Offspring Of Holocaust Survivors Research Articles

Evil-related threats and mental health concomitants among offspring of Holocaust survivors gay men

Objectives In view of the accumulated stress associated with the combination of intergenerational trauma and minority stress, we aimed to examine whether offspring of Holocaust survivors (OHS) reported stronger evil-related threats compared to non-OHS individuals and whether OHS gay men experienced stronger threats. We also examined whether sexual orientation moderated the hypothesized indirect effect of Holocaust background on mental health through evil-related threats. Method Participants were 346 middle-aged and older Israeli men (mean age = 60.56, SD = 8.42, range 50–86). Among them, 173 identified as gay men, and 81 identified as OHS. Participants completed measures of evil-related threats, depression, and life satisfaction. Results Analysis of covariance revealed that OHS men reported stronger evil-related threats compared to non-OHS men. Yet, an interaction between Holocaust background and sexual orientation indicated that OHS gay men reported stronger evil-related threats compared to non-OHS gay men, while no such difference existed among heterosexual counterparts. Conditional indirect effect analysis showed a significant indirect effect, in which Holocaust background related to higher depressive symptoms and lower life satisfaction through evil-related threats among gay men, but not among heterosexual men. Conclusion This study sheds light on the particular experience of evil-related threats, focusing on older OHS gay men and the mental health vulnerability associated with it. In applied contexts, this might help identify a sexual minority group that is particularly sensitive to adverse mental health and offer it supporting interventions.

Caregiver burden among adults caring for their Holocaust-survivor parents during the COVID-19 pandemic.

This study aimed to examine the caregiver burden among offspring of Holocaust survivors (OHS) caring for their parents during the COVID-19 pandemic, hypothesizing that caregivers whose parents suffer from posttraumatic stress disorder (PTSD) would report an increased burden. The sample consisted of 109 caregivers with older adult care recipient parents (average caregivers' age = 57.67, SD = 8.49). Caregivers were divided into three groups: 20 OHS who reported that at least one care recipient had PTSD, 60 OHS who reported that their care recipients did not have PTSD, and 29 comparison caregivers (whose care recipients did not undergo the Holocaust). Caregivers completed questionnaires about SARS-CoV-2 exposure, COVID-19 concerns, helping their care recipients, their experiences of caregiver burden, and perceived changes to their caregiver burden during the pandemic. The caregivers also reported PTSD symptoms-in themselves as well as in their care recipients. Relative to comparisons, OHS with parental PTSD reported higher caregiver burden in four aspects: time-dependent burden, developmental burden, physical burden, and social burden. Furthermore, OHS reported a greater perceived increase in caregiver burden during the pandemic than the comparisons. The study findings illuminate the difficulties OHS caregivers, especially those whose care recipients have PTSD, face during the COVID-19 pandemic. This group of caregivers is at risk of experiencing more distress and may need help and support. Further research is needed to determine whether people taking care of their posttraumatic parents following other massive traumatic events also feel a heavier caregiver burden-both in general and specifically during the current pandemic.

Posttraumatic stress disorder symptoms among offspring of Holocaust survivors: A systematic review and meta-analysis.

Posttraumatic stress disorder symptoms among offspring of Holocaust survivors: A systematic review and meta-analysis.

Psychological impact of the outbreak of COVID-19 on Holocaust survivors in France

