Parental PTSD, health behaviors and successful aging among offspring of Holocaust survivors
Introduction
Myriad studies have identified traumatic exposure and especially posttraumatic stress disorder (PTSD) as risk factors for unhealthy behaviors including smoking, alcohol abuse and low frequency of physical activity (Rheingold et al., 2004). These behaviors comprise an important path to increased physical morbidity seen among traumatized individuals (Schnurr, 2017). As engagement in health behaviors tend to continue across generations (e.g., Pugliese and Tinsley, 2007), it is possible that parental trauma exposure and PTSD not only relate to parental behavior, but also linger on to associate with health behaviors and physical status of offspring. This latter possibility is underexplored. To address this issue, the current study assessed health behaviors and indices of successful aging among Holocaust survivors (HS) and their adult offspring.
Exposure to traumatic events, and especially PTSD, increase the risk for a variety of health-risk behaviors such as substance abuse (Rheingold et al., 2004). PTSD is also related to less preventive health behaviors (e.g., physical activity, diet and regular utilization of medical care), although this relationship is less consistent across studies (Lee and Park, 2018). Traumatized individuals may turn to substance use with the attempt to rapidly minimize discomfort linked with trauma-related losses, PTSD symptoms and related negative emotions (Rheingold et al., 2004). Decreased preventive health behaviors among traumatized victims associate with dampened motivation for proactive measures, low self-efficacy, and foreshortened future orientation (Lee and Park, 2018).
Relatedly, theoretical models and empirical works suggest that unhealthy behaviors mediate the effect of trauma exposure and PTSD on various markers of aging among survivors (Schnurr, 2017). Utilizing an extensive outlook at the aging of trauma survivors, scholars began to assess the relationship of behaviors with multiple indices of health usually clustered under the concept of successful aging (e.g., Pietrzak et al., 2014, Bodner et al., 2018).
Successful aging was originally described as the combination between freedom from disease and disability and active engagement with life (Rowe and Kahn, 1987). Criticized for depicting an extraordinary or exceptional aging, rather than successful aging (Martin et al., 2015), scholars recently suggested to move from the prior dichotomous operationalization (i.e., either successful or unsuccessful aging) to a continuous one, as individuals experience limitations in one functional domain may perform relatively well in other domains (Kok et al., 2017). Not surprisingly, substance abuse history is among the factors related to less successful aging among trauma survivors (Pietrzak et al., 2014). The current study followed this broad-scope view and assessed the link between health behaviors and successful aging from an intergenerational perspective.
There is a fairly large and consistent literature demonstrating moderate resemblance between parents' and offspring health behaviors. For example, parental alcohol consumption is positively associated with drinking in offspring (Rossow et al., 2016). Similarly, parents' smoking is related to their children's smoking (Leonardi-Bee et al., 2011), and parental modeling behavior, as well as parental support for physical activity, are associated with offspring physical activity (Pugliese and Tinsley, 2007). The correlation between parents' health behaviors and their offspring behaviors can extend for decades (e.g., Hemmingsson et al., 2017).
The link between parents' and offspring health behaviors can reflect the latter tendency to emulate parental behaviors (Bandura, 1986). This link can also result from parents engaging in unhealthy behaviors being more lenient towards children's risky behaviors, or being unable to fulfil their responsibilities and take adequate care of their offspring. Poor parenting accompanying parental negative health behaviors could also associate with mental health and later health-risk behaviors among offspring (Reczek et al., 2017).
Despite the abovementioned findings, the intergenerational association of unhealthy behaviors among trauma survivors and their family members is underexplored. As this study focuses on HS and their offspring, the next section will briefly review the health behaviors and aging in these groups.
Most of the literature suggests that the behaviors and health of HS and their offspring are not an inevitable consequence of exposure per se, but rather, relate to an unresolved attempt to cope with the trauma mainly manifested by parental PTSD (Yehuda et al., 2008, Shrira et al., 2017). Accordingly, large-scale studies on community-dwelling individuals did not find HS (Shmotkin et al., 2003) or their offspring (Levav et al., 2007, Shrira et al., 2011) to differ from comparisons in health behaviors. However, other studies with samples coping with stress, or with samples characterized by significant clinical features, did allude to the possibility of higher rates of unhealthy behaviors among HS and offspring. For example, Kimron and Cohen (2012) showed that HS used more emotional-focused coping (including alcohol use) when being hospitalized. Emotional-focused coping further explained the greater psychological distress seen among HS relative to other hospitalized older adults. In another sample characterized with an extraordinarily high rates of parental PTSD (77.0%), Yehuda et al. (2008) found a slightly higher frequency of substance abuse disorder among offspring of HS relative to comparisons, yet they did not find parental PTSD (as reported by offspring themselves) to be related to an increased risk of such disorder.
With regard to successful aging and its indices, there is evidence that physical morbidity is higher among HS who suffer from PTSD (Brodaty et al., 2004), and burgeoning evidence suggests that their offspring also manifest less successful aging (Shrira et al., 2017) and perceive their aging in less favourable terms (Shrira, 2016). Therefore, the current study will separate HS to those with and without probable PTSD, with an attempt to point at unhealthy behaviors as one possible factor associating with less successful aging in families of HS with PTSD.
The study compared health behaviors and indices of successful aging among HS and comparison parent-offspring dyads. The first hypothesis was that relative to the other dyads (comparison and HS without PTSD), HS with probable PTSD and their offspring would report more unhealthy behaviors. Offspring of HS with probable PTSD will also show less successful aging relative to their counterparts. The second hypothesis maintained that the relationship between parental PTSD and offspring successful aging would be mediated by parents' health behaviors and the health behaviors of the offspring themselves.
