Transgenerational transmission of trauma in families of Holocaust survivors: the consequences of extreme family functioning on resilience, sense of coherence, anxiety and depression

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.

The Long-Term Effects of Living in a Shared and Continuous Traumatic Reality: The Case of Israeli Families on the Border With Gaza

This article presents a literature review of the concept of intergenerational transmission of traumatic stress among a specific population of Israeli parents and children living near the Israeli/Gaza border, an area that can essentially be viewed as a laboratory of shared, continuous, and stressful reality resulting from ongoing political violence. The Google Scholar database was used to search only for peer-reviewed articles written in English and published between 2002 and 2020, and the particular focus of the study was Israeli families living in the "Gaza envelope": communities that have been on the receiving end of rockets and mortars from Gaza for the past 20 years. The review was based on 35 articles and sheds light on the existence of studies using a variety of perspectives (e.g., psychological, biopsychosocial, and behavioral). Findings demonstrate the effects of continuous stress situations on the family dynamic, even before birth, among this small population. In addition, they show that to understand the unique process of intergenerational trauma transmission in a shared continuous traumatic reality, it is important to adopt a comprehensive perspective so as to understand the reciprocal, long-lasting, and transgenerational effects of being exposed to traumatic stress. This perspective can be used as a basis for developing family intervention strategies that are appropriate for preventing stress outcomes that derive from living in the context of persistent violence.

Associations of childhood neglect, difficulties in emotion regulation, and psychological distresses to COVID-19 pandemic: An intergenerational analysis

BACKGROUND

Although individuals' psychological responses to trauma are varied, significant associations between parental and offspring's reactions have been documented among trauma-exposed families. Common susceptible factors originated from intergenerational transmission may be underlying mechanisms of this phenomenon.

OBJECTIVE

This study aimed to investigate the intergenerational transmission of depression and anxiety during early outbreak of COVID-19 and further examined whether the transmission of child neglect and difficulties in emotion regulation (ER) was associated with the transmission of psychological distresses.

METHODS

Self-reported questionnaires of depression, anxiety, COVID-19 related worries, difficulties in ER, physical and emotional neglect suffered in childhood were completed by 2011 Chinese parent - offspring dyads. Path analysis was used to examine hypothesized relationships.

RESULTS

The proportions of physical neglect and emotional neglect were 31.2% and 16.9% respectively among parents, while 28.6% and 20.8% respectively among offspring. There were remarkably similar in response patterns between parents and offspring. Parents' COVID-19 related worries, depression and anxiety levels were significantly associated with offspring's COVID-19 related worries, depression and anxiety. Difficulties in ER not only impacted psychological distresses directly, but also mediated the relationships between childhood neglect and psychological distresses among both parents and offspring. Difficulties in ER and childhood neglect, as important risk factors, were modestly transmitted from parent to offspring.

CONCLUSIONS

Family members shared a certain degree of similarity in psychological reactions to trauma. Transmitted susceptible factors from parents to offspring may contribute to this similarity. Family therapy may be suitable for family members exposed to the same traumatic events.

Advocating for a Collaborative Research Approach on Transgenerational Transmission of Trauma

Since Myers (1915) coined the term 'shell shock' to define the prolonged suffering of soldiers returning from the Great War, the psychological and physical result of distressing experiences, known as trauma, has been of academic interest. Transgenerational transmission of trauma effects has been recorded, demonstrating that on some level, the exposure to trauma of one generation can impact individuals of a subsequent generation (Yehuda & Lehrner, 2018). Observational studies on children of holocaust survivors formed the basis of this trajectory of research (Rakoff, 1966), and eventually this phenomenon became referred to as the transgenerational transmission of trauma (TTT). Since then, TTT has been observed in several contexts, including within families who have experienced high rates historical trauma (O'Neill et al., 2016), within regions high-frequencies of historical war and terrorism (Yehuda & Lehrner, 2018) and those who have undergone famine (Ahmed, 2010). This report aims to outline several pathways (biological, psychological, and sociological) by which trauma may be transmitted across generations. Moreover, it discusses several methods of trauma assessment and the related challenges and benefits. Lastly, this report advocates a biopsychosocial approach - an interdisciplinary model using the interplay of biological, psychological, and social-environmental factors - to research TTT. By promoting the benefits of such an interdisciplinary approach we attempt to break up silos between disciplines and encourage collaboration between academics from various backgrounds researching this topic to better serve individuals impacted by TTT.

