These results suggest that various traumatic factors associate with perceived higher psychological vulnerability to international conflicts, even when there is no direct personal threat. Practitioners should be aware of these factors among individuals exposed to trauma.

"Help Children Walking on the Right Path": Understanding Parents' and Grandparents' Perceptions on Violence Against Children in Cambodia and Prevention Strategies

This study examined parents' and grandparents' understanding of violence against children (VAC) strategies to prevent VAC in the home. Research questions: What do parents and grandparents understand about VAC? Which child discipline practices are violent? What are strategies to prevent VAC? Participants: 30 parents and grandparents from a small rural community. Six focus group discussions (FGDs) in which participants shared their perceptions and practices relating to child discipline, forms of VAC, and proposed intervention strategies. In two community forums, participants discussed intervention strategies produced in separate FGDs and agreed on three priority strategies. During the FGDs and community meetings, none of the participants ever mentioned any laws, regulations, or government strategies to address VAC in the home. Participants expressed confusion and mixed feelings and responses on forms of VAC. Some agreed on deception, manipulation, intimidation (som lot), threats (Kom ream, harsh words, scolding (je), and physical punishment (i.e., beating or beating with an object) as an unacceptable discipline that would adversely impact children's well-being. Others agreed on cautiously using such disciplines to a certain degree and context. Participants proposed three priority strategies to address VAC in the home, of which two-community awareness and education and community-based efforts-fit with the Cambodia 2017 to 2024 Action Plan Strategies to Prevent and Respond to VAC. The third strategy, addressing alcohol harm-related violence, though not regarded in the 2017 to 2024 Action Plan, was considered pivotal in preventing VAC. Parents and grandparents have a substantial role in child protection at home. Nevertheless, without a clear definition of VAC or articulation of protecting children from violence in the home, it would be challenging to involve parents/grandparents for effective intervention. Participants' three priority strategies have a substantial policy and program implications for Cambodia's primary prevention of VAC action strategy. Community-based mobilization, education, and capacity building need to start and sustain the community.

Event centrality and secondary traumatization among Holocaust survivors' offspring and grandchildren: A three-generation study

The present study examined the intergenerational transmission of the Holocaust trauma in relation to levels of secondary traumatization and event centrality across three generations in a cross-sectional survey. Participants included 92 Holocaust survivor-offspring-grandchild triads (Holocaust G1-G2-G3) and 67 comparison triads (Comparison G1-G2-G3). Holocaust G1 reported higher levels of post-traumatic stress disorder (PTSD) symptoms relative to Comparison G1. Holocaust G2 and G3 reported significantly higher secondary traumatization relative to Comparison G2 and G3, respectively. Holocaust G3 also reported significantly higher scores in event centrality relative to Comparison G3. In survivor families, the indirect effect of PTSD symptoms in Holocaust G1 predicted Holocaust G2's secondary traumatization, which subsequently predicted Holocaust G3's secondary traumatization. Moreover, PTSD symptoms in Holocaust G1 predicted Holocaust G3's event centrality through secondary traumatization in both Holocaust G2 and G3 and event centrality in Holocaust G2. In the comparison groups, trauma transmission was not observed in three generations. Findings elucidate unique intergenerational transmission of the Holocaust trauma in survivor families, which comprise both personal and societal constituents. Moreover, the findings show that event centrality is a distinctive mechanism in intergenerational transmission in survivor families.

