1
|
Bonumwezi JL, Grapin SL, Uddin M, Coyle S, Habintwali D, Lowe SR. Intergenerational trauma transmission through family psychosocial factors in adult children of Rwandan survivors of the 1994 genocide against the Tutsi. Soc Sci Med 2024; 348:116837. [PMID: 38579628 DOI: 10.1016/j.socscimed.2024.116837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
Thirty years after the 1994 genocide against the Tutsi in Rwanda, children of survivors are being increasingly documented to be at higher risk compared to their peers for adverse mental health outcomes. However, no studies in Rwanda have empirically explored family psychosocial factors underlying this intergenerational transmission of trauma. We investigated family psychosocial factors that could underlie this transmission in 251 adult Rwandan children of survivors (mean age = 23.31, SD = 2.40; 50.2% female) who completed a cross-sectional online survey. For participants with survivor mothers (n = 187), we found that both offspring-reported maternal trauma exposure and maternal PTSD were indirectly associated with children's PTSD via maternal trauma communication (specifically, nonverbal and guilt-inducing communication), and that maternal PTSD was indirectly associated with children's PTSD, anxiety, and depression symptoms through family communication styles. For participants with survivor fathers (n = 170), we found that paternal PTSD symptoms were indirectly associated with children's anxiety and depression symptoms via paternal parenting styles (specifically, abusive and indifferent parenting). Although replication is needed in longitudinal research with parent-child dyads, these results reaffirm the importance of looking at mass trauma in a family context and suggest that intergenerational trauma interventions should focus on addressing family communication, trauma communication, and parenting.
Collapse
Affiliation(s)
| | - Sally L Grapin
- Department of Psychology, Montclair State University, Montclair, NJ, USA
| | - Monica Uddin
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Samantha Coyle
- Department of Psychology, Montclair State University, Montclair, NJ, USA
| | | | - Sarah R Lowe
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, CT, USA
| |
Collapse
|
2
|
Mak C, Wieling E. Intergenerational transmission of traumatic stress and relational disruptions among Cambodian refugee families in the United States. J Health Psychol 2024:13591053241245098. [PMID: 38581351 DOI: 10.1177/13591053241245098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
Cambodian refugees resettled in the United States were severely affected by genocidal trauma and have been trapped in decades of intergenerational transmission of traumatic stress and relational disruptions without much public attention. This manuscript reports on data collected as part of a Cambodian needs assessment that employed methodological principles of critical ethnography and was grounded by a human ecological theoretical model. Eighteen professionals who served Cambodian communities were interviewed. The interviews were transcribed in Khmer or/and English and analyzed using the Developmental Research Sequence resulting in three domains (Pre-Migration, During Migration, and Post Resettlement in the United States) and four categories (i.e. Impact on Self, Couple Relationships, Parent-Child Relationships, and Context) within each domain. The thematic findings emphasize intergenerational transmission of psychopathology, disruptions in parent-child relationships, and a critical need to support parents to promote positive child development within Cambodian communities.
Collapse
|
3
|
Niwenahisemo LC, Hong S, Kuang L. Assessing anxiety symptom severity in Rwandese adolescents: cross-gender measurement invariance of GAD-7. Front Psychiatry 2024; 15:1346267. [PMID: 38528981 PMCID: PMC10962260 DOI: 10.3389/fpsyt.2024.1346267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/15/2024] [Indexed: 03/27/2024] Open
Abstract
Background Anxiety disorders are among the most common mental health problems experienced by adolescents worldwide because of their evident significant impact on their quality of life and functioning. The generalized anxiety disorder item (GAD-7) was manufactured to identify the severity of self-reported anxiety symptoms. Efforts to address and screen for mental health problems in Rwanda have been limited, and the importance of screening for anxiety disorders is high. The primary aim of this study was to analyze the psychometric properties of the Kinyarwanda version of the Generalized Anxiety Disorder GAD-7, and then test the measurement invariance of the GAD-7 by gender. Methods We used the Rwandese version of GAD-7 among secondary school students in Kigali city (n=1813). Measurement invariance of the GAD-7 across gender and report on anxiety symptom severity prevalence. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to examine measurement invariance. Results Our findings demonstrated that in the sample of 1813 adolescents aged between 12 and 17 years, generalized anxiety symptoms prevalence rates were higher in females (46.4%) than males (n= 29.8%) GAD-7 demonstrated good reliability and validity coefficients with a Cronbach's α of .077 and KMO and Bartlett test of Sphericity = 0.835. In addition to these psychometric properties, the GAD-7 screening scale had equivalence for configural and metric invariance across groups with excellent fit indices, and we confirmed partial scalar invariance across groups. Conclusion The GAD-7 can be used in cross-group comparison of generalized anxiety disorder prevalence, and we acknowledge that full scalar invariance is generally difficult to confirm, especially due to gender differences. We recommend that future studies further investigate populations living in rural areas and conduct trials that will focus on anxiety-specific treatment in Rwandan Clinical health care centers to determine the diagnostic accuracy of this screening tool.
Collapse
Affiliation(s)
| | - Su Hong
- *Correspondence: Su Hong, ; Li Kuang,
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
4
|
Veronese G, Mahamid F, Bdier D. Transgenerational trauma and collective resilience: A qualitative analysis of the experiences of settler-colonial violence among three generations of Palestinian refugees. Int J Soc Psychiatry 2023; 69:1814-1824. [PMID: 37283084 DOI: 10.1177/00207640231175787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Palestinian people have endured collective dispossession and social suffering for 74 years from the so-called Al-Nakba (Palestinian catastrophe). AIMS The present exploratory work sought to analyze experiences of settler-colonial violence over three generations of Palestinian refugees. METHODS Forty-five participants (Mage = 44.45; range 13-85) were recruited via snowball sampling and interviewed to explore their understanding of transgenerational and collective trauma. Interviews were analyzed through thematic content analysis, resulting in four emerging themes distributed among the three generations. RESULTS The four themes encompassed (1) The impact of Al-Nakba, (2) Hardships, challenges, and quality of life, (3) Coping strategies, and (4) Dreams and hopes for the future. The results have been discussed using local idioms of distress and resilience. CONCLUSIONS The Palestinian experience of transgenerational trauma and resilience depicts a portrait of extreme trauma and endurance that cannot be reduced to the mere nosographic collection of Western-informed psychiatric symptoms. Instead, a human rights approach to Palestinian social suffering is most recommended.
Collapse
Affiliation(s)
- Guido Veronese
- Department of Human Sciences and Education 'R.Massa', University of Milano-Bicocca, Milano, Italy
- Department of Psychology, Stellenbosch University, South Africa
| | - Fayez Mahamid
- Department of Human Sciences, An-Najah National University, Nablous, State of Palestine
| | - Dana Bdier
- Department of Human Sciences and Education 'R.Massa', University of Milano-Bicocca, Milano, Italy
- Department of Human Sciences, An-Najah National University, Nablous, State of Palestine
| |
Collapse
|
5
|
Mutuyimana C, Maercker A. Clinically relevant historical trauma sequelae: A systematic review. Clin Psychol Psychother 2023; 30:729-739. [PMID: 36716783 DOI: 10.1002/cpp.2836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The purpose of this systematic review (SR) was to present the current state of research on historical trauma, and the topics closely related to its semantic space that include intergenerational trauma, collective trauma, and extended cultural bodily and mental responses, in order to identify gaps in the literature that need to be addressed. METHODS A search of empirical studies from 1990 to 2022 was performed via Scopus, Web of Science, MEDLINE, EBSCOhost-PsychInfo, and Embase, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. RESULTS The initial search yielded 1012 studies, 52 of which were included in the current review. The results show that the historical trauma concept has a high potential for new research in the field of Global Mental Health. Gaps in the literature were identified, including a lack of standard features of historical trauma, and assessments of historical trauma in additional contexts than its original fields of application with Indigenous Americans. CONCLUSION Although the introduction of the concept of historical trauma was intended to fill the gap of trauma-related difficulties not covered by the criteria of post-traumatic stress disorder (PTSD), this concept needs further scientific refinement.
Collapse
Affiliation(s)
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
6
|
Langevin R, Kern A, Fernet M, Brassard A. Emerging Adults' Adverse Life Events and Psychological Functioning: A Comparison Based on Intergenerational Trajectories of Child Maltreatment. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:5774-5804. [PMID: 36213948 PMCID: PMC9969488 DOI: 10.1177/08862605221127214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Intergenerational continuity of child maltreatment (CM) is a well-documented phenomenon of concern; however, its effects on the child's level of exposure to CM, as well as subsequent trauma exposure and adult functioning remain undocumented. The present study aimed to further explore the intergenerational effects of CM by comparing emerging adults (EA; ages 18-25) on their exposure to CM, adult victimization, and psychological functioning according to their mother's CM histories. One hundred and eighty-five mothers and their EA completed independently an online survey measuring sociodemographics, material deprivation, CM, adult victimization, and psychological functioning. The participating dyads (primarily White and female-identifying) were recruited online through social media, universities, and advertisements in non-profit organizations throughout Canada. Findings revealed that maternal histories of CM were associated with increased neglectful and physically abusive acts endured in childhood for maltreated EA. Maternal histories of CM, regardless of the EA' victimization status, were associated with a higher EA' number of adulthood interpersonal-but not non-interpersonal-traumas experienced. While a maternal history of CM was a risk factor for intimate partner violence (IPV) in maltreated EA, it was protective for non-maltreated EA. Maltreated EA with maltreated versus non-maltreated mothers presented more psychological difficulties, but only if they also reported material deprivation. Practitioners working with children at-risk or exposed to CM should document parents' histories of CM and take that into account in their assessments and intervention practices. This study also provides further evidence to support social policies targeting the family system as a whole.
Collapse
|
7
|
Abdulah DM, Abdulla BMO, Liamputtong P. The lived experience of surviving from the Islamic State attack and capture in Iraq and Syria: An arts-based qualitative study with Yazidi young women. Int J Soc Psychiatry 2023; 69:117-133. [PMID: 34991403 DOI: 10.1177/00207640211068981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In August 2014, the Islamic State in Iraq and Syria (ISIS) attacked the Sinjar district and destroyed several villages and towns and killed several individuals. AIM In this study, the Yazidi young women who survived the ISIS attack were encouraged to express their lived experiences through paintings following participation in a 6-month art-based intervention program. METHODS A total of 13 Yazidi Kurdish females aged 18 to 25 years (Mean: 21.7 years) were invited to participate in an art-based (drawing and painting) course for 6 months in 2018. They were invited to draw or paint images that portrayed their lived experiences of attack and capture by the ISIS. Qualitative research situated within feminist methodology was used with the young women in this study. The interviews were analyzed using the descriptive content analysis method. RESULTS The paintings and narratives of the participants were constructed into three main themes: fear and traumatic experiences; feeling of hopelessness; and freedom and hope. During the attack and capture, due to the escape, rape, and horrific treatments by the ISIS fighters, the young women were traumatized severely. They were sold as a sex slave by the ISIS fighters. The participants still had severe anxiety and psychological challenges after being free from the capture. However, despite their traumatic experiences and feeling of hopelessness, most of them were hoping for freedom and a better future. CONCLUSIONS This study showed that the Yazidi young females still experienced psychological challenges burdens even 3 years after the traumatic day. However, the participants showed their resilience through feeling hopeful for freedom and a better future.