Experience of children growing up with a parent who has military-related post-traumatic stress disorder: a qualitative systematic review

OBJECTIVE

The objective of this review is to describe the experiences of children growing up in military families whose parents have military-related post-traumatic stress disorder.

INTRODUCTION

Whether serving as a peacekeeper or warrior, military service is both physically and psychologically demanding, increasing exposures to potentially traumatic and morally injurious events and threats to personal safety. Those who have served in the military are at increased risk for developing post-traumatic stress disorder, which includes symptoms such as emotional numbing, withdrawal, and hyperarousal. Research has focused on the experiences of and impacts on spouses and partners of military veterans with post-traumatic stress disorder, with quantitative and synthesis studies reporting on measurable impacts on children growing up in military families where a parent is diagnosed with post-traumatic stress disorder.

INCLUSION CRITERIA

This review included children who are or have grown up in military families in domestically peaceful nations that deploy their armed forces to global locations of political instability, armed civil conflict, and/or natural disasters for the purposes of peacekeeping, humanitarian aid, or war, as well as parents living with post-traumatic stress disorder who speak specifically about the experience of their children. Situations of homeland conflict were excluded. The military families of interest are those with one or more parent having a diagnosis of post-traumatic stress disorder associated with military service. Traumatic experiences leading to post-traumatic stress disorder can be acquired prior to military service or through unrelated experiences, so it cannot be presumed that military service or even combat deployment, in and of itself, causes post-traumatic stress disorder. This review includes the experiences of children currently in childhood as well as adult children of a parent with current or previous military service.

METHODS

The following databases were first searched in August 2016 and updated in January 9, 2020: MEDLINE, Embase, Web of Science Core Collection, CINAHL, PsycINFO, AMED, ERIC, and ProQuest Dissertations and Theses Global. This review was conducted in accordance with JBI methodology for systematic reviews of qualitative evidence and with an a priori protocol published in 2018.

RESULTS

Twelve studies were included. The majority of the studies were published after 2006. The review represents the experiences of 139 children (n = 66) and adult children (n = 73) participants from military families in the United States, Canada, and Australia. There were four synthesized findings: i) Parental post-traumatic stress disorder creates a volatile and distressing climate within the family, eliciting a range of responses from children (86 findings across three categories); ii) Parental post-traumatic stress disorder ripples through the family system, disrupting interpersonal communication and relationships during childhood (57 findings over four categories); iii) Children can experience emotional and psychological difficulties well into adulthood (84 findings across five categories); and iv) Making sense of it all and moving beyond parental post-traumatic stress disorder can take significant time, energy, and support (74 findings across four categories).

CONCLUSIONS

The quality of the included studies proved to be high, giving strength to this review. Effective ways of communicating with children about the nature of both the traumatic exposure and the post-traumatic stress disorder itself must be developed. While individuals with post-traumatic stress disorder deserve appropriate interventions to alleviate symptoms and improve functioning, it is not sufficient for recovery from post-traumatic stress disorder either for the individual or for the family who has been deeply affected themselves. Prospective and longitudinal research is needed, ensuring that both the voice of the child and multiple perspectives within family systems are included and compared.

Mechanisms Explaining the Relationship Between Maternal Torture Exposure and Youth Adjustment In Resettled Refugees: A Pilot Examination of Generational Trauma Through Moderated Mediation

The intergenerational effects of trauma resulting from torture and war are complex and multi-faceted and have important implications for the family system. The current study aimed to identify key relationships between refugee maternal caregiver exposure to torture, mental health, and physical health with maternal-reported youth adjustment. Ninety-six Karen maternal caregivers originating from Burma and resettled in the United States participated in a cross-sectional, explanatory mixed methods study. Maternal mental health distress was found to mediate the relationship betweenmaternal torture experiences and youth adjustment, R² = .357. Physical health problems was found to moderate the degree to which mental health distress mediated the relationship between torture and war trauma experiences and youth adjustment, R² = .409. The current study is significant in that it enhances our mechanistic understanding of factors relevant to the intergenerational effects of trauma within families where maternal caregivers experienced trauma from torture and/or war.

