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O'Toole BI. Intergenerational Transmission of Posttraumatic Stress Disorder in Australian Vietnam Veterans' Daughters and Sons: The Effect of Family Emotional Climate While Growing Up. J Trauma Stress 2022; 35:128-137. [PMID: 34121220 DOI: 10.1002/jts.22700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 11/11/2022]
Abstract
Posttraumatic stress disorder (PTSD) in military veterans increases the risk of PTSD in their offspring, a concept known as "intergenerational transmission;" however, the mechanism by which this transmission may occur is, as yet, undetermined. The present study included a nonclinical sample of 197 Australian Army veterans of the Vietnam War who were interviewed 17 years before in-person interviews of their adult daughters (n = 163) and sons (n = 120) were conducted. Veterans' PTSD symptoms were assessed using the Mississippi Scale for Combat-Related PTSD. Approximately 17 years later, offspring PTSD symptoms were assessed using the Clinician-Administered PTSD Scale for DSM-IV. In addition, offspring described the family emotional climate during their youth; responses were coded using the Family Affective Attitude Rating Scale (FAARS) to produce scale scores of veterans' negative, positive, and family relationship styles. A path analysis was conducted via structural equation modeling to test for significant path coefficients between veteran PTSD, family emotional climate, and offspring PTSD symptoms. For daughters, significant path coefficients were observed between veteran PTSD scores and FAARS scores, path coefficient = -.268; FAARS scores and offspring CAPS severity scores, path coefficient = -.223; and veteran PTSD scores and daughters' CAPS severity scores, path coefficient = .186. No satisfactory model could be found for sons. The results suggest that a positive emotional climate while growing up may be a significant protective factor against the development of PTSD in veterans' daughters, but other factors remain significant in veteran-to-offspring intergenerational transmission.
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Affiliation(s)
- Brian I O'Toole
- Brain and Mind Centre, University of Sydney, Sydney, Australia
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Lim BH, Hodges MA, Lilly MM. The Differential Effects of Insecure Attachment on Post-Traumatic Stress: A Systematic Review of Extant Findings and Explanatory Mechanisms. TRAUMA, VIOLENCE & ABUSE 2020; 21:1044-1060. [PMID: 30599805 DOI: 10.1177/1524838018815136] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
It is well-documented that insecure attachment poses substantial risks to post-trauma recovery. Although attachment anxiety reliably predicts and is associated with elevated post-traumatic stress symptoms (PTSS), the attachment avoidance-PTSS link has been far less consistent. This suggests both attenuating and enhancing connections between attachment difficulties and post-trauma outcomes. The goal of this study is 2-fold: (a) to review and summarize extant evidence concerning the relation between insecure attachment and PTSS and (b) to review mechanism(s) underlying attachment anxiety and attachment avoidance that may explain the development of PTSS. Following a systematic review of the empirical literature investigating attachment, trauma, and post-trauma reactions, a total of 138 studies were identified and summarized. The review further identifies explanatory mechanisms underlying the association between insecure attachment and PTSS, including stress appraisals, cognitive factors, self-esteem, emotion regulation strategies, social factors, and trauma-specific factors (i.e., type of trauma, extreme stress). Implications for practice, policy, and research are discussed.
