Survivor Families Research Articles

"A crossroads generation." Great-grandchildren of Holocaust survivors' perspectives on the impact of the genocide on family functioning.

As a cultural trauma, the Holocaust exerted negative psychological effects on many survivors, with such effects often extending to their families. Research has explored these effects with respect to the survivors' children and grandchildren, but the experiences of the next generation have yet to be canvassed. Knowledge about resilience in Holocaust survivor families is also comparatively sparse. In this exploratory study, 10 semi-structured interviews were conducted with Australian great-grandchildren of Holocaust survivors, garnering perspectives concerning the genocide's impact on family functioning. Six superordinate themes were identified through Interpretive Phenomenological Analysis: The experience of being raised by the third generation, honoring traumatic family histories, the need to move on, proudly identifying with the Holocaust, valuing achievement and ambition, and the importance of not taking things for granted. The findings suggest that multiple generations within survivor families grapple with the lingering negative effects of the Holocaust. Concurrently, attempting to redress these effects has the potential to benefit family dynamics and processes.

Breaking the Silence About Compulsory Social Measures in Switzerland: Consequences for Survivor Families

So‐called compulsory social measures (CSM) represent a dark chapter in Swiss history. Hundreds of thousands of children and adolescents from families affected by poverty were placed in foster families and homes, or used as labourers on farms. These decisions could hardly be appealed. Many minors suffered traumatic violence in out‐of‐home placements. In 1981 the relevant laws were redrafted and the practice of CSM was officially stopped. Nevertheless, CSM were considered taboo for decades in Swiss politics and society. Often survivors even concealed their experiences from their own partners and children. It was not until 2013 that a major political and social reappraisal began. Against this background, we analyse how the state breaking its silence on the issue, through the initiating of public reappraisal, changed the way families deal with their parents’ history regarding CSM. To this end, six biographical interviews with adult descendants of survivors were analysed using grounded theory methodology. The results show that the public reappraisal triggered processes of revealing secrets from parental history in families, which also enabled emotional rapprochement between family members. However, it also opened up new areas of family tension and found expression in new constellations of silence. Overall Switzerland’s state action had ambivalent consequences for survivor families.

Parenthood for childhood cancer survivors: unfounded fear of cancer development in offspring and related health behaviors.

Current literature reveals no increased risk for adverse non-hereditary health outcomes in the offspring of childhood cancer survivors (CCS), yet survivors reported concerns regarding their offspring's health. To investigate how the fear of cancer development in offspring influences parental behavior related to health and prevention, survey reports from 256 European adult CCS and 256 age- and sex-matched siblings who participated in a multicenter study on offspring health were analyzed in the present study. Analyses of covariance and chi-square tests were conducted to test for differences between CCS and siblings in outcome variables (all related to healthy parenting behavior). CCS reported higher fear levels (p = 0.044, Partial η2 = 0.01) and less alcohol consumption (p = 0.011, Phi = 0.12) and smoking (p = 0.022, Phi = 0.11) during pregnancy than siblings. In survivor families, children were breastfed less often (p < 0.001, Phi = 0.18). Partial correlation analyses showed that CCS' fear levels decreased with increasing age (r = -0.16, p = 0.014), time since oncological therapy (r = -0.19, p = 0.003), and number of children (r = -0.21, p = 0.001). Overall, due to their own experiences with cancer, many CCS harbor misperceptions regarding the health outcomes of their offspring. Although the fear decreases with increasing distance from the active disease, any fear should be taken seriously, even if unfounded, and combated through targeted educational measures.

Echoes of ancestral trauma: Russo-Ukrainian War salience and psychological distress among subsequent generations in Holocaust survivor families.