Intergenerational trauma transmission is associated with brain metabotranscriptome remodeling and mitochondrial dysfunction

Intergenerational trauma increases lifetime susceptibility to depression and other psychiatric disorders. Whether intergenerational trauma transmission is a consequence of in-utero neurodevelopmental disruptions versus early-life mother–infant interaction is unknown. Here, we demonstrate that trauma exposure during pregnancy induces in mouse offspring social deficits and depressive-like behavior. Normal pups raised by traumatized mothers exhibited similar behavioral deficits to those induced in pups raised by their biological traumatized mothers. Good caregiving by normal mothers did not reverse prenatal trauma-induced behaviors, indicating a two-hit stress mechanism comprising both in-utero abnormalities and early-life poor parenting. The behavioral deficits were associated with profound changes in the brain metabotranscriptome. Striking increases in the mitochondrial hypoxia marker and epigenetic modifier 2-hydroxyglutaric acid in the brains of neonates and adults exposed prenatally to trauma indicated mitochondrial dysfunction and epigenetic mechanisms. Bioinformatic analyses revealed stress- and hypoxia-response metabolic pathways in the neonates, which produced long-lasting alterations in mitochondrial energy metabolism and epigenetic processes (DNA and chromatin modifications). Most strikingly, early pharmacological interventions with acetyl-L-carnitine (ALCAR) supplementation produced long-lasting protection against intergenerational trauma-induced depression.

Sammy Alhassen, Siwei Chen, et al. use mouse models to examine the effects of prenatal and postnatal stress on metabolomic and transcriptomic pathways in the brain. Their results suggest that altered mitochondrial metabolism may underlie trauma-induced behavioral deficits, and that correcting metabolism with ALCAR supplementation may protect against intergenerational transmission of traumatic stress.

Intergenerational Transmission of Traumatic Stress and Resilience Among Cambodian Immigrant Families Along Coastal Alabama: Family Narratives

Purpose: Intergenerational transmission of psychological trauma is an ongoing global public health concern. Cambodia experienced ∼4 years of genocide, causing about 2 million deaths. Many survivors fled and resettled in the United States where they continued to face the psychological and relational consequences of forced displacement, with limited access to mental health treatment. This study employed an ecological social determinants of health framework to explore how resettled families discussed traumatic experiences and resilience transmitted across three generations.

Methods: Narrative inquiry-guided, in-depth semistructured interviews were conducted with intergenerational families: five grandparents, six parents, and nine adult children. The interview protocol included developing detailed family genograms that facilitated the sharing of experiences of living through the Cambodian genocide (1975–1979) and resettlement to the United States in the 1980s. A thematic data analysis was conducted across individual and family experiences before, during, and after the genocide and resettlement.

Results: The findings highlight parent–child relationships as the primary mechanism of intergenerational transmission of traumatic stress and resilience among Cambodian immigrant families. Specifically, high parental expectations, authoritarian parenting, corporal punishment, and submissive communication styles were reported. On the other hand, strong bonds and less hierarchy between parents and children were found to be resilience factors among this population.

Conclusions: The results of this qualitative study underscore the need for a systemic mental health conceptualization for practitioners working with resettled Cambodian families to overcome the cycle of intergenerational transmission of traumatic stress and promote resilience postresettlement.

Integrative Review of Related Factors and Defining Characteristics of Lack of Family Integrity

PURPOSE

To identify the related factors that compromise family integrity and the defining characteristics of poor family integrity.

METHODS

Integrative review in databases: Pubmed, Scopus, Cinahl, PsycInfo, and Web of Science. The inclusion and exclusion criteria led to the selection of 12 articles.

FINDINGS

Family conflicts, lack of communication, and detachment from family as risk factors that have a negative impact on family integrity. A decrease in the physical and psychological quality of life as defining characteristics of poor family integrity.

CONCLUSIONS

Lack of family integrity has a significant impact on the physical, mental, and social health of its members.

IMPLICATIONS FOR NURSING PRACTICE

Findings will allow nurses to implement interventions for the maintenance or improvement of family integrity.

