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

Adverse Childhood Experience, Parental Bonding, and Fatherhood as Parenting Vulnerabilities to Social Anxiety Severity

Background: The present study aims to elucidate the association between adverse childhood experiences, parental bonding, fatherhood, and social anxiety symptoms among emerging adults within an Iranian context. Methods: This prospective cross-sectional study utilized self-reported assessments to evaluate fatherhood, parental bonding, anxious thoughts, and childhood trauma. The study was administered to 242 university students exhibiting social anxiety symptoms. Among the participants, 181 (74.8%) were boys and 61 (25.2%) were girls between the ages of 18 and 29. In terms of educational background, 64.9% of them held a bachelor's degree, and 35.1% held a master's degree. A majority of them (84.3%) were of middle-class socio-economic status, 6.6% were of low income, and 9.1% were of high income. Results: Analysis via multiple linear regression revealed that individuals with adverse childhood experiences exhibited heightened levels of social anxiety symptoms (R2 = 0.32) compared to their counterparts without such experiences. Furthermore, fatherhood (R2 = 0.28), paternal bonding (R2 = 0.26), and maternal bonding (R2 = 0.26) were all significantly and equally associated with variance in social anxiety symptoms. The findings underscored the substantial correlation between ACEs, fatherhood, and both maternal and paternal bonding with social anxiety symptoms in adulthood. Conclusions: Accordingly, the study emphasizes the importance of thoroughly assessing the multifaceted contributors to social anxiety. Such insights are pivotal for the design and implementation of community-based preventive interventions aimed at reducing the societal burden of social anxiety disorders.

"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.

Local clinician perspectives on cause, impact, and treatment of key expressions of distress in Cambodian children

Child trauma and posttraumatic stress in Cambodia is highly prevalent, perpetuated within a postwar sociocultural context. The examination of locally meaningful expressions of distress is needed to provide culturally sensitive assessment and treatment of trauma-affected Cambodian children. The acceptable, feasible, and sustainable incorporation of expressions of distress into assessment and intervention development relies on key mental health professionals operating in Cambodia, who can provide invaluable perspectives on child trauma experiences in this particular sociocultural context. In this study, qualitative interviews were conducted with 15 Cambodian mental health professionals (MHPs) who work directly with trauma-affected Cambodian children. MHPs were presented with seven key posttraumatic problems derived from previous qualitative interviews with Cambodian children and caregivers, and discussed 1) the causes of these problems, 2) the impact of the problem on the child or those around them, 3) the current treatment for the problem in Cambodia, and 4) recommended treatment. MHPs provided unique insights and perspectives of trauma-affected children in the Cambodian context regarding key target problems, including palpitations, difficulties in school, headache, and thinking too much, and highlighted future directions for assessment and intervention. Recommendations are discussed in regard to programming design and organizational training development to promote culturally salient, feasible, and sustainable mental health service provision in Cambodia.

Exploring the Shared Experiences of Yazidis Who Survived Genocide

In August 2014, the Islamic State of Iraq (ISIS) and the Levant (ISIL) brutally attacked the Yazidi people and occupied Sinjar and other villages in Northern Iraq. The massacre of Yazidis that began in August 2014 was declared by the United Nations as genocide. To gain a better understanding and raise awareness of these atrocities, we conducted a qualitative, phenomenological study with 35 Yazidis, who survived the genocide. The aim of the study was to elucidate the Yazidis' processing of the genocide and how it affects their psychological functioning. Coding and theming were the methods used to categorize, bring meaning and identity to Yazidis'genocidal experiences. The interviews took place between April and June 2019. Data analysis of the interview transcripts revealed that Yazidis, who survived the genocide of 2014, commonly experienced 11 themes related to hopelessness, fear, loss, grief, distrust, change, advocacy, optimism, shock, intrusive memories, and guilt. Results from this study reveal the vulnerabilities of ethnic minorities at risk of being abducted, killed, raped, and displaced. Moreover, the inherent risk of future genocides is illustrated through the experiences shared by the Yazidis.

