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

Gaza's hidden crisis: adults, children, and generations of psychological torment to come

For more than a year, the world has been exposed to the ongoing conflict in Gaza, and the destruction, medical devastation, and the death toll of this crisis. What has been largely missing from the picture, has been an attention to the long-term mental health impact of the ongoing trauma among the Palestinian civilians and the Israeli hostages in Gaza. This article anticipates the enduring generational impact of war trauma on mental health of the civilians in Gaza, drawing from the author's clinical and research experiences of Iraqi, Syrian, Afghan, African, and Ukrainian war-exposed civilians, refugees, and survivors of torture. Across most different studies, war exposure leads to PTSD in nearly 30-50% of adult civilians, and similar rates of depression and anxiety. Civilians in Gaza, facing daily horrors and a profound sense of helplessness, are likely experiencing even greater psychological distress. Children, significantly affected during critical developmental stages, are at risk of long-term mental and physical health issues. The psychological, cultural, and epigenetic aspects of the intergenerational transmission of trauma can lead to psychological torment across generations. Addressing the mental health needs of these populations is crucial to mitigating the profound and lasting impact of war.

Amplified psychological reaction to civil unrest among Holocaust survivor descendants

The evidence regarding the intergenerational effects of the Holocaust points to a heightened sensitivity to traumatic and stressful events, as well as to threats. These effects were found across at least three generations: the survivors themselves, their children, and their grandchildren. More specifically, this sensitivity is manifested in increased psychological reactions to adverse circumstances, especially when such situations trigger associations with the Holocaust. During 2023 Israel has experienced unprecedented civil unrest and protests following the government's plan to promote a judicial overhaul. Many expressed fears for Israeli democracy and the integrity of the social fabric in Israel. The current study examined how Holocaust descendants (i.e., children and grandchildren of Holocaust survivors) experienced this prolonged social unrest. A web-based random sample of 706 Israeli Jews born after World War II completed questionnaires several months before the unrest began (Wave 1, 2022) and seven months into the unrest (Wave 2, 2023). Supporting most of our hypotheses, Holocaust descendants reported higher civil unrest salience (i.e., more preoccupation with the political and social upheaval) relative to comparison descendants (i.e., children and grandchildren of those not directly exposed to the Holocaust). Relative to comparison descendants, Holocaust descendants were also at a greater risk of reporting exacerbation in anxiety since the judicial overhaul was introduced, but not in depression or somatisation symptoms. Results remained significant after controlling Wave 1 distress level, background characteristics, level of engagement in civil unrest, and participants' viewpoint on the judicial overhaul. The findings further corroborate unique reactions to stress among Holocaust descendants, this time by highlighting increased preoccupation and increased exacerbation in anxiety during a period of prolonged political and social turmoil.

Long-lasting effects of post-traumatic stress disorder in Yazidi women living in Northern Iraqi camps

The severity of post-traumatic stress disorder and its long-lasting effects among the Yazidi population has not yet been investigated.

Objectives

This study evaluated the impact of PTSD severity and chronicity on physiological and anthropometric parameters in women survivors of the genocide-related events after the so-called Islamic State of Iraq and Syria (ISIS) attack in 2014.

Methods

The diagnosis PTSD was assessed using PTSD Checklist for DSM-5 (PCL-5). Participants were divided into: External control (healthy individuals living outside the camps), Internal control (healthy individuals living in the camps), and PTSD group (individuals diagnosed with PTSD). The PTSD group was subdivided according to chronicity <2 years, 2-5 years, and >5 years and subdivided according to PTSD severity into "Moderate", "Severe" and "Extreme". Systolic blood pressure (SBP), diastolic blood pressure (DBP), blood oxygen saturation (SPO2) and heart rate (HR) were evaluated. Weight, height and waist circumference were measured. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated.

Results

The PTSD group showed significant increases in SBP, DBP, heart rate, BMI, WC, weight, and WHtR compared to the control groups. SPO2 values decreased in the PTSD group. As the disease progressed, there were further increases in SBP, DBP, heart rate, BMI, WC, WHtR, and weight. Similar increases were observed with the severity of the disease.

Conclusion

Our data indicates that a long-term impact on physiological and anthropometric parameters is present in women diagnosed with PTSD which might be aggravated by the severity and chronicity of the disease.

Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience

Anisman, H., Doubad, D., Asokumar, A. & Matheson, K. Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience. NEUROSCI BIOBEHAV REV, XXXX. Immigration occurs between countries either to obtain employment, for family reunification or to escape violence and other life-threatening conditions. Refugees and asylum seekers are often obligated to overcome a uniquely challenging set of circumstances prior to and during migration. Settlement following immigration may pose yet another set of stressors related to acculturation to the host country, as well as financial insecurity, discrimination, language barriers, and social isolation. Here we discuss the multiple consequences of immigration experiences, focusing on the health disturbances that frequently develop in adults and children. Aside from the psychosocial influences, immigration-related challenges may cause hormonal, inflammatory immune, and microbiota changes that favor psychological and physical illnesses. Some biological alterations are subject to modification by epigenetic changes, which have implications for intergenerational trauma transmission, as might disruptions in parenting behaviors and family dysfunction. Despite the hardships experienced, many immigrants and their families exhibit positive psychological adjustment after resettlement. We provide information to diminish the impacts associated with immigration and offer strength-based approaches that may foster resilience.

War trauma impacts in Ukrainian combat and civilian populations: Moral injury and associated mental health symptoms

This is the first study to compare active-duty soldiers and student civilian samples during the first three months of the Ukrainian-Russian war in relation to moral injury and its association with PTSD, anxiety and depression. A total of 350 participants, including 191 active-duty soldiers of the Ukrainian Armed Force (UAF), who were on the frontline during the full-scale invasion of Russian troops in February 2022, and 159 students from different HEIs in Volyn oblast, were recruited into the study through their attendance at the Ukrainian Psychotrauma Center. Prior to the in-person group-intervention program of psychosocial support for military and civil populations at the Ukrainian Psychotrauma Center, moral injury, PTSD, depression, and anxiety were assessed. Results showed significantly higher moral injury, PTSD, depression, and anxiety scores in civilian students, with a two-way ANOVA indicating a significant impact of female gender in civilians only. A hierarchical regression indicated that moral injury is a predictor of PTSD symptoms in both active-duty and civilian student groups. However, previous family trauma of genocide is associated with PTSD symptoms in active soldiers only. The findings of the current study could contribute insights for clinical practice for combatants and civilians during the current war.