Identified in late 2019 as originating from Wuhan, China, coronavirus disease (COVID-19) outbreak has spread rapidly and globally. The health crisis that is linked to COVID-19 has been declared a public health emergency of international concern (Zhong et al., 2020) and was described by UN Secretary General, Antonio Guterres, as being the worst world crisis since Second world war. In France, first cases of COVID-19 were officially confirmed on January 24, 2020 (Bernard Stoecklin, Rolland, & Silue, 2020). In a televised address on March 16, 2020, French President Emmanuel Macron declared six times during a speech to nation that “we are at war” against virus. He used following warrior rhetoric: “We fight neither against an army or against another nation, but enemy is there, invisible, elusive and advancing” (Kauffmann, 2020). The overuse of war metaphor when speaking about coronavirus, as well as measures of advising social distancing and self-isolation to decrease spread of coronavirus, are causing unknown levels of fear and suffering for older people who are more vulnerable to stress and anxiety (Yang et al., 2020, Johal, 2009). In contexts such as COVID-19 health crisis, Holocaust survivors (HSs) are often more vulnerable to accumulative and/or new traumatic events, which may awaken or augment reactions to a previously experienced traumatic event (Kimron & Cohen, 2012, Baider, Peretz, & Kaplan De-Nour, 1993, Christenson, Walker, Ross, & Maltbie, 1981, Yehuda et al., 1995). Several studies have reported considerable emotional distress that was experienced among HSs during Gulf War scud missile attacks in 1991 (Solomon & Prager, 1992), during threat of terror in Israel (Zloof, Yaphe, Durst, Venuta, & Fusman, 2005) or after terrorist attacks on World Trade Center on September 11, 2001, in USA (Lamet & Dyer, 2004). For some HSs, home confinement and helplessness that are being experienced during COVID-19 health crisis have resulted in re-experiencing of wartime traumas that occurred more than 76 years ago. Few studies have examined negative psychological impact of COVID-19 in HSs (Cohn-Schwartz et al., 2020; Shrira, Maytles, & Frenkel-Yosef, 2020, Maytles, Frenkel-Yosef, & Shrira, 2021) and offspring of HSs (Shrira & Felsen, 2021, Felsen,2021) in Israel and in US. France has fourth largest number of Holocaust survivors in world (approximately 40,000 survivors are located in France), according to estimates from Conference on Jewish Material Claims Against Germany (Claims Conference). The COVID-19 health crisis provides a rare opportunity to examine how HSs in France may react to a second traumatic event that exhibits some similarities with original trauma, especially in regard to situation of lockdown combined with fear of death for either HS or for members of their family.

Parental PTSD and psychological reactions during the COVID-19 pandemic among offspring of Holocaust survivors.

Previous evidence suggests heightened sensitivity to life-threatening challenges among offspring of Holocaust survivors (OHS). Therefore, this study examined the psychological reactions of aging OHS during the COVID-19 pandemic. A convenience sample (N = 297, mean age = 66.85) of North American Jews rated posttraumatic stress disorder (PTSD) symptoms for their parents and for themselves. They further rated their psychological distress, COVID-19-related worries, loneliness, and social support. Respondents were divided into four groups: OHS with two parents with probable PTSD, with one such parent, with no such parent, and comparisons whose parents did not undergo the Holocaust. OHS with two parents with PTSD reported the highest levels of PTSD symptoms. Controlling for respondents' own PTSD, OHS with two parents with PTSD reported higher psychological distress relative to comparisons. Moreover, OHS with parental PTSD reported higher loneliness relative to OHS without parental PTSD or comparisons. The groups did not differ in COVID-19-related worries or social support. The distress experienced by OHS with parental PTSD seems more general, and is possibly related to the multiple coalescing crises that occurred since the pandemic began, rather than to the health risk associated directly with COVID-19. Moreover, while OHS acknowledge having good social support, some of them nevertheless feel lonely. This possibly reflects unique interpersonal difficulties characteristic in Holocaust survivor families. These findings suggest that OHS with parental PTSD (especially when both parents had symptoms) represent a group of older adults who are relatively susceptible to negative psychological effects of the current pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Supplemental Material for Parental PTSD and Psychological Reactions During the COVID-19 Pandemic Among Offspring of Holocaust Survivors

Supplemental Material for Parental PTSD and Psychological Reactions During the COVID-19 Pandemic Among Offspring of Holocaust Survivors

Intergenerational Effects of Maternal Holocaust Exposure on FKBP5 Methylation.

