Research report
Range and specificity of war-related trauma to posttraumatic stress; depression and general health perception: Displaced former World War II children in late life

https://doi.org/10.1016/j.jad.2010.07.009Get rights and content

Abstract

Background

Dose–response relation of war experiences and posttraumatic stress, depression and poor health functioning in late life is well documented in war-affected populations. The influence of differing trauma types experienced by war-affected population in the study of dose–response relation of war trauma and psychological maladaptation in late life has not been investigated. We examined a subgroup of displaced elders and investigated whether specific trauma types were associated with differential health outcomes.

Methods

From representative practitioner lists, matched groups of former displaced and non-displaced World War II children were assigned, yielding a total sample of 417 participants (response rate 50%). Measurement encompassed a self-report survey including the Impact of Event Scale-Revised, the Patient Health Questionnaire and the Harvard Trauma Questionnaire.

Results

Consistent dose-relation between war-related experiences and posttraumatic stress or depressive symptoms in late life was found for both, displaced and non-displaced elders, whereas a gradient for poor health perception was only found in displaced people. Trauma types derived from principal component analysis showed differential associations with health outcomes. Human Right Violations emerged as risk factor for posttraumatic stress symptoms and Deprivation & Threat to Life as risk factor for depressive symptoms. Poor self-rated health was associated with multiple trauma types.

Limitations

Non-random recruitment, retrospective design and use of self-report.

Conclusions

Posttraumatic stress and depression are associated with war-related experiences more than 60 years after World War II. Results suggest that different trauma types lead to unique variants of syndrome configurations, which may result from different etiological factors.

Section snippets

Participants' recruitment

This study is part of the Longitudinal Urban Cohort Aging Study (LUCAS) in Hamburg, Germany (von Renteln-Kruse, 2008). The sample was initially drawn from representative patient lists of general practitioners registered in the entire metropolitan area of Hamburg (for procedure see Stuck et al., 2007). In the current psychosocial study a subsample, with all former displaced person (n = 414) and a comparison group of non-displaced persons (n = 414) matched by gender and age were eligible to

Results

Besides gender as an associated variable with PTSD (F = 4.539, p = .0001) and Depression Syndrome (F = 6.69, p = .010) no other socio-demographic variable has been found for being associated with symptomatology. Noteworthy is the lack of correlation between age at time of event exposure and PTSD (r = .053, p = .303) and Depression Syndrome (r = .001, p = .989) as well as between time passed since the experience of the most severe event and PTSD (r = −.037, p = .465) and Depression Syndrome (r.=014, p = .785.).

Limitations

A number of limitations need to be noted. Since the study groups are drawn from a reassessment of the LUCAS-Sample (von Renteln-Kruse, 2008), the representativeness of the original LUCAS community sample of elderly people living in the greater Hamburg area, could not be maintained. The resulting non-random sampling procedures may have introduced selection biases and impaired the generalizability of the results. The measure of cumulative trauma was unable to take into account qualitative

Discussion

Findings of this study suggest that even more than 60 years later, WW II related trauma exposure poses a risk on mental health functioning. Moreover, in addition to a given dose response effect of cumulative trauma exposure, mental health outcomes are likely to be triggered by unique trauma types.

The study demonstrated a large effect size of Cohen's d = .83 with displaced former WW II children having experienced more war-related trauma events during their WW II childhood. Besides the effect large

Conclusion

The study stresses the relevance of heterogeneity in trauma exposure in war-affected populations in the long-term. In former WW II children emerged essential diversity in levels and types of trauma experienced. In accordance with DSM-IV, Human Right Violations revealed as predictor of posttraumatic stress status, whereas Deprivation & Threat to Life is demonstrated to be predictive for depression status in late life. These findings contribute to different etiological models for PTSD and

Role of funding source

Funding for the current study was provided by the German Federal Ministry of Education and Research (FMER, Grant 01ET0710) as part of the interdisciplinary LUCAS consortium (coordinator in chief: Prof. Wolfgang von Renteln-Kruse). The FMER had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

None of the authors has a conflict of interest to be declared.

Acknowledgements

We appreciate and would like to thank to the German Federal Ministry of Education and Research that funded the interdisciplinary LUCAS consortium. We would like to thank the research office of the Albertinen-Haus Centre of Geriatrics and Gerontology, namely Susann Laub for the distribution of the postal survey and the maintenance of the participants as well as Stefan Golgert for the statistical sampling and matching. We are grateful to all members of the LUCAS consortium, and the Hamburg

References (58)

  • H. Berman

    Children and war: current understanding and future directions

    Public Health Nurs.

    (2001)
  • I. Bramsen et al.

    Posttraumatic stress in aging World War II survivors after a firework disaster: a controlled prospective study

    J. Trauma. Stress

    (2006)
  • G. Chimieti et al.

    Children´s reactions to war-related stress. Affective symptoms and behavior problems

    Soc. Psychiatry Psychiatr. Epidemiol.

    (1989)
  • J. Cohen

    Statistical Power Analysis for the Behavior Sciences

    (1988)
  • U. Dapp et al.

    Active and healthy living in old age — results from a representative survey of community-dwelling senior citizens in Hamburg

    Z. Gerontol. Geriatr.

    (2009)
  • A. Dyregov et al.

    Trauma exposure and psychological reactions to genocide among Rwandan children

    J. Trauma. Stress

    (2000)
  • A. Dyregrov et al.

    Children exposed to warfare: a longitudinal study

    J. Trauma. Stress

    (2002)
  • I.M. Engelhard et al.

    A prospective study of the relationship between posttraumatic stress and physical health symptoms

    Int. J. Clin. Health Psychol.

    (2009)
  • L.R. Fabrigar et al.

    Evaluating the use of explanatory factor analysis in psychological research

    Psychol. Meth.

    (1999)
  • L. Farhood et al.

    Exposure to war-related traumatic events, prevalence of PTSD, and general psychiatric morbidity in a civilian population from southern Lebanon

    J. Transcult. Nurs.

    (2006)
  • M. Horowitz et al.

    Impact of event scale: a measure of subjective stress

    Psychosom. Med.

    (1979)
  • J.F. Ilkin et al.

    Anxiety, post-traumatic stress disorder and depression in Korean War veterans fifty years after the war

    Br. J. Psychiatry

    (2007)
  • C. Joffe et al.

    The Sydney Holocaust Study: posttraumatic stress disorder and other psychosocial morbidity in an aged community sample

    J. Trauma. Stress

    (2003)
  • S. Joseph

    Psychometric evaluation of Horowitz's impact of event scale: a review

    J. Trauma. Stress

    (2000)
  • K. Kaniasty et al.

    Longitudinal linkages between perceived social support and posttraumatic stress symptoms: Sequential roles of social causation and social selection

    J. Trauma. Stress

    (2008)
  • L.P. Kelley et al.

    A comparison of PTSD symptom patterns in three types of civilian trauma

    J. Trauma. Stress

    (2009)
  • I.A. Kira et al.

    Measuring cumulative trauma dose, types and profiles using a development-based taxonomy of traumas

    Traumatology

    (2008)
  • J. Klapow et al.

    Psychological disorders and distress in older primary care patients: a comparison of older and younger samples

    Psychosom. Med.

    (2002)
  • K.C. Koenen et al.

    Persisting Postraumatic Stress Disorder symptoms and their relationship to functioning in Vietnam Veterans: a 14-year follow-up

    J. Trauma. Stress

    (2008)
  • Cited by (0)

    View full text