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.

Trauma-related mental health problems among mothers in Taiwan and their relationship with children's emotional and behavioral problems

ABSTRACTBackground: Trauma can give rise to mental health problems and emotional and interpersonal difficulties, which in turn can perpetuate the cycle of trauma and adversity for future generations. However, little is known about the prevalence and potential effects of trauma and trauma-related mental health problems among parents.Objective: The primary goal of this study was to examine childhood and adulthood trauma and trauma-related symptoms among mothers of children aged between 6 and 18. We also conducted exploratory analyses of their potential relationship with children's emotional and behavioural problems.Method: A total of 817 mothers living with a child aged between 6 and 18 in Taiwan completed standardized self-report assessments of trauma exposure, trauma-related symptoms, and children's emotional and behavioural problems. A subsample (n = 256) also provided follow-up data after six months.Results: Most surveyed mothers reported at least one childhood traumatic event (74.79%) and one adulthood traumatic event (78.70%); 4.4% met the ICD-11 criteria for PTSD, and 12.1% for complex PTSD; 11.4% reported clinically significant dissociative symptoms. Mothers' complex PTSD and dissociative symptoms were cross-sectionally correlated with children's emotional and behavioural problem (rs = .186 to .239, p < .001). After controlling for possible confounding variables and baseline scores, mothers' childhood non-betrayal trauma reported at baseline was found to be a predictor of children's emotional and behavioural problems reported at follow up.Conclusion: This study is the first to provide data regarding childhood and adulthood trauma and trauma-related disorders, including ICD-11 complex PTSD, among mothers in the community. It calls for more studies to understand the potential effects of intergenerational trauma.

Terror catastrophizing: association with anxiety, depression, and transgenerational effects

Background & Objectives: Terror catastrophizing, defined as an ongoing fear of future terrorist attacks, is associated with a higher incidence of anxiety disorders, among other psychological impacts. However, previous studies examining terror catastrophizing's relationship to other mental health disorders are limited. The current study sought to determine if patients diagnosed with anxiety and depression would experience increased terror catastrophizing. Additionally, this study aimed to investigate whether parental terror catastrophizing increases children's internalizing symptoms.Design & Methods: Individuals were randomly drawn from the Danish Civil Registration System and invited to complete a series of questionnaires to measure terror catastrophizing tendency, lifetime parental trauma, and children's internalizing symptoms. In total, n = 4,175 invitees completed the survey of which 933 reported on a child between 6 and 18 years. Responses were analyzed using a generalized linear regression model.Results: Participants diagnosed with anxiety alone or comorbid with depression were more likely to experience symptoms of terror catastrophizing than undiagnosed participants (β = 0.10, p < .001; β = 0.07, p = .012). Furthermore, the parental tendency to catastrophize terror was associated with higher internalizing symptoms in children (β = 0.09, p = .006), even after taking parental diagnoses, as well as lifetime and childhood trauma into account.Conclusion: The results can inform clinical practices to account for a patient's potential to exhibit increased terror catastrophizing tendencies or be more affected by traumatic events. Additionally, they can offer insights for designing novel preventative interventions for the whole family, due to the relation between parental tendencies for terror catastrophizing and the internalizing symptoms observed in children.

Parental Preconception Adversity and Offspring Mental Health in African Americans and Native Americans in the United States: A Systematic Review

This systematic review examines the impact of parental preconception adversity on offspring mental health among African Americans (AAs) and Native Americans (NAs), two populations that have experienced historical trauma and currently experience ethnic/racial mental health disparities in the United States. PsycINFO, PubMed, CINAHL, Scopus, and Web of Science were searched for studies that included at least two generations of AAs or NAs from the same family, measured parental preconception adversity and their offspring's mental health, and examined the association between these variables. Over 3,200 articles were screened, and 18 articles representing 13 unique studies were included in this review. Among the studies with samples that included AAs (n = 12, 92%), 10 (83%) reported a significant association between parental preconception adversity and adverse offspring mental health. The only study with a sample of NAs (n = 1, 8%) also reported a significant association between these variables. Although the literature suggests that parental preconception adversity is associated with offspring mental health among AAs and NAs, it must be interpreted in the context of the small number of studies on this topic and the less-than-ideal samples utilized-just one study included a sample of NAs and several studies (n = 6, 46%) used multi-ethnic/racial samples without testing for ethnic/racial disparities in their results. A more rigorous body of literature on this topic is needed as it may help explain an important factor underlying ethnic/racial mental health disparities, with important implications for interventions and policy.

Intergenerational Transmission of Ethnoracial Historical Trauma in the United States

Throughout time, ethnoracial groups have endured a range of traumatic experiences as historically marginalized members of the United States. The consequences of these experiences have been referred to as historical trauma (HT): a collective trauma, inflicted on a group of people who share a specific identity, that has psychological, physical, and social impacts on succeeding generations. In this review, we examine the literature on HT in relation to US ethnoracial groups by defining HT, providing a background for its development, and describing critiques of the concept. We then review the literature on HT in relation to Indigenous Americans, African Americans, and Asian Americans. For each group, we address the nature of HT, the transmission of HT and its impacts, and healing strategies. We conclude with a summary of the benefits, limitations, and complexities of HT research as well as recommendations for future work in this area.

Sex and gender in psychotrauma research

Background: Posttraumatic stress disorder (PTSD) is two to three times more common in women than in men. To better understand this phenomenon, we need to know why men, women, and possibly individuals with other sex/gender identities respond differently to trauma. To stimulate sex and gender sensitive research, the European Journal of Psychotraumatology (EJPT) was the first journal to adopt a gender policy. In addition, a call for papers entitled Integrating and Evaluating Sex and Gender in Psychotrauma Research was announced.Objective: This special issue synthesizes the past five years of psychotrauma research with regard to sex/gender differences.Method: Seventy-seven articles were identified from EJPT archives, including five systematic reviews. These articles examined sex differences and/or gender differences in exposure to trauma, posttraumatic stress responses, or how sex and gender impacts (mental) health outcomes or treatment responses.Results: Findings from these studies outlined that: 1. sex and gender still need to be more clearly defined, also in relation to the context that codetermine trauma responses, like other 'diversity' variables; 2. in most studies, sex and gender are measured or reported as binary variables; 3. sex and gender are important variables when examining trauma exposure, responses to these events, symptoms trajectories, and mental and physical health outcomes across the life span; and 4. in PTSD treatment studies, including a meta-analysis and a systematic review, sex and gender were not significant predictors of treatment outcome.Conclusion: Future research must focus on sex and gender as important and distinct variables; they should include sex and gender in their statistical analyses plan to better clarify associations between these variables and (responses to) psychotrauma. To enhance reporting of comparable data across studies, we provide suggestions for future research, including how to assess sex and gender.