There is growing evidence that exposure to trauma prior to conception can affect offspring. The authors have reported that adult offspring of Holocaust survivors showed lower methylation of FK506 binding protein 5 (FKBP5) intron 7, site 6 compared with Jewish comparison volunteers. The present study sought to replicate this finding in a larger sample and to examine parental and offspring correlates of observed effects. Cytosine methylation was measured in blood using pyrosequencing. The independent replication sample consisted of 125 Holocaust offspring and 31 control subjects. Additional analyses, performed in a larger sample of 147 offspring and 40 control subjects that included the 31 previously studied participants, examined associations of parental trauma-related variables (i.e., sex of the exposed parent, parental posttraumatic stress disorder, age at Holocaust exposure) and offspring characteristics (i.e., childhood trauma exposure, lifetime psychiatric diagnoses, psychotropic medication use, FKBP5 rs1360780 genotype, FKBP5 gene expression, and neuroendocrine measures) with offspring FKBP5 methylation. FKBP5 site 6 methylation was significantly lower in Holocaust offspring than in control subjects, an effect associated with maternal Holocaust exposure in childhood and with lower offspring self-reported anxiety symptoms. FKBP5 gene expression was elevated in Holocaust offspring. FKBP5 methylation was associated with indices of glucocorticoid sensitivity but not with basal FKBP5 gene expression. This study replicates and extends the previously observed decrement in FKBP5 intron 7, site 6 methylation in Holocaust offspring. The predominance of this effect in offspring of mothers exposed during childhood implicates maternal developmental programming as a putative mechanism.

Variables Connecting Parental PTSD to Offspring Successful Aging: Parent-Child Role Reversal, Secondary Traumatization, and Depressive Symptoms.

The effects of parental trauma on offspring of Holocaust survivors (OHS) are debated in the literature. Recently, scholars suggested that it may be more productive to ask when and via which mechanisms such effects are observed. Following, the current study examines if parental Holocaust-related posttraumatic stress disorder (PTSD) symptoms are linked with the aging processes of their middle-aged offspring. Beyond this association, we also suggested a putative mediation path, indicating three underlying mechanisms by which parental trauma lingers on: perceived parent–child role reversal, secondary traumatization, and depressive symptoms. Using a convenience sample of 682 community-dwelling participants, comprising 341 older adult parent–middle-aged offspring dyads (M age = 81.71 and 54.58 for parents and offspring, respectively) to address this issue. Parents reported PTSD with the valid measure of PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition. OHS reported perceived parent–child role reversal, secondary traumatization, depressive symptoms, and completed indices of successful aging. Based on parents’ reports, we divided the parent–offspring dyads into three groups: OHS whose parents had probable PTSD (n dyads = 43), OHS whose parents did not have PTSD (n dyads = 161), and comparison with parents who did not undergo the Holocaust (n dyads = 137). Findings reveal that OHS with parents suffering from probable PTSD aged less successfully than comparisons. Serial mediation analyses validated the aforementioned putative pathway (perceived parent–child role reversal, secondary traumatization, and depression) linking parental PTSD with offspring successful aging. Our findings are discussed through a vignette depicting a fictional OHS character. These underlying mechanisms suggest that different types of interventions, each geared towards a specific mechanism, may mitigate the lingering effect of parental PTSD on diminished OHS successful aging.

Parental PTSD, health behaviors and successful aging among offspring of Holocaust survivors

Unhealthy behaviors and physical morbidity are more common among trauma survivors, especially those who suffer from posttraumatic stress disorder (PTSD). This study looked at the underexplored relationships between parental PTSD, unhealthy behaviors and aging of trauma survivors' offspring. Dyads of parents (mean age = 82.42) and offspring (mean age = 55.48) reported PTSD symptoms, health behaviors and completed indices of successful aging. Dyads were divided into three groups: Holocaust survivors (HS) with probable PTSD (n = 28 dyads), HS without PTSD (n = 86 dyads) and comparison parents without PTSD (n = 73 dyads). Relative to the other groups, HS parents with probable PTSD and their offspring reported more unhealthy behaviors. Serial mediation models showed that the effect of parental PTSD on offspring successful aging was mediated by both parental and offspring unhealthy behaviors. Findings remained significant after controlling for background characteristics and offspring PTSD. This study provides preliminary evidence that PTSD is related to unhealthy behaviors across generations in HS families. Possible mechanisms for such intergenerational effect and its clinical implication are discussed.