Epigenetic Mechanisms of Paternal Stress in Offspring Development and Diseases

The major biological function of the sperm cell is to transmit the paternal genetic and epigenetic information to the embryo as well as the following offspring. Sperm has a unique epigenome. An increasing body of epidemiological study supports that paternal stress induced by environmental exposures and lifestyle can modulate the sperm epigenome (including histone modification, DNA methylation, and noncoding RNA expression), sperm-egg fusion, embryo development, and offspring health. Based on the existing literature, we have summarized the paternal exposure on sperm epigenome along with the representative phenotypes of offspring and the possible mechanism involved.

Factors influencing unmet need for contraception amongst adolescent girls and women in Cambodia

Background

Unmet need is the gap between women’s need and their practice of using contraception. Unmet need for contraception in female adolescents and women in Cambodia is a public health concern which may lead to unintended pregnancies or abortions that can contribute to maternal morbidity and mortality.

Methods

Bronfenbrenner’s Social Ecological Model was used as a theoretical framework to analyze data from the 2014 Cambodian Demographic and Health Survey to ascertain demographic and social factors potentially associated with unmet need for contraception. Bivariate and weighted multiple logistic regression analyses with adjusted odds ratios (AOR) were conducted for 4,823 Cambodian, sexually active females aged 15–29 years.

Results

The percentage of unmet need for contraception was 11.7%. At the individual level of the Social Ecological Model, there was an increased likelihood of unmet need in adolescent girls 15–19 years and women 20–24 years. Unmet need was decreased in currently employed women. At the microenvironment level, there was an increased likelihood of unmet need with the husband’s desire for more children and when the decision for a woman’s access to healthcare was made by someone else in the household. At the macroenvironment level, unmet need was decreased in women who could access a health facility near their residence to obtain medical care. There were no urban rural differences found in the Cambodian sample population.

Conclusion

Unmet need for contraception in Cambodian females adolescents and women is associated with younger age, unemployment and low personal autonomy for accessing healthcare but not with education or wealth status. There is a need to implement culturally appropriate reproductive and sexual health literacy programs to increase access to modern contraception and to raise women’s autonomy.

Mental health is biological health: Why tackling "diseases of the mind" is an imperative for biological anthropology in the 21st century

The germ theory of disease and the attendant public health initiatives, including sanitation, vaccination, and antibiotic treatment, led to dramatic increases in global life expectancy. As the prevalence of infectious disease declines, mental disorders are emerging as major contributors to the global burden of disease. Scientists understand little about the etiology of mental disorders, however, and many of the most popular psychopharmacological treatments, such as antidepressants and antipsychotics, have only moderate-to-weak efficacy in treating symptoms and fail to target biological systems that correspond to discrete psychiatric syndromes. Consequently, despite dramatic increases in the treatment of some mental disorders, there has been no decrease in the prevalence of most mental disorders since accurate record keeping began. Many researchers and theorists are therefore endeavoring to rethink psychiatry from the ground-up. Anthropology, especially biological anthropology, can offer critical theoretical and empirical insights to combat mental illness globally. Biological anthropologists are unique in that we take a panhuman approach to human health and behavior and are trained to address each of Tinbergen's four levels of analysis as well as culture. The field is thus exceptionally well-situated to help resolve the mysteries of mental illness by integrating biological, evolutionary, and sociocultural perspectives.

Factors Influencing Unintended Pregnancies amongst Adolescent Girls and Young Women in Cambodia

Background: Unintended pregnancies in Cambodian youth are a major reproductive health concern with detrimental personal and socioeconomic consequences. A social ecological model was used to identify sociodemographic factors potentially associated with unintended pregnancies, and an analysis of data from the 2014 Cambodian Demographic and Health Survey was used to determine associations. Methods: Weighted data were analysed using multiple logistic regression analyses for 3406 Cambodian sexually active single, in union or married females aged 15–29 years. Results: The prevalence of unintended pregnancy was 12.3%. Unintended pregnancy was significantly associated with younger age groups (15–24 years), multiparity, history of abortion, and current use of modern contraceptive methods. All women had an increased likelihood of unintended pregnancy when the husband alone or someone else in the household made decisions about their access to healthcare. Conclusion: The burden of unintended pregnancies is associated with young age, multiparity, history of abortions, unemployment, and low autonomy for accessing healthcare. Multi-pronged, holistic reproductive and sexual health program interventions are needed to increase literacy and accessibility to modern contraception and to raise awareness about women’s health and status in Cambodia.