Programming the next generation of prenatal programming of stress research: A review and suggestions for the future of the field

In this article, I highlight core ideas, empirical findings, and advances in the study of how stress during pregnancy may prenatally program child neurodevelopmental, psychopathological, and health outcomes, emphasizing reviews, metanalyses, and recent contributions of conceptual and empirical work. The article offers a perspective on the history of this area of science, the underrecognized contributions of influential scholars from diverse fields of study, what we know from the evidence to date, the persistent challenges in sorting through what is left to learn, and suggestions for future research. I include sections focused on promoting resilience, pregnancy interventions that demonstrate positive effects across two generations, and the translational implications of the accruing data for practice and policy, highlighting opportunities for integrating across a range of fields and sectors. In the concluding sections, I discuss lessons learned from conducting this work and provide a closing summary of progress and future directions. The goal of this writing was to provide a viewpoint on some ways that emerging intergenerational transmission scholars might responsibly contribute to the future of the field of developmental psychopathology.

Post-traumatic Stress Disorder: The Influence of the Environmental Context and Analysis of Oxidative Stress and Inflammatory and Glycemic Markers in Women Living in Kurdistan Regional Government-Iraq

Background Internally displaced persons (IDP) camps are still home to a large number of female survivors of the Yazidi genocide carried out in Iraq in 2014 by the Islamic organization known as the Islamic State of Iraq and Syria (ISIS). Many of these women suffer from a persistent form of post-traumatic stress disorder (PTSD), which can last for many years. On the other hand, little is known about the intricate etiology of PTSD. Objectives In this observational cross-sectional study, the biochemical parameters, including inflammatory and oxidative stress (OXS) markers, were evaluated in two groups: the case group (women with newly diagnosed PTSD) and the control group (apparently healthy women). Furthermore, how the environment impacts the biochemical and OXS parameters of people not diagnosed with PTSD but living in IDP camps was also analyzed. Materials and methods The PTSD group (n=55, age=30.0 years) was made up of women survivors of genocide-related events living in IDP camps in the Kurdistan region of Iraq. The studied parameters in the PTSD group have been compared to two healthy control groups: (1) internal control group (n=55, age=28.1 years): healthy women living inside the IDP camps; and (2) external control group (n=55, age=28.3 years): healthy women living outside the IDP camps. The diagnosis of PTSD was conducted using a validated Kurdish version of the PTSD Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (PCL-5) scale. Blood samples were collected to determine the level of glycated hemoglobin (HbA1c) and the concentrations of fasting serum glucose (FSG), C-reactive protein (CRP), ceruloplasmin (CP), 8-hydroxydeoxyguanosine (8-OHdG), glutathione (GSH), malondialdehyde (MDA), protein carbonyls (PC), and catalase (CAT) activity. Results Women with PTSD presented increased values of FSG (4.41%, p<0.05), HbA1c (4.74%, p<0.05), and CRP (114.29%, p<0.05), as well as increased levels of 8-OHdG (185.97%, p<0.001), CP (27.08%, p<0.001), MDA (141.97%, p<0.001), and PC (63.01%, p<0.001), besides increased CAT activity (121.5%, p<0.001), when compared with the control groups. A significant reduction of GSH (-20.33%, p<0.05) was observed in PTSD patients as compared to the external control group. In relation to the internal control group, women diagnosed with PTSD presented significantly increased levels of FSG (3.88%, p<0.05), HbA1c (2.83%, p<0.05), CRP (77.97%, p<0.05), and PC (41.3%, p<0.05), as well as increased levels of 8-OHdG (118.84%, p<0.001), CP (22.72%, p<0.001), MDA (90.67%, p<0.001), and CAT activity (55.31%, p<0.001). Healthy individuals residing in IDP camps, compared with external healthy control, presented significantly elevated levels of 8-OHdG (30.68%, p<0.001), MDA (26.91%, p<0.001), PC (15.37%, p<0.001), and CAT activity (42.62%, p<0.001). Conclusion Our findings indicate that PTSD significantly influences glycemic, inflammatory, oxidant, and antioxidant parameters, as evidenced by increased levels of FSG, HbA1C, CRP, PC, MDA, 8-OHdG, and CP, as well as increased CAT activity and a reduced GSH concentration in the PTSD group in comparison to the external control group. Additionally, our results suggest that the environmental context in IDP camps by itself can potentially affect oxidant and antioxidant parameters, as evidenced by the increased concentrations of 8-OHdG, MDA, and PC and increased CAT activity found in individuals not diagnosed with PTSD but living inside the camps.

Holocaust communication, attachment orientation and distress among descendants of female holocaust survivors

The multiple studies that have examined the transgenerational transmission of Holocaust trauma from survivors to their descendants have yielded inconsistent results. These can be attributed to differences in assessment tools and to individual differences between survivors, such as their specific experiences during the Holocaust. This study examined the differences between daughters and granddaughters of female Holocaust survivors (HS) of concentration camps (CCS) versus survivors of other circumstances (ghettos, concealment, etc.; OCCS) in terms of communication about their mothers' or grandmothers' Holocaust trauma (Holocaust communication), their attachment orientations, and their psychological distress. The sample was composed of 79 dyads of daughters of HS and their own daughters, divided into two groups according to the survivors' Holocaust experiences (CCS-47 dyads; OCCS-32 dyads). The findings indicated that daughters of CCS reported a higher number of conversations about the Holocaust with their mothers, perceived their mothers as more distant during Holocaust communication, and reported more guilt feelings than daughters of OCCS. Holocaust communication between daughters and granddaughters was characterized by shorter conversations, and granddaughters perceived their mothers as sadder in the CCS group than in the OCCS group. No difference between groups was found in Holocaust communication between survivors and their granddaughters. No difference was found between groups in their psychological distress. The granddaughters of CCS scored higher on attachment anxiety than the other group. Most of the significant differences between groups were linked to subtle differences in the characteristics of communication and in the inter-personal sphere.

Harbingers of Hope: Scientists and the Pursuit of World Peace

The ongoing wars in many regions-such as the conflict between Israel and Hamas-as well as the effects of war on communities, social services, and mental health are covered in this special editorial. This article emphasizes the need for international efforts to promote peace, offer humanitarian aid, and address the mental health challenges faced by individuals and communities affected by war and violence.