Where the Holocaust and Al-Nakba Met: Radioactive identifications and the psychoanalytic frame

The author, who is of Palestinian heritage, revisits her treatment with a Jewish analyst, who is the offspring of Holocaust survivors. She demonstrates how the transference-countertransference matrix was both constructed and compromised by politics and intergenerational trauma, some aspects of which remained unconscious, others conscious; some of which were enacted, others analyzed. The analytic scene was a microcosm of world events in which “radioactive identifications” (Gampel, 1993, 1998; Gampel and Mazor, 2004) with political and historical issues affected the psychoanalytic situation, resulting in repeated enactments and, finally, an impasse that led to the premature termination of the treatment.

Filial anxiety and sense of obligation among offspring of Holocaust survivors

ABSTRACTObjectives: Much is known about adult children caring for their aging parents, yet the potentially unique experience of offspring caring for traumatized parents is underexplored. Therefore, the current studies assessed filial anxiety and sense of obligation among offspring of Holocaust survivors (OHS) in caring for their parents.Method: In Study 1, we interviewed 10 OHS (mean age = 61.0) in order to extract themes of filial anxiety. Based on Study 1's data, a newly constructed scale of filial anxiety was administered in Study 2 to 59 adult offspring (mean age = 56.4): 28 OHS and 31 comparisons. Study 3 included 143 dyads of parents and offspring (mean age = 55.4 and 81.7, respectively): 86 Holocaust dyads and 57 comparison dyads. Parents reported posttraumatic stress disorder (PTSD) symptoms and offspring reported filial anxiety and sense of obligation.Results: In Study 1, interviewees referred to concerns about parent experiencing decline alongside caregiving difficulties. In Study 2, OHS reported higher filial anxiety and sense of obligation relative to comparisons. This group difference was mediated by sense of obligation. In Study 3, OHS with parental PTSD reported higher filial anxiety and sense of obligation relative to comparisons. Once more, filial sense of obligation served as a mediator. In Studies 2–3, results remained significant after adjusting for offspring symptoms.Conclusion: Parental exposure to the Holocaust, and especially parental PTSD, related to higher filial obligation, which in turn was related to higher filial anxiety. These findings bear important implications for practitioners working with survivors' families

Interpersonal vulnerability among offspring of Holocaust survivors gay men and its association with depressive symptoms and life satisfaction

The aim of the current study was to examine whether offspring of Holocaust survivors (OHS) gay men report higher interpersonal vulnerability in comparison to non-OHS gay men, and to further assess whether that vulnerability mediates the association between having a Holocaust background and mental health outcomes (depressive symptoms and life satisfaction). For this purpose, a community-dwelling sample of 79 middle-aged and older OHS and 129 non-OHS gay men completed measures of hostile-world scenario (HWS) in the interpersonal domain, satisfaction from current steady relationship, depressive symptoms and life satisfaction. Results indicated that OHS reported higher HWS interpersonal vulnerability and lower satisfaction from current relationship in comparison to non-OHS gay men. Also, having a Holocaust background had an indirect effect on depressive symptoms and life satisfaction through HWS interpersonal vulnerability as well as through satisfaction from current relationship. These findings are the first to suggest interpersonal vulnerability of older OHS, in comparison to non-OHS, gay men, and an association between this vulnerability and adverse psychological outcomes. This interpersonal vulnerability, possibly representing HWS threats of both early family-based trauma and current sexual minority stress, along with its implications, should be addressed by practitioners who work with older gay men having a Holocaust background.

Parental Post-traumatic Stress Disorder Symptoms Are Related to Successful Aging in Offspring of Holocaust Survivors.