Collapse
Affiliation(s)
- Deldar Morad Abdulah
- Community and Maternity Health Nursing Unit, College of Nursing, University of Duhok, Duhok, Iraqi Kurdistan
| | | | - Pranee Liamputtong
- Professor of Behaviour Sciences, College of Health Sciences, VinUniversity, Hanoi, Vietnam
| |
Collapse
|
8
|
Jansen S, Niyonsenga J, Ingabire CM, Jansen A, Nzabonimpa E, Ingabire N, Kangabe J, Sarabwe E, Richters A, Rutayisire T, Nsabimana E. Evaluating the impact of Community-Based Sociotherapy on social dignity in post-genocide Rwanda: study protocol for a cluster randomized controlled trial. Trials 2022; 23:1035. [PMID: 36539840 PMCID: PMC9768903 DOI: 10.1186/s13063-022-06994-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Community-Based Sociotherapy (CBS) is an approach that was introduced in Rwanda in 2005, with the aim of improving psychosocial well-being among its participants and facilitating reconciliation processes. Over the years, CBS has been adapted contextually and the effectiveness of the approach has been measured in different ways, using qualitative and quantitative study designs. This study specifically assesses the effectiveness of CBS in terms of fostering the social dignity of participants as the primary outcome. METHODS/DESIGN A cluster randomized controlled trial design with person-level outcomes whereas the CBS treatment is delivered at the cluster level. A total of 1200 eligible participants will be randomly assigned to two groups in a 1:1 ratio. Participants in the intervention group will receive the CBS intervention, while the control group will be waitlisted. The primary outcome measure is a self-designed and psychometrically validated Social Dignity Scale. The secondary outcome measures will be the WHO (Five) Well-Being Index (WHO-5), the Multidimensional Scale of Perceived Social Support (MSPSS), the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), the Self-reporting Questionnaire (SRQ-20), and the perceived parental self-efficacy scale. The primary analysis will be performed following an intention to treat analysis, using generalized estimating equation modeling. DISCUSSION We expect this cluster randomized controlled trial to provide insight into the effectiveness of CBS on social dignity and secondary psychosocial outcomes among its group participants, who have different socio-historical backgrounds including genocide survivors, perpetrators, bystanders and their descendants, people in conflicts (family/community), and local leaders. This study will inform CBS implementers, policymakers, practitioners, and other stakeholders on the role of social dignity in interventions that focus on psychosocial healing. TRIAL REGISTRATION ISRCTN ISRCTN11199072. It was registered on 2 April 2022.
Collapse
Affiliation(s)
- Stefan Jansen
- grid.10818.300000 0004 0620 2260Mental Health & Behaviour Research Group, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Japhet Niyonsenga
- grid.10818.300000 0004 0620 2260Mental Health & Behaviour Research Group, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda ,grid.10818.300000 0004 0620 2260Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | | | | | | | | | | | | | - Epaphrodite Nsabimana
- grid.10818.300000 0004 0620 2260Mental Health & Behaviour Research Group, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| |
Collapse
|
9
|
Kahn S, Denov M. Transgenerational trauma in Rwandan genocidal rape survivors and their children: A culturally enhanced bioecological approach. Transcult Psychiatry 2022; 59:727-739. [PMID: 35200060 PMCID: PMC9716383 DOI: 10.1177/13634615221080231] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Multiple theories, including attachment, family systems, and epigenetics, among many others, have been invoked to explain the mechanisms through which trauma is transmitted from one generation to the next. To move toward integration of extant theories and, thus, acknowledgement of multiple pathways for transmission of trauma, the authors explore the potential of applying a culturally enhanced bioecological theory to transgenerational trauma (TGT). Data from in-depth qualitative interviews in Rwanda more than two decades after the genocide, with 44 mothers of children born of genocidal rape, and in-depth interviews and focus groups with a total of 60 youth born of genocidal rape, were analyzed according to the processes of culturally enhanced bioecological theory. The findings from a hybrid inductive and deductive thematic analysis suggest that a culturally enhanced bioecological theory of human development allows for an integrated, multi-dimensional analysis of individual, family, cultural, and societal factors of transmission of TGT. Some facets of the data, however, are not accounted for in the theory, specifically, how some mothers were able to create and sustain a positive bond with their children born of genocidal rape, despite societal and family pressure to abandon or abort them. Nonetheless, the findings demonstrate how a culturally enhanced bioecological theory can be an important overarching framework for developing policies and practices to help interrupt or mitigate TGT, strengthen resilience, and facilitate healing for children born of genocidal rape, their mothers, and their families.
Collapse
|
10
|
Wang X, Yin G, Guo F, Hu H, Jiang Z, Li S, Shao Z, Wan Y. Associations of Maternal Adverse Childhood Experiences with Behavioral Problems in Preschool Children. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP20311-NP20330. [PMID: 34652992 DOI: 10.1177/08862605211050093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Investigations have found maternal adverse childhood experiences (ACEs) cause an intergenerational danger to their children's health. However, no study has investigated the effects of maternal ACEs on behavioral problems of preschool children in China and gender differences on these effects. This paper aims to investigate the role of maternal ACEs on behavioral problems of preschool children in China and explore gender differences as related to these behavioral problems. Stratified cluster sampling method was used to select 7318 preschool children from 12 districts in Hefei city, China. A questionnaire survey was conducted to collect information on maternal exposure to ACEs and Conners' Parent Rating Scales. Logistic regression was used to analyze the relationship between maternal ACEs and children's behavioral problems. The prevalence of behavioral problems in preschool children was 16.0%, while it was higher among girls (18.4%) than boys (13.92%) (χ2 = 27.979, p < 0.001). The rate of behavioral problems in children in the group of mothers with ACEs was higher than those without ACEs (all p < 0.05). Maternal ACEs were associated with increased risk of the behavior problems in preschool children (adjusted OR 2.91, 95% CI 2.45-3.45), and no gender difference (in girls 3.01, 2.38-3.81, in boys 2.79, 2.17-3.58, respectively) was found. Maternal ACEs were associated with increased risk of each type of the behavioral problems of preschool children, except that maternal emotional neglect was not associated with psycho-physical problems, impulse-activities, and anxiety. The only gender differences found were higher conduct problems related to maternal emotional abuse and ACEs and higher anxiety related to maternal physical abuse and community violence in girls compared with boys. Mothers exposured to ACEs are more likely to have children with behavioral health problems in preschool period. Further research is needed to explore the mechanisms by which maternal ACEs influence children's behavioral problems.
Collapse
Affiliation(s)
- Xiaoyan Wang
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Gangzhu Yin
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Feng Guo
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Haili Hu
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Zhicheng Jiang
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Shuqin Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| | - Ziyu Shao
- Hefei City Maternal and Child Health & Family Planning Service Center, Hefei, China
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, 12485Anhui Medical University, Hefei, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China
| |
Collapse
|
11
|
Mbiydzenyuy NE, Hemmings SMJ, Qulu L. Prenatal maternal stress and offspring aggressive behavior: Intergenerational and transgenerational inheritance. Front Behav Neurosci 2022; 16:977416. [PMID: 36212196 PMCID: PMC9539686 DOI: 10.3389/fnbeh.2022.977416] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Ngala Elvis Mbiydzenyuy
- Department of Basic Science, School of Medicine, Copperbelt University, Ndola, Zambia
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Cape Town, South Africa
- *Correspondence: Ngala Elvis Mbiydzenyuy,
| | - Sian Megan Joanna Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lihle Qulu
- Division of Medical Physiology, Biomedical Science Research Institute, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
12
|
A possible anti-anxiety effect of appetitive aggression and a possible link to the work of Donald Winnicott. Scand J Child Adolesc Psychiatr Psychol 2022; 10:102-113. [PMID: 36133733 PMCID: PMC9454322 DOI: 10.2478/sjcapp-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Various pleasant sensations that give a particularly intense pleasure are able to improve anxiety. In the present study I consider the possibility that their anti-anxiety action depends on the strong pleasure they provide, and I propose a possible mechanism of this action. According to some studies, also appetitive aggression (an aggression that provokes a strong pleasure and that is performed only for the pleasure it provides) can improve anxiety, and in this article I consider the possibility that the pleasure of appetitive aggression is able to reduce anxiety by the same mechanism I have proposed for other intense pleasurable sensations. The aggression performed by a child against the mother or against a substitute for the mother in the first period of life (a period in which this aggression is not dangerous) is a recurring theme throughout the work of of Donald Winnicott. Winnicott stresses that this aggression is necessary for the normal development of the child, and that the child must be free to practise it. According to Winnicott, this aggression is highly pleasurable and is not a response to unpleasant or hostile external situations. For these characteristics it seems to correspond to appetitive aggression in the adult that has been found to be able to reduce anxiety. Consequently, aggression performed by the child in the first period of life may also relieve anxiety, in the same way that appetitive aggression helps against anxiety in the adult. In his writings, Winnicott returns several times to an unthinkable or archaic anxiety that children experience when they feel abandoned by their mother for a period that is too long for them, and all children, according to Winnicott, live on the brink of this anxiety. In this study I propose the hypothesis that aggression in the early period of life may be necessary for children because the intense pleasure it provides may help them against this continuously impending anxiety.
Collapse
|
13
|
Langevin R, Hébert M, Kern A. Maternal History of Child Sexual Abuse and Maladaptive Outcomes in Sexually Abused Children: The Role of Maternal Mental Health. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP14485-NP14506. [PMID: 33926300 PMCID: PMC9326797 DOI: 10.1177/08862605211013963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The effects of child sexual abuse (CSA) have been found to surpass generations as maternal history of CSA is associated with increased difficulties in sexually abused children. However, little is known about the mechanisms underlying this association. The present study aimed to test maternal mental health symptoms including psychological distress, post-traumatic stress disorder (PTSD) symptoms, and dissociation as mediators of the relationship between maternal CSA and children's internalizing, externalizing, and dissociation symptoms in a large sample of sexually abused children. A total of 997 sexually abused children aged 3-14 years old and their mothers were recruited at five specialized intervention centers offering services to sexually abused children and their families. The children were divided into two groups depending on their mothers' self-reported history of CSA. Mothers completed a series of questionnaires assessing their mental health and children's functioning. Maternal history of CSA was associated with increased maternal psychological distress, PTSD symptoms, and dissociation following children's disclosure of CSA. In turn, maternal psychological distress and maternal dissociation were associated with increased child internalizing, externalizing, and dissociation symptoms. Maternal PTSD symptoms were associated with child internalizing symptoms. Maternal mental health difficulties mediated the association between maternal CSA and sexually abused children's maladaptive outcomes. Clinicians should assess for possible history of CSA in mothers of sexually abused children and determine how best to support them to cope with the aftermaths of their child's disclosure and with their own traumatic past.