The Russo-Ukrainian War intensified when Russian troops invaded Ukraine in February 2022. The current study examined whether children (second generation; G2) and grandchildren (third generation; G3) of Holocaust survivors are more preoccupied with the war relative to comparisons. Moreover, whether there was more exacerbation in psychological distress in Holocaust survivor families relative to comparisons since the escalation of the war. A random sample from a web-based survey company included 1,071 Jewish Israeli adults (297 Holocaust G2, 224 comparison G2, 379 Holocaust G3, and 171 comparison G3). The average age of the participants was 62.95 ± 10.25, 61.79 ± 10.13, 34.02 ± 8.65, and 33.55 ± 8.26, respectively. Participants answered questionnaires on background characteristics, Russo-Ukrainian War exposure, Russo-Ukrainian War salience, and general psychological distress before and since the escalation of the war. Findings showed that Holocaust G2 and G3, relative to comparisons, reported more Russo-Ukrainian War salience. Moreover, more psychological distress symptom exacerbation was found in Holocaust survivor families relative to comparisons since the escalation of the war. Finally, Holocaust G2 and G3 with more Holocaust survivors in the family showed higher anxious preoccupation with the war and Holocaust G3 with more survivor grandparents showed more exacerbation in psychological distress. Findings suggest a specific vulnerability due to intergenerational transmission of trauma in Holocaust survivor families, including increased preoccupation with and perceptiveness to potential threats of human-induced trauma. Strengthening previous recommendations, mental health practitioners should focus on reducing the preoccupation with threat and the increased psychological distress of Holocaust survivor families when faced with current adversity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Functional impairment is associated with medical debt in male cancer survivors and credit card debt in female cancer survivors.

To examine the associations of functional limitations with medical and credit card debt among cancer survivor families and explore sex differences in these associations. This cross-sectional study used data from the 2019 wave of the Panel Study of Income Dynamics, a nationally representative, population-based survey of individuals and households in the US administered in both English and Spanish and includes all households where either the head of household or spouse/partner reported having been diagnosed with cancer. Participants reported on functional limitations in six instrumental activities of daily living (IADL) and seven activities of daily living (ADL). Functional impairment was categorized as 0, 1-2 and ≥ 3 limitations. Medical debt was defined as self-reported unpaid medical bills. Credit card debt was defined as revolving credit card debt. Multivariable logistic regression analyses were performed. Credit card debt was more common than medical debt (39.8% vs. 7.6% of cancer survivor families). Families of male cancer survivors were 7.3 percentage points more likely to have medical debt and 16.0 percentage points less likely to have credit card debt compared to families of female cancer survivors. Whereas male cancer survivors with increasing levels of impairment were 24.7 percentage point (p-value = 0.006) more likely to have medical debt, female survivors with more functional impairment were 13.6 percentage points (p-value = 0.010) more likely to have credit card debt. More research on medical and credit card debt burden among cancer survivors with functional limitations is needed.

Family involvement and secondary traumatization in Holocaust survivor families: An actor-partner interdependence model.

The study aimed to examine the interpersonal relationships between family involvement (i.e., emotional and behavioral strategies that underscore family members' well-being and familial legacy) and secondary traumatization (i.e., symptoms of distress resulting from close contact with a traumatized individual) in Holocaust survivors and comparison families. We assessed levels of family involvement and secondary traumatization in children and grandchildren of survivors (Holocaust G2 and G3) and comparisons. Next, we examined whether there are within and between generation relationships between family involvement and secondary traumatization (i.e., G2's family involvement affects G3's secondary traumatization and vice versa). The sample included 92 Holocaust G2-G3 dyads and 67 equivalent comparison dyads (comparison G2 and G3 of European origin, whose parents or grandparents were not in Nazi/pro-Nazi dominated countries). Participants answered questionaries on background characteristics, family involvement, and secondary traumatization. Secondary traumatization was significantly higher among Holocaust G2 and G3 than comparison G2 and G3, respectively. Family involvement was significantly higher among Holocaust G2 than comparison G2. An Actor-Partner Interdependence model showed that participants who reported greater family involvement reported higher secondary traumatization in all families (i.e., an actor effect). A significant partner effect was found only in Holocaust families. In these families, greater family involvement in one generation was related to higher secondary traumatization in the other generation. The findings suggest a unique interpersonal mechanism of intergenerational transmission of trauma in Holocaust families that appears to affect both generations, which may help design multigenerational interventions with survivor families, focusing on family involvement. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

“It Just Permeated everything.” Third Generation Holocaust Survivor Perspectives Regarding the Genocide’s Impact on Family Functioning

ABSTRACT Research into the intergenerational effects of the Holocaust has focused on traumatization of the survivors’ children, and has yet to explore adaptive responses in succeeding generations. In this study, 10 semi-structured interviews were conducted with Australian adult grandchildren of Holocaust survivors. Interpretive phenomenological analysis identified six themes: connection and discomfort with the Holocaust’s salience, reckoning with a legacy of trauma, insecurity and survival strategies, the value of a strong education, family is everything, and valuing a communal outlook. These findings imply that the Holocaust’s traumatizing effects linger for multiple generations, but responding in adaptive ways benefits relationships within survivor families.