Intergenerational effects of witnessing domestic violence: Health of the witnesses and their children

Studies that explore intergenerational effects of witnessing domestic violence during childhood (“witnessing”) are lacking. We examined effects of witnessing on general health status for adults who witnessed domestic violence during childhood and their children. Cross-sectional data from population-based phone interviews conducted in Philadelphia during 2012–2013 provided health information for 329 parents and children, and parent's witnessing exposure. We used propensity scores to predict parent's witnessing status using childhood confounders; response models included inverse probability of treatment weighting and population weights for standardization. Separate standardized multivariate logistic regression models provided average treatment effects and 95% CIs for associations between childhood witnessing and below average health for: 1) adults who witnessed and 2) their children. Sensitivity analyses guided interpretation. Standardized models showed no differences in average treatment effects for below average adult health for witnesses vs. non-witnesses [0.04 (−0.12, 0.19)]. Conversely, children whose parents witnessed had considerably higher probability of having below average health than children whose parents did not witness [0.15 (0.02, 0.28)]. An unmeasured confounder would need 3.0-fold associations with both exposure and outcome to completely remove observed effects, indicating a moderate relationship. However, the lower confidence bound could cross 1.0 in the presence of a weaker unmeasured confounder having 1.2-fold associations with both exposure and outcome, while controlling for our same measured confounders. Witnessing during childhood did not affect adult health in our population, but we found moderate evidence supporting harmful intergenerational effects of witnessing on health, with parent's witnessing exposure affecting their child's health.

The effects of childhood maltreatment on epigenetic regulation of stress-response associated genes: an intergenerational approach

While biological alterations associated with childhood maltreatment (CM) have been found in affected individuals, it remains unknown to what degree these alterations are biologically transmitted to the next generation. We investigated intergenerational effects of maternal CM on DNA methylation and gene expression in N = 113 mother-infant dyads shortly after parturition, additionally accounting for the role of the FKBP5 rs1360780 genotype. Using mass array spectrometry, we assessed the DNA methylation of selected stress-response-associated genes (FK506 binding protein 51 [FKBP5], glucocorticoid receptor [NR3C1], corticotropin-releasing hormone receptor 1 [CRHR1]) in isolated immune cells from maternal blood and neonatal umbilical cord blood. In mothers, CM was associated with decreased levels of DNA methylation of FKBP5 and CRHR1 and increased NR3C1 methylation, but not with changes in gene expression profiles. Rs1360780 moderated the FKBP5 epigenetic CM-associated regulation profiles in a gene × environment interaction. In newborns, we found no evidence for any intergenerational transmission of CM-related methylation profiles for any of the investigated epigenetic sites. These findings support the hypothesis of a long-lasting impact of CM on the biological epigenetic regulation of stress-response mediators and suggest for the first time that these specific epigenetic patterns might not be directly transmitted to the next generation.

Transgenerational trauma in a post-conflict setting: Effects on offspring PTSS/PTSD and offspring vulnerability in Cambodian families

We assessed transgenerational effects of maternal traumatic exposure, posttraumatic stress symptoms and posttraumatic stress disorder on trauma-related symptoms in Cambodian offspring born after the genocidal Khmer Rouge Regime. We conducted a randomized cross-sectional study. N=378 mothers from 4 provinces of the country and one of each of their grown-up children were interviewed. Lifetime traumatic exposure was determined using a context-adapted event list. Present posttraumatic stress symptoms and a potential posttraumatic stress disorder were assessed using the civilian version of the Posttraumatic Stress Disorder Checklist. We found no indication of transgenerational effects that were directly related to maternal traumatic exposure, posttraumatic stress symptoms or posttraumatic stress disorder. Instead, a gender-specific moderating effect was found. Individual traumatic exposure had a stronger effect on posttraumatic stress symptoms in daughters, the higher the mother's lifetime traumatic exposure. There is evidence of an interaction between lifetime traumatic exposure of mothers and their offspring that can be interpreted as an increased vulnerability to symptoms of posttraumatic stress in daughters. The mechanisms of transgenerational trauma in the Cambodian context require further research, as learning from previous conflicts will be instructive when addressing the pressing humanitarian needs of today's world.