Collapse
|
14
|
Hankerson SH, Moise N, Wilson D, Waller BY, Arnold KT, Duarte C, Lugo-Candelas C, Weissman MM, Wainberg M, Yehuda R, Shim R. The Intergenerational Impact of Structural Racism and Cumulative Trauma on Depression. Am J Psychiatry 2022; 179:434-440. [PMID: 35599541 PMCID: PMC9373857 DOI: 10.1176/appi.ajp.21101000] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depression among individuals who have been racially and ethnically minoritized in the United States can be vastly different from that of non-Hispanic White Americans. For example, African American adults who have depression rate their symptoms as more severe, have a longer course of illness, and experience more depression-associated disability. The purpose of this review was to conceptualize how structural racism and cumulative trauma can be fundamental drivers of the intergenerational transmission of depression. The authors propose that understanding risk factors for depression, particularly its intergenerational reach, requires accounting for structural racism. In light of the profoundly different experiences of African Americans who experience depression (i.e., a more persistent course of illness and greater disability), it is critical to examine whether an emerging explanation for some of these differences is the intergenerational transmission of this disorder due to structural racism.
Collapse
Affiliation(s)
- Sidney H. Hankerson
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, Department of Population Health Sciences & Policy, 1425 Madison Avenue, New York, NY 10029
| | - Nathalie Moise
- Columbia University Irving Medical Center, Department of Medicine, 622 West 168 Street, PH 9, New York, NY 10032
| | - Diane Wilson
- Icahn School of Medicine at Mount Sinai, New York; Department of Medicine Columbia University Irving Medical Center, New York; City University of New York
| | - Bernadine Y. Waller
- Columbia University Irving Medical Center, Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Kimberly T. Arnold
- University of Pennsylvania Perelman School of Medicine, Department of Family Medicine and Community Health, University of Pennsylvania Center for Public Health Initiatives, University of Pennsylvania Leonard Davis Institute of Health Economics, Penn Presbyterian Medical Center, Andrew Mutch Building, Floor 6, 51 N. 39th Street, Philadelphia, PA 19104
| | - Cristiane Duarte
- Columbia University Irving Medical Center, New York State Psychiatric Institute, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032
| | - Claudia Lugo-Candelas
- Columbia University Irving Medical Center, Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Myrna M Weissman
- Columbia University, Mailman School of Public Health, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive Unit 24, New York, New York 10032
| | - Milton Wainberg
- Columbia University Irving Medical Center, New York State Psychiatric Institute, Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032
| | - Rachel Yehuda
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, The Bronx James J. Peters VA Medical Center, 1 Gustave L. Levy Pl, New York, NY 10029
| | - Ruth Shim
- University of California at Davis, Department of Psychiatry
| |
Collapse
|
15
|
Que nous apprenent les enfants des survivants de la shoah sur la transmission transgenerationnelle du traumatisme? EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2021.100249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
16
|
Pells K, Breed A, Uwihoreye C, Ndushabandi E, Elliott M, Nzahabwanayo S. 'No-One Can Tell a Story Better than the One Who Lived It': Reworking Constructions of Childhood and Trauma Through the Arts in Rwanda. Cult Med Psychiatry 2022; 46:632-653. [PMID: 34907486 PMCID: PMC9436865 DOI: 10.1007/s11013-021-09760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 11/21/2022]
Abstract
The intergenerational legacies of conflict and violence for children and young people are typically approached within research and interventions through the lens of trauma. Understandings of childhood and trauma are based on bio-psychological frameworks emanating from the Global North, often at odds with the historical, political, economic, social and cultural contexts in which interventions are enacted, and neglect the diversity of knowledge, experiences and practices. Within this paper we explore these concerns in the context of Rwanda and the aftermath of the 1994 Genocide Against the Tutsi. We reflect on two qualitative case studies: Connective Memories and Mobile Arts for Peace which both used arts-based approaches drawing on the richness of Rwandan cultural forms, such as proverbs and storytelling practices, to explore knowledge and processes of meaning-making about trauma, memory, and everyday forms of conflict from the perspectives of children and young people. We draw on these findings to argue that there is a need to refine and elaborate understandings of intergenerational transmission of trauma in Rwanda informed by: the historical and cultural context; intersections of structural and 'everyday' forms of conflict and social trauma embedded in intergenerational relations; and a reworking of notions of trauma 'transmission' to encompass the multiple connectivities between generations, temporalities and expressions of trauma.
Collapse
Affiliation(s)
- Kirrily Pells
- Social Research Institute, University College London, 18 Woburn Square, London, WC1H 0NR, UK.
| | - Ananda Breed
- School of Fine & Performing Arts, College of Arts, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS Lincolnshire UK
| | | | - Eric Ndushabandi
- University of Rwanda, Kigali, Rwanda ,Institute of Research and Dialogue for Peace, PO Box 7109, Kigali, Rwanda
| | | | | |
Collapse
|
17
|
Mwanamwambwa V, Pillay BJ. Posttraumatic stress disorder and psychological distress in Rwandan refugees living in Zambia. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1177/00812463211031812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study investigated posttraumatic stress disorder and psychological distress among Rwandan refugees living in the townships of Lusaka, Zambia. Refugees are often exposed to trauma and violence which leads to a wide range of psychological distress and mental disorders. Two hundred and sixty-seven refugees participated in the study. The sample consisted of older and younger adult refugees, 128 (47.9%) males and 139 (52.1%) females, from Lusaka. The Impact of Event Scale–Revised and the General Health Questionnaire-28 were administered to all participants. The study found that a significant number of participants reported posttraumatic stress disorder and psychological distress. About 76.8% endorsed posttraumatic stress disorder symptoms. In addition, 31.8% reported somatic symptoms, 36.7% anxiety or insomnia, 27.3% social dysfunction, and 22.8% severe depression. Lower education ( p < .01), larger family size ( p < .001), lack of financial support ( p < .05), and being unemployed ( p < .001) were positively associated with posttraumatic stress disorder and psychological distress. Intervention strategies aimed at improving the lives of refugees should be ongoing and must encompass a well-articulated, structured refugee policy that emphasizes mental health and psychological needs.
Collapse
Affiliation(s)
- Victor Mwanamwambwa
- Department of Behavioural Medicine, Nelson R Mandela School of Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Basil Joseph Pillay
- Department of Behavioural Medicine, Nelson R Mandela School of Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| |
Collapse
|
18
|
Zhou YG, Shang ZL, Zhang F, Wu LL, Sun LN, Jia YP, Yu HB, Liu WZ. PTSD: Past, present and future implications for China. Chin J Traumatol 2021; 24:187-208. [PMID: 33994278 PMCID: PMC8343811 DOI: 10.1016/j.cjtee.2021.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/30/2021] [Accepted: 04/18/2021] [Indexed: 02/04/2023] Open
Abstract
There has been a long history since human beings began to realize the existence of post-traumatic symptoms. Posttraumatic stress disorder (PTSD), a diagnostic category adopted in 1980 in the Diagnostic and Statistical Manual of Mental Disorders-Ⅲ, described typical clusters of psychiatric symptoms occurring after traumatic events. Abundant researches have helped deepen the understanding of PTSD in terms of epidemiological features, biological mechanisms, and treatment options. The prevalence of PTSD in general population ranged from 6.4% to 7.8% and was significantly higher among groups who underwent major public traumatic events. There has been a long way in the studies of animal models and genetic characteristics of PTSD. However, the high comorbidity with other stress-related psychiatric disorders and complexity in the pathogenesis of PTSD hindered the effort to find specific biological targets for PTSD. Neuroimage was widely used to elucidate the underlying neurophysiological mechanisms of PTSD. Functional MRI studies have showed that PTSD was linked to medial prefrontal cortex, anterior cingulate cortex and sub-cortical structures like amygdala and hippocampus, and to explore the functional connectivity among these brain areas which might reveal the possible neurobiological mechanism related to PTSD symptoms. For now, cognitive behavior therapy-based psychotherapy, including combination with adjunctive medication, showed evident treatment effects on PTSD. The emergence of more effective PTSD pharmacotherapies awaits novel biomarkers from further fundamental research. Several natural disasters and emergencies have inevitably increased the possibility of suffering from PTSD in the last two decades, making it critical to strengthen PTSD research in China. To boost PTSD study in China, the following suggestions might be helpful: (1) establishing a national psychological trauma recover project, and (2) exploring the mechanisms of PTSD with joint effort and strengthening the indigenized treatment of PTSD.
Collapse
Affiliation(s)
- Yao-Guang Zhou
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Zhi-Lei Shang
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Fan Zhang
- Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Li-Li Wu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Lu-Na Sun
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Yan-Pu Jia
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Hai-Bo Yu
- Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,Corresponding author.
| | - Wei-Zhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,Corresponding author. Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China.
| |
Collapse
|
19
|
Cooper DK, Erolin KS, Wieling E, Durtschi J, Aguilar E, Higuera MOD, Garcia-Huidobro D. Family Violence, PTSD, and Parent-Child Interactions: Dyadic Data Analysis with Mexican Families. CHILD & YOUTH CARE FORUM 2021; 49:915-940. [PMID: 33746465 DOI: 10.1007/s10566-020-09564-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Family violence has been shown to have a dramatic impact on individual and family life in the United States and other countries. Numerous studies have assessed the influence that exposure to violence can have on family dynamics and parent-child relationships. However, less is known about the association between family violence and parent-child relationships with Mexican families. OBJECTIVE Guided by social interaction learning theory, the purpose of this study was to explore the role of exposure to family violence on PTSD and mother-child interaction patterns. METHODS Eighty-seven mother-child dyads from Mexico completed assessments for exposure to family violence, PTSD, and observational tasks were analyzed to assess prosocial parent-child interactions (i.e., positive communication and problem solving). We conducted an actor-partner independence model (APIM) to examine the association between exposure to family violence, PTSD and mother-child relationship dynamics. RESULTS As expected, higher exposure to family violence was linked to higher PTSD symptoms for mothers. Unexpectedly, higher maternal PTSD symptoms were associated with better communication during dyadic interaction tasks with their children. CONCLUSIONS The present study suggests that individuals from certain cultures (i.e., Mexico) may respond differently to experiencing family violence. The use of multiple measurement methods to assess the relational effects of trauma on family dynamics can advance the scientific understanding of trauma affected families.