Family Burden of ICU Survivors and Correlations with Patient Quality of Life and Psychometric Scores - A Pilot Study.

Post intensive care syndrome (PICS) affects an increasing number of critical illness survivors and their families, with serious physical and psychological sequelae. Since little is known about the burden of critical illness on ICU survivor families, we conducted a prospective observational study aiming to assess this, and investigate correlations of the patients' psychometric and health-related quality of life (HRQOL) scores with family burden. Twenty-nine patients were evaluated in the presence of a family member. Participants were assessed with the use of validated scales for anxiety, depression, post-traumatic stress disorder, cognitive decline, and the family burden scale (FBS). High burden was present in 27.6% of family members. Statistically significant correlations were observed between the FBS score and trait anxiety, depression, and the physical and psychological components of HRQOL. Our results suggest that family burden following critical illness is common, suggesting that its assessment should be incorporated in the evaluation of PICS-family in large observational studies.

Supplemental Material for Family Involvement and Secondary Traumatization in Holocaust Survivor Families: An Actor–Partner Interdependence Model

Supplemental Material for Family Involvement and Secondary Traumatization in Holocaust Survivor Families: An Actor–Partner Interdependence Model

Come Back Stronger After Suffered for Child Sexual Abuse: A Case Study to Understand the Family Resilience Process

Background: Child sexual abuse (CSA) is quite prevalent in Indonesia, with an increased rate over several years. The negative impacts of CSA have been investigated in several studies and the coping strategies for CSA survivors. However, the resilience at the family level is rarely analyzed. This study investigates the resilience process of the CSA survivor's families after they were affected by the CSA incident. Methods: Using a qualitative approach, we collected the data by interviewing and observing a family suffering from a CSA incident, the Geulis family (informant pseudonym). Data then were analyzed using thematic analysis with a family resilience model developed by Henry et al. (2015). Results: The CSA incident has led to several adverse events in the Geulis (family, including unintended pregnancy, dropping out of school, hesitancy to stay in the hometown and loss of job and family income. With the support from extended family and some organizations, Geulis and her mother were able to find a new place to live and a new job for Geulis' mother, and Geulis was able to start a new relationship and continue her study for a while. The complex and continuous adaptation process of the Geulis family was also analyzed using the family adaptive systems component. Conclusion: The Geulis family could function normally after experiencing the negative impact of CSA with some adjustment in their life and dynamic process in the family. Environment, including extended family, government, and non-government organizations, plays a vital role in supporting family resilience.

Cancer-Related Barriers to Health Behaviors Among Adolescent and Young Adult Survivors of Pediatric Cancer and Their Families.

Adolescent and young adult (AYA) survivors of pediatric cancer and their caregivers frequently do not meet national guidelines for physical activity (PA), nutrition, or sleep. Respondents from N = 73 AYA-aged (mean [M] = 19.0 years, range = 11-30 years) survivor families completed a survey on cancer-related barriers to health behaviors. Almost all respondents (68/73, 93.2%) endorsed ≥1 cancer-specific barrier(s) to current health behaviors (median = 5, standard deviation = 3.42, range = 0-16) in their family. Cancer-related barriers to PA, nutrition, and sleep were positively correlated (PA-nutrition: r = 0.39, p = 0.001; PA-sleep: r = 0.41, p < 0.001; nutrition-sleep: r = 0.52, p < 0.001). Wellness interventions are needed to address the unique needs of AYA-aged survivors and support multiple health behaviors simultaneously.

Editorial

This issue continues a tradition in this journal of devoting issues to the broad theme of ‘Judaism and Psychotherapy’. It began formally in autumn 1982, but the journal had already explored the topic earlier with occasional writings as noted by Howard Cooper. The dedicated issues grew out of a series of lectures on the topic initiated by Leo Baeck College and were subsequently continued in collaboration with the Raphael Centre, a Jewish counselling service. The origin of this exploration belongs in large part to the influence of Irene Bloomfield z’l, who became involved, together with Dr Wendy Greengross z’l, in the establishment of a pioneering programme of ‘Pastoral Care and Counselling’ for the rabbinic students at the College. It is a privilege to be able to include in this issue a previously unpublished paper by Irene, together with Gaby Glassman, her partner in pioneering work on the impact of the Holocaust on the second generation of survivor families.

