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Lurie I, Goldberger N, Gur Orr A, Haklai Z, Mendlovic S. Suicide Among Holocaust Survivors: A National Registry Study. Arch Suicide Res 2022; 26:1219-1231. [PMID: 33403930 DOI: 10.1080/13811118.2020.1868366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Previous findings regarding European Holocaust survivors' suicide risk are conflicting. North African survivors' suicide risk was not previously studied. In this study, we aimed to determine suicide risk among European and North African Holocaust survivors. The study was based on the Israeli population census from 1972, followed until 2015 for suicide. European survivors were grouped into survivors of severe Nazi persecution (HS) and early HS. North African survivors were grouped into those from Algeria, Libya and Tunisia who were likely to have suffered more severe persecution (group 1) and those from Morocco who apparently suffered less persecution (group 2). Comparison groups were chosen according to similar ethnic origins who were not under Nazi control. Age standardized suicide rates, Standard Mortality Ratios (SMR) were calculated. Cox regression analysis was used to assess suicide risk. The age adjusted suicide rates (per 100,000) among Europeans were: HS 17.8 (95%CI 16.9-18.6), early HS 28.6 (95%CI 24.9-32.2), comparison group 20.3 (95%CI 18.5-22.1). Among North Africans: group 1, 6.9 (95%CI 5.6-8.2), group 2, 4.8 (95%CI 4.0-5.5), comparison group, 8.5 (95% CI 6.4-11.0). The SMRs with European comparisons were 0.88 (95%CI 0.84-0.92) for HS and 1.41 (95%CI 1.20-1.65) for early HS. SMRs with North African comparisons were 0.81 (95%CI 0.67-0.97) for group 1 and 0.57 (95%CI 0.48-0.66) for group 2. Cox regression models showed significantly higher suicide risk for European early HS vs comparisons (Hazard Ratio (HR) = 1.31, 95% CI 1.12-1.52), and lower risk for HS (0.89, 95%CI 0.80-0.98). North African group 2 had significantly lower HR (0.58, 95%CI 0.43-0.79). To conclude, higher resilience was found among European survivors of severe adversity, compared to those who suffered lesser persecution. No elevated risk was found among North African survivors.
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Weinstein G, Lutski M, Keinan-Boker L, Goldbourt U, Tanne D. Holocaust exposure and late-life cognitive performance in men with coronary heart disease. J Psychiatr Res 2021; 134:1-7. [PMID: 33360219 DOI: 10.1016/j.jpsychires.2020.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Holocaust victims experienced extreme physical and mental stress that could lead to prolonged deficits in psychological and physiological well-being. We aimed to examine whether exposure to Holocaust conditions is associated with cognitive function and decline in a sample of old male adults with coronary heart disease (CHD). METHODS The sample included 346 individuals with CHD who participated in a clinical trial in 1990-1997 (mean age 56.7 ± 6.5 y). During 2004-2008 (mean age 71.8 ± 6.5 y) and 2011-2013 (mean age 77.1 ± 6.4 y) participants underwent computerized cognitive assessments. Exposure to Holocaust conditions was based on self-report at the second assessment. Linear regression and mixed-effect models were conducted to evaluate the associations between Holocaust survivorship and subsequent cognitive performance and rate of cognitive decline. RESULTS Forty-Three participants (12%) survived concentration camps/ghettos, 69 (20%) were Holocaust survivors who escaped concentration camps/ghettos, and 234 (68%) were not Holocaust survivors. After adjustment for potential confounders, concentration camp/ghetto survivors had poorer global cognitive performance and poorer attention (β = -3.90; 95%CI: 7.11;-0.68 and β = -4.11; 95%CI: 7.83;-0.38, respectively) compared to individuals who were not exposed to Holocaust conditions. Additionally, participants who reported being at concentration camps/ghettoes had increased cognitive decline in global performance and executive function (β = -0.19; 95%CI: 0.37;-0.008 and β = -0.29; 95%CI: 0.53;-0.06, respectively) compared to participants who were not Holocaust survivors. Lastly, those who were Holocaust survivors but not in concentration camps/ghettos had greater decline in attention (β = -0.11; 95%CI: 0.21;-0.01). DISCUSSION Exposure to Holocaust conditions in early-life may be linked with poorer cognitive function and greater cognitive decline decades later in old-adults with CHD.