Collapse
Affiliation(s)
- Daniel K Cooper
- Methodology Center and Edna Bennett Pierce Prevention Research Center, the Pennsylvania State University
| | - Kara S Erolin
- Department of Family Therapy, Nova Southeastern University
| | - Elizabeth Wieling
- Marriage and Family Therapy, Department of Human Development and Family Science, University of Georgia
| | - Jared Durtschi
- Department of Family Studies and Human Services, Kansas State University
| | | | | | - Diego Garcia-Huidobro
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile
| |
Collapse
|
20
|
Daskalakis NP, Xu C, Bader HN, Chatzinakos C, Weber P, Makotkine I, Lehrner A, Bierer LM, Binder EB, Yehuda R. Intergenerational trauma is associated with expression alterations in glucocorticoid- and immune-related genes. Neuropsychopharmacology 2021; 46:763-773. [PMID: 33173192 PMCID: PMC8027026 DOI: 10.1038/s41386-020-00900-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/19/2020] [Accepted: 10/22/2020] [Indexed: 01/02/2023]
Abstract
Offspring of trauma survivors are more likely to develop PTSD, mood, and anxiety disorders and demonstrate endocrine and molecular alterations compared to controls. This study reports the association between parental Holocaust exposure and genome-wide gene expression in peripheral blood mononuclear cells (PBMC) from 77 Holocaust survivor offspring and 15 comparison subjects. Forty-two differentially expressed genes (DEGs) were identified in association with parental Holocaust exposure (FDR-adjusted p < 0.05); most of these genes were downregulated and co-expressed in a gene network related to immune cell functions. When both parental Holocaust exposure and maternal age at Holocaust exposure shared DEGs, fold changes were in the opposite direction. Similarly, fold changes of shared DEGs associated with maternal PTSD and paternal PTSD were in opposite directions, while fold changes of shared DEGs associated with both maternal and paternal Holocaust exposure or associated with both maternal and paternal age at Holocaust exposure were in the same direction. Moreover, the DEGs associated with parental Holocaust exposure were enriched for glucocorticoid-regulated genes and immune pathways with some of these genes mediating the effects of parental Holocaust exposure on C-reactive protein. The top gene across all analyses was MMP8, encoding the matrix metalloproteinase 8, which is a regulator of innate immunity. To conclude, this study identified a set of glucocorticoid and immune-related genes in association with parental Holocaust exposure with differential effects based on parental exposure-related factors.
Collapse
Affiliation(s)
- Nikolaos P. Daskalakis
- grid.240206.20000 0000 8795 072XDepartment of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA USA ,grid.66859.34Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, USA ,grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Changxin Xu
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.274295.f0000 0004 0420 1184Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY USA
| | - Heather N. Bader
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.274295.f0000 0004 0420 1184Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY USA
| | - Chris Chatzinakos
- grid.240206.20000 0000 8795 072XDepartment of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA USA ,grid.66859.34Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, USA
| | - Peter Weber
- grid.419548.50000 0000 9497 5095Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Iouri Makotkine
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.274295.f0000 0004 0420 1184Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY USA
| | - Amy Lehrner
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.274295.f0000 0004 0420 1184Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY USA
| | - Linda M. Bierer
- grid.59734.3c0000 0001 0670 2351Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.274295.f0000 0004 0420 1184Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY USA
| | - Elisabeth B. Binder
- grid.419548.50000 0000 9497 5095Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany ,grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA USA
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Mental Health Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.
| |
Collapse
|
21
|
Binagwaho A, Remera E, Bayingana AU, Gishoma D, Scott KW, Goosman M, Campbell E, Agbonyitor M, Kayiteshonga Y, Nsanzimana S. Addressing the mental health needs of children affected by HIV in Rwanda: validation of a rapid depression screening tool for children 7-14 years old. BMC Pediatr 2021; 21:59. [PMID: 33514343 PMCID: PMC7844907 DOI: 10.1186/s12887-020-02475-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/16/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Depression in children presents a significant health burden to society and often co-exists with chronic illnesses, such as human immunodeficiency virus (HIV). Research has demonstrated that 10-37% of children and adolescents living with HIV also suffer from depression. Low-and-middle income countries (LMICs) shoulder a disproportionate burden of HIV among other health challenges, but reliable estimates of co-morbid depression are lacking in these settings. Prior studies in Rwanda, a LMIC of 12 million people in East Africa, found that 25% of children living with HIV met criteria for depression. Though depression may negatively affect adherence to HIV treatment among children and adolescents, most LMICs fail to routinely screen children for mental health problems due to a shortage of trained health care providers. While some screening tools exist, they can be costly to implement in resource-constrained settings and are often lacking a contextual appropriateness. METHODS Relying on international guidelines for diagnosing depression, Rwandan health experts developed a freely available, open-access Child Depression Screening Tool (CDST). To validate this tool in Rwanda, a sample of 296 children with a known diagnosis of HIV between ages 7-14 years were recruited as study participants. In addition to completing the CDST, all participants were evaluated by a mental health professional using a structured clinical interview. The validity of the CDST was assessed in terms of sensitivity, specificity, and a receiver operating characteristic (ROC) curve. RESULTS This analysis found that depression continues to be a co-morbid condition among children living with HIV in Rwanda. For identifying these at-risk children, the CDST had a sensitivity of 88.1% and specificity of 96.5% in identifying risk for depression among children living with HIV at a cutoff score of 6 points. This corresponded with an area under the ROC curve of 92.3%. CONCLUSIONS This study provides evidence that the CDST is a valid tool for screening depression among children affected by HIV in a resource-constrained setting. As an open-access and freely available tool in LMICs, the CDST can allow any health practitioner to identify children at risk of depression and refer them in a timely manner to more specialized mental health services. Future work can show if and how this tool has the potential to be useful in screening depression in children suffering from other chronic illnesses.
Collapse
Affiliation(s)
- Agnes Binagwaho
- University of Global Health Equity, Kigali, Rwanda
- Harvard Medical School, Boston, MA, USA
- Dartmouth College Geisel School of Medicine, Hanover, NH, USA
| | - Eric Remera
- University of Global Health Equity, Kigali, Rwanda
- Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Darius Gishoma
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | | | | | | | | | - Sabin Nsanzimana
- University of Global Health Equity, Kigali, Rwanda
- Rwanda Biomedical Center, Kigali, Rwanda
| |
Collapse
|
22
|
Biracyaza E, Habimana S. Contribution of community-based sociotherapy interventions for the psychological well-being of Rwandan youths born to genocide perpetrators and survivors: analysis of the stories telling of a sociotherapy approach. BMC Psychol 2020; 8:102. [PMID: 32993777 PMCID: PMC7526217 DOI: 10.1186/s40359-020-00471-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 09/22/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Psychological well-being (PWB) refers to inter- and intra-individual levels of positive functioning that include one's relatedness with others and self-referent attitudes that include one's sense of mastery and personal growth. PWB consists of hedonism and eudaimonia building on thoughts, feelings, and behaviors. Sociotherapy is a community-based health intervention that contributes to the promotion of PWB worldwide. Starting from an analysis of trauma transmitted from the perpetrators and survivors of the Rwandan genocide to their descendants, this article is aimed at exploring the contribution of therapeutic sessions to PWB among youth. METHOD A qualitative study design based on shared testimonies was carried out. Field reports from the sociotherapists, written texts, and testimonies of changes presented in the conviviality meetings were analyzed using transactional analysis. We included 24 reflexive texts upon completion of 8 months of the therapeutic program. RESULTS Results indicated that before sociotherapy sessions, youth born to genocide survivors and perpetrators had psychosocial distress, including low self-esteem, hopelessness, anxiety, stigma, thoughts of revenge, shame, depression, and antisocial behaviors. Sociotherapy significantly contributed to the reduction of these psychosocial problems. Participating youth reported feeling safe, trusted, respected, and healthier than before the sociotherapy. This intervention created inner healing, social cohesion, alleviated their sufferings of trauma, restored their families and contributed to community resilience. Results revealed that youth developed PWB, helping them to what appeared to be psychosocial problems as being potentially healthy, enhancing self-acceptance, and respecting humanity. Youth also became the vector for the reconciliation and reconstruction of their humanity. CONCLUSION Sociotherapy is a community health intervention that has an effective outcome on the personal well-being of of youth. This therapy impacted the individual, social, and familial resilience of youth who developed their capacity to regain and maintain health. The intervention restored their PWB, characterized by increased positive functioning specifically in the areas of autonomy, ecological mastery, individual growth, purpose in life, good relationships with others, and improved self-esteem.
Collapse
Affiliation(s)
- Emmanuel Biracyaza
- District Manager of the Sociotherapy Programme, Prison Fellowship Rwanda (PFR), Embassy of the Kingdom of the Netherlands (EKN) project, Southern Province, P.O Box: 2098, Kigali, Rwanda.
| | - Samuel Habimana
- Rwanda Resilience and Grounding Organization (RRGO), Kigali, Rwanda
| |
Collapse
|
23
|
Rudahindwa S, Mutesa L, Rutembesa E, Mutabaruka J, Qu A, Wildman DE, Jansen S, Uddin M. Transgenerational effects of the genocide against the Tutsi in Rwanda: A post-traumatic stress disorder symptom domain analysis. AAS Open Res 2020. [DOI: 10.12688/aasopenres.12848.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: A number of studies have investigated transgenerational effects of parental post-traumatic stress disorder (PTSD) and its repercussions for offspring. Few studies however, have looked at this issue in the African context. Methods: The present study addresses this gap by utilizing a Pearson correlation matrix to investigate symptom severity within the three Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) PTSD symptom domains in mothers exposed to the genocide against the Tutsi in Rwanda (n=25) and offspring (n=25), and an ethnically matched set of controls (n=50) who were outside of Rwanda during the 1994 genocide. All mothers were pregnant with the offspring included in the study during the time of the genocide. Results: Total PTS score was significantly (p<0.01) correlated with each of the three symptom domains at various strengths in both cases and controls. No significant differences in association of total PTS score and PTSD symptom domains were observed between exposed mothers and offspring, suggesting that each symptom domain contributed equivalently to both exposed mothers and offspring distress. In contrast, the re-experiencing symptom domain showed a significant difference in correlation to overall PTS score in non-exposed mothers compared to their offspring (p<0.05), with mothers showing a significantly higher correlation. Furthermore, the correlation between avoidance/numbing symptoms to overall PTS was significantly different (p≤0.01) across exposed and non-exposed mothers. As a secondary analysis, we explored the relationship between DNA methylation in the glucocorticoid receptor (NR3C1) locus, an important stress modulating gene, and PTSD symptom domains, finding an association between DNA methylation and re-experiencing among genocide-exposed mothers that exceeded any other observed associations by approximately two-fold. Conclusions: This is the first report, to our knowledge, of a symptom-based analysis of transgenerational transmission of PTSD in sub-Saharan Africa. These findings can be leveraged to inform further mechanistic and treatment research for PTSD.