Metaphors and cultural narratives on adaptive responses to severe adversity: A field study among the Indigenous Pitaguary community in Brazil

The expressions resilience and posttraumatic growth represent metaphorical concepts that are typically found in Euro-American contexts. Metaphors of severe adversity or trauma and the expressions of overcoming it vary across cultures-a lacuna, which has not been given much attention in the literature so far. This study aimed to explore the metaphorical concepts that the Indigenous Pitaguary community in Brazil uses to talk about adaptive and positive responses to severe adversity and to relate them to their socio-cultural context. We carried out 14 semi-structured interviews during field research over a one-month period of fieldwork. The data were explored with systematic metaphor analysis. The core metaphors included images of battle, unity, spirituality, journeys, balance, time, sight, transformation, and development. These metaphors were related to context-specific cultural narratives that underlie the Pitaguary ontological perspective on collectivity, nature, and cosmology. The results suggest that metaphors and cultural narratives can reveal important aspects of a culture's collective mindset. To have a contextualized understanding of expressive nuances is an essential asset to adapt interventions to specific cultures and promote culture-specific healing and recovery processes.

Society, individual, family, and school factors contributing to child mental health in war: The ecological-theory perspective

Mental health problems are common in war-affected areas, but children have different levels of vulnerability. Based on ecological theory (Bronfenbrenner, 2005), this study analyses how factors related to the child (cognitive capacity), their family (parental depression and parenting styles), and their school (teachers' practices and peer relations) mediate the association between traumatic stress (traumatic war experiences and stressful life-events) and child mental health (posttraumatic stress and psychological distress symptoms). The participants were 303 Palestinian children (51.2% girls) of 10-13 years (M = 10.94 ± 0.50) and their parents from the Gaza Strip. The children filled in questionnaires during school classes and the parents did so at their homes. The results of structural equation modeling substantiated the hypothesis that parental depression, poor parenting and low-quality peer relations mediated between traumatic stress and children's mental health problems. Contrary to the hypothesis, child-related factors did not mediate that association. To conclude, parents and peers provide important age-salient social resources for children in war conditions, and psychosocial interventions should therefore enhance their beneficial functions.

Experiences of children exposed to parental post-traumatic stress disorder while growing up in military and veteran families: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this review is to understand how parental Post-Traumatic Stress Disorder (PTSD) might impact children growing up in military and veteran families. The following question will guide and inform the review: What is the experience of children growing up in military families where the military or veteran parent is living with post-traumatic stress disorder?

Intergenerational Transmission of Resilience? Sense of Coherence Is Associated between Lithuanian Survivors of Political Violence and Their Adult Offspring

Little is known about intergeneration effects on mental health in the families of survivors of political oppression of communist regime in Central and Eastern Europe. We aimed to explore post-traumatic stress in the second generation of the Lithuanian survivors of political violence, and analyze links between parental and adult offsprings' sense of coherence in the families exposed to political violence during the oppressive communist regime in Lithuania. A total of 110 matched pairs of communist regime political violence survivors (mean age = 73.22 years) and their adult offspring (mean age = 44.65 years) participated in this study. Life-time traumatic experiences and sense of coherence were measured in both parents and their offspring. Post-traumatic stress symptoms were assessed in the second generation of survivors. We found a high vulnerability in the second generation of the Lithuanian families of political violence survivors, with a 29% of probable PTSD in the second generation based on self-report measures. A significant positive correlation between parental and adult offsprings' sense of coherence was found. Post-traumatic stress symptoms were associated negatively with a sense of coherence in the second generation. Our study indicates the links between parental and the second generation's sense of coherence in the families of survivors of political violence. The study raises broader questions about the intergenerational aspects of resilience. Further studies are needed to explore the links between parental and child sense of coherence in other samples.

Family systems approach to attachment relations, war trauma, and mental health among Palestinian children and parents