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Affiliation(s)
- Ban Hong Lim
- University of California, Los Angeles, Los Angeles, CA, USA
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Gunter HN, O'Toole BI, Dadds MM, Catts SV. Family emotional climate in childhood and risk of PTSD in adult children of Australian Vietnam veterans. Psychiatry Res 2020; 294:113509. [PMID: 33075652 DOI: 10.1016/j.psychres.2020.113509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/08/2020] [Indexed: 12/14/2022]
Abstract
The mechanisms of intergenerational transmission of posttraumatic stress disorder (PTSD) from parent to child are not yet known. We hypothesised that the mechanisms involved in trauma transmission may be dependent upon sex specific caregiver-child dyads and these dyads may have a differential impact on post-traumatic stress disorder (PTSD). A non-clinical sample of adult offspring (N = 306) of Australian Vietnam veterans was interviewed in-person to assess the relationship between family emotional climate and caregiver attachment with the offspring's adult experience of post-traumatic stress disorder (PTSD). Attachment to the veteran father was not associated with sons' PTSD, but was for daughters. Attachment to mother was associated with PTSD and depression for both sons and daughters, with positive and warm attachment related to reduced PTSD diagnosis and its symptom clusters. A less positive family emotional environment was related to increased PTSD symptoms in daughters, while for sons a negative relationship style with their mother was related to increased frequency and severity of numbing/avoidance behaviours and hyperarousal symptoms. The findings suggest that sex-related differences in caregiver-child dyads do have a differential impact on PTSD symptom domains and may be one environmental mechanism by which trauma is transmitted across generations.
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Affiliation(s)
- Helen N Gunter
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Brian I O'Toole
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
| | - Mark M Dadds
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Stanley V Catts
- Department of Psychiatry, University of Queensland, Brisbane, Australia
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Aloni R, Mikulincer M, Zerach G, Solomon Z. The intergenerational sequelae of war captivity: the impact of a self-amplifying cycle of PTSD and attachment insecurities on offspring's attachment orientations. Eur J Psychotraumatol 2020; 11:1741859. [PMID: 32363009 PMCID: PMC7178882 DOI: 10.1080/20008198.2020.1741859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/04/2022] Open
Abstract
Background: War captivity is one of the most severe human-made traumatic events which lead to self-amplifying cycle of post-traumatic stress disorder (PTSD) symptoms and attachment insecurities. Solid evidence in the literature pointed out on the intergenerational transmission of PTSD symptoms. However, no research has been conducted on the intergenerational transmission of attachment insecurities and the effect of the self-amplifying cycle among former prisoners of war (ex-POWs) and their offspring attachment insecurities. Objective: This research aims to explore the intergenerational impact of a self-amplifying cycle of PTSD and attachment insecurities among ex-POWs on their offspring's attachment orientations. Method: We sampled dyads of Israeli ex-POWs of the Yom Kippur war and their adult offspring (ex-POW group) (n = 80) as well as dyads of Israeli veterans who fought in the Yom Kippur war, but were never held captive, and their adult offspring (control group) (n = 40). Veterans reported on PTSD severity and attachment orientations (anxiety, avoidance). Offspring reported on attachment orientations. We conducted (a) hierarchical regressions to predict offspring attachment orientations as a function of veterans' attachment orientations, and (b) moderated mediation analyses examining the role of veterans' PTSD in the intergenerational transmission of attachment orientations. Results: Ex-POWs' attachment anxiety was associated with offspring's reports of higher attachment anxiety and avoidance, and this intergenerational transmission of attachment was mediated by ex-POWs' PTSD severity. These effects were not significant in the control group. Conclusions: Decades after the war end, the intergenerational sequelae of war captivity are evident by the impact of the self-amplifying cycle of PTSD and attachment insecurities among ex-POWs and their offspring's attachment insecurities. Therefore, it is imperative for clinicians to recognize the intergenerational transmission and to focus not only on the trauma but also on the traumatized person's attachment injuries and the shattering of core beliefs about the world, self, and others, in the context of attachment-based therapies.