Collapse
|
24
|
Dozio E, Feldman M, Bizouerne C, Drain E, Laroche Joubert M, Mansouri M, Moro MR, Ouss L. The Transgenerational Transmission of Trauma: The Effects of Maternal PTSD in Mother-Infant Interactions. Front Psychiatry 2020; 11:480690. [PMID: 33329072 PMCID: PMC7733963 DOI: 10.3389/fpsyt.2020.480690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/04/2020] [Indexed: 11/25/2022] Open
Abstract
The objective of the study was to examine the process of mother to infant trauma transmission among traumatized mothers in humanitarian contexts. We investigated the impact of mothers' post-traumatic stress disorder symptoms on the quality of the dyadic interaction by conducting a microanalysis of mother-infant interactions at specific moments when trauma was recalled, compared to more neutral moments. Twenty-four mother-infant dyadic interactions of traumatized mothers and children aged from 1.5 to 30 months Central Africa, Chad, and Cameroon were videotaped during three sequences: a neutral initial session (baseline) exploring mothers' representations of the infant and of their bonding; a second sequence, "the traumatic narration," in which mothers were asked to talk about the difficult events they had experienced; and a third sequence focusing on a neutral subject. Three minutes of each sequence were coded through a specific grid for microanalysis [based on the scales developed at Bobigny Faculty of Medicine and the work of (1)], according to different communication modalities (touch, visual, and vocal), for both the mother and the child. Impact of traumatic event (IES-R), the level of depression and anxiety (HAD) were investigated in order to have a holistic understanding of the trauma transmission mechanism. The data analysis highlighted significant differences in mothers, children and their interaction during the "traumatic narration": mothers touched and looked at the infant less, looked more absent and smiled less, and looked less at the interviewer; infants looked less at the interviewer, and sucked the breast more. The mother-child interaction "infant self-stimulation-mother looks absent" and "Infant sucks the breast-mother looks absent" occurred more often during the mothers' traumatic narrations. The "absence" of the mother during trauma recall seems to have repercussions on infants' behavior and interaction; infants show coping strategies that are discussed. We found no significant associations between interaction and infant gender and age, the severity of traumatic experience, mothers' depression and anxiety symptoms, and the country of residence. The results of the microanalysis of interaction can shed light on the fundamental role of intermodal exchanges between mother and infant in trauma transmission during mothers' trauma reactivation.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Lisa Ouss
- Hôpital Necker-Enfants Malades, Assistance Publique Hopitaux De Paris, Paris, France
| |
Collapse
|
25
|
Batchelor V, Pang TY. HPA axis regulation and stress response is subject to intergenerational modification by paternal trauma and stress. Gen Comp Endocrinol 2019; 280:47-53. [PMID: 30981703 DOI: 10.1016/j.ygcen.2019.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 12/20/2022]
Abstract
There is increasing evidence that one's risk for psychiatric disturbances and metabolic syndromes is influenced by their parents' own health history, lifestyle and living environment. For example, paternal high fat diet is strongly linked to neuroendocrine dysregulation in offspring and increased risk for diabetes. The potential intergenerational impact of paternal stress has only just begun to emerge, with the initial evidence suggestive of greater risk for anxiety-related disorders. The hypothalamic-pituitary-adrenal (HPA)-axis is a key neuroendocrine signalling system involved in physiological homeostasis and stress response. In individuals, dysregulation of this system is closely associated with behavioral deficits and mood disorders. Various preclinical models of paternal stress have demonstrated robust behavioral shifts but little is known about the intergenerational modification of HPA axis function. This review will present evidence drawn from a range of laboratory mouse and rat models that the intergenerational influence of paternal stress on offspring behavioral phenotypes involve some level of HPA axis dysregulation. It makes the case that further investigations to comprehensively profile HPA axis function in offspring generations is warranted.
Collapse
Affiliation(s)
- Vicky Batchelor
- Department of Anatomy & Neuroscience, University of Melbourne, VIC 3010, Australia; Florey Institute of Neurosciences and Mental Health, University of Melbourne, VIC 3010, Australia
| | - Terence Y Pang
- Department of Anatomy & Neuroscience, University of Melbourne, VIC 3010, Australia; Florey Institute of Neurosciences and Mental Health, University of Melbourne, VIC 3010, Australia.
| |
Collapse
|
26
|
Forke CM, Catallozzi M, Localio AR, Grisso JA, Wiebe DJ, Fein JA. Intergenerational effects of witnessing domestic violence: Health of the witnesses and their children. Prev Med Rep 2019; 15:100942. [PMID: 31321205 PMCID: PMC6614529 DOI: 10.1016/j.pmedr.2019.100942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/09/2019] [Accepted: 06/28/2019] [Indexed: 12/04/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Christine M Forke
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States of America.,Violence Prevention Initiative, Children's Hospital of Philadelphia, United States of America.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, United States of America
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center-College of Physicians & Surgeons, United States of America.,Heilbrunn Department of Population & Family Health, Columbia University Medical Center, New York, NY, United States of America.,Mailman School of Public Health, New York, NY, United States of America
| | - A Russell Localio
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States of America
| | - Jeane Ann Grisso
- Departments of Public Health, Nursing, and Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Douglas J Wiebe
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, United States of America
| | - Joel A Fein
- Violence Prevention Initiative, Children's Hospital of Philadelphia, United States of America.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, United States of America.,Division of Emergency Medicine, Children's Hospital of Philadelphia, United States of America
| |
Collapse
|
27
|
Yudkin JS, Messiah SE. Understanding the etiology and impact of hatred globally in a public health context. Int J Public Health 2019; 64:1257-1258. [PMID: 31273407 DOI: 10.1007/s00038-019-01279-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Joshua S Yudkin
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA.
| | - Sarah E Messiah
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| |
Collapse
|
28
|
Lapp HE, Hunter RG. Early life exposures, neurodevelopmental disorders, and transposable elements. Neurobiol Stress 2019; 11:100174. [PMID: 31193573 PMCID: PMC6536887 DOI: 10.1016/j.ynstr.2019.100174] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/27/2019] [Accepted: 05/21/2019] [Indexed: 12/26/2022] Open
Abstract
Transposable elements make up a much larger portion of the genome than protein-coding genes, yet we know relatively little about their function in the human genome. However, we are beginning to more fully understand their role in brain development, neuroinflammation, and adaptation to environmental insults such as stress. For instance, glucocorticoid receptor activation regulates transposable elements in the brain following acute stress. Early life is a period of substantial brain development during which transposable elements play a role. Environmental exposures and experiences during early life that promote abnormal regulation of transposable elements may lead to a cascade of events that ultimately increase susceptibility to disorders later in life. Recent attention to transposable elements in psychiatric illness has begun to clarify associations indicative of dysregulation of different classes of transposable elements in stress-related and neurodevelopmental illness. Though individual susceptibility or resiliency to psychiatric illness has not been explained by traditional genetic studies, the wide inter-individual variability in transposable element composition in the human genome make TEs attractive candidates to elucidate this differential susceptibility. In this review, we discuss evidence that regulation of transposable elements in the brain are stage-specific, sensitive to environmental factors, and may be impacted by early life perturbations. We further present evidence of associations with stress-related and neurodevelopmental psychiatric illness from a developmental perspective.
Collapse
Affiliation(s)
- Hannah E Lapp
- University of Massachusetts Boston, 100 Morrissey Blvd Boston, MA, 02125, USA
| | - Richard G Hunter
- University of Massachusetts Boston, 100 Morrissey Blvd Boston, MA, 02125, USA
| |
Collapse
|
29
|
Ramo-Fernández L, Boeck C, Koenig AM, Schury K, Binder EB, Gündel H, Fegert JM, Karabatsiakis A, Kolassa IT. The effects of childhood maltreatment on epigenetic regulation of stress-response associated genes: an intergenerational approach. Sci Rep 2019; 9:983. [PMID: 31000782 PMCID: PMC7052131 DOI: 10.1038/s41598-018-36689-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Laura Ramo-Fernández
- Department of Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, Ulm, 89081, Germany.
| | - Christina Boeck
- Department of Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, Ulm, 89081, Germany
| | - Alexandra M Koenig
- Department of Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, Ulm, 89081, Germany
| | - Katharina Schury
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, 89075, Ulm, Germany
| | - Elisabeth B Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, 80804, Germany.,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, 89081, Ulm, Germany
| | - Jöerg M Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, 89075, Ulm, Germany
| | - Alexander Karabatsiakis
- Department of Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, Ulm, 89081, Germany
| | - Iris-Tatjana Kolassa
- Department of Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, Ulm, 89081, Germany.
| |
Collapse
|
30
|
Serpeloni F, Radtke KM, Hecker T, Sill J, Vukojevic V, de Assis SG, Schauer M, Elbert T, Nätt D. Does Prenatal Stress Shape Postnatal Resilience? - An Epigenome-Wide Study on Violence and Mental Health in Humans. Front Genet 2019; 10:269. [PMID: 31040859 PMCID: PMC6477038 DOI: 10.3389/fgene.2019.00269] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/12/2019] [Indexed: 12/24/2022] Open
Abstract
Stress during pregnancy widely associates with epigenetic changes and psychiatric problems during childhood. Animal studies, however, show that under specific postnatal conditions prenatal stress may have other, less detrimental consequences for the offspring. Here, we studied mental health and epigenome-wide DNA methylation in saliva following intimate partner violence (IPV) during pregnancy in São Gonçalo, a Brazilian city with high levels of violence. Not surprisingly, mothers exposed to pregnancy IPV expressed elevated depression, PTSD and anxiety symptoms. Children had similar psychiatric problems when they experienced maternal IPV after being born. More surprisingly, when maternal IPV occurred both during (prenatal) and after pregnancy these problems were absent. Following prenatal IPV, genomic sites in genes encoding the glucocorticoid receptor (NR3C1) and its repressor FKBP51 (FKBP5) were among the most differentially methylated and indicated an enhanced ability to terminate hormonal stress responses in prenatally stressed children. These children also showed more DNA methylation in heterochromatin-like regions, which previously has been associated with stress/disease resilience. A similar relationship was seen in prenatally stressed middle-eastern refugees of the same age as the São Gonçalo children but exposed to postnatal war-related violence. While our study is limited in location and sample size, it provides novel insights on how prenatal stress may epigenetically shape resilience in humans, possibly through interactions with the postnatal environment. This translates animal findings and emphasizes the importance to account for population differences when studying how early life gene–environment interactions affects mental health.
Collapse
Affiliation(s)
- Fernanda Serpeloni
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany.,Department of Studies in Violence and Health Jorge Careli, National School of Public Health of Rio de Janeiro - National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Karl M Radtke
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany.,Evolutionary Biology and Zoology, Department of Biology, University of Konstanz, Konstanz, Germany
| | - Tobias Hecker
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Johanna Sill
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Vanja Vukojevic
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - Simone G de Assis
- Department of Studies in Violence and Health Jorge Careli, National School of Public Health of Rio de Janeiro - National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maggie Schauer
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Thomas Elbert
- Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Daniel Nätt
- Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
| |
Collapse
|
31
|
Complex PTSD and intergenerational transmission of distress and resilience among Tutsi genocide survivors and their offspring: A preliminary report. Psychiatry Res 2019; 271:121-123. [PMID: 30472506 DOI: 10.1016/j.psychres.2018.11.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/18/2018] [Accepted: 11/18/2018] [Indexed: 11/21/2022]
Abstract
The research on survivors of genocide has focused on PTSD, but complex PTSD (CPTSD) and its potential effect on intergenerational transmission are understudied. This study assessed complex PTSD and resilience among Tutsi genocide survivors (n = 60, mean age = 52.27 [SD = 6.27]) and their offspring (n = 60, mean age = 21.21 [SD = 1.78]). Offspring of parents suffering from PTSD or CPTSD reported more secondary traumatization symptoms relative to offspring of parents without PTSD (p < 0.0001). Moreover, parental CPTSD was related to lower resilience among both survivors and offspring (p < 0.0001). The current findings suggest that parental CPTSD may have broader influences manifested in offspring lower resilience.