Genome-wide neonatal epigenetic changes associated with maternal exposure to the COVID-19 pandemic

BACKGROUND

During gestation, stressors to the fetus, including viral exposure or maternal psychological distress, can fundamentally alter the neonatal epigenome, and may be associated with long-term impaired developmental outcomes. The impact of in utero exposure to the COVID-19 pandemic on the newborn epigenome has yet to be described.

METHODS

This study aimed to determine whether there are unique epigenetic signatures in newborns who experienced otherwise healthy pregnancies that occurred during the COVID-19 pandemic (Project RESCUE). The pre-pandemic control and pandemic cohorts (Project RESCUE) included in this study are part of a prospective observational and longitudinal cohort study that evaluates the impact of elevated prenatal maternal stress during the COVID-19 pandemic on early childhood neurodevelopment. Using buccal swabs collected at birth, differential DNA methylation analysis was performed using the Infinium MethylationEPIC arrays and linear regression analysis. Pathway analysis and gene ontology enrichment were performed on resultant gene lists.

RESULTS

Widespread differential methylation was found between neonates exposed in utero to the pandemic and pre-pandemic neonates. In contrast, there were no apparent epigenetic differences associated with maternal COVID-19 infection during pregnancy. Differential methylation was observed among genomic sites that underpin important neurological pathways that have been previously reported in the literature to be differentially methylated because of prenatal stress, such as NR3C1.

CONCLUSIONS

The present study reveals potential associations between exposure to the COVID-19 pandemic during pregnancy and subsequent changes in the newborn epigenome. While this finding warrants further investigation, it is a point that should be considered in any study assessing newborn DNA methylation studies obtained during this period, even in otherwise healthy pregnancies.

Long-lasting effects of World War II trauma on PTSD symptoms and embodiment levels in a national sample of Poles

The main aim of this study was to investigate the long-lasting influences of World War II (WWII) trauma in a national sample of Poles, based on Danieli's (1998) survivors' post-trauma adaptational styles (fighter, numb, victim) and their link with current post-traumatic stress disorder (PTSD) symptoms and embodiment level among participants. We also sought to investigate whether the level of knowledge about WWII trauma among ancestors could moderate that association. The study was conducted among a representative sample of 1598 adult Poles obtained from an external company. Participants filled out the Danieli Inventory of Multigenerational Legacies of Trauma, the knowledge about traumatic World War II experiences in the family questionnaire, the Posttraumatic Diagnostic Scale-5, and the Experience of Embodiment Scale. We observed a positive relationship between all survivors' post-trauma adaptational styles and current levels of PTSD symptoms among participants. In addition, PTSD level mediated the relationships between those adaptational styles and embodiment intensity; that mediation was additionally moderated by a lack of knowledge about WWII trauma among ancestors in our participants. Our study adds to the literature on intergenerational trauma by highlighting the importance of evaluating embodiment in understanding the mechanisms of trauma transmission. Furthermore, it highlights the moderating effect of knowledge of family history in this mechanism and the need to share family histories with subsequent generations.

How to deal with the past? How collective and historical trauma psychologically reverberates in Eastern Europe

Traumatic stress studies have recently addressed the issue of 'historical trauma' that well explain the impact of collective or totalitarian trauma. The example of former communist Eastern Europe shows that there are many individual and socio-psychological consequences that still have effects today. This paper summarizes concepts and findings on 'historical traumas' that describe such long-lasting effects. The focus is on the side of the victims and their family descendants and thus also on the moral heirs of the dissidents, e.g., the Russian NGO Memorial. Analogous to developments in psychotraumatology, increasing knowledge in this area can explain psychosocial pathologies but also help develop effective remedies. This includes the development of a culture of remembrance, socio-therapeutic interventions and increased sensitivity towards those patients and clients who have such a personal legacy.

Exposure to self-reported traumatic events and probable PTSD in a national sample of Poles: Why does Poland's PTSD prevalence differ from other national estimates?

BACKGROUND

There is a lack of studies on trauma exposure and PTSD prevalence in Poland on representative samples. Available data from studies on convenient samples show very high rates of probable PTSD compared with relevant estimates in other countries.

OBJECTIVE

This study aimed to measure the exposure to self-report traumatic events (PTEs) and to estimate the current rate of prevalence of probable posttraumatic stress disorder (PTSD) in accordance with DSM-5 criteria in a population-based sample of Poles. Additionally, the link between PTSD intensity and level of life satisfaction was investigated.

METHOD

A representative sample of 1,598 adult Poles was recruited. Probable PTSD was assessed with the Posttraumatic Diagnostic Scale for DSM-5 (PDS-5) and the Satisfaction with Life Scale (SWLS) was also used.

RESULTS

The findings showed that 60.3% of Poles had experienced at least one PTE and 31.1% of those who had been exposed to trauma reported symptoms of PTSD. At the level of the entire sample, the obtained rate for probable PTSD was 18.8%. The traumatic events with the highest probabilities of PTSD symptoms were child abuse and sexual assault. Levels of life satisfaction were significantly lower in the group of participants with probable PTSD.

CONCLUSIONS

We found that the current prevalence of probable PTSD in Poland is intriguingly high relative to rates reported in comparable representative samples from other countries across the world. Possible mechanisms are discussed, including a lack of social acknowledgement of WWII and other traumas as well as poor access to trauma-focused care. We hope that this research may inspire more studies investigating cross-national differences in PTSD and trauma exposure.

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.

Kindled emotions: Commemoration and the importance of meaning making, support and recognition

Commemorative events, organized in the aftermath of war or large-scale violence, can have an emotional impact on those who are attending. We examined several characteristics that might influence this impact. In a quasi-experimental pretest-posttest study, participants (n = 307) watched footage of the broadcast of the Dutch National Commemoration, in which World War II is remembered. A control group of 48 participants watched the commemoration broadcast live on Remembrance Day. They were matched for age, gender, war experience and migration background with 48 participants from the study group who watched the footage, to conduct a comparability check. We found some evidence that watching the footage was comparable to watching the commemoration live on Remembrance Day in terms of emotional response and experience of psychosocial factors. Participants in the footage sample (n = 307) responded with an increase of negative and decrease of positive emotions. Individual characteristics were limitedly related to the emotional response; posttraumatic stress symptom severity predicted increased negative emotions. Experiencing meaning making, support and, to a lesser extent, recognition through commemorating was related to experiencing more positive emotions. The findings indicate these psychosocial factors may buffer the emotional distress elicited by commemoration and contribute to important cognitive and social benefits. Practical implications are discussed.