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Affiliation(s)
- Roy Aloni
- School of Social Work, Ariel University, Tel-Aviv, Israel
| | - Mario Mikulincer
- School of Psychology, Interdisciplinary Center Herzliya, Herzliya, Israel
| | - Gadi Zerach
- Department of Behavioral Sciences and Psychology, Ariel University, Ariel, Israel
| | - Zahava Solomon
- School of Social Work, Ariel University, Tel-Aviv, Israel
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Batchelor V, Pang TY. HPA axis regulation and stress response is subject to intergenerational modification by paternal trauma and stress. Gen Comp Endocrinol 2019; 280:47-53. [PMID: 30981703 DOI: 10.1016/j.ygcen.2019.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 12/20/2022]
Abstract
There is increasing evidence that one's risk for psychiatric disturbances and metabolic syndromes is influenced by their parents' own health history, lifestyle and living environment. For example, paternal high fat diet is strongly linked to neuroendocrine dysregulation in offspring and increased risk for diabetes. The potential intergenerational impact of paternal stress has only just begun to emerge, with the initial evidence suggestive of greater risk for anxiety-related disorders. The hypothalamic-pituitary-adrenal (HPA)-axis is a key neuroendocrine signalling system involved in physiological homeostasis and stress response. In individuals, dysregulation of this system is closely associated with behavioral deficits and mood disorders. Various preclinical models of paternal stress have demonstrated robust behavioral shifts but little is known about the intergenerational modification of HPA axis function. This review will present evidence drawn from a range of laboratory mouse and rat models that the intergenerational influence of paternal stress on offspring behavioral phenotypes involve some level of HPA axis dysregulation. It makes the case that further investigations to comprehensively profile HPA axis function in offspring generations is warranted.
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Affiliation(s)
- Vicky Batchelor
- Department of Anatomy & Neuroscience, University of Melbourne, VIC 3010, Australia; Florey Institute of Neurosciences and Mental Health, University of Melbourne, VIC 3010, Australia
| | - Terence Y Pang
- Department of Anatomy & Neuroscience, University of Melbourne, VIC 3010, Australia; Florey Institute of Neurosciences and Mental Health, University of Melbourne, VIC 3010, Australia.
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Castro-Vale I, Severo M, Carvalho D, Mota-Cardoso R. Intergenerational transmission of war-related trauma assessed 40 years after exposure. Ann Gen Psychiatry 2019; 18:14. [PMID: 31413722 PMCID: PMC6688296 DOI: 10.1186/s12991-019-0238-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 07/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The intergenerational transmission of posttraumatic stress disorder (PTSD) from parent to offspring has been suggested in the literature, but this is highly controversial. We aimed to study the association between veterans' war exposure and lifetime PTSD and the psychological characteristics of their respective offspring, 40 years after war-related trauma. METHODS Forty-four adult offspring of veterans with PTSD and 29 offspring of veterans without PTSD were included in the study, from a total of 46 veterans. War exposure intensity, lifetime PTSD, and the general psychopathology (with Brief Symptom Inventory-BSI) of the veterans were studied, as were childhood trauma, attachment, and the general psychopathology (with BSI) of their offspring. RESULTS Veterans' war exposure was associated with BSI in the offspring with regard to somatisation (β = 0.025; CI 0.001, 0.050), phobic anxiety (β = 0.014; CI: 0.000, 0.027), Global Severity Index (GSI) (β = 0.022; CI 0.005, 0.038), and Positive Symptom Distress Index (β = 0.020; CI 0.006, 0.033). The fathers' GSI mediated only 18% of the effect of the veterans' total war exposure on offspring's GSI. Fathers' war exposure was associated with offspring's physical neglect as a childhood adversity, although non-significantly (p = 0.063). None of the other variables was associated with veterans' war exposure, and veterans' lifetime PTSD was not associated with any of the variables studied. CONCLUSIONS The offspring of war veterans showed increased psychological suffering as a function of their fathers' war exposure intensity, but not of their fathers' lifetime PTSD. These results could be used to suggest that mental health support for veterans' offspring should consider the war exposure intensity of their fathers, and not just psychopathology. This could spare offspring's suffering if this mental health support could be delivered early on, after veterans return from war.