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Affiliation(s)
- Galit Weinstein
- School of Public Health, University of Haifa, Haifa, Israel.
| | - Miri Lutski
- The Israel Center for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lital Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel; The Israel Center for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
| | - Uri Goldbourt
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Tanne
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Stroke and Cognition Institute, Rambam Health Care Campus, Haifa, Israel
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Kodesh A, Levav I, Levine SZ. Exposure to Genocide and the Risk of Dementia. J Trauma Stress 2019; 32:536-545. [PMID: 31206904 DOI: 10.1002/jts.22406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 02/02/2019] [Accepted: 02/03/2019] [Indexed: 01/19/2023]
Abstract
Competing hypotheses stating that past genocide exposure reduces (owing to resilience) versus increases (owing to vulnerabilities) the risk of dementia are yet to receive empirical support. This study tested these competing hypotheses. Registry data were extracted on 51,752 Israeli residents without dementia from September 2002 to January 2012; individuals were born between 1901 and 1945, alive on January 2012, and followed-up for the risk of dementia between January 2013 and October 2017. Groups were classified as exposed to the European Holocaust, based on government recognition, or unexposed. Hazard ratios (HRs) from Cox regression models were used to quantify the risk of dementia between the groups, adjusting for demographic and diagnostic covariates; additionally, 12 sensitivity analyses were computed. In total 10,780 participants (20.8%) were exposed to the Holocaust and 5,584 (10.8%) were diagnosed with dementia during follow-up. Dementia rates were 16.5% in the Holocaust-exposed group and 9.3% in the unexposed group. In the primary analysis, the estimated unadjusted HR of dementia for the exposed compared to the unexposed group was 1.77, 95% CI [1.67, 1.87], and the adjusted HR was 1.21, 95% CI [1.15, 1.28]. Sensitivity analyses significantly replicated the primary results with similar point estimates, adjusted HRs = 1.18-1.28, all ps < .001; all HRs had a small effect size. The current study results are consistent with the hypothesis that exposure to the extreme adversities of genocide heightens vulnerability to the risk of dementia in later life.
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Affiliation(s)
- Arad Kodesh
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Meuchedet Healthcare, Department of Mental Health, Tel Aviv, Israel
| | - Itzhak Levav
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Stephen Z Levine
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Lindert J, Kawachi I, Knobler HY, Abramowitz MZ, Galea S, Roberts B, Mollica R, McKee M. The long-term health consequences of genocide: developing GESQUQ - a genocide studies checklist. Confl Health 2019; 13:14. [PMID: 31011364 PMCID: PMC6460659 DOI: 10.1186/s13031-019-0198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 03/27/2019] [Indexed: 12/04/2022] Open
Abstract
Background Genocide is an atrocity that seeks to destroy whole populations, leaving empty countries, empty spaces and empty memories, but also a large health burden among survivors is enormous. We propose a genocide reporting checklist to encourage consistent high quality in studies designed to provide robust and reliable data on the long term impact of genocide. Methods An interdisciplinary (Public Health, epidemiology, psychiatry, medicine, sociology, genocide studies) and international working committee of experts from Germany, Israel, the United States, and the United Kingdom used an iterative consensus process to develop a genocide studies checklist for studies of the long term health consequences. Results We created a list of eight domains (A Ethical approval, B External validity, C Misclassification, D Study design, E Confounder, F Data collection, G Withdrawal) with 1–3 specific items (total 17). Conclusion The genocide studies checklist is easy to use for authors, journal editors, peer reviewers, and others involved in documenting the health consequences of genocide. Electronic supplementary material The online version of this article (10.1186/s13031-019-0198-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jutta Lindert
- 1Department of Health and Social Work, University of Applied Sciences Emden/Leer, Constantiaplatz 4, 26723 Emden, Germany.,2Women's Research Center, Brandeis University, Waltham, Massachusetts USA
| | - Ichiro Kawachi
- 3Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts USA
| | | | - Moshe Z Abramowitz
- 1Department of Health and Social Work, University of Applied Sciences Emden/Leer, Constantiaplatz 4, 26723 Emden, Germany.,2Women's Research Center, Brandeis University, Waltham, Massachusetts USA.,3Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts USA.,4Hadassah Medical School, Jerusalem, Israel.,5Dean's Office, Boston University School of Public Health, Boston, Massachusetts USA.,6Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Harvard Program in Refugee Trauma, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Cambridge, USA
| | - Sandro Galea
- 5Dean's Office, Boston University School of Public Health, Boston, Massachusetts USA
| | - Bayard Roberts
- 6Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Mollica
- Harvard Program in Refugee Trauma, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Cambridge, USA
| | - Martin McKee
- 6Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Coêlho BM, Santana GL, Duarte-Guerra LS, Viana MC, Neto FL, Andrade LH, Wang YP. The role of gender in the structure of networks of childhood adversity. Psychiatry Res 2018; 270:348-356. [PMID: 30293013 DOI: 10.1016/j.psychres.2018.09.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/16/2018] [Accepted: 09/25/2018] [Indexed: 11/27/2022]
Abstract
The objective of present study is to investigate the relationship between different childhood adversities. The potential impact of early adversity on prevention programs is discussed. Data on twelve childhood adversities was collected from a representative sample of 5037 members of the general population living in a large metropolitan area. Data were analyzed through network analysis, to estimate and compare network connectivity and centrality measures by gender. Over half the respondents had been exposed to at least one adversity during their earlier developmental stage. Among adversity-exposed persons, 48.4% presented simultaneous adversities, most of which were related to 'family dysfunction' and 'maltreatment' (mean = 2.9 adversities). Women reported more adversities than men (59.0% vs. 47.6%). Although the 'global' network connectivity across adversities was similar in both genders, 'regional' distinctions in the network structure were found. While 'neglect' and 'parental death' were more important for women than men, 'parental mental disorders' was more important for men. Gender-related childhood adversities were clustered experiences. Adversities related to 'early family dysfunction' and 'maltreatment' were prominent features in the networks of both boys and girls. Differential preventive and intervention programs should take into account gender-related patterns of exposure and reporting patterns of early adversity.