A fascinating, yet underexplored, question is whether traumatic events experienced by previous generations affect the aging process of subsequent generations. This question is especially relevant for offspring of Holocaust survivors (OHS), who begin to face the aging process. Some preliminary findings point to greater physical dysfunction among middle-aged OHS, yet the mechanisms behind this dysfunction need further clarification. Therefore, the current studies assess aging OHS using the broad-scoped conceptualization of successful aging, while examining whether offspring successful aging relates to parental post-traumatic stress disorder (PTSD) symptoms and offspring’s secondary traumatization symptoms. In Study 1, 101 adult offspring (mean age = 62.31) completed measures of parental PTSD, secondary traumatization, as well as successful aging indices – objective (medical conditions, disability and somatic symptoms) and subjective (perceptions of one’s aging). Relative to comparisons and OHS who reported that none of their parents suffered from probable PTSD, OHS who reported that their parents suffered from probable PTSD had lower scores in objective and subjective measures of successful aging. Mediation analyses showed that higher level of secondary traumatization mediated the relationship between parental PTSD and less successful aging in the offspring. Study 2 included 154 dyads of parents (mean age = 81.86) and their adult offspring (mean age = 54.48). Parents reported PTSD symptoms and offspring reported secondary traumatization and completed measures of objective successful aging. Relative to comparisons, OHS whose parent had probable PTSD have aged less successfully. Once again, offspring secondary traumatization mediated the effect. The findings suggest that parental post-traumatic reactions assessed both by offspring (Study 1) and by parents themselves (Study 2) take part in shaping the aging of the subsequent generation via reactions of secondary traumatization in the offspring. The studies also provide initial evidence that these processes can transpire even when offspring do not have probable PTSD or when controlling offspring anxiety symptoms. Our findings allude to additional behavioral and epigenetic processes that are potentially involved in the effect of parental PTSD on offspring aging, and further imply the need to develop interdisciplinary interventions aiming at promoting successful aging among offspring of traumatized parents.

The impact of war on mental health: lest we forget

The often-unconscious and enduring impact of war is one of the driving forces of history. Yet these terrible costs and the lessons learned by psychiatry tend to be forgotten (1). At a time when many nations are remembering the legacy of World War I, the greatest military conflagration in history, it is timely to reflect on what has been learnt about the impacts of war on mental health. Ironically, it is only since the inclusion of post-traumatic stress disorder (PTSD) in the DSM-III in 1980 (2) that the field of traumatic stress has blossomed and been subsequently underpinned by a major body of neuroscience and clinical research. Despite the slow development of interest into the long-term consequences of the traumatic stress of war, many of the developments in mental health care in the 20th century emerged from the innovations demanded by the need to deal more effectively with the flood of mental casualties amongst the combatants of World Wars I and II. The model of community psychiatry was adapted from the model of forward psychiatry developed by the military to deal with acute combat stress reactions; this model was underpinned by the principles of the provision of early treatment close to the battle front with the expectancy of recovery and return to service (1). Crisis intervention, group therapy and therapeutic communities were innovations that evolved out of the military medical corps (1). However, psychiatrists who served in the military were often conflicted by powerful and potentially competing value systems concerning whether their primary responsibility was to the soldier or to the war effort (3). The prevailing attitudes would tend to indicate that individuals’ interests often lost out – the veteran who broke down in battle was generally stigmatized. The diagnoses promulgated by the profession, such as compensation neurosis, lack of moral fibre and inadequate personality reflected how the problem was seen to be caused by moral weakness and vulnerability (4). In this characterization, the causal role of the horrors of combat were minimized by psychiatry, in contrast to compensation seeking and vulnerability.

Transmitting the sum of all fears: Iranian nuclear threat salience among offspring of Holocaust survivors.

Many Israelis are preoccupied with the prospect of a nuclear-armed Iran, frequently associating it with the danger of annihilation that existed during the Holocaust. The current article examined whether offspring of Holocaust survivors (OHS) are especially preoccupied and sensitive to the Iranian threat, and whether this susceptibility is a part of their increased general image of actual and potential threats, defined as the hostile world scenario (HWS). Study 1 (N = 106) showed that relative to comparisons, OHS reported more preoccupation with the Iranian nuclear threat. Moreover, the positive relationship between the salience of the Iranian threat and symptoms of anxiety was stronger among OHS. Study 2 (N = 450) replicated these findings, while focusing on the Iranian nuclear threat salience and symptoms of psychological distress. It further showed that OHS reported more negative engagement with the HWS (i.e., feeling that surrounding threats decrease one's sense of competence), which in turn mediated their increased preoccupation with the Iranian threat. The results suggest that intergenerational transmission of the Holocaust trauma includes heightened preoccupation with and sensitivity to potential threats of annihilation, and that the specific preoccupation with threats of annihilation reflects a part of a more general preoccupation with surrounding threats.