Collapse
|
32
|
Morina N, Stam K, Pollet TV, Priebe S. Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions. A systematic review and meta-analysis of epidemiological studies. J Affect Disord 2018; 239:328-338. [PMID: 30031252 DOI: 10.1016/j.jad.2018.07.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/21/2018] [Accepted: 07/08/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Epidemiological surveys on depression and posttraumatic stress disorder (PTSD) among civilian war survivors in war-afflicted regions have produced heterogeneous prevalence estimates of these conditions. METHODS To determine the prevalence of both depression and PTSD in civilian war survivors in the area of conflict, we conducted a systematic search of Medline, PsycInfo, and Pilots databases. We included epidemiological studies that had used structured clinical interviews. We conducted random effects meta-analyses on prevalence proportions as well as univariate mixed model meta-regressions. RESULTS We included 33 studies that assessed prevalences of depression (k = 18) and/or PTSD (k = 30). Across all studies, pooled point prevalences of 0.27 and 0.26 were found for depression and PTSD, respectively. Ten percent of participants fulfilled criteria for both disorders. Surveys with a higher mean age of participants reported higher prevalence of depression. Furthermore, samples with higher rates of unemployment and higher percentages of women reported higher prevalence of PTSD, whereas samples with a higher number of participants living with a partner reported lower prevalence of PTSD. LIMITATIONS The findings are limited by poor psychometric reporting practices. CONCLUSIONS Our findings suggest that both depression and PTSD are highly prevalent in war survivors who stayed in the area of conflict. Yet, future research on this topic need to focus on psychometric properties of instruments used to assess psychopathology among war survivors. Notwithstanding this limitation, there is an urgent need for large-scale mental health programs that are appropriate for war-affected countries with limited resources and address depression as much as PTSD.
Collapse
Affiliation(s)
- Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany; Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Kimberly Stam
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas V Pollet
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, UK
| |
Collapse
|
33
|
Yehuda R, Lehrner A. Intergenerational transmission of trauma effects: putative role of epigenetic mechanisms. World Psychiatry 2018; 17:243-257. [PMID: 30192087 PMCID: PMC6127768 DOI: 10.1002/wps.20568] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 12/18/2022] Open
Abstract
This paper reviews the research evidence concerning the intergenerational transmission of trauma effects and the possible role of epigenetic mechanisms in this transmission. Two broad categories of epigenetically mediated effects are highlighted. The first involves developmentally programmed effects. These can result from the influence of the offspring's early environmental exposures, including postnatal maternal care as well as in utero exposure reflecting maternal stress during pregnancy. The second includes epigenetic changes associated with a preconception trauma in parents that may affect the germline, and impact fetoplacental interactions. Several factors, such as sex-specific epigenetic effects following trauma exposure and parental developmental stage at the time of exposure, explain different effects of maternal and paternal trauma. The most compelling work to date has been done in animal models, where the opportunity for controlled designs enables clear interpretations of transmissible effects. Given the paucity of human studies and the methodological challenges in conducting such studies, it is not possible to attribute intergenerational effects in humans to a single set of biological or other determinants at this time. Elucidating the role of epigenetic mechanisms in intergenerational effects through prospective, multi-generational studies may ultimately yield a cogent understanding of how individual, cultural and societal experiences permeate our biology.
Collapse
Affiliation(s)
- Rachel Yehuda
- James J. Peters Bronx Veterans Affairs Hospital, Bronx, NY, USA
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amy Lehrner
- James J. Peters Bronx Veterans Affairs Hospital, Bronx, NY, USA
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
34
|
Abstract
AbstractThe question of whether and how the effects of cultural trauma can be transmitted intergenerationally from parents to offspring, or even to later generations, has evoked interest and controversy in academic and popular forums. Recent methodological advances have spurred investigations of potential epigenetic mechanisms for this inheritance, representing an exciting area of emergent research. Epigenetics has been described as the means through which environmental influences “get under the skin,” directing transcriptional activity and influencing the expression or suppression of genes. Over the past decade, this complex environment–biology interface has shown increasing promise as a potential pathway for the intergenerational transmission of the effects of trauma. This article reviews challenges facing research on cultural trauma, biological findings in trauma and posttraumatic stress disorder, and putative epigenetic mechanisms for transmission of trauma effects, including through social, intrauterine, and gametic pathways. Implications for transmission of cultural trauma effects are discussed, focused on the relevance of cultural narratives and the possibilities of resilience and adaptivity.
Collapse
|
35
|
Ibrahim H, Ertl V, Catani C, Ismail AA, Neuner F. Trauma and perceived social rejection among Yazidi women and girls who survived enslavement and genocide. BMC Med 2018; 16:154. [PMID: 30208905 PMCID: PMC6136186 DOI: 10.1186/s12916-018-1140-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In August 2014, the Islamic State of Iraq and Syria (ISIS), a terrorist organization, attacked the Yazidi's ancestral homeland in northwestern Iraq. Among other atrocities, they abducted thousands of women and girls and traded many of them into sexual slavery. The aim of this study is to determine the mental health of women and girl survivors of these events in relation to enslavement and experiences with genocide-related events, as well as perceived social rejection in their community. METHODS Between February and July 2017, trained local assessors interviewed a sample of 416 Yazidi women and girls (65 of whom had survived sexual enslavement), aged between 17 and 75 years, and living in internally displaced person camps in the Kurdistan Region of Iraq. Post-traumatic stress disorder (PTSD) and depression symptoms were assessed using validated Kurdish versions of standard instruments. Scales for trauma exposure and perceived rejection were developed for the purpose of this study. RESULTS Participants reported a high number of traumatic events. More than 80% of girls and women, and almost all participants who were formerly enslaved, met criteria for a probable DSM-5 PTSD diagnosis. Trauma exposure and enslavement predicted poor mental health. In addition, among formerly enslaved girls and women, perceived social rejection in their community mediated the relationship between traumatic enslavement events and depression symptoms. CONCLUSIONS In a context of maximum adversity, enslavement and war-related events contribute to high levels of PTSD and depression. Perceived social rejection seems to play a role in the relationship between trauma exposure and mental health among abducted genocide survivors. Providing psychosocial support and treatment for Yazidi people is essential and urgently required.
Collapse
Affiliation(s)
- Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany. .,Department of Clinical Psychology, Koya University, Koya, Kurdistan Region, Iraq. .,vivo International, Konstanz, Germany.
| | - Verena Ertl
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International, Konstanz, Germany
| | - Claudia Catani
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International, Konstanz, Germany
| | - Azad Ali Ismail
- Department of Clinical Psychology, Koya University, Koya, Kurdistan Region, Iraq
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International, Konstanz, Germany
| |
Collapse
|
36
|
Mukamana D, Collins A, Rosa WE. Genocide Rape Trauma: A Conceptual Framework for Understanding the Psychological Suffering of Rwandan Survivors. Res Theory Nurs Pract 2018; 32:125-143. [PMID: 29792253 DOI: 10.1891/1541-6577.32.2.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 1994, the Rwandan genocide claimed the lives of approximately 1 million Tutsi and moderate Hutu citizens. Systematic rape was a strategic component of the Hutu extremist plan to eradicate the Tutsi minority population. This involved collective and repeated sexual assaults with brutal violence, public humiliation, and torture. This article maps the ongoing psychological impact on Rwandan genocide rape survivors and identifies implications for international nursing practice. The research formalizes their narratives, identifying a number of interconnected elements that combine to produce myriad forms of chronic psychological suffering in the Rwandan context. This work in turn reveals the specific needs of these survivors that may be addressed by nursing. It allows nurses, as experts in managing the human responses to health and illness, to develop a more complete understanding of psychological suffering as it pertains to vulnerable populations during and in the wake of extreme social conflict. This clarifies the roles of nurse educators, clinicians, and policy advocates as key agents in providing genocide rape survivors with the resources and expertise needed to effectively manage their ongoing trauma.
Collapse
|
37
|
Rudahindwa S, Mutesa L, Rutembesa E, Mutabaruka J, Qu A, Wildman DE, Jansen S, Uddin M. Transgenerational effects of the genocide against the Tutsi in Rwanda: A post-traumatic stress disorder symptom domain analysis. AAS Open Res 2018. [DOI: 10.12688/aasopenres.12848.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: A number of studies have investigated transgenerational effects of parental post-traumatic stress disorder (PTSD) and its repercussions for offspring. Few studies however, have looked at this issue in the African context. Methods: The present study addresses this gap, utilizing confirmatory factor analysis (CFA), to investigate symptom severity within the three Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) PTSD symptom domains in mothers exposed to the genocide against the Tutsi in Rwanda (n=25) and offspring (n=25), and an ethnically matched control group of mothers (n=25) and offspring (n=25) who were outside of Rwanda during the genocide. All mothers were pregnant during the time of the genocide with the offspring included in the study. Missing data were excluded from the analyses. Results: We found that among the three symptom domains of PTSD, the re-experiencing symptom domain loaded most strongly onto PTSD among mothers directly exposed to the genocide (Beta = 0.95). In offspring of exposed mothers, however, the three symptom domains of PTSD yielded almost equal loading values (Beta range = 0.84-0.86). Conversely, among non-exposed mothers and their offspring, the hyperarousal symptom domain of PTSD loaded most strongly onto PTSD (Beta = 1.00, Beta = 0.94, respectively). As a secondary analysis, we also explored the relation between DNA methylation in the glucocorticoid receptor (NR3C1) locus, an important stress modulating gene, and individual PTSD symptom domains, finding a strong association between DNA methylation and re-experiencing among genocide-exposed mothers that exceeded any other observed associations by approximately two-fold. Conclusions: This is the first report, to our knowledge, of a symptom-based analysis of transgenerational transmission of PTSD in Africa. These findings can be leveraged to inform further mechanistic and treatment research for PTSD.