Cambodian boys' transitions into young adulthood: exploring the influence of societal and masculinity norms on young men's health

A growing body of evidence focuses on the experiences of young men in low-income countries, including their health vulnerabilities. Much of this research has been conducted in sub-Saharan Africa, Asia and Latin America. Limited evidence exists on the norms influencing boys' transitions into young adulthood in Southeast Asia, and in Cambodia in particular. To help fill this gap, we conducted a comparative case study using participatory methods with 16-19-year-old young men in rural and urban Cambodia, and with the adults who intersect in their lives. Findings suggest that in line with their counterparts growing up elsewhere, Cambodian boys welcome becoming young men as a time of newly acquired adult roles and responsibilities, while some may experience growing up as a time of bodily change, burgeoning sexual feelings and limited sources of support and guidance. As a result, some may strive more intensely to conform to the alcohol use and violence modelled by the older men in their environments. Additional research is needed to better understand the vulnerabilities of boys' transition into young adulthood in Cambodia today, and how to prevent or reduce engagement with these more negative practices.

Exploring communication of traumatic experiences from Khmer Rouge genocide survivors to their offspring: In-depth interviews with both generations

BACKGROUND

Traumatic events experienced by parents who have survived genocide influence mental health among their offspring. This study aims at exploring how the communication of traumatic events between Khmer Rouge survivors and their offspring was perceived by both generations.

METHODS

Qualitative interviews were performed with six Khmer Rouge survivors and with six young people representing the second generation and were analysed using a content analysis approach.

DISCUSSION

Parents felt that informing their children was important to instill gratitude for living a better life and to empower them. Among children, this was met with empathy but sometimes also disbelief and at times they blamed their parents for being too submissive.

CONCLUSION

The study discloses the complexity, pros and cons of intergenerational sharing of trauma.

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.

The lasting impact of early-life adversity on individuals and their descendants: potential mechanisms and hope for intervention

The adverse effects of early-life stress are pervasive, with well-established mental and physical health consequences for exposed individuals. The impact of early adverse experiences is also highly persistent, with documented increases in risk for mental illness across the life span that are accompanied by stable alterations in neural function and hormonal responses to stress. Here, we review some of these 'stress phenotypes', with a focus on intermediary factors that may signal risk for long-term mental health outcomes, such as altered development of the fear regulation system. Intriguingly, recent research suggests that such stress phenotypes may persist even beyond the life span of the individuals, with consequences for their offspring and grand-offspring. Phenotypic characteristics may be transmitted to future generations via either the matriline or the patriline, a phenomenon that has been demonstrated in both human and animal studies. In this review, we highlight behavioral and epigenetic factors that may contribute to this multigenerational transmission and discuss the potential of various treatment approaches that may halt the cycle of stress phenotypes.

Influences of maternal and paternal PTSD on epigenetic regulation of the glucocorticoid receptor gene in Holocaust survivor offspring

OBJECTIVE

Differential effects of maternal and paternal posttraumatic stress disorder (PTSD) have been observed in adult offspring of Holocaust survivors in both glucocorticoid receptor sensitivity and vulnerability to psychiatric disorder. The authors examined the relative influences of maternal and paternal PTSD on DNA methylation of the exon 1F promoter of the glucocorticoid receptor (GR-1F) gene (NR3C1) in peripheral blood mononuclear cells and its relationship to glucocorticoid receptor sensitivity in Holocaust offspring.

METHOD

Adult offspring with at least one Holocaust survivor parent (N=80) and demographically similar participants without parental Holocaust exposure or parental PTSD (N=15) completed clinical interviews, self-report measures, and biological procedures. Blood samples were collected for analysis of GR-1F promoter methylation and of cortisol levels in response to low-dose dexamethasone, and two-way analysis of covariance was performed using maternal and paternal PTSD as main effects. Hierarchical clustering analysis was used to permit visualization of maternal compared with paternal PTSD effects on clinical variables and GR-1F promoter methylation.