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Affiliation(s)
- Ivone Castro-Vale
- 1Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.,2Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
| | - Milton Severo
- 3Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.,4Department of Medical Education and Simulation, Faculty of Medicine, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Davide Carvalho
- 2Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal.,5Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Sāo Joāo, Faculty of Medicine, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Rui Mota-Cardoso
- 1Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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O'Toole BI, Dadds M, Burton MJ, Rothwell A, Catts SV. Growing up with a father with PTSD: The family emotional climate of the children of Australian Vietnam veterans. Psychiatry Res 2018; 268:175-183. [PMID: 30031270 DOI: 10.1016/j.psychres.2018.06.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/08/2018] [Accepted: 06/24/2018] [Indexed: 12/21/2022]
Abstract
A non-clinical sample of male Australian Vietnam veterans, their wives, and adult offspring were interviewed in-person in a national epidemiological study to assess the relationship between the mental ill-health of veterans and the emotional climate of the family while the children were growing up. Veterans were assessed 17 years before their children using standardised psychiatric diagnostic interviews. Family emotional climate was assessed using offspring ratings of parental attachment, and codings of positive and negative family relationship styles based on five minute speech samples provided by the offspring. Sons and daughters had different views of their mothers and fathers, and were less positive towards their fathers particularly if he had posttraumatic stress disorder (PTSD). Veteran PTSD and depression significantly negatively impacted the family emotional climate, while mothers' mental health was not related. Veteran PTSD symptoms were lowest in secure attachment to the veteran and highest in inconsistent attachment for both sons and daughters, but were not related to attachment to the mother. Veteran PTSD was related to daughters' but not sons' perceptions of family emotional climate. The impact of veterans' PTSD on their families' emotional climate is more marked for daughters than sons.
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Affiliation(s)
- Brian I O'Toole
- Brain and Mind Centre, University of Sydney, Sydney, Australia.
| | - Mark Dadds
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | - Alice Rothwell
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Stanley V Catts
- Brain and Mind Centre, University of Sydney, Sydney, Australia; School of Psychiatry, Queensland University, Brisbane, Australia
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Zerach G. Coping strategies of former prisoners of war mediate the intergenerational transmission of posttraumatic stress symptoms. ANXIETY, STRESS, AND COPING 2017; 31:175-187. [PMID: 29258355 DOI: 10.1080/10615806.2017.1419333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Certain coping strategies, characterized by emotional coping or disengagement/ avoidance, have been linked to posttraumatic stress disorder (PTSD) and PTSD symptoms (PTSS). However, the role of primary trauma victims' coping strategies in the intergenerational transmission of PTSS is still lacking. This prospective study assessed the mediating role of former prisoners of war's (ex-POWs) coping strategies in the associations between ex-POWs' PTSS and their adult offspring's secondary PTSS in relation to their fathers' captivity and psychiatric symptomatology. DESIGN A correlational, prospective study. METHOD A sample from the 1973 Yom Kippur War composed of 79 Israeli ex-POW father-offspring dyads completed self-report measures. Fathers were assessed in 2001 and 2008, and their adult offspring participated in 2014. RESULTS ex-POWs' problem-focused coping strategies of active coping and planning, as well as disengagement-oriented coping strategies of alcohol and substance use and venting of emotions, were negatively associated with offspring's PTSS and psychiatric symptomatology. Importantly, ex-POWs' venting of emotions mediated the link between ex-POWs' PTSS and their offspring's secondary PTSS. CONCLUSIONS Ex-POWs with PTSS might expose their offspring to dysregulated mood, behaviors, and cognitions. Special awareness should be given to the venting of emotions coping style as possible mechanism for the intergenerational transmission of captivity-related PTSS.
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Affiliation(s)
- Gadi Zerach
- a Department of Behavioral Sciences , Ariel University , Ariel , Israel
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Zerach G, Solomon Z. Gender differences in posttraumatic stress symptoms among former prisoners of wars’ adult offspring. ANXIETY STRESS AND COPING 2017; 31:21-31. [DOI: 10.1080/10615806.2017.1368835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Gadi Zerach
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Zahava Solomon
- Bob Shapell School of Social Work and I-Core Research Center for Mass Trauma, Tel Aviv University, Tel Aviv, Israel
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