Section snippets
Participants
A convenience sample included 374 community-dwelling participants, who consisted 187 dyads of parents and adult offspring. All parents were Jewish of European origin born before 1945. Offspring were born after 1945 and had two parents who were alive during World War II. HS and their offspring included 114 dyads, and comparison parents without a Holocaust background and their offspring included 73 dyads. Holocaust background was determined by parents' presence under Nazi or pro-Nazi occupation
Group differences in unhealthy behaviors and successful aging
Among parents, there was a significant group difference in unhealthy behaviors (F[2,184] = 6.82, p = .001, η2 = .07). Post-hoc Bonferroni tests showed that HS with probable PTSD had a higher unhealthy behaviors score (M = 2.75, SD = 1.71) than each of the two other parent groups (M = 1.94, SD = 1.24, and M = 1.67, SD = 1.21, for HS without PTSD and comparison parents). The group difference in unhealthy behaviors remained significant after adjusting for covariates (F[2,180] = 5.79, p = .004, η2p
Discussion
Corroborating the study hypotheses, HS suffering from probable PTSD as well as their offspring reported more unhealthy behaviors than HS without PTSD or comparison parents and their offspring. Moreover, the relationship between parental PTSD and offspring less successful aging was mediated by parental unhealthy behaviors and offspring unhealthy behaviors. I now move on to discuss these findings in detail.
The current findings extend previous findings regarding more unhealthy behaviors among
References (46)
- et al.
Combat stress reactions, posttraumatic stress disorder, cumulative life stress, and physical health among Israeli veterans twenty years after exposure to combat
Soc. Sci. Med.
(2005) - et al.
Posttraumatic stress disorder, poor physical health and substance use behaviors in a national trauma-exposed sample
Psychiatry. Res.
(2011) - et al.
The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis
Prev. Med.
(2012) - et al.
Successful aging among older veterans in the United States
Am. J. Geriatr. Psychiatry.
(2014) - et al.
Relationships with parents and adult children's substance use
Addict. Behav.
(2017) - et al.
Does adolescent's exposure to parental intimate partner conflict and violence predict psychological distress and substance use in young adulthood? A longitudinal study
Child. Abuse. Negl.
(2014) Nongenetic inheritance and transgenerational epigenetics
Trends. Mol. Med.
(2015)- et al.
Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors
J. Psychiatr. Res.
(2008) Diagnostic and Statistical Manual of Mental Disorders
(2013)Social Foundations of Thought and Action: A Social Cognitive Theory
(1986)
Gender differences in the self-rated health–mortality association: is it poor self-rated health that predicts mortality or excellent self-rated health that predicts survival?
Gerontologist
A light in a sea of darkness: the moderating role of emotional complexity in the PTSD symptoms-successful aging association
Aging. Ment. Health.
Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders–fifth edition (PCL-5) in veterans
Psychol. Assess.
Vulnerability to post‐traumatic stress disorder and psychological morbidity in aged holocaust survivors
Int. J. Geriatr. Psychiatry
Subjective well-being: gender differences in Holocaust survivors-specific and cross-national effects
Aging. Ment. Health.
A question of who, not if: psychological disorders in Holocaust survivors’ children
Psychol. Trauma.
Brief Symptom Inventory (BSI)-18. Administration, Scoring and Procedures Manual
Fathers’ alcohol consumption and risk of alcohol-related hospitalization in offspring before 60 years of age
Drugs
Holocaust Trauma: Psychological Effects and Treatment
The search for biomarkers of Holocaust trauma
J. Trauma. Stress. Disor. Treat.
Coping and emotional distress during acute hospitalization in older persons with earlier trauma: the case of Holocaust survivors
Qual. Life. Research.
Capturing the diversity of successful aging: an operational definition based on 16-year trajectories of functioning
Gerontologist
Cited by (13)
Event centrality and secondary traumatization among Holocaust survivors' offspring and grandchildren: A three-generation study
2021, Journal of Anxiety DisordersCitation Excerpt :These studies demonstrated that Holocaust G2 with parental PTSD reported high secondary traumatization and lower successful aging scores than Comparison G2 (Hoffman & Shrira, 2019), whereas Holocaust G2 without parental PTSD, or Holocaust G2 with low secondary traumatization tended to report perceptions of aging similar to Comparison G2 (Shrira, 2016; Shrira et al., 2017). There is also documentation that survivors' PTSD is associated with unhealthy behaviors across generations in Holocaust families (Shrira, 2019). It has been argued in the literature that the intergenerational transmission of the trauma of the Holocaust does not cease with Holocaust G2 (e.g., Fossion, Rejas, Servais, Pelc, & Hirsch, 2003; Wiseman & Barber, 2008).
Association of Traumatic Injury and Incident Myocardial Infarction and Stroke: A Prospective Population-Based Cohort Study
2023, Reviews in Cardiovascular MedicineLONG-TERM PHYSICAL HEALTH OUTCOMES IN CHILD HOLOCAUST SURVIVORS AND IN OFFSPRING OF HOLOCAUST SURVIVORS
2023, Routledge International Handbook of Multidisciplinary Perspectives on Descendants of Holocaust SurvivorsLATE-LIFE MANIFESTATIONS OF ANCESTRAL TRAUMA: The Case of Older Adult Offspring of Holocaust Survivors
2023, Routledge International Handbook of Multidisciplinary Perspectives on Descendants of Holocaust SurvivorsPAST, PRESENT,AND FUTURE PERSPECTIVES OF HOLOCAUST TRAUMA TRANSMISSION
2023, Routledge International Handbook of Multidisciplinary Perspectives on Descendants of Holocaust Survivors