RESULTS

A significant interaction demonstrated that in the absence of maternal PTSD, offspring with paternal PTSD showed higher GR-1F promoter methylation, whereas offspring with both maternal and paternal PTSD showed lower methylation. Lower GR-1F promoter methylation was significantly associated with greater postdexamethasone cortisol suppression. The clustering analysis revealed that maternal and paternal PTSD effects were differentially associated with clinical indicators and GR-1F promoter methylation.

CONCLUSIONS

This is the first study to demonstrate alterations of GR-1F promoter methylation in relation to parental PTSD and neuroendocrine outcomes. The moderation of paternal PTSD effects by maternal PTSD suggests different mechanisms for the intergenerational transmission of trauma-related vulnerabilities.

Self-perception of when old age begins for Cambodian elders living in the United States

OBJECTIVE

To deepen the understanding of the life course of refugees this study explores the question: when do Cambodian elders perceive the beginning of old age?

METHODS

In-depth interviews were conducted with 32 Cambodians, age range 53-82, who attended an elder day center in an urban setting in Massachusetts. Interviews were transcribed and analyzed using the modified grounded theory approach.

RESULTS

The analysis revealed that the participants primarily reported two determinants to defining when old age begins: 1) the body "has too many illnesses" due to harsh working conditions; and 2) social role transition into grandparent.

DISCUSSION

This study extends research on cultural differences in aging, specifically identifying the cultural difference in the definition of when "old age" begins. Age is culturally derived and creates expectations for social roles, health, self-identity, and behavior. Understanding how refugees experience the cultural discrepancies in their expectations of aging can inform providers who serve this population.

Maternal PTSD associates with greater glucocorticoid sensitivity in offspring of Holocaust survivors

Intergenerational effects of trauma have been observed clinically in a wide range of populations, and parental PTSD has been associated with an increased risk for psychopathology in offspring. In studies of Holocaust survivor offspring, parental PTSD, and particularly maternal PTSD, has been associated with increased risk for PTSD, low basal urinary cortisol excretion and enhanced cortisol suppression in response to dexamethasone. Such findings implicate maternally derived glucocorticoid programming in the intergenerational transmission of trauma-related consequences, potentially resulting from in utero influences or early life experiences. This study investigated the relative influence of Holocaust exposure and PTSD in mothers and fathers on glucocorticoid sensitivity in offspring. Eighty Holocaust offspring and 15 offspring of non-exposed Jewish parents completed evaluations and provided blood and urine samples. Glucocorticoid sensitivity was evaluated using the lysozyme suppression test (LST), an in vitro measure of glucocorticoid receptor sensitivity in a peripheral tissue, the dexamethasone suppression test (DST), and 24-h urinary cortisol excretion. Maternal PTSD was associated with greater glucocorticoid sensitivity in offspring across all three measures of glucocorticoid function. An interaction of maternal and paternal PTSD on the DST and 24-h urinary cortisol showed an effect of decreased glucocorticoid sensitivity in offspring with paternal, but not maternal, PTSD. Although indirect, these findings are consistent with the hypothesis that epigenetic programming may be involved in the intergenerational transmission of trauma-related effects on glucocorticoid regulation.

Parental styles in the intergenerational transmission of trauma stemming from the Khmer Rouge regime in Cambodia

The impact of parental styles in intergenerational transmission of trauma among mothers who survived the Khmer Rouge regime in Cambodia, in power from 1975 to 1979, and their teenaged children was examined in 2 studies. In Study 1, 46 Cambodian female high school students and their mothers were recruited. Each daughter completed anxiety and depression measures as well as assessment of her mother's role-reversing, overprotective, and rejecting parental styles, whereas the mothers completed measures of their trauma exposure during the Khmer Rouge regime and PTSD symptoms. In support of trauma transmission, the mother's PTSD symptoms were predictive of her daughter's anxiety. Moreover, the mother's role-reversing parental style was shown to mediate the relationship between her own and her daughter's symptoms. In support of their generalizability, the results were replicated in Study 2 in a Cambodian-American refugee sample comparing 15 mental health treatment-seeking mothers and their teenaged children with 17 nontreatment-seeking mother-child pairs. The implications of the findings within the larger literature on intergenerational trauma transmission stemming from genocide are discussed.