Intergenerational consequences of the Holocaust on offspring mental health: a systematic review of associated factors and mechanisms

Exposure to war and violence has major consequences for society at large, detrimental impact on people's individual lives, and may also have intergenerational consequences. To gain more insight into these intergenerational consequences, research addressing the impact of the Holocaust on offspring is an important source of information. The aim of the current study was to systematically review the mechanisms of intergenerational consequences by summarizing characteristics in Holocaust survivors and their offspring suggested to impact the offspring's mental health. We focused on: 1) parental mental health problems, 2) (perceived) parenting and attachment quality, 3) family structure, especially parental Holocaust history, 4) additional stress and life events, and 5) psychophysiological processes of transmission. We identified 23 eligible studies published between 2000 and 2018. Only Holocaust survivor studies met the inclusion criteria. Various parent and child characteristics and their interaction were found to contribute to the development of psychological symptoms and biological and epigenetic variations. Parental mental health problems, perceived parenting, attachment quality, and parental gender appeared to be influential for the mental well-being of their offspring. In addition, having two survivor parents resulted in higher mental health problems compared to having one survivor parent. Also, there was evidence suggesting that Holocaust survivor offspring show a heightened vulnerability for stress, although this was only evident in the face of actual danger. Finally, the results also indicate intergenerational effects on offspring cortisol levels. Clinical and treatment implications are discussed.

Interpersonal vulnerability among offspring of Holocaust survivors gay men and its association with depressive symptoms and life satisfaction

The aim of the current study was to examine whether offspring of Holocaust survivors (OHS) gay men report higher interpersonal vulnerability in comparison to non-OHS gay men, and to further assess whether that vulnerability mediates the association between having a Holocaust background and mental health outcomes (depressive symptoms and life satisfaction). For this purpose, a community-dwelling sample of 79 middle-aged and older OHS and 129 non-OHS gay men completed measures of hostile-world scenario (HWS) in the interpersonal domain, satisfaction from current steady relationship, depressive symptoms and life satisfaction. Results indicated that OHS reported higher HWS interpersonal vulnerability and lower satisfaction from current relationship in comparison to non-OHS gay men. Also, having a Holocaust background had an indirect effect on depressive symptoms and life satisfaction through HWS interpersonal vulnerability as well as through satisfaction from current relationship. These findings are the first to suggest interpersonal vulnerability of older OHS, in comparison to non-OHS, gay men, and an association between this vulnerability and adverse psychological outcomes. This interpersonal vulnerability, possibly representing HWS threats of both early family-based trauma and current sexual minority stress, along with its implications, should be addressed by practitioners who work with older gay men having a Holocaust background.

Shadows of the past and threats of the future: ISIS anxiety among grandchildren of Holocaust survivors

The current study examined intergenerational transmission of trauma in grandchildren of Holocaust survivors. While many typically do not find evidence for such effects, careful reading of the relevant literature suggests conditions under which such effects may be obtained. Following, we made use of three factors. First, we took the number of grandparents exposed to the Holocaust into account. Second, we examined participants who were exposed to present terror and displayed posttraumatic stress disorder (PTSD) symptoms. Third, we measured anxiety of a future ISIS threat, which in its genocidal nature is reminiscent of the Holocaust. Results reveal that grandchildren having all four grandparents who survived the Holocaust in conjunction with them directly experiencing PTSD symptoms demonstrated greater ISIS anxiety than other groups. Results are discussed in reference to various conditions that may determine the likelihood of intergenerational transmission of trauma emerging.

Subjective well-being: gender differences in Holocaust survivors-specific and cross-national effects

OBJECTIVES

Subjective well-being (SWB) has become an important concept in evaluating older adults' quality of life. The cognitive and emotional evaluations which are used to appraise it differ in structure, characteristics, and effects on life. The purpose of this study was to support hypotheses regarding expected Holocaust survivors-specific effects and cross-cultural differences on three indicators of SWB.

METHOD

We recruited samples of 50 male and female Israeli Holocaust survivors, other older Israelis, and older Canadians (N = 300) for allowing us to distinguish survivors-specific effects from cross-national differences. State anxiety, depressive symptoms, and life-satisfaction were compared across groups of men and women. Where univariate differences were detected, post hoc comparisons were computed to determine which of the groups significantly differed.

RESULTS

In general, a higher level of SWB was found among Canadians in comparison to both comparative Israeli groups. Level of depressive symptoms was significantly higher among women survivors than in the other two groups. Both groups of Israeli women had higher scores on anxiety than Canadian Women; less apparent were differences across groups of men. Life-satisfaction did not differ among the groups.