Collapse
|
38
|
Berckmoes LH, de Jong JTVM, Reis R. Intergenerational transmission of violence and resilience in conflict-affected Burundi: a qualitative study of why some children thrive despite duress. Glob Ment Health (Camb) 2017; 4:e26. [PMID: 29299333 PMCID: PMC5745362 DOI: 10.1017/gmh.2017.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Research suggests that in environments where community conflict and violence are chronic or cyclical, caregiving can impact how children may begin to reproduce violence throughout the various stages of their lives. The aim of this study is to understand how caregiving affects processes of reproducing violence and resilience among children in conflict-affected Burundi. METHODS We combined a socio-ecological model of child development with a child-actor perspective. We operationalized the core concepts 'vulnerable household', 'resilience', and 'caregiving' iteratively in culturally relevant ways, and put children's experiences at the center of the inquiry. We carried out a comparative case study among 74 purposively sampled vulnerable households in six collines in three communes in three provinces in the interior of Burundi. Burundian field researchers conducted three consecutive interviews; with the head of the household, the main caregiver, and a child. RESULTS Our findings reveal a strong congruence between positive caregiving and resilience among children. Negative caregiving was related to negative social behavior among children. Other resources for resilience appeared to be limited. The overall level of household conditions and embedment in communities attested to a generalized fragile ecological environment. CONCLUSIONS In conflict-affected socio-ecological environments, caregiving can impact children's functioning and their role in reproducing violence. Interventions that support caregivers in positive caregiving are promising for breaking cyclical violence.
Collapse
Affiliation(s)
- L. H. Berckmoes
- The Netherlands Institute for the Study of Crime and Law Enforcement, Amsterdam, Noord-Holland, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - J. T. V. M. de Jong
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
- Boston University School of Medicine, Boston, USA
| | - R. Reis
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
- Department of Public Health & Primary Care, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
- School of Child and Adolescent Health, The Children's Institute, University of Cape Town, Leiden, Zuid-Holland, South Africa
| |
Collapse
|
39
|
How Legacies of Genocide Are Transmitted in the Family Environment: A Qualitative Study of Two Generations in Rwanda. SOCIETIES 2017. [DOI: 10.3390/soc7030024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
40
|
|
41
|
Cooper EJ, Hudson JS, Kranzberg MB, Motherwell L. Current and Future Challenges in Group Therapy. Int J Group Psychother 2017; 67:S219-S239. [PMID: 38449267 DOI: 10.1080/00207284.2016.1238750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This article reviews changes and considers challenges in group therapy since AGPA's 50th anniversary 25 years ago. The authors acknowledge the many important changes that have occurred in research, theory, and practice in the last two and a half decades, but focus on four topics: treating trauma with cultural sensitivity; the impact of technology on groups; challenges for LGBTQ clients in group; and the future for psychodynamic groups. The authors review the literature and provide recommendations on how to address the challenges.
Collapse
|
42
|
Luca C, Silvia C, Giulia B, Renata T. Do parental traumatic experiences have a role in the psychological functioning of early adolescents with binge eating disorder? Eat Weight Disord 2016; 21:635-644. [PMID: 27438789 DOI: 10.1007/s40519-016-0303-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/11/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Few studies have addressed the psychological characteristics of adolescents with binge eating disorder (BED). No research has focused on the psychological functioning of these adolescents' parents or on the prevalence of traumatic experiences among them. METHODS In this study, 202 adolescents aged 11-13 and their parents were recruited from mental health clinics to complete the youth self-report (YSR), the response evaluation measure for youth (REM-71), the Toronto Alexithymia Scale (TAS-20), the Symptom Check-List (SCL-90-R), and the traumatic experience checklist (TEC). RESULTS Female adolescents scored higher than males on withdrawal, internalizing problems, dissociation, and somatization subscales. Boys scored higher than girls on externalizing problems and acting out subscales. Maternal depression predicted withdrawal and dissociation in female adolescents. Maternal sexual abuse predicted social problems in males and self-destructive behaviors in females. Paternal physical abuse predicted delinquent behavior and acting out in males. CONCLUSIONS Our data suggest that parental traumatic experiences play a role in their offspring's mental health; the data also showed different psychopathological configurations in male and female adolescents with BED and their parents, suggesting the development of prevention and treatment polices specific to gender.
Collapse
Affiliation(s)
- Cerniglia Luca
- Uninettuno International Telematic University, Corso Vittorio Emanuele II, 39, Rome, Italy.
| | | | | | | |
Collapse
|
43
|
Uwizeye G, Lee BX, Kroll T. Health system redesign following sexual violence during the genocide in Rwanda. Int J Public Health 2016; 61:959-960. [PMID: 27771750 DOI: 10.1007/s00038-016-0873-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 08/09/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Bandy X Lee
- Yale University, School of Medicine, Law and Psychiatry Division, New Haven, CT, USA
| | - Thilo Kroll
- UCD School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| |
Collapse
|
44
|
Kaputu-Kalala-Malu C, Walker TD, Ntumba-Tshitenge O, Mafuta EM, Tugirimana PL, Misson JP. The challenge of managing headache disorders in a tertiary referral neurology clinic in Rwanda. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2016; 21:151-7. [PMID: 27094526 PMCID: PMC5107270 DOI: 10.17712/nsj.2016.2.20150640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the pattern, management, and outcome of headaches among patients treated at Outpatient Neurology Clinic. METHODS A retrospective study was conducted at the Out-Patient Neurology Clinic of the Butare University Teaching Hospital, University of Rwanda, Butare, Rwanda between February and May 2015. We extracted the demographic data, headache characteristics, and associated conditions, prior pain-relieving medication use, waiting time before consultation, the results of paraclinical investigations, final diagnosis according to the International Classification of Headache Disorders, management, and 3-month clinical outcome from the medical records of all patients who consulted for headache over 36-month period. Epi Data and Statistical package for Social sciences software version 21.0 (SPSS Inc, Chicago, IL, USA) software were used for data processing. RESULTS Headache disorders represent a quarter of all neurological consultations. Patients were predominantly female (67%) and young (78% <45 years old). One-third (34%) presented with chronic tension-type headache. Neuroimaging demonstrated an abnormality in a significant minority (14%). Amitriptyline was the most commonly used drug (60%) in management. Forty percent of those patients followed for 3 months did not experience any clinical improvement. CONCLUSION Headache is among the most common medical complaints in the Outpatient Neurology Clinic, with a wide array of underlying diagnoses, and a significant yield on neuroimaging. A significant proportion of those suffering from headache disorders have poor short-term outcomes. Novel approaches, such as headache support groups and alternative pharmacological agents, should be investigated for these patients.
Collapse
Affiliation(s)
- Célestin Kaputu-Kalala-Malu
- From the Neurology Service (Kaputu-Kalala-Malu, Walker), Department of Internal Medicine, the department of Pediatrics (Ntumba-Tshitenge), Butare University Teaching Hospital, Huye, the Department of Internal Medicine (Tugirimana), Kigali University Teaching Hospital, Kigali, Rwanda, the Child Neurology (Kaputu-Kalala-Malu), Department of Neurology, Centre Neuropsychopathologique Hospital, the school of Public Health (Mafuta), Kinshasa University Teaching Hospital, Kinshasa, Republic democratic of Congo, and the service of Paediatrics and Child Neurology (Misson), CHR Citadelle Hospital and CHU Sart Tilmam, University Hospital, University of Liège, Liège, Belgium,Address correspondence and reprint request to: Dr. Célestin Kaputu-Kalala-Malu, Child Neurology, Department of Neurology, Centre Neuropsychopathologique Hospital, Kinshasa University Teaching Hospital, Kinshasa, Republic Democratic of Congo. E-mail:
| | - Timothy D. Walker
- From the Neurology Service (Kaputu-Kalala-Malu, Walker), Department of Internal Medicine, the department of Pediatrics (Ntumba-Tshitenge), Butare University Teaching Hospital, Huye, the Department of Internal Medicine (Tugirimana), Kigali University Teaching Hospital, Kigali, Rwanda, the Child Neurology (Kaputu-Kalala-Malu), Department of Neurology, Centre Neuropsychopathologique Hospital, the school of Public Health (Mafuta), Kinshasa University Teaching Hospital, Kinshasa, Republic democratic of Congo, and the service of Paediatrics and Child Neurology (Misson), CHR Citadelle Hospital and CHU Sart Tilmam, University Hospital, University of Liège, Liège, Belgium
| | - Olga Ntumba-Tshitenge
- From the Neurology Service (Kaputu-Kalala-Malu, Walker), Department of Internal Medicine, the department of Pediatrics (Ntumba-Tshitenge), Butare University Teaching Hospital, Huye, the Department of Internal Medicine (Tugirimana), Kigali University Teaching Hospital, Kigali, Rwanda, the Child Neurology (Kaputu-Kalala-Malu), Department of Neurology, Centre Neuropsychopathologique Hospital, the school of Public Health (Mafuta), Kinshasa University Teaching Hospital, Kinshasa, Republic democratic of Congo, and the service of Paediatrics and Child Neurology (Misson), CHR Citadelle Hospital and CHU Sart Tilmam, University Hospital, University of Liège, Liège, Belgium
| | - Eric M. Mafuta
- From the Neurology Service (Kaputu-Kalala-Malu, Walker), Department of Internal Medicine, the department of Pediatrics (Ntumba-Tshitenge), Butare University Teaching Hospital, Huye, the Department of Internal Medicine (Tugirimana), Kigali University Teaching Hospital, Kigali, Rwanda, the Child Neurology (Kaputu-Kalala-Malu), Department of Neurology, Centre Neuropsychopathologique Hospital, the school of Public Health (Mafuta), Kinshasa University Teaching Hospital, Kinshasa, Republic democratic of Congo, and the service of Paediatrics and Child Neurology (Misson), CHR Citadelle Hospital and CHU Sart Tilmam, University Hospital, University of Liège, Liège, Belgium
| | - Pierrot L. Tugirimana
- From the Neurology Service (Kaputu-Kalala-Malu, Walker), Department of Internal Medicine, the department of Pediatrics (Ntumba-Tshitenge), Butare University Teaching Hospital, Huye, the Department of Internal Medicine (Tugirimana), Kigali University Teaching Hospital, Kigali, Rwanda, the Child Neurology (Kaputu-Kalala-Malu), Department of Neurology, Centre Neuropsychopathologique Hospital, the school of Public Health (Mafuta), Kinshasa University Teaching Hospital, Kinshasa, Republic democratic of Congo, and the service of Paediatrics and Child Neurology (Misson), CHR Citadelle Hospital and CHU Sart Tilmam, University Hospital, University of Liège, Liège, Belgium
| | - Jean P. Misson
- From the Neurology Service (Kaputu-Kalala-Malu, Walker), Department of Internal Medicine, the department of Pediatrics (Ntumba-Tshitenge), Butare University Teaching Hospital, Huye, the Department of Internal Medicine (Tugirimana), Kigali University Teaching Hospital, Kigali, Rwanda, the Child Neurology (Kaputu-Kalala-Malu), Department of Neurology, Centre Neuropsychopathologique Hospital, the school of Public Health (Mafuta), Kinshasa University Teaching Hospital, Kinshasa, Republic democratic of Congo, and the service of Paediatrics and Child Neurology (Misson), CHR Citadelle Hospital and CHU Sart Tilmam, University Hospital, University of Liège, Liège, Belgium
| |
Collapse
|
45
|
Williams ZM. Transgenerational influence of sensorimotor training on offspring behavior and its neural basis in Drosophila. Neurobiol Learn Mem 2016; 131:166-75. [PMID: 27044678 DOI: 10.1016/j.nlm.2016.03.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/23/2016] [Accepted: 03/30/2016] [Indexed: 01/01/2023]
Abstract
Whether specific learning experiences by parents influence the behavior of subsequent generations remains unclear. This study examines whether and what aspects of parental sensorimotor training prior to conception affect the behavior of subsequent generations and identifies the neural circuitries in Drosophila responsible for mediating these effects. Using genetic and anatomic techniques, I find that both first- and second-generation offspring of parents who underwent prolonged olfactory training over many days displayed a weak but selective approach bias to the same trained odors. However, I also find that the offspring did not differentiate between orders based on whether parental training was aversive or appetitive. Disruption of both olfactory-receptor and dorsal-paired-medial neuron input into the mushroom bodies abolished this change in offspring response, but disrupting synaptic output from α/β neurons of the mushroom body themselves had little effect on behavior even though they remained necessary for enacting newly trained conditioned responses. This study provides a circuit-based understanding of how specific sensory experiences in Drosophila may bias the behavior of subsequent generations, and identifies a transgenerational dissociation between the effects of conditioned and unconditioned sensory stimuli.