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).

Event centrality and secondary traumatization among Holocaust survivors' offspring and grandchildren: A three-generation study

The present study examined the intergenerational transmission of the Holocaust trauma in relation to levels of secondary traumatization and event centrality across three generations in a cross-sectional survey. Participants included 92 Holocaust survivor-offspring-grandchild triads (Holocaust G1-G2-G3) and 67 comparison triads (Comparison G1-G2-G3). Holocaust G1 reported higher levels of post-traumatic stress disorder (PTSD) symptoms relative to Comparison G1. Holocaust G2 and G3 reported significantly higher secondary traumatization relative to Comparison G2 and G3, respectively. Holocaust G3 also reported significantly higher scores in event centrality relative to Comparison G3. In survivor families, the indirect effect of PTSD symptoms in Holocaust G1 predicted Holocaust G2's secondary traumatization, which subsequently predicted Holocaust G3's secondary traumatization. Moreover, PTSD symptoms in Holocaust G1 predicted Holocaust G3's event centrality through secondary traumatization in both Holocaust G2 and G3 and event centrality in Holocaust G2. In the comparison groups, trauma transmission was not observed in three generations. Findings elucidate unique intergenerational transmission of the Holocaust trauma in survivor families, which comprise both personal and societal constituents. Moreover, the findings show that event centrality is a distinctive mechanism in intergenerational transmission in survivor families.

Psychological symptoms of cancer survivors during the COVID-19 outbreak: A longitudinal study.

Due to the coronavirus disease 2019 (COVID-19) pandemic, self-isolation at home was adopted to control the spread of COVID-19 in China for 3 months from 29 January 2020. The psychological status of cancer survivors is affected by their social environment. In this study, we investigated the psychological status and psychological symptoms of Chinese cancer survivors. A longitudinal study design was adopted, and an online sample of cancer survivors was successfully recruited via the Internet communities of cancer support groups. From 14 February to 25 May, 111 cancer survivor families completed the symptom checklist 90 (SCL-90) online three times (T1:14 to 24 February; T2: 1 to 10 April; T3: 15 to 25 May). For survivors and their family members, the mean total score of the SCL-90 was 172.05 (13.30) and 142.76 (26.80) at T1, 155.91 (12.18) and 133.42 (15.93) at T2, and 142.75 (11.56) and 130.14 (14.16) at T3, respectively. The SCL-90 scores of cancer survivors were significantly higher than those of family members and Chinese norms at T1, T2, and T3. Nine psychological symptoms of the SCL-90 in cancer survivors significantly declined from T1 to T2 and T3. The COVID-19 pandemic has had a significant adverse impact on cancer survivors and their families. Psychological assistance should be provided to cancer survivors.

A mixed-methods study of the disease experience in hematopoietic stem cell transplantation survivors: the contribution of text analysis

Objectives Few studies have detected qualitative and quantitative aspects of patients who underwent HSCT during childhood. The aims of this study are to explore the most recurrent narrative themes of HSCT experience in families five years after the procedure, and to observe statistical correlations between meaning attributed to the experience and defined variables. Methods Thirty-five families of pediatric HSCT survivors participated in the research. Both survivors and their families were asked to write a brief composition about their disease experiences. Qualitative analysis of the texts was performed using the T-LAB software. Information about medical aspects and psychological problems in HSCT survivors were collected with interviews and administering the Child Behavior Checklist 6–18. Results HSCT survivor families that reported the presence of externalizing and internalizing symptoms focused on thematic areas concerning broken families with separation between parents and the affected child versus healthy children. Conclusions Long term psychological problems seem to be connected to the perception of family disruption. Specifically, family relationships seem to be the factor that protects from or enhances the risk of psychopathology in HSCT survivors. Moreover, the use of metaphoric terms to refer to HSCT presents higher associations with psychopathology. On the contrary, the possibility of referring directly to the transplantation is associated with psychological well-being. It is important to consider the family as a group in order to improve care.

Benefits of Attending a Weekend Childhood Cancer Survivor Family Retreat.