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Affiliation(s)
- Bruno Mendonça Coêlho
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Departamento de Psiquiatria, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Geilson Lima Santana
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Leorides Severo Duarte-Guerra
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria Carmen Viana
- Department of Social Medicine Post-Graduate Program in Public Health, Health Sciences Center, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
| | - Francisco Lotufo Neto
- Departamento de Psiquiatria, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Laura Helena Andrade
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Yuan-Pang Wang
- Nucleo de Epidemiologia Psiquiatrica (LIM-23), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Lurie I, Gur A, Haklai Z, Goldberger N. Suicide Risk Among Holocaust Survivors Following Psychiatric Hospitalizations: A Historic Cohort Study. Arch Suicide Res 2018; 22:496-509. [PMID: 28925807 DOI: 10.1080/13811118.2017.1366377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The association between Holocaust experience, suicide, and psychiatric hospitalization has not been unequivocally established. The aim of this study was to determine the risk of suicide among 3 Jewish groups with past or current psychiatric hospitalizations: Holocaust survivors (HS), survivors of pre-Holocaust persecution (early HS), and a comparison group of similar European background who did not experience Holocaust persecution. In a retrospective cohort study based on the Israel National Psychiatric Case Register (NPCR) and the database of causes of death, all suicides in the years 1981-2009 were found for HS (n = 16,406), early HS (n = 1,212) and a comparison group (n = 4,286). Age adjusted suicide rates were calculated for the 3 groups and a logistic regression model was built to assess the suicide risk, controlling for demographic and clinical variables. The number of completed suicides in the study period was: HS-233 (1.4%), early HS-34 (2.8%), and the comparison group-64 (1.5%). Age adjusted rates were 106.7 (95% CI 93.0-120.5) per 100,000 person-years for HS, 231.0 (95% CI 157.0-327.9) for early HS and 150.7 (95% CI 113.2-196.6) for comparisons. The regression models showed significantly higher risk for the early HS versus comparisons (multivariate model adjusted OR = 1.68, 95% CI 1.09-2.60), but not for the HS versus comparisons. These results may indicate higher resilience among the survivors of maximal adversity compared to others who experienced lesser persecution.
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Levav I, Klomek AB. A review of epidemiologic studies on suicide before, during, and after the Holocaust. Psychiatry Res 2018; 261:35-39. [PMID: 29276992 DOI: 10.1016/j.psychres.2017.12.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/10/2017] [Accepted: 12/15/2017] [Indexed: 12/27/2022]
Abstract
The available literature on the risk of suicides related to the Holocaust (1939-1945) and its aftermath differs in its time periods, in the countries investigated, and in the robustness of its sources. Reliable information seems to indicate that the risk of suicide for Jews in Nazi Germany and Austria during the pre-war period (1933-1939) was elevated, while information on suicide during the internment in the concentration camps is fraught with problems. The latter derives from the Nazis' decision to hide the statistics on the inmates' causes of death, and from the prevailing life conditions that impeded separation between self-inflicted death and murder. Reliable studies conducted in Israel among refugees who entered pre-state Israel, 1939-1945, and post-World War II survivors reaching Israel (1948 on), show a mixed picture: suicide rates among the former were higher than comparison groups, while the latter group shows evidence of resilience.