CONCLUSIONS

Our findings regarding depression support the survivor-specific effect hypothesis for women, and a national effect on anxiety, but not any effect on life-satisfaction. These findings suggest significant differences in impacts of traumatic life events on cognitive versus emotional indicators of SWB. This issue should be further investigated due to its practical implications in use of various measures of SWB with people who experienced traumatic events.

Investigation of implicit avoidance of displacement-related stimuli in offspring of trauma exposed, forcibly-displaced individuals

There is an ongoing debate as to whether traumatization also affects the close relatives of trauma survivors who have symptoms of PTSD. Although many studies provide evidence favoring a transgenerational transmission, other studies have not found evidence to support this idea. The present study examined whether adult offspring of individuals exposed to trauma during forced displacement with (n=22) and without PTSD (n=24) exhibit an implicit avoidance of stimuli related to the parental trauma compared to children of non-trauma exposed control participants (n=23) using an Approach-Avoidance task (AAT). Offspring participants were requested to push (i.e., avoidance) or pull (i.e., approach) displacement-related and neutral pictures, whereby response direction depended on a non-affective dimension (color of the pictures). Results suggest that the offspring of non-PTSD participants exhibit implicit avoidance of displacement-related stimuli. This rather unexpected finding might either indicate resilience amongst offspring of PTSD participants or that offspring of non-PTSD participants are particularly affected. If these results were to replicate, they suggest that implicit avoidance tendencies amongst the offspring of trauma exposed participants might partially contribute to their heightened PTSD vulnerability. Longitudinal studies are needed to elucidate whether implicit avoidance tendencies are associated with increased stress vulnerability.

Perceptions of aging among middle-aged offspring of traumatized parents: the effects of parental Holocaust-related communication and secondary traumatization

OBJECTIVES

Traumatized parents may transmit anxieties of physical deterioration and demise to their offspring. These anxieties can amplify negative perceptions of the aging process when the offspring enter old age. The current study examined how middle-aged offspring of Holocaust survivors (OHS) recount trauma-related communication by their parents, and how these reports are related to offspring's perceptions of their aging process.

METHOD

The study included 450 respondents at the age range of 50-67 (mean age = 57.5, SD = 4.6): 300 OHS and 150 comparisons. Participants reported parental communication of the Holocaust, completed measures of subjective successful aging, aging and death anxieties, and reported secondary traumatization assessing symptoms, developed as a result of a close and continuous relationship with a traumatized parent.

RESULTS

Latent profile analysis identified two profiles of parental Holocaust-related communication: intrusive and informative. Offspring who reported intrusive parental communication about the Holocaust perceived themselves as aging less successfully and were more anxious of aging and death than comparisons. Offspring who reported informative parental communication and comparisons did not differ in perceptions of aging. Secondary traumatization mediated these group differences, meaning, intrusive parental communication was related to higher secondary traumatization, which in turn was related to less favorable perceptions of aging.

CONCLUSION

These findings allude to the possibility that secondary traumatization mold negative perceptions of the aging process among middle-aged offspring of traumatized parents. Mental health practitioners may help OHS process fragmented and intrusive remnants of parental trauma, thereby diminishing secondary traumatization, and promoting more adaptive perceptions of aging.

Imaging surveillance programs for women at high breast cancer risk in Europe: Are women from ethnic minority groups adequately included? (Review)