Collapse
Affiliation(s)
- Ziv M Williams
- Harvard-MIT Health Sciences and Technology, Boston, MA, United States; Harvard Medical School Program in Neuroscience, Boston, MA, United States; Department of Neurosurgery, MGH-HMS Center for Nervous System Repair, Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
46
|
Smoller JW. The Genetics of Stress-Related Disorders: PTSD, Depression, and Anxiety Disorders. Neuropsychopharmacology 2016; 41:297-319. [PMID: 26321314 PMCID: PMC4677147 DOI: 10.1038/npp.2015.266] [Citation(s) in RCA: 256] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/05/2015] [Accepted: 08/26/2015] [Indexed: 02/06/2023]
Abstract
Research into the causes of psychopathology has largely focused on two broad etiologic factors: genetic vulnerability and environmental stressors. An important role for familial/heritable factors in the etiology of a broad range of psychiatric disorders was established well before the modern era of genomic research. This review focuses on the genetic basis of three disorder categories-posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and the anxiety disorders-for which environmental stressors and stress responses are understood to be central to pathogenesis. Each of these disorders aggregates in families and is moderately heritable. More recently, molecular genetic approaches, including genome-wide studies of genetic variation, have been applied to identify specific risk variants. In this review, I summarize evidence for genetic contributions to PTSD, MDD, and the anxiety disorders including genetic epidemiology, the role of common genetic variation, the role of rare and structural variation, and the role of gene-environment interaction. Available data suggest that stress-related disorders are highly complex and polygenic and, despite substantial progress in other areas of psychiatric genetics, few risk loci have been identified for these disorders. Progress in this area will likely require analysis of much larger sample sizes than have been reported to date. The phenotypic complexity and genetic overlap among these disorders present further challenges. The review concludes with a discussion of prospects for clinical translation of genetic findings and future directions for research.
Collapse
Affiliation(s)
- Jordan W Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| |
Collapse
|
47
|
Küffer AL, Thoma MV, Maercker A. Transgenerational aspects of former Swiss child laborers: do second generations suffer from their parents' adverse early-life experiences? Eur J Psychotraumatol 2016; 7:30804. [PMID: 27784510 PMCID: PMC5081486 DOI: 10.3402/ejpt.v7.30804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 09/05/2016] [Accepted: 09/19/2016] [Indexed: 02/06/2023] Open
Abstract
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," Mage=76.13, SD=6.81 and n=19, parental controls, Mage=72.63, SD=5.96) and their offspring (n=21, former "Verdingkinder" offspring, Mage=52.91, SD=5.90, and n=29 offspring controls, Mage=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.
Collapse
Affiliation(s)
- Andreas L Küffer
- Division for Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland.,Department of Psychiatry, University of California in San Francisco, San Francisco, CA, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA;
| | - Myriam V Thoma
- Division for Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland
| | - Andreas Maercker
- Division for Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland
| |
Collapse
|
48
|
Augsburger M, Meyer-Parlapanis D, Bambonye M, Elbert T, Crombach A. Appetitive Aggression and Adverse Childhood Experiences Shape Violent Behavior in Females Formerly Associated with Combat. Front Psychol 2015; 6:1756. [PMID: 26635666 PMCID: PMC4646969 DOI: 10.3389/fpsyg.2015.01756] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/02/2015] [Indexed: 11/13/2022] Open
Abstract
This study investigated the impact of violent experiences during childhood, posttraumatic stress disorder (PTSD) and appetitive aggression on everyday violent behavior in Burundian females with varying participation in war. Moreover, group differences in trauma-related and aggression variables were expected. Appetitive aggression describes the perception of violence perpetration as fascinating and appealing and is a common phenomenon in former combatants. Semi-structured interviews were conducted with 158 females, either former combatants, supporters of armed forces or civilians during the civil war in Burundi. The PTSD Symptom Scale Interview was used to assess PTSD symptom severity, the Appetitive Aggression Scale to measure appetitive aggression and the Domestic and Community Violence Checklist to assess both childhood maltreatment and recent aggressive behavior. Former combatants had experienced more traumatic events, perpetrated more violence and reported higher levels of appetitive aggression than supporters and civilians. They also suffered more severely from PTSD symptoms than civilians but not than supporters. The groups did not differ regarding childhood maltreatment. Both appetitive aggression and childhood violence predicted ongoing aggressive behavior, whereas the latter outperformed PTSD symptom severity. These findings support current research showing that adverse childhood experiences and a positive attitude toward aggression serve as the basis for aggressive behavior and promote an ongoing cycle of violence in post-conflict regions. Female members of armed groups are in need of demobilization procedures including trauma-related care and interventions addressing appetitive aggression.
Collapse
Affiliation(s)
| | | | | | - Thomas Elbert
- Department of Psychology, University of Konstanz Konstanz, Germany ; Department of Psychology, University Lumière Bujumbura, Burundi
| | - Anselm Crombach
- Department of Psychology, University of Konstanz Konstanz, Germany ; Department of Psychology, University Lumière Bujumbura, Burundi
| |
Collapse
|
49
|
Rugema L, Mogren I, Ntaganira J, Krantz G. Traumatic episodes and mental health effects in young men and women in Rwanda, 17 years after the genocide. BMJ Open 2015; 5:e006778. [PMID: 26109109 PMCID: PMC4480039 DOI: 10.1136/bmjopen-2014-006778] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To investigate mental health effects associated with exposure to trauma in Rwanda during the 1994 genocide period, and over the lifetime, in Rwandan men and women aged 20-35 years. SETTING This was a cross-sectional population-based study conducted in the southern province of Rwanda. Data was collected during December 2011 to January 2012. PARTICIPANTS A total population of 917 individuals were included, 440 (48%) men and 477 (52%) women aged 20-35 years. Number of households for inclusion in each village was selected proportional to the total number of households in each selected village. The response rate was 99.8%. Face-to-face interviewing was done by experienced and trained clinical psychologists, following a structured questionnaire. RESULTS Women were slightly less exposed during the genocide period (women 35.4% and men 37.5%; p=0.537), but more women than men were exposed to traumatic episodes over their lifetime (women 83.6%, n=399; men 73.4%, n=323; p<0.001). Current major depressive episodes (MDE) were twice as prevalent in women as in men. Traumatic episodes experienced in the genocide period severely affected men's current mental health status with relative risk (RR) 3.02 (95% CI 1.59 to 5.37) for MDE past and with RR 2.15 (95% CI 1.21 to 3.64) for suicidality. Women's mental health was also affected by trauma experienced in the genocide period but to an even higher extent, by similar trauma experienced in the lifetime with RR 1.91 (95% CI 1.03 to 3.22) for suicidality and RR 1.90 (95% CI 1.34 to 2.42) for generalised anxiety disorder, taking spousal physical/sexual violence into consideration. CONCLUSIONS Depression, post-traumatic stress disorder, anxiety and suicidal attempts are prevalent in Rwanda, with rates twice as high in women compared with men. For women, exposure to physical and sexual abuse was independently associated with all these disorders. Early detection of gender-based violence through homes and community interventions is important.
Collapse
Affiliation(s)
- Lawrence Rugema
- Department of Community Health, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umea, Sweden
| | - Joseph Ntaganira
- Department of Community Health, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gunilla Krantz
- Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
50
|
Cattaneo A, Macchi F, Plazzotta G, Veronica B, Bocchio-Chiavetto L, Riva MA, Pariante CM. Inflammation and neuronal plasticity: a link between childhood trauma and depression pathogenesis. Front Cell Neurosci 2015; 9:40. [PMID: 25873859 PMCID: PMC4379909 DOI: 10.3389/fncel.2015.00040] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/27/2015] [Indexed: 12/13/2022] Open
Abstract
During the past two decades, there has been increasing interest in understanding and characterizing the role of inflammation in major depressive disorder (MDD). Indeed, several are the evidences linking alterations in the inflammatory system to Major Depression, including the presence of elevated levels of pro-inflammatory cytokines, together with other mediators of inflammation. However, it is still not clear whether inflammation represents a cause or whether other factors related to depression result in these immunological effects. Regardless, exposure to early life stressful events, which represent a vulnerability factor for the development of psychiatric disorders, act through the modulation of inflammatory responses, but also of neuroplastic mechanisms over the entire life span. Indeed, early life stressful events can cause, possibly through epigenetic changes that persist over time, up to adulthood. Such alterations may concur to increase the vulnerability to develop psychopathologies. In this review we will discuss the role of inflammation and neuronal plasticity as relevant processes underlying depression development. Moreover, we will discuss the role of epigenetics in inducing alterations in inflammation-immune systems as well as dysfunction in neuronal plasticity, thus contributing to the long-lasting negative effects of stressful life events early in life and the consequent enhanced risk for depression. Finally we will provide an overview on the potential role of inflammatory system to aid diagnosis, predict treatment response, enhance treatment matching, and prevent the onset or relapse of Major Depression.
Collapse
Affiliation(s)
- Annamaria Cattaneo
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, King's College London London, UK ; IRCCS Centro S Giovanni di Dio, Fatebenefratelli Brescia, Italy
| | - Flavia Macchi
- Department of Pharmacological and Biomolecular Sciences, University of Milan Milan, Italy
| | - Giona Plazzotta
- IRCCS Centro S Giovanni di Dio, Fatebenefratelli Brescia, Italy
| | - Begni Veronica
- Department of Pharmacological and Biomolecular Sciences, University of Milan Milan, Italy
| | - Luisella Bocchio-Chiavetto
- IRCCS Centro S Giovanni di Dio, Fatebenefratelli Brescia, Italy ; Faculty of Psychology, eCampus University Novedrate (Como), Italy
| | - Marco Andrea Riva
- Department of Pharmacological and Biomolecular Sciences, University of Milan Milan, Italy
| | - Carmine Maria Pariante
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, King's College London London, UK
| |
Collapse
|