Background: Trauma affects the family unit as a whole; however, most existing research uses individual or, at most, dyadic approaches to analyse families with histories of trauma. Objective: This study aims to identify potentially distinct family types according to attachment, parenting, and sibling relations, to analyse how these family types differ with respect to war trauma, and to explore how children's mental health and cognitive processing differ across these family types. Method: Participants included Palestinian mothers and fathers (N = 325) and their children (one per family; 49.4% girls; 10-13 years old; mean ± SD age = 11.35 ± 0.57 years) after the Gaza War of 2008-2009. Both parents reported their exposure to war trauma, secure attachment availability, and parenting practices, as well as the target child's internalizing and externalizing symptoms [Strengths and Difficulties Questionnaire (SDQ)]. Children reported their symptoms of post-traumatic stress disorder (on the Children's Revised Impact Event Scale), depression (Birleson), and SDQ, as well as their post-traumatic cognitions (Children's Post Traumatic Cognitions Inventory). Results: A cluster analysis identified four family types. The largest type reflected secure attachment and optimal relationships (security and positive family relationships, 36.2%, n = 102), and the smallest exhibited insecurity and problematic relationships (insecurity and negative family relationships, 15.6%; n = 44). Further, families with discrepant experiences (23.0%; n = 65) and moderate security and neutral relationships (25.2%; n = 71) emerged. The insecurity and negative relationships family type showed higher levels of war trauma; internalizing, externalizing, and depressive symptoms among children; and dysfunctional post-traumatic cognitions than other family types. Conclusion: The family systems approach to mental health is warranted in war conditions, and therapeutic interventions for children should, thus, also involve parents and siblings. Knowledge of unique family attachment patterns is fruitful for tailoring therapeutic treatments and preventive interventions for war-affected children and families.

Family Dynamics and Personal Strengths among Dementia Caregivers in Argentina

This study examined whether healthier family dynamics were associated with higher personal strengths of resilience, sense of coherence, and optimism among dementia caregivers in Argentina. Caregivers are usually required to assist individuals with dementia, and family members have typically fulfilled that role. Personal strengths such as resilience, sense of coherence, and optimism have been shown to protect caregivers from some of the negative experiences of providing care, though the family-related variables associated with these personal strengths are largely unknown. Hierarchical multiple regressions investigated the extent to which family dynamics variables are associated with each of the caregiver personal strengths after controlling for demographic and caregiver characteristics. A sample of 105 caregivers from Argentina completed a set of questionnaires during a neurologist visit. Family dynamics explained 32% of the variance in resilience and 39% of the variance in sense of coherence. Greater family empathy and decreased family problems were uniquely associated with higher resilience. Greater communication and decreased family problems were uniquely associated with higher sense of coherence. Optimism was not found to be significantly associated with family dynamics. These results suggest that caregiver intervention research focused on the family may help improve caregiver personal strengths in Argentina and other Latin American countries.

Transgenerational aspects of former Swiss child laborers: do second generations suffer from their parents' adverse early-life experiences?

BACKGROUND

Recent research suggests that childhood adversity exerts a lasting impact not only on the affected individuals but also on their offspring. Little is known about the role of parental rearing behavior in the transgenerational conveyance of parental childhood adversity and filial psychological health.

OBJECTIVE

Hence, it was the aim of the current study to investigate the relationship between parental rearing behavior of former Swiss indentured child laborers ("Verdingkinder") and psychological health of their adult offspring.

METHODS

We applied a two-generation control-group design with two parental samples (n=16, former "Verdingkinder," M_age=76.13, SD=6.81 and n=19, parental controls, M_age=72.63, SD=5.96) and their offspring (n=21, former "Verdingkinder" offspring, M_age=52.91, SD=5.90, and n=29 offspring controls, M_age=44.55, SD=7.71). Parental rearing behavior, childhood trauma, and psychological health were assessed with questionnaires. Data were analyzed using Bayesian analyses, where Bayes factors (BF) of 3 or higher were considered as substantial evidence for the tested hypotheses.

RESULTS

We found that "Verdingkinder" offspring reported more physical abuse (BF₁₀=5.197) and higher total childhood trauma exposure (BF₁₀=2.476). They described both their fathers (BF₁₀=14.246) and mothers (BF₁₀=24.153) as less emotional and their mothers as more punitive (BF₁₀=18.725). An increased sense of reflection, for instance, one's ability to take different perspectives, was found in the offspring controls (BF₁₀=5.245). Furthermore, exploratory analyses revealed that lower perceived familial emotionality was associated with higher psychopathology (all BF₁₀=10.471) and higher pessimism (all BF₁₀=5.396).

DISCUSSION

Our data provide cross-sectional evidence of a meaningful transgenerational relationship between parental childhood adversity, dysfunctional rearing behavior, and psychological health of offspring. Prospective studies are needed to investigate these findings in a longitudinal setting.