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Affiliation(s)
- Itzhak Levav
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel
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Li Y, Zhao L, Yu D, Ding G. Exposure to the Chinese famine in early life and depression in adulthood. PSYCHOL HEALTH MED 2018; 23:952-957. [DOI: 10.1080/13548506.2018.1434314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Yaru Li
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Liyun Zhao
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Dongmei Yu
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Gangqiang Ding
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
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Holocaust exposure and subsequent suicide risk: a population-based study. Soc Psychiatry Psychiatr Epidemiol 2017; 52:311-317. [PMID: 28032138 DOI: 10.1007/s00127-016-1323-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To examine the association between the extent of genocide exposure and subsequent suicide risk among Holocaust survivors. METHODS Persons born in Holocaust-exposed European countries during the years 1922-1945 that immigrated to Israel by 1965 were identified in the Population Registry (N = 209,429), and followed up for suicide (1950-2014). They were divided into three groups based on likely exposure to Nazi persecution: those who immigrated before (indirect; n = 20,229; 10%), during (partial direct; n = 17,189; 8%), and after (full direct; n = 172,061; 82%) World War II. Groups were contrasted for suicide risk, accounting for the extent of genocide in their respective countries of origin, high (>70%) or lower levels (<50%). Cox model survival analyses were computed examining calendar year at suicide. Sensitivity analyses were recomputed for two additional suicide-associated variables (age and years since immigration) for each exposure group. All analyses were adjusted for confounders. RESULTS Survival analysis showed that compared to the indirect exposure group, the partial direct exposure group from countries with high genocide level had a statistically significant (P < .05) increased suicide risk for the main outcome (calendar year: HR 1.78, 95% CI 1.09, 2.90). This effect significantly (P < .05) replicated in two sensitivity analyses for countries with higher relative levels of genocide (age: HR 1.77, 95% CI 1.09, 2.89; years since immigration: HR 1.85, 95% CI 1.14, 3.02). The full direct exposure group was not at significant suicide risk compared to the indirect exposure group. Suicide associations for groups from countries with relative lower level of genocide were not statistically significant. DISCUSSION This study partly converges with findings identifying Holocaust survivors (full direct exposure) as a resilient group. A tentative mechanism for higher vulnerability to suicide risk of the partial direct exposure group from countries with higher genocide exposure includes protracted guilt feelings, having directly witnessed atrocities and escaped death.
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Levine SZ, Levav I, Pugachova I, Yoffe R, Becher Y. Transgenerational effects of genocide exposure on the risk and course of schizophrenia: A population-based study. Schizophr Res 2016; 176:540-545. [PMID: 27401532 DOI: 10.1016/j.schres.2016.06.019] [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: 02/08/2016] [Revised: 06/09/2016] [Accepted: 06/17/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hypotheses about the sequel of parental genocide exposures on the offspring's risk and course of schizophrenia remain untested. AIMS To test hypotheses related to the transgenerational transmission of parental genocide exposure on the risk and course of schizophrenia. METHODS Data were extracted from the National Population Register on all offspring (N=51.233; born: 1948-1989) whose parents were born (1922 to 1945) in Nazi- dominated European nations. Both parents either immigrated before (indirect exposure: n=1627, 3.2%) or after (direct exposure: n=49.606, 96.8%) the Nazi era. Offspring subgroups were identified from the initial timing of parental exposure (e.g., likely in utero, combined in utero and postnatal, or postnatal). Schizophrenia disorders were ascertained (1950-2014) from the National Psychiatric Case Registry. Cox models were computed to compare the offspring groups with respect to the risk and the adverse course of schizophrenia, adjusting for confounders. RESULTS The offspring rates on the risk and course of schizophrenia did not differ by parental affiliation to the direct and indirect exposure groups. Cox models showed that offspring subgroups with maternal Holocaust exposures in utero only (HR=1.74, 1.13, 2.66) and combined in utero and postnatal (HR=1.48, 1.05, 2.10); as well as paternal Holocaust exposures combined in utero and postnatal (HR=1.48, 1.08, 2.05), and early postnatal (aged 1-2; HR=1.49, 1.10, 2.00) had a significantly (P<0.05) higher psychiatric re-hospitalization rate than the indirect group. CONCLUSIONS Transgenerational genocide exposure was unrelated to the risk of schizophrenia in the offspring, but was related to a course of deterioration during selected critical periods of early life.
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Affiliation(s)
- Stephen Z Levine
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel.
| | - Itzhak Levav
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
| | - Inna Pugachova
- Department of Information and Evaluation, Ministry of Health, Jerusalem 9101002, Israel
| | - Rinat Yoffe
- Department of Information and Evaluation, Ministry of Health, Jerusalem 9101002, Israel
| | - Yifat Becher
- Department of Information and Evaluation, Ministry of Health, Jerusalem 9101002, Israel
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