Exposure to war and conflict: The individual and inherited epigenetic effects on health, with a focus on post-traumatic stress disorder

War and conflict are global phenomena, identified as stress-inducing triggers for epigenetic modifications. In this state-of-the-science narrative review based on systematic principles, we summarise existing data to explore the outcomes of these exposures especially in veterans and show that they may result in an increased likelihood of developing gastrointestinal, auditory, metabolic and circadian issues, as well as post-traumatic stress disorder (PTSD). We also note that, despite a potential "healthy soldier effect", both veterans and civilians with PTSD exhibit the altered DNA methylation status in hypothalamic-pituitary-adrenal (HPA) axis regulatory genes such as NR3C1. Genes associated with sleep (PAX8; LHX1) are seen to be differentially methylated in veterans. A limited number of studies also revealed hereditary effects of war exposure across groups: decreased cortisol levels and a heightened (sex-linked) mortality risk in offspring. Future large-scale studies further identifying the heritable risks of war, as well as any potential differences between military and civilian populations, would be valuable to inform future healthcare directives.

Does Hope Reverberate Between Generations?

Intergenerational transmission refers to the transmission of stories, traits, abilities, ideas, behaviors, and various outcomes from parents to their children. To date, there has been little research on the intergenerational transmission of positive behavior, traits, and actions. To determine whether hope may be transmitted from one generation to the next, a qualitative study was performed, using narrative inquiry and thematic analysis. Over 4 months, four mothers of children with mental illness were engaged in repeated conversations about stories of hope related to their past and how they envisioned hope in their children. Findings indicated that hope could be transmitted to the next generation, either explicitly (verbally) or implicitly (i.e., expressed through actions involving one's children). We conclude that also positive patterns may be transmitted both explicitly and implicitly from one generation to the next. Transmitting hope between generations played a significant role in the mothers' experiences of hope.

Formal perspectives on shared interbrain activity in social communication: Insights from information and control theories

The mechanisms underlying a reorientation of neuroscience from a single-brain to a multi-brain frame of reference have long been with us. These revolve around the evolutionary exaptation of the inevitable second-law 'leakage' of crosstalk between co-resident cognitive phenomena. Crosstalk characterizes such processes as immune response, wound-healing, gene expression, as so on, up through and including far more rapid neural processes. It is not a great leap-of-faith to infer that similar phenomena affect/afflict social interactions between individuals within and across populations.

Dark tourism, the holocaust, and well-being: A systematic review

Dark tourists experience negative and positive feelings in Holocaust places, suggesting emotional ambivalence. The research question of this study is, "is feeling well-being, as a consequence of dark tourism, a way of banalizing the horror?". The purpose of this study is threefold: to provide an updated systematic literature review (SLR) of dark tourism associated with Holocaust sites and visitors' well-being; to structure the findings into categories that provide a comprehensive overview of the topics; and to identify which topics are not well covered, thus suggesting knowledge gaps. Records to be included should be retrievable articles in peer-reviewed academic journals, books, and book chapters, all focused on the SLR's aims and the research question; other types of publications were outrightly excluded. The search was performed in Web of Science, Scopus, and Google Scholar databases with three keywords and combinations: "dark tourism", "Holocaust", and "well-being". Methodological decisions were based on the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. During the process, 144 documents were included, of which 126 were journal articles, 8 were books, and 10 were book chapters. The results point out a hierarchical structure with the main category (Dark tourism - Holocaust - Well-being) and three second-order categories (Dark tourism - Holocaust, Dark tourism - Well-being, and Holocaust - Well-being), from which different subcategories emerge: motivations for visiting places and guiding; ambivalent emotional experience that leads to the transformation of the self; and intergenerational trauma. The gaps identified were the trivialization of horror in Holocaust places; dark tourist profile; motivations and constraints behind visiting dark places; Holocaust survivors and their descendants' well-being; how dark tourism associated with the Holocaust positively or negatively impacts well-being. Major limitations included: lack of randomized allocation; lack of standard outcome definitions; and suboptimal comparison groups. Positive and negative impacts on the well-being of the Holocaust dark tourist were sought, as they are associated with the marketing and management, promotion, digital communication, guiding, or storytelling design of such locations.

Psychosocial family-level mediators in the intergenerational transmission of trauma: Protocol for a systematic review and meta-analysis

INTRODUCTION

Family-level psychosocial factors appear to play a critical role in mediating the intergenerational transmission of trauma; however, no review article has quantitatively synthesized causal mechanisms across a diversity of trauma types. This study aims to systematically consolidate the epidemiological research on family-level psychosocial mediators and moderators to ultimately produce causal diagram(s) of the intergenerational transmission of trauma.

METHODS

We will identify epidemiological peer-reviewed publications, dissertations, and conference abstracts that measure the impact of at least one psychosocial family-level factor mediating or moderating the relationship between parental trauma exposure and a child mental health outcome. English, French, Kinyarwanda, and Spanish articles will be eligible. We will search MEDLINE, PsycINFO, PTSDpubs, Scopus, and ProQuest Dissertations and Theses and will conduct forward citation chaining of included documents. Two reviewers will perform screening independently. We will extract reported mediators, moderators, and relevant study characteristics for included studies. Findings will be presented using narrative syntheses, descriptive analyses, mediation meta-analyses, moderating meta-analyses, and causal diagram(s), where possible. We will perform a risk of bias assessment and will assess for publication bias.

DISCUSSION

The development of evidence-based causal diagram(s) would provide more detailed understanding of the paths by which the psychological impacts of trauma can be transmitted intergenerationally at the family-level. This review could provide evidence to better support interventions that interrupt the cycle of intergenerational trauma.

TRIAL REGISTRATION

Systematic review registration: PROSPERO registration ID #CRD42021251053.

The mental health consequences on children of the war in Ukraine: A commentary

The news from Ukraine is currently full of heart-wrenching stories accompanied by graphic images of civilian casualties and massacres that are telecast world-wide on a daily basis. It is hard to fathom the magnitude of the devastation and disruption to regular lives and everyday routines that war brings with it, the witnessing of countless deaths, the associated trauma of living in perpetual fear, and the daily experience of many families and orphans who are crowded into basement bomb shelters now for months on end. These issues make us contemplate the mental health consequences, among other lasting effects, of this costly war in Ukraine, and wars in other countries not so widely featured in Western news. Despite people of all ages being affected by war, children are especially vulnerable. This commentary outlines some of the epidemiology of the consequences of war, the mental health sequelae specifically, and the complexity of providing culturally and contextually relevant interventions that meet the needs of children.