Perceptions of aging among middle-aged offspring of traumatized parents: the effects of parental Holocaust-related communication and secondary traumatization

Objectives: Traumatized parents may transmit anxieties of physical deterioration and demise to their offspring. These anxieties can amplify negative perceptions of the aging process when the offspring enter old age. The current study examined how middle-aged offspring of Holocaust survivors (OHS) recount trauma-related communication by their parents, and how these reports are related to offspring's perceptions of their aging process.Method: The study included 450 respondents at the age range of 50–67 (mean age = 57.5, SD = 4.6): 300 OHS and 150 comparisons. Participants reported parental communication of the Holocaust, completed measures of subjective successful aging, aging and death anxieties, and reported secondary traumatization assessing symptoms, developed as a result of a close and continuous relationship with a traumatized parent.Results: Latent profile analysis identified two profiles of parental Holocaust-related communication: intrusive and informative. Offspring who reported intrusive parental communication about the Holocaust perceived themselves as aging less successfully and were more anxious of aging and death than comparisons. Offspring who reported informative parental communication and comparisons did not differ in perceptions of aging. Secondary traumatization mediated these group differences, meaning, intrusive parental communication was related to higher secondary traumatization, which in turn was related to less favorable perceptions of aging.Conclusion: These findings allude to the possibility that secondary traumatization mold negative perceptions of the aging process among middle-aged offspring of traumatized parents. Mental health practitioners may help OHS process fragmented and intrusive remnants of parental trauma, thereby diminishing secondary traumatization, and promoting more adaptive perceptions of aging.

Family Involvement and Holocaust Salience among Offspring and Grandchildren of Holocaust Survivors

The present research focuses on family involvement reported by offspring and grandchildren of Holocaust survivors (OHS and GHS, respectively). Study 1 included a convenience sample of 75 participants, divided into 2 groups (36 OHS and 39 comparisons). Study 2 included a convenience sample of 92 dyads of OHS and GHS. Both samples completed the Family Involvement Questionnaire and the Holocaust Salience Scale. In line with the hypotheses, Study 1 found that, relative to comparisons, OHS presented greater familial involvement. Only OHS with strong family involvement showed higher Holocaust salience than comparisons. Study 2 showed higher familial involvement among OHS as compared to GHS, and significant parent-child correlations. The results show that family involvement is related to intergenerational transmission of the trauma, especially among OHS. Yet, among OHS and GHS, parents’ and children’s family involvement were associated. The theoretical and practical implications of these findings are discussed.

Influences of maternal and paternal PTSD on epigenetic regulation of the glucocorticoid receptor gene in Holocaust survivor offspring.

Differential effects of maternal and paternal posttraumatic stress disorder (PTSD) have been observed in adult offspring of Holocaust survivors in both glucocorticoid receptor sensitivity and vulnerability to psychiatric disorder. The authors examined the relative influences of maternal and paternal PTSD on DNA methylation of the exon 1F promoter of the glucocorticoid receptor (GR-1F) gene (NR3C1) in peripheral blood mononuclear cells and its relationship to glucocorticoid receptor sensitivity in Holocaust offspring. Adult offspring with at least one Holocaust survivor parent (N=80) and demographically similar participants without parental Holocaust exposure or parental PTSD (N=15) completed clinical interviews, self-report measures, and biological procedures. Blood samples were collected for analysis of GR-1F promoter methylation and of cortisol levels in response to low-dose dexamethasone, and two-way analysis of covariance was performed using maternal and paternal PTSD as main effects. Hierarchical clustering analysis was used to permit visualization of maternal compared with paternal PTSD effects on clinical variables and GR-1F promoter methylation. A significant interaction demonstrated that in the absence of maternal PTSD, offspring with paternal PTSD showed higher GR-1F promoter methylation, whereas offspring with both maternal and paternal PTSD showed lower methylation. Lower GR-1F promoter methylation was significantly associated with greater postdexamethasone cortisol suppression. The clustering analysis revealed that maternal and paternal PTSD effects were differentially associated with clinical indicators and GR-1F promoter methylation. This is the first study to demonstrate alterations of GR-1F promoter methylation in relation to parental PTSD and neuroendocrine outcomes. The moderation of paternal PTSD effects by maternal PTSD suggests different mechanisms for the intergenerational transmission of trauma-related vulnerabilities.