To explore the long-term benefits to families of childhood cancer survivors who attended a weekend childhood cancer survivor family retreat. Descriptive-qualitative study including families who had attended the weekend retreat at least once but not in the past 12 months, and who attend a large pediatric hematology and oncology cancer survivorship program in Texas. A semistructured interview guide was used during three audio-taped focus groups to explore the benefits of having attended a weekend retreat. Descriptive qualitative analysis was used to analyze the focus groups' transcripts. Seven families participated in the focus groups, and the themes identified were reconnecting (with others or family), putting life in perspective, and changing outlook on life. Retreats offer families of cancer survivors opportunities to reconnect with others and their own family members in a therapeutic environment. These reconnections in a therapeutic environment enriched the families' positive outlooks on life and changed their perspectives. Families of childhood cancer survivors report a lack of support following the completion of therapy. Retreats in a nonclinical therapeutic setting optimize family-perceived support, relationship building, and reconnecting survivor families.

The experiences of attempt survivor families and how they cope after a suicide attempt in Ghana: a qualitative study

BackgroundGhana’s socio-cultural landscape proscribes suicidal behaviour, and this has serious ramifications for attempt survivors and their families. The objective of this qualitative study was to understand the experiences of the families of attempt survivors and how they cope with the aftermath of the attempt.MethodsTen families with attempted suicides agreed to participate in the study, hence they were interviewed. The information gathered was manually analyzed according to Interpretative Phenomenological Analysis (IPA) resulting in three major thematic areas.ResultsThree major themes emerged two of which addressed negative experiences and reactions towards the attempts: Experiencing shame and stigma, and Reactive affect. The third theme addressed the coping resources of these informants under the theme: Surviving the stress of attempt. The specific coping resources included personalized spiritual coping, social support, and avoidance.ConclusionsFamily systems theory is used to explain some of the findings of this study, and the implication for clinical practice and designing postvention programs for families after a suicide attempt are addressed.

Neurodevelopment and Health-Related Quality of Life in Infants Born with Gastroschisis: A 6-Year Retrospective French Study.

Introduction Quantify quality of life (QoL) outcomes in gastroschisis children is little assessed. The primary objective was to describe the long-term outcome of newborns with gastroschisis treated in three tertiary care hospitals of France in terms of neurodevelopment and QoL. Materials and Methods The study reported was a cross-sectional, descriptive multicentric retrospective study assessing the outcome of newborns with gastroschisis, born between January 1, 2009, and December 31, 2014, treated at two large and French level III neonatal intensive care units. Long-term outcome data were assessed by questionnaires sent to the infants' parents. Questionnaires explored global health, neurological development, and quality of life (overall assessment including socio-economic and medical), Age & Stages Questionnaire, infants' quality of life (KIDSCREEN), and quality of parents' life (General Questionnaire Short Form-36). Results In this study, 50% of the survivor's families answered the assessment form (n = 33). The average follow-up age was 40 months, ranging from 8 months to 6 years. Cases of simple gastroschisis more often had a normal score for "communication" (p = 0.033), while patients who received morphine for a longer duration had significantly lower scores for the items "communication" and "problem resolving" (p = 0.024 and p = 0.011, respectively). Children's QoL was significantly lower for patients with gestational age younger than 36 weeks (p = 0.023) and for patients born following "fetal cause delivery" (p = 0.022). Parents had a significantly higher physical composite score if their child underwent primary closure (p = 0.012). Conclusion Our analyses confirm the idea that cases of complex gastroschisis and preterm delivery may lead to poorer outcome. Such hindsight (40 months in mean) allowed for an interesting assessment of development long after the patient's initial hospitalization and to confirm these results, a standardized neuropsychological evaluation of patients should be done when at least 6 years old. An accurate assessment of the social environment and its impact on the development and QoL of children will be fundamental to avoid selection bias.

Survivor Family Memory Work at Sites of Holocaust Remembrance: Institutional Enlistment or Family Agency?

Contrary to analyses of top-down national intervention in and construction of familial memory, a study of intergenerational memory work at communal sites of Holocaust memory shows the family’s enlistment of institutions as resources to salvage lost or silent Holocaust memory. The memory work carried out by families of Holocaust survivors at a number of such sites reveals both the top-down enlistment of familial memory and the bottom-up intergenerational transmission of Holocaust tales within the family. The findings highlight processes of negotiation and cooperation between state-run public institutions and survivor families in the construction of familial Holocaust memory and alternative sites of commemoration.