Examining intergenerational transmission of Holocaust trauma as it relates to Jewish identity, communication type, and mental well-being

A growing body of literature has examined how historical trauma can transmit across generations. Within this literature, one's level of enculturation is thought to impact their awareness of historical losses, which, in turn, is hypothesized to relate to mental well-being. Some studies have suggested that family communication about historical trauma can impact the strength of cultural identity and mental well-being. The current study sampled second- and third-generation Holocaust survivors to examine how family communication about the Holocaust relates to historical loss awareness and the strength of Jewish identity. Adults (N = 98) with relatives who had either been killed in or who survived the Holocaust completed online questionnaires. First, we examined the associations among Jewish identity, historical loss awareness, and family communication about the Holocaust. Next, we examined whether Holocaust-related family communication type predicted mental well-being. Healthy communication was classified as frequent and willing, and unhealthy communication was classified as indirect and guilt-inducing. Multiple linear regression analyses indicated that stronger Jewish identity and more frequent family Holocaust communication predicted more historical loss awareness, R² = .22. Unhealthy communication was related to poorer mental well-being, R² = .09, lending support to the idea that family narratives about trauma impact the next generation. Implications for healing from historical trauma are discussed.

Prenatal maternal stress and offspring aggressive behavior: Intergenerational and transgenerational inheritance

Even though studies have shown that prenatal maternal stress is associated with increased reactivity of the HPA axis, the association between prenatal maternal stress and fetal glucocorticoid exposure is complex and most likely dependent on unidentified and poorly understood variables including nature and timing of prenatal insults. The precise mechanisms in which prenatal maternal stress influence neuroendocrine signaling between the maternal-placental-fetal interface are still unclear. The aim of this review article is to bring comprehensive basic concepts about prenatal maternal stress and mechanisms of transmission of maternal stress to the fetus. This review covers recent studies showing associations between maternal stress and alterations in offspring aggressive behavior, as well as the possible pathways for the “transmission” of maternal stress to the fetus: (1) maternal-fetal HPA axis dysregulation; (2) intrauterine environment disruption due to variations in uterine artery flow; (3) epigenetic modifications of genes implicated in aggressive behavior. Here, we present evidence for the phenomenon of intergenerational and transgenerational transmission, to better understands the mechanism(s) of transmission from parent to offspring. We discuss studies showing associations between maternal stress and alterations in offspring taking note of neuroendocrine, brain architecture and epigenetic changes that may suggest risk for aggressive behavior. We highlight animal and human studies that focus on intergenerational transmission following exposure to stress from a biological mechanistic point of view, and maternal stress-induced epigenetic modifications that have potential to impact on aggressive behavior in later generations.

The Effects of Maternal Disaster Exposure on Adolescent Mental Health 12 Years Later

Natural disasters adversely impact children's mental health, with increased parent or child exposure and subsequent parental distress predicting poorer outcomes. It remains unknown, however, whether the psychological consequences of disasters for children persist long-term, and if so, why and for whom. We therefore examined the effects of mothers' exposure to Hurricane Katrina on adolescent children's mental health 12 years later, distinguishing between direct effects of disaster exposure and effects mediated by maternal distress, and evaluating moderation by child age and gender. Data were from a 2003-2018 study of young, low-income, primarily African American mothers living in New Orleans when Hurricane Katrina occurred in 2005 (n = 328). Mothers rated their mental health about one year pre-Katrina and one, four, and 12 years afterwards. They reported on an adolescent child's (ages 10-17, mean = 14.46) internalizing and externalizing symptoms 12 years post-Katrina using the Strengths and Difficulties Questionnaire. Path analytic models adjusting for mothers' pre-disaster distress showed that, whereas the direct effects of maternal hurricane exposures on child mental health were not significant, the indirect effects were. Specifically, mothers who experienced more Katrina-related stressors had higher distress thereafter, which predicted poorer child outcomes. Results did not differ significantly by child age. Gender differences are discussed. Findings suggest that disasters can affect child mental health for many years, even for those who were very young or not yet born at the time, due to parents' disaster-related distress. Addressing parents' mental health needs in the aftermath of disasters may improve child well-being long-term.

"All emigrants are up to the physical, mental, and moral standards required": A tale of two child rescue schemes

The current paper critically assesses and reflects on the ideals and realities of two major (British) child migration schemes, namely the British Home Child scheme (1869-1930) and the Kindertransport scheme (1938-1940), to add to current understandings of their place within wider international histories of child migration, moral reforms, eugenics, settlement, and identity. Specifically, we focus on constructions of "mentally and physically deficient" children/young people, informed by eugenic viewpoints and biological determinism, and how this guided inclusion and exclusion decisions in both schemes. Both schemes made judgements regarding which children should be included/excluded in the schemes or returned to their country of origin (as was the case with children in the Canadian child migration scheme) fueled by a type of eugenics oriented to transplanting strong physical and psychologically resilient specimens. By viewing the realities of the child migration schemes, including the varied experiences and narratives in relation to child migrants, in light of eugenicist narratives of difference, pathology, victimhood, and contamination, we shed a light on uneven practices, formations of power, and expectations of the times.

Canada's Colonial Genocide of Indigenous Peoples: A Review of the Psychosocial and Neurobiological Processes Linking Trauma and Intergenerational Outcomes

The policies and actions that were enacted to colonize Indigenous Peoples in Canada have been described as constituting cultural genocide. When one considers the long-term consequences from the perspective of the social and environmental determinants of health framework, the impacts of such policies on the physical and mental health of Indigenous Peoples go well beyond cultural loss. This paper addresses the impacts of key historical and current Canadian federal policies in relation to the health and well-being of Indigenous Peoples. Far from constituting a mere lesson in history, the connections between colonialist policies and actions on present-day outcomes are evaluated in terms of transgenerational and intergenerational transmission processes, including psychosocial, developmental, environmental, and neurobiological mechanisms and trauma responses. In addition, while colonialist policies have created adverse living conditions for Indigenous Peoples, resilience and the perseverance of many aspects of culture may be maintained through intergenerational processes.