Elevation of 11β-hydroxysteroid dehydrogenase type 2 activity in Holocaust survivor offspring: evidence for an intergenerational effect of maternal trauma exposure.

Adult offspring of Holocaust survivors comprise an informative cohort in which to study intergenerational transmission of the effects of trauma exposure. Lower cortisol and enhanced glucocorticoid sensitivity have been previously demonstrated in Holocaust survivors with PTSD, and in offspring of Holocaust survivors in association with maternal PTSD. In other work, reduction in the activity of the enzyme 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD-2), which inactivates cortisol, was identified in Holocaust survivors in comparison to age-matched, unexposed Jewish controls. Therefore, we investigated glucocorticoid metabolism in offspring of Holocaust survivors to evaluate if similar enzymatic decrements would be observed that might help to explain glucocorticoid alterations previously shown for Holocaust offspring. Holocaust offspring (n=85) and comparison subjects (n=27) were evaluated with clinical diagnostic interview and self-rating scales, and asked to collect a 24-h urine sample from which concentrations of cortisol and glucocorticoid metabolites were assayed by GCMS. 11β-HSD-2 activity was determined as the ratio of urinary cortisone to cortisol. Significantly reduced cortisol excretion was observed in Holocaust offspring compared to controls (p=.046), as had been shown for Holocaust survivors. However, 11β-HSD-2 activity was elevated for offspring compared to controls (p=.008), particularly among those whose mothers had been children, rather than adolescents or adults, during World War II (p=.032). The effect of paternal Holocaust exposure could not be reliably investigated in the current sample. The inverse association of offspring 11β-HSD-2 activity with maternal age at Holocaust exposure is consistent with the influence of glucocorticoid programming. Whereas a long standing reduction in 11β-HSD-2 activity among survivors is readily interpreted in the context of Holocaust related deprivation, understanding the directional effect on offspring will require replication and further exploration.

Maternal PTSD associates with greater glucocorticoid sensitivity in offspring of Holocaust survivors

Intergenerational effects of trauma have been observed clinically in a wide range of populations, and parental PTSD has been associated with an increased risk for psychopathology in offspring. In studies of Holocaust survivor offspring, parental PTSD, and particularly maternal PTSD, has been associated with increased risk for PTSD, low basal urinary cortisol excretion and enhanced cortisol suppression in response to dexamethasone. Such findings implicate maternally derived glucocorticoid programming in the intergenerational transmission of trauma-related consequences, potentially resulting from in utero influences or early life experiences. This study investigated the relative influence of Holocaust exposure and PTSD in mothers and fathers on glucocorticoid sensitivity in offspring. Eighty Holocaust offspring and 15 offspring of non-exposed Jewish parents completed evaluations and provided blood and urine samples. Glucocorticoid sensitivity was evaluated using the lysozyme suppression test (LST), an in vitro measure of glucocorticoid receptor sensitivity in a peripheral tissue, the dexamethasone suppression test (DST), and 24-h urinary cortisol excretion. Maternal PTSD was associated with greater glucocorticoid sensitivity in offspring across all three measures of glucocorticoid function. An interaction of maternal and paternal PTSD on the DST and 24-h urinary cortisol showed an effect of decreased glucocorticoid sensitivity in offspring with paternal, but not maternal, PTSD. Although indirect, these findings are consistent with the hypothesis that epigenetic programming may be involved in the intergenerational transmission of trauma-related effects on glucocorticoid regulation.