Women from ethnic minority groups, including immigrants and refugees are reported to have low breast cancer (BC) screening rates. Active, culturally-sensitive outreach is vital for increasing participation of these women in BC screening programs. Women at high BC risk and who belong to an ethnic minority group are of special concern. Such women could benefit from ongoing trials aimed at optimizing screening strategies for early BC detection among those at increased BC risk. Considering the marked disparities in BC survival in Europe and its enormous and dynamic ethnic diversity, these issues are extremely timely for Europe. We systematically reviewed the literature concerning European surveillance studies that had imaging in the protocol and that targeted women at high BC risk. The aim of the present review was thereby to assess the likelihood that women at high BC risk from minority ethnic groups were adequately included in these surveillance programs. Twenty-seven research groups in Europe reported on their imaging surveillance programs for women at increased BC risk. The benefit of strategies such as inclusion of magnetic resonance imaging and/or more intensive screening was clearly documented for the participating women at increased BC risk. However, none of the reports indicated that sufficient outreach was performed to ensure that women at increased BC risk from minority ethnic groups were adequately included in these surveillance programs. On the basis of this systematic review, we conclude that the specific screening needs of ethnic minority women at increased BC risk have not yet been met in Europe. Active, culturally-sensitive outreach is needed to identify minority women at increased BC risk and to facilitate their inclusion in on-going surveillance programs. It is anticipated that these efforts would be most effective if coordinated with the development of European-wide, population-based approaches to BC screening.

Depression, not PTSD, is associated with attentional biases for emotional visual cues in early traumatized individuals with PTSD

Using variants of the emotional Stroop task (EST), a large number of studies demonstrated attentional biases in individuals with PTSD across different types of trauma. However, the specificity and robustness of the emotional Stroop effect in PTSD have been questioned recently. In particular, the paradigm cannot disentangle underlying cognitive mechanisms. Transgenerational studies provide evidence that consequences of trauma are not limited to the traumatized people, but extend to close relatives, especially the children. To further investigate attentional biases in PTSD and to shed light on the underlying cognitive mechanism(s), a spatial-cueing paradigm with pictures of different emotional valence (neutral, anxiety, depression, trauma) was administered to individuals displaced as children during World War II (WWII) with (n = 22) and without PTSD (n = 26) as well as to non-traumatized controls (n = 22). To assess whether parental PTSD is associated with biased information processing in children, each one adult offspring was also included in the study. PTSD was not associated with attentional biases for trauma-related stimuli. There was no evidence for a transgenerational transmission of biased information processing. However, when samples were regrouped based on current depression, a reduced inhibition of return (IOR) effect emerged for depression-related cues. IOR refers to the phenomenon that with longer intervals between cue and target the validity effect is reversed: uncued locations are associated with shorter and cued locations with longer RTs. The results diverge from EST studies and demonstrate that findings on attentional biases yield equivocal results across different paradigms. Attentional biases for trauma-related material may only appear for verbal but not for visual stimuli in an elderly population with childhood trauma with PTSD. Future studies should more closely investigate whether findings from younger trauma populations also manifest in older trauma survivors.

Neuropsychological functioning in posttraumatic stress disorder following forced displacement in older adults and their offspring

The aim of the present study was to investigate neuropsychological performance in an untried trauma sample of older adults displaced during childhood at the end of World War II (WWII) with and without posttraumatic stress disorder (PTSD) as well as transgenerational effects of trauma and PTSD on their offspring. Displaced older adults with (n=20) and without PTSD (n=24) and nondisplaced healthy individuals (n=11) as well as one of their respective offspring were assessed with a large battery of cognitive tests (primarily targeting memory functioning). No evidence for deficits in neuropsychological performance was found in the aging group of displaced people with PTSD. Moreover, no group difference emerged in the offspring groups. Findings may be interpreted as first evidence for a rather resilient PTSD group of older adults that is available for assessment 60 years after displacement.

Parental styles in second generation effects of genocide stemming from the Khmer Rouge regime in Cambodia

This study examined the impact of parental styles on second generation effects of trauma among adolescent offspring of survivors of the Khmer Rouge (KR) genocide in Cambodia. Two hundred high school students completed measures addressing their parents' trauma stemming from the KR regime, parental styles (role reversing, overprotective), depression and anxiety. Parents' role reversing parental style and mothers' overprotective parenting were shown to mediate the impact of their trauma symptoms on the child's depression and anxiety. The implications of the findings are discussed.

