Trauma, mental health, and intergenerational associations in Kosovar Families 11 years after the war

Abstract

BackgroundWhile there is a considerable amount of literature addressing consequences of trauma in veterans and holocaust survivors, war and postwar civilian populations, particularly children, are still understudied. Evidence regarding intergenerational effects of trauma in families is inconsistent.ObjectiveTo shed light on intergenerational aspects of trauma-related mental health problems among families 11 years after the Kosovo war.MethodIn a cross-sectional study, a paired sample of 51 randomly selected triplets (school-aged child, mother, father, N=153) of Kosovar families was investigated with regard to trauma exposure, posttraumatic stress (UCLA Posttraumatic Diagnostic Scale), anxiety (Spence Children's Anxiety Scale, Hopkins Symptom Checklist-25), and depressive symptoms (Depressionsinventar für Kinder und Jugendliche [DIKJ; depression inventory for children and adolescents], Hopkins Symptom Checklist-25).ResultsConsiderable trauma exposure and high prevalence rates of clinically relevant posttraumatic stress, anxiety, and depressive symptoms were found in both parents and children. While strong correlations were found between children's depressive symptoms and paternal posttraumatic stress, anxiety and depressive symptoms, maternal symptoms did not correlate with their children's. In multiple regression analyses, only posttraumatic stress symptoms of fathers were significantly related with children's depressive symptoms.ConclusionEleven years after the Kosovo war, the presence of posttraumatic stress, anxiety, and depressive symptoms in civilian adults and their children is still substantial. As symptoms of parents and children are associated, mental health problems of close ones should be actively screened and accounted for in comprehensive treatment plans, using a systemic approach. Future research should include longitudinal studies conducting multivariate analyses with larger sample sizes in order to investigate indicators, causal and resilience factors.

The Impact of Parental Operational Stress Injury on Child Mental Health and Well-Being: A Scoping Review

“…Collaboration across military and civilians in education, communities, businesses, philanthropic organizations, faith-based institutions, and government is necessary to provide the response and support military families need (Buehrle, 2014;Campbell et al, 2011;Cozza, 2011;Cozza, Haskins, et al, 2013;Gorman et al, 2010;Harrison et al, 2014;Kudler & Porter, 2013;Lester & Flake, 2013;Lester, 2012;Schick et al, 2013), especially when transitions occur (Campbell et al, 2011;Cozza, 2011). Kudler and Porter (2013) succinctly describe the ideal: "[W]e must go beyond clinical models that focus on military children as individuals and develop a public health approach that harnesses the strengths of the communities that surround them.…”

“…It is recommended that awareness of military service connected to the family be part of clinical assessment for all patients/clients and that the unique vulnerabilities and requirements be recognized (Cozza, 2011). Given the familial context in which parental OSI needs to be addressed, screening tools for children and parents should be incorporated into health settings, such that parents are screened for need when their children present for service, and vice versa (Cozza, 2011;Schick et al, 2013). In like manner, schools should be routinely determining the military connectedness of new students, along with child protection agencies, the courts, and law enforcement (Kudler & Porter, 2013;Lester & Flake, 2013).…”

“…Parental distress and poor mental health, regardless of the source, leads to higher levels of emotional, behavioral, and adjustment problems in children (Chandra et al, 2010;Cozza, 2011;Cozza, Holmes, et al, 2013;Dekel & Goldblatt, 2008 Parental OSI symptoms have been shown to correlate strongly with children's depressive symptoms (Schick, Morina, Klaghofer, Schnyder, & M€ uller, 2013;Taheri et al, 2012) and anxiety Taheri et al, 2012). Adolescent children of male PTSD veterans admitted to inpatient psychiatry experienced higher rates of suicide attempts (Boricevic Mar sanic, Aukst Margetic, Zecevic, et al, 2014), with double the rate of reported internalizing and externalizing problems and significantly higher rates of emotional dysregulation, substance use, anger, aggression, and depression than adolescents of veterans without PTSD (Boricevic Mar sanic, Aukst Margetic, Jukic, et al, 2014).…”

Paternal environmental enrichment transgenerationally alters affective behavioral and neuroendocrine phenotypes

“…Recent studies have revealed that these effects are also present in the progeny of the affected parents. Clinical studies have shown a path for non-genetic transmission of paternal transgenerational effects including those of post-traumatic stress disorder (PTSD) to non-exposed offspring (Schick et al, 2013;Vaage et al, 2011;Yehuda et al, 2014). Genomic DNA sequence is the main carrier of biological information that is passed on to offspring; however, recent studies have demonstrated that epigenetic modifications can also be paternally transmitted to the offspring via the germ cells (Gapp et al, 2014;Rodgers et al, 2013).…”

Epigenetic Risk Factors for Diseases: A Transgenerational Perspective

“…Diet variation depending on season of conception has also been reported to affect health and DNAme in fi rstgeneration offspring in Gambia (Waterland et al 2010 ). Other studies have reported the effects of nutritional or environmental factors such as nutritious food supplementation, paternal smoking in childhood, or maternal or paternal stress exposure, from parent to offspring in humans (Engel et al 2005 ;Chen et al 2006 ;Behrman et al 2009 ;Vaage et al 2011 ;Schick et al 2013 ). Importantly, all studies in humans are inevitably confounded by genetic heterogeneity, family dynamics, living and seasonal conditions, and poor experimental control, all of which need to be carefully considered when interpreting results (Lumey et al 2011 ).…”