Posttraumatic Stress Disorder Across Two Generations: Concordance and Mechanisms in a Population-Based Sample

doi:10.1016/j.biopsych.2012.03.020

Biological Psychiatry

Volume 72, Issue 6, 15 September 2012, Pages 505-511

https://doi.org/10.1016/j.biopsych.2012.03.020 Get rights and content

Background

Research conducted using small samples of persons exposed to extreme stressors has documented an association between parental and offspring posttraumatic stress disorder (PTSD), but it is unknown whether this association exists in the general population and whether trauma exposure mediates this association. We sought to determine whether mothers' posttraumatic stress symptoms were associated with PTSD in their young adult children and whether this association was mediated by higher trauma exposure in children of women with PTSD.

Methods

Using data from a cohort of mothers (n = 6924) and a cohort of their children (n = 8453), we calculated risk ratios (RR) for child's PTSD and examined mediation by trauma exposure.

Results

Mother's lifetime posttraumatic stress symptoms were associated with child's PTSD in dose–response fashion (mother's 1–3 symptoms, child's RR = 1.2; mother's 4–5 symptoms, RR = 1.3; mother's 6–7 symptoms, RR = 1.6, compared with children of mothers with no symptoms, p < .001 for each). Mother's lifetime symptoms were also associated with child's trauma exposure in dose–response fashion. Elevated exposure to trauma substantially mediated elevated risk for PTSD in children of women with symptoms (mediation proportion, 74%, p < .001).

Conclusions

Intergenerational association of PTSD is clearly present in a large population-based sample. Children of women who had PTSD were more likely than children of women without PTSD to experience traumatic events; this suggests, in part, why the disorder is associated across generations. Health care providers who treat mothers with PTSD should be aware of the higher risk for trauma exposure and PTSD in their children.

Section snippets

Sample

We assess the relationship between maternal and child PTSD in 2 longitudinal cohorts, the Nurses' Health Study II (NHSII), a cohort of women, and the Growing Up Today Study (GUTS), a cohort of their children. The NHSII is a cohort of 116,430 female nurses from 14 populous U.S. states whose nursing boards were able to provide information on nurses' gender and birth date. Because the goal of the NHSII was to establish a long-term longitudinal cohort, only the most responsive potential

Results

Mothers in our sample were a mean age of 55 years in 2008, as were women in the whole NHSII. Mothers in our sample were somewhat more likely to be white (98% vs. 95%), less likely to be Hispanic (1.5% vs. 1.9%), and were more likely to have been married at baseline (95% vs. 77%) compared with the whole NHSII. Children in our study were the same mean age, 12 years, as the whole GUTS sample at baseline. Children in our sample were slightly less likely to be Hispanic (1.4% vs. 1.6%) and more

Discussion

Our results suggest that risk for PTSD may be transmitted intergenerationally in a large population-based sample. We found a dose–response relationship: women who had experienced high levels of PTSD symptoms during their life had children at higher risk of PTSD compared with women with lower levels of PTSD symptoms. Elevated exposure to traumatic events in children of mothers with PTSD was likely a major mechanism for this risk transmission. However, we found that mother's PTSD symptoms

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Archival ReportPosttraumatic Stress Disorder Across Two Generations: Concordance and Mechanisms in a Population-Based Sample

Background

Methods

Results

Conclusions

Section snippets

Sample

Results

Discussion

Relationship of parental trauma exposure and PTSD to PTSD, depressive and anxiety disorders in offspring

J Psychiatr Res

Children in families of torture victims: Transgenerational transmission of parents' traumatic experiences to their children

Int J Soc Welfare

Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors

J Psychiatr Res

Posttraumatic stress disorder across two generations of Cambodian refugees

J Am Acad Child Adolesc Psychiatry

Maternal and child posttraumatic stress disorder in cases of child maltreatment

Child Abuse Neglect

Are children of Holocaust survivors less well-adapted?A meta-analytic investigation of secondary traumatization

J Trauma Stress

Is there intergenerational transmission of trauma?The case of combat veterans' children

Am J Orthopsychiatry

Transmission of response to trauma?Second-generation Holocaust survivors' reaction to cancer

Am J Psychiatry

The impact of posttraumatic stress disorder on partners and children of Australian Vietnam veterans

Aust N Z J Psychiatry

Attachment and traumatic stress in female holocaust child survivors and their daughters

Am J Psychiatry

The adjustment of children of Australian Vietnam veterans: Is there evidence for the transgenerational transmission of the effects of war-related trauma?

Aust N Z J Psychiatry

The adjustment of children of Australian Vietnam veterans: Is there evidence for the transgenerational transmission of the effects of war-related trauma?

Aust N Z J Psychiatry

Resilience and vulnerability among refugee children of traumatized and non-traumatized parents

Child Adolesc Psychiatry Ment Health

Childhood trauma and risk for PTSD: Relationship to intergenerational effects of trauma, parental PTSD, and cortisol excretion

Dev Psychopathol

A study on the relationship between posttraumatic stress disorder in flood victim parents and children in Hunan, China

Aust N Z J Psychiatry

Transgenerational transmission of cortisol and PTSD risk

Prog Brain Res

Low cortisol and risk for PTSD in adult offspring of holocaust survivors

Am J Psychiatry

DHEA and DHEA-S: A review

J Clin Pharmacol

Children's exposure to violence and distress symptoms: Influence of caretakers' psychological functioning

Int J Behav Med

Comparison of the family history method to direct interview: Factors affecting the diagnosis of depression

J Affect Disord

Inter-informant agreement on diagnoses and prevalence estimates of anxiety disorders: Direct interview versus family history method

Psychiatry Res

Aggression, anxiety, and social development in adolescent children of war veterans with PTSD versus those of non-veterans

J Res Med Sci

The cycle of trauma; relationship aggression in male Vietnam veterans with symptoms of posttraumatic stress disorder

Violence Vict

Problems in families of male Vietnam veterans with posttraumatic stress disorder

J Consult Clin Psychol

Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder

Am J Public Health

Posttraumatic stress disorder: The etiologic specificity of wartime stressors

Am J Psychiatry

Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents

Compr Psychiatry

Association study of trauma load and SLC6A4 promoter polymorphism in posttraumatic stress disorder: Evidence from survivors of the Rwandan genocide

J Clin Psychiatry

Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research

Psychol Bull

The epidemiology of trauma, PTSD, and other posttrauma disorders

Trauma Violence Abuse

Symptoms of dissociation in humans experiencing acute, uncontrollable stress: A prospective investigation

Am J Psychiatry

Sexual experiences survey: Reliability and validity

J Consult Clin Psychol

The Revised Conflict Tactics Scales (CTS2)

J Fam Issues

Archival Report
Posttraumatic Stress Disorder Across Two Generations: Concordance and Mechanisms in a Population-Based Sample