Exposure to War Prior to Conception: Maternal Emotional Distress Forecasts Sex-Specific Child Behavior Problems

Objectives: Exposure to maternal stress during the prenatal period adversely affects child outcomes. Recent investigations have shifted to an even earlier period, the preconception period, to better understand the role of this formative period in human health and disease. We investigated the links between maternal emotional distress following preconception exposure to war, and child outcomes at age 10. Material and Methods: Before becoming pregnant, mothers were exposed to missile bombardment on the north of Israel in the 2006 war. Mothers who conceived within 12 months after the war were recruited and compared to mothers who conceived during the same period but lived in Israel but outside missile range. During the initial assessment, mothers completed a questionnaire on emotional distress. At 10 years of age, mothers and children (N = 68) reported on child socio-emotional outcomes. Results: Multiple regression analyses revealed that, in girls, higher maternal emotional distress following preconception war exposure predicted more internalizing and externalizing behavior problems, and more behavior regulation problems. In boys, maternal emotional distress was not significantly related to outcomes. Conclusion: Maternal emotional distress following preconception exposure to war forecasts sex-specific child behavioral problems as reported by the mother and the child. Though the results warrant cautious interpretation because of the relatively small sample size and differential attrition, our findings add to the small but growing body of research on the consequences of maternal stress exposure prior to conception for the next generation.

Perceived racial and social class discrimination and cannabis involvement among Black youth and young adults

BACKGROUND

The current study examines the association of perceived racial and social class discrimination with cannabis involvement among Black youth and young adults.

METHODS

This secondary analysis used data from the Missouri Family Study (MOFAM), a high-risk longitudinal family study of alcohol use disorder, oversampled for Black families. Offspring (n = 806) and their mothers were interviewed by telephone. Cox proportional hazards regression analyzes were used to examine associations of racial and social class discrimination (experienced by offspring and their mothers) with offspring cannabis involvement. Two stages of cannabis involvement were analyzed: timing of 1) initiation and 2) transition from initiation to first cannabis use disorder (CUD) symptom.

RESULTS

The study found that offspring report of experiencing racial (HR: 1.28, CI: 1.01-1.62) and social class discrimination (HR: 1.45, CI: 1.14-1.84) were associated with cannabis initiation in our fully adjusted model. Mothers' report of discrimination predicted a lower hazard of cannabis initiation among offspring (HR: 0.79, CI: 0.64-0.98). Offspring social class discrimination (HR: 2.45, CI: 1.71-3.51) predicted an increased hazard of transition from initiation to first CUD symptom, while offspring racial discrimination (HR: 0.57, CI: 0.39-0.85) was associated with lower hazard of transition in our fully adjusted model.

CONCLUSIONS

As rates for cannabis use among Black youth are disproportionately rising, there is a critical need to identify pathways to its use among Black youth. These findings suggest racial and social class discrimination may be important targets in efforts to prevent cannabis involvement among Black youth and emerging adults.

[Physical and Psychological Consequences of Political Imprisonment in the Soviet Zone of Occupation and the German Democratic Republic]

About 180 000 to 300 000 people were imprisoned for political reasons in the Soviet Zone of Occupation (SBZ) and the German Democratic Republic (GDR). Traumatic stress, like political imprisonment, can lead to long-term health impairments. Furthermore, research on political imprisonment suggests a transgenerational transfer of health impairments. The current article aims at providing an overview of physical and psychological consequences of political imprisonment in the SBZ and GDR and underlining the relevance of the study currently conducted at Charité - Universitätsmedizin Berlin. Previous studies indicate increased prevalence rates for psychiatric syndromes and physical symptoms in the population of former political prisoners in the SBZ and GDR. There still is a need for a systematic assessment of possible health-related effects of political imprisonment in the SBZ/GDR on former prisoners and their offspring.

Personal characteristics of World War Two survivor offspring related to the presence of indirect intrusions

Background: A substantial proportion of clinical World War Two survivor offspring reports intrusions about war events they did not experience themselves. Objective: To help identify factors that contribute to the development of such indirect intrusions (i.e. intrusions about non-self-experienced traumatic events), we examined the personal characteristics of survivor offspring that were related to the presence of indirect intrusions. To explore the specificity of these relationships, we compared characteristics related to the presence of indirect and direct intrusions (i.e. intrusions about self-experienced traumatic events). Methods: Participants (N = 98) were post-war offspring of World War Two survivors in treatment in one of two clinics specialized in mental health services for war victims. We assessed the presence of indirect and direct intrusions as well as the following personal characteristics: gender, education level, trait dissociation, affect intensity, attentional control, mental imagery, fantasy proneness, and current psychopathology. Results: Reports of indirect intrusions were more frequent in individuals high in fantasy proneness, trait dissociation, and current psychopathology. Reports of direct intrusions were more frequent in women, individuals scoring high on trait dissociation, affect intensity, and current psychopathology. Fantasy proneness was a unique correlate of indirect intrusions. Conclusions: These findings are consistent with the idea that intrusions are the result of (re)constructive processes affected by several factors including personal characteristics.

HIGHLIGHTS

Offspring of World War Two survivors often experience indirect intrusions.We examined personal characteristics related to indirect and direct intrusions.Fantasy proneness was the best predictor of indirect intrusions.Gender was the best predictor of direct intrusions.

Combatting intergenerational effects of psychotrauma with multifamily therapy

There is growing evidence that parental trauma is associated with psychosocial disorders, externalizing and internalizing problems, and higher sensitivity to posttraumatic stress disorder (PTSD) in children. Recent research findings suggest multidimensional relational, psychological, and neurobiological interrelated pathways of intergenerational influence. Moreover, the intergenerational effects of parental trauma need to be understood within a broader systemic context, as a part of family adaptation. This article explores research findings and clinical practice to enhance our understanding of intergenerational processes and presents directions for therapeutic interventions. A trauma-focused multi-family therapy, aiming to restrict the relational consequences of parental trauma and strengthen family resilience, is described. The proposition is that to facilitate and improve the quality of parent-child interaction in response to psychotrauma, fostering emotion regulation capacities and mentalization is crucial. These efforts offered through family group interventions may benefit various families coping with adversity in culturally diverse societies.

Recognizing and Breaking the Cycle of Trauma and Violence Among Resettled Refugees

Purpose of Review

The number of refugees across the globe continues to grow, leaving a large proportion of the global population in a vulnerable state of health. However, the number of robust clinical interventions has not kept apace. This paper provides a general review of literature on the trauma and violence that refugees face, the impact on health outcomes, and some of the promising models for clinical intervention.

Recent Findings

Refugees experience a cycle of trauma, violence, and distress that begins before migration and continues during migration and after resettlement. It has been challenging to develop robust clinical interventions due to the cumulative and cyclic effects of trauma, as well as the unique experiences of trauma that each refugee community and each refugee individual faces.