The impact of stressors on second generation Indian Residential School survivors

From 1863 to 1996, many Aboriginal children in Canada were forced to attend Indian Residential Schools (IRSs), where many experienced neglect, abuse, and the trauma of separation from their families and culture. The present study examined the intergenerational impact of IRS exposure on depressive symptomatology in a convenience sample of 143 First Nations adults. IRS experiences had adverse intergenerational effects in that First Nations adults who had a parent attend IRS (n = 67) reported greater depressive symptoms compared to individuals whose parents did not attend (n = 76). Parental IRS attendance moderated the relations between stressor experiences (adverse childhood experiences, adult traumas, and perceived discrimination) and depressive symptoms, such that second generation Survivors exhibited greater symptomatology. Adverse childhood experiences partially mediated the relation between parental IRS attendance and both adult trauma and perceived discrimination. Moreover, both of these adulthood stressors partially mediated the relation between adverse childhood experiences and depressive symptoms. Finally, all three stressors demonstrated a unique mediating role in the relation between parental IRS attendance and depressive symptoms. Although alternative directional paths could not be ruled out, offspring of IRS Survivors appeared at increased risk for depression, likely owing to greater sensitivity to and experiences of childhood adversity, adult traumas, and perceived discrimination.

Transgenerational effects of trauma in midlife: Evidence for resilience and vulnerability in offspring of Holocaust survivors

Despite abundant research on offspring of Holocaust survivors (OHS), it is relatively unknown how they function in middle age. Transgenerational effects of the Holocaust may be stronger among middle-aged OHS as they previously suffered from early inclement natal and postnatal environment and now face age-related decline. However, middle-aged OHS may successfully maintain the resilience they demonstrated at a younger age. This study performed a wide-spectrum functional assessment of middle-aged OHS and a comparison group (N = 364) drawn from the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel). OHS, and especially those with two survivor parents, reported a higher sense of well-being but more physical health problems than the comparison group. The discussion provides possible explanations for this mixed functional profile. (PsycINFO Database Record

Traumatic stress symptoms and breast cancer: the role of childhood abuse

OBJECTIVE

The present study investigated relations between reported childhood abuse and recent traumatic stress symptoms in women newly diagnosed with breast cancer (n=330).

METHODS

As part of a larger ongoing study, patients from eight public and private hospitals were referred by their physicians and completed the Childhood Trauma Questionnaire (CTQ), and the Impact of Events Scale-breast cancer (IES), which measured breast cancer-related intrusive and avoidant symptoms.

RESULTS

Emotional abuse, physical abuse, and sexual abuse were correlated with intrusive symptoms. Cancer-related avoidant symptoms approached significance in their relation to emotional and sexual abuse. Multivariate analysis, controlling for age and time since diagnosis, revealed that childhood emotional abuse was an independent predictor of breast cancer-related intrusive symptoms, but that childhood physical abuse and sexual abuse were not significant predictors.

CONCLUSIONS

Childhood emotional, physical, and sexual abuse were associated with breast cancer-related intrusive symptoms. Emotional abuse uniquely predicted intrusive symptoms after controlling for other predictors. Results suggest that a cancer diagnosis may trigger cognitive and emotional responses that relate to patients' prior trauma experiences.

PRACTICE IMPLICATIONS

Physicians and psychologists treating women with breast cancer should be aware that a history of childhood abuse may exacerbate patients' cancer-related intrusive symptoms. Interventions for women affected by both childhood abuse and breast cancer may be most effective when they address both stressors and associated emotional responses. Findings highlight the importance of additional research to explore links between prior trauma and distress following a cancer diagnosis stress.

A cross-sectional study of the psychosexual impact of cancer-related infertility in women: third-party reproductive assistance

INTRODUCTION

This study empirically assessed emotional and sexual functioning, reproductive concerns, and quality of life (QOL) of cancer-related infertile women in comparison to those without a cancer history and explored awareness of third-party reproduction options in cancer survivors.