Summary

Trauma-informed care is a critical component of health care. Developing stronger guidelines for trauma-informed care will help clinicians better provide inclusive and equitable care for refugee patients.

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.

Cardinal role of the environment in stress induced changes across life stages and generations

The stress response in rodents and humans is exquisitely dependent on the environmental context. The interactive element of the environment is typically studied by creating laboratory models of stress-induced plasticity manifested in behavior or the underlying neuroendocrine mediators of the behavior. Here, we discuss three representative sets of studies where the role of the environment in mediating stress sensitivity or stress resilience is considered across varying windows of time. Collectively, these studies testify that environmental variation at an earlier time point modifies the relationship between stressor and stress response at a later stage. The metaplastic effects of the environment on the stress response remain possible across various endpoints, including behavior, neuroendocrine regulation, region-specific neural plasticity, and regulation of receptors. The timescale of such variation spans adulthood, across stages of life history and generational boundaries. Thus, environmental variables are powerful determinants of the observed diversity in stress response. The predominant role of the environment suggests that it is possible to promote stress resilience through purposeful modification of the environment.

Resilience: Safety in the Aftermath of Traumatic Stressor Experiences

The relationship between adverse experiences and the emergence of pathology has often focused on characteristics of the stressor or of the individual (stressor appraisals, coping strategies). These features are thought to influence multiple biological processes that favor the development of mental and physical illnesses. Less often has attention focused on the aftermath of traumatic experiences, and the importance of safety and reassurance that is necessary for longer-term well-being. In some cases (e.g., post-traumatic stress disorder) this may be reflected by a failure of fear extinction, whereas in other instances (e.g., historical trauma), the uncertainty about the future might foster continued anxiety. In essence, the question becomes one of how individuals attain feelings of safety when it is fully understood that the world is not necessarily a safe place, uncertainties abound, and feelings of agency are often illusory. We consider how individuals acquire resilience in the aftermath of traumatic and chronic stressors. In this respect, we review characteristics of stressors that may trigger particular biological and behavioral coping responses, as well as factors that undermine their efficacy. To this end, we explore stressor dynamics and social processes that foster resilience in response to specific traumatic, chronic, and uncontrollable stressor contexts (intimate partner abuse; refugee migration; collective historical trauma). We point to resilience factors that may comprise neurobiological changes, such as those related to various stressor-provoked hormones, neurotrophins, inflammatory immune, microbial, and epigenetic processes. These behavioral and biological stress responses may influence, and be influenced by, feelings of safety that come about through relationships with others, spiritual and place-based connections.

"Children Are Not Children Anymore; They Are a Lost Generation": Adverse Physical and Mental Health Consequences on Syrian Refugee Children

This research examines Syrian refugee mothers’ accounts of the physical and mental health of their children being affected by war traumas and displacement challenges. Open-ended audio-recorded interviews were conducted in Arabic with 23 mothers residing in Jordan. Using a narrative approach in the data collection and analysis, five major themes were identified: (1) children were exposed to diverse war traumatic experiences in Syria; (2) the escape journey and refugee camps threatened children’s lives; (3) displacement and family stressors exposed children to poverty, hostility from local peers, educational and recreational challenges, child labor, and domestic violence (these three major themes were considered as trauma related variables); (4) children were not only directly affected physically and mentally by their own traumatic experiences and displacement stressors, but these experiences were mediated and magnified by familial interrelated processes, evidenced in intergenerational transmission of trauma, harsh parenting style, parental control, and parentification; and (5) adverse consequences of both trauma related variables and family processes directly and indirectly traumatized children and adversely impacted their physical and mental health. We examined the themes that emerged from the data in view of three theoretical frameworks and the impact of trauma in the family system on child development. To conclude, humanitarian organizations that provide services and interventions to refugees need to take into account familial processes and not only individual factors affecting refugee children’s physical and mental health. Further implications on policies and trauma research are discussed.

Repeated, Ongoing, and Systemic Incidents of Racism and their Harmful Mental Health Effects:: Addressing Trauma in the Lives of African Americans

This article will examine the correlation between racial incidents faced by African Americans and the psychological impact these incidents have on members of African American communities, specifically focusing on the correlation between aggressive and frequent law enforcement contact/interaction and the traumatic impacts faced by African Americans as a result of said contacts and interactions. It will also attempt to contextualize the meaning of racial trauma and its ever-present reality for African Americans. Special attention will be paid to African American youth and young adults and the ongoing traumas faced by this group as they navigate through facets of American society, both within and without their communities. A historical analysis will bolster the theory that historical events can and do create trauma (peripheral) for African Americans. The article will then discuss racial trauma as the result of frequent and ever-present forms of discrimination, including how interactions with law enforcement can exacerbate mental health issues related to trauma. Finally, recommendations will be made to reduce and prevent trauma associated with law enforcement contact and interaction.

Risk of psychiatric diagnoses in children and adolescents of parents with torture trauma and war trauma

OBJECTIVE

Evidence point to intergenerational effects of trauma in refugee populations. This study estimates the risk of psychiatric diagnoses in children of severely traumatized refugees. The unique clinical sample consisted of refugee parents treated for torture trauma and war trauma, and outcomes were investigated using population-level data.

METHOD

A nationwide register study, following all children residing in Denmark. The exposure was parental torture trauma and war trauma, and outcomes were any psychiatric disorder, mood, neurotic, behavioural and emotional disorders and disorders of psychological development. Children's hazard of being diagnosed was estimated using Cox proportional hazards regression. Study participants were followed from the date of birth or immigration to their 18th birthday.

RESULTS

The cohort included 3 346 993 children of which 19 294 were identified as offspring to traumatized refugees. During the study period, 205 610 children were diagnosed with a psychiatric disorder. Children with parents from the Middle East and Northern Africa had a hazard ratio of 0.78 (95% CI: 0.72, 0.84) for those treated for parental trauma and 0.79 (95% CI: 0.76, 0.81) for those not treated compared with children of non-traumatized Danish-born parents. For children of parents from former Yugoslavia, the corresponding estimates were 0.69 (95% CI: 0.58, 0.81) and 0.69 (95% CI: 0.65, 0.73).

CONCLUSION

The results suggest that children of parents with and without registered torture trauma and war trauma have a lower risk of being diagnosed with a psychiatric disorder compared to children of Danish-born parents. These findings contradict research done on the transmission of trauma but supports evidence suggesting mental health services underutilization by refugee and ethnic minority populations.