METHODS

One hundred twenty-two cancer survivors (Gynecologic and Bone Marrow/Stem Cell Transplant) with cancer-related infertility and 50 non-cancer infertile women completed a self-report survey assessing: reproductive concerns (RCS), mood (CES D), distress (IES), sexual function (FSFI), menopause (SCL), QOL (SF 12), relationships (ADAS), and exploratory (reproductive options) items.

RESULTS

Cancer survivors exhibited greater sexual dysfunction and lower physical QOL than non-cancer infertile women (P < 0.001). No significant group differences were identified for mood (CES-D), mental health QOL (SF-12), reproductive concerns (RCS), and relationship satisfaction (ADAS). All groups scored in the FSFI range of sexual dysfunction, and with RCS scores above published means. Multivariate comparisons showed comparable depression and distress levels for all groups, but cancer survivors had poorer physical QOL [F(5,146)=4.22, P < 0.01]. A significant effect was also found for knowledge of third-party reproductive options on depression and distress levels [F(3,97)=4.62,P < 0.01]. Adjusted means demonstrated higher depression and distress scores for women with perceived unmet informational needs.

CONCLUSIONS

Overall, loss of fertility was an emotionally challenging experience for women regardless of its cause. Cancer survivors were found to have lower scores of physical QOL and sexual function than non-cancer infertile women. Unmet informational needs about reproductive options appeared to be associated with negative mood and increased distress in cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Targeted interventions to increase knowledge about reproductive options could be of great assistance to women pursuing parenthood in cancer survivorship. Additionally, intervention studies to improve sexual functioning and QOL in women with cancer-related infertility should be a priority of future research.

Loss of resources as mediators between interpersonal trauma and traumatic and depressive symptoms among women with cancer

We hypothesized that loss of interpersonal, financial and work resources would mediate the relationship between physical and sexual abuse, cancer-related Posttraumatic Stress Disorder (PTSD) symptoms, noncancer-related PTSD symptoms and depressive mood among women with cancer. Participants were 64 women with heterogeneous cancers (64.1% breast cancer) seeking outpatient treatment. Structured interviews were conducted to assess for pre-cancer interpersonal trauma, recent loss of interpersonal, financial and work resources, cancer-related PTSD symptoms, noncancer-related PTSD symptoms and depressive mood. Only interpersonal loss mediated the relationship between earlier interpersonal trauma and current PTSD symptoms and depressive mood. Implications of the findings are discussed.

Breast cancer and psychological distress: mothers' and daughters' traumatic experiences

GOAL OF WORK

The objective of this exploratory retrospective study was to assess the effects of breast cancer diagnosis upon the psychological distress of adult breast cancer patients and their mothers, particularly mothers who experienced past trauma.

MATERIALS AND METHODS

Four groups of mother-daughter dyads were evaluated using self-reporting measures of psychological distress [Brief Symptom Inventory (BSI)], familial support (PFS), and adjustment to cancer (MAC, IES): breast cancer patients whose mothers were Holocaust survivors (group 1), breast cancer patients with non-traumatized mothers (group 2), healthy daughters of Holocaust survivor mothers (group 3), and a control group of healthy daughters with non-traumatized mothers (group 4).

MAIN RESULTS

Distress levels of both mothers and daughters in group 1 were significantly higher than distress levels of mothers and daughters in the other three groups. Daughters' distress levels in all four groups were found to be significantly related to mothers' distress levels, with the highest correlation found in both groups of cancer patients. The factors of having a clinically distressed mother and being a second-generation daughter contributed the most to predicting the clinical distress of the daughter.

CONCLUSIONS

The outcomes imply that the mother's traumatic past intensifies the distressing effect of cancer diagnosis upon both the patient and her mother. The findings concerning the impact of cancer diagnosis upon the patients' non-traumatized mothers were more ambiguous. The results support the idea that in the case of breast cancer patients, a complete psychological evaluation must include not only spouses and children but also the familial background of the patient and the history of the patients' mothers.