WWII traumatic events, subjective well-being and valuation of life in the very old

Traumatic events are known to have harmful effects on health throughout life [3]. Around 70% of the global population experience at least one traumatic event throughout their lifetime [19]. Many old people intentionally or unintentionally re-engage with early life traumatic experiences, which is often perceived as stressful [4, 5]. Nevertheless, positive subjective well-being (SWB; i.e. positive reactions to one’s life [6]) and high valuation of life (VoL; affectpive and cognitive appraisals of the perceived value of one’s life [24]) seem to be widespread in the very old population [17, 33]. While the very old population (≥ 80 years) is expected to triple by the middle of this century [12] studies about the long-lasting effects of traumatic events on SWB and VoL in this specific population are still rare.

In Germany, scholars with a background in psychodynamic psychotherapy pioneered work in the field of late effects of traumatic World War II (WWII) experiences, based on their clinical experiences [22, 26, 28, 29]. This was followed by epidemiological studies. In a representative study conducted in 2008, around 57% of all Germans aged 60–85 years said they had experienced at least 1 war-related traumatic event [10]. This group experienced WWII as children or adolescents, at a time when the vulnerability for stress-related disorders is elevated [3, 30]. Previous studies focused on the long-lasting pathological consequences of WWII-related traumatic events, such as posttraumatic stress disorder (PTSD). Selected subsamples showed a prevalence of PTSD in older adults between 1% in former WWII child soldiers [21] and 42% in former displaced children [35]. Compared to other traumatic WWII experiences, the experience of sexual violence was particularly associated with PTSD symptoms in older age [20]. War-related experiences that cannot be described as traumatic in the strict sense, such as the absence of the father in childhood, are also associated with psychiatric symptoms in older age [7]. A representative survey held in 2005 showed a PTSD prevalence of over 3% in older German adults born in 1945 or earlier (and over 7% when partial PTSD was included) [9]. The study by Glaesmer et al. [10] showed a similar prevalence of 4%. In a 25-year longitudinal study of 50 older adults born between 1933 and 1945, Hiltl et al. [16] found associations between childhood burden and psychosomatic disorders but not between WWII traumatic events and psychosomatic disorders in later life.

The long-term effects of traumatic events, lasting for years to decades, are complex and difficult to measure but many individuals experience more war-related thoughts, memories, and feelings after being confronted with the normative process of aging (e.g. retirement, loss of close relatives). In summary, there is ample evidence of the pathological effects of early WWII-related trauma; however, findings on nonpathological outcomes, such as SWB and VoL, are still insufficient. The present study sought to broaden the understanding of long-term effects of WWII traumatic experiences in the very old population by examining their associations with SWB and VoL.

This study examined WWII traumatic experiences that are perceived as burdening by today’s very old (≥80 years) and their association with SWB and VoL. To this end, a representative sample was used from Germany’s most populated federal state NRW. About 42% of the very old respondents stated that they perceive traumatic experiences related to WWII as stressful. Bombing and flight were most frequently mentioned as the most stressful experiences.

While most other studies aimed at the psychopathological consequences of WWII traumatic events (i.e. mainly PTSD), the present study focused on the effects on SWB and VoL. As expected, suffering from the effects of WWII traumatic events was associated with more negative affect (i.e. depressive symptoms), even after controlling for a wide range of vulnerabilities for depression in very old age (e.g. age, gender, number of treated medical conditions, and full inpatient care).

The results are in line with previous studies about traumatic WWII experiences in the very old German population. For example, 10 years earlier, Glaesmer et al. found that 57% of the population of older adults reported having experienced at least one traumatic war event, which was associated with higher risks for current depressive symptoms [10]. Experiencing civil and war traumatic events was also repeatedly associated with depressive symptoms in international studies (e.g. [2]). Considered together, this underlines the association of WWII traumatic events with negative affect in today’s very old population.

In the present study, suffering from WWII traumatic experiences was, however, not associated with positive affect. This finding supports the dual channel model of Lawton et al. [23], which postulates that positive affect is more closely related to outer influences, such as quality of time and friends, while negative affect is more closely related to inner influences, such as health.

Additionally, suffering from the effects of WWII traumatic events was not associated with VoL. The VoL can be divided into two distinct dimensions: optimism and engagement. Optimism is “a cognitive, optimistic and future-oriented stance towards life” [8], while engagement describes a state of “problem-solving, activation towards and confidence in obtaining one’s desired goals” [8]. The present results partly contradict the finding that traumatic war events are associated with lower satisfaction with life and quality of life in younger civilian [1] and veteran [32] populations.

The Later-Adulthood Trauma Reengagement (LATR) concept of Davison et al. [4, 5] provides one theoretical framework that helps to explain late life influences of early life traumatic war experiences. The authors found that many aging veterans who initially did not develop posttraumatic stress symptoms after traumatic experiences in war re-engaged with their traumatic experiences when confronted with their own aging. Heuft’s concept of trauma reactivation [15] focussed on processes that are not limited to veterans. He formulated that older individuals may deal with unresolved trauma due to more time resources (e.g. retirement) and often feel pressure to complete their unfinished tasks. In addition, experiencing helplessness due to physical aging can revive previous trauma. The results of the present study contribute in several ways to the understanding of these processes in the very old population. Firstly, more than 42% of the sample perceived WWII traumatic experiences, such as bombing or flight as burdening and, thus, might be in the process of trauma re-engagement. In addition, trauma re-engagement was associated with more negative affect; however, positive affect and VoL were not significantly affected by traumatic WWII experiences, adding to the previous body of research. Thus, the influence of traumatic WWII experiences appears to affect primarily negative mood but does not significantly affect other domains of psychological well-being. This finding should be further investigated in subsequent studies.

Nevertheless, the findings of the present study also have an encouraging component. As Glaesmer et al. [10] found in 2008, about 57% of the German older adults (60–85 years) reported having experienced traumatic WWII events. In the present study, a lower proportion of about 42% of the very old reported suffering from the effects of WWII traumatic experiences. Instead of interpreting the elevated negative affect as a negative outcome of the re-engagement with WWII traumatic events, the missing differences in positive affect, optimism, and engagement with life could be seen as a sign of resilience. Whereby resilience can be defined as a “process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of stress” [34] and therefore should not be confused with the absence of symptoms. Future studies could implement measurements of posttraumatic growth (i.e. subjective experience of positive change after traumatic event) to further investigate this process in the very old population. At the same time, a possible cohort effect must be kept in mind when comparing the results of the present study with those of Glaesmer et al. [10].

The well-known limitations of cross-sectional designs regarding causality must be kept in mind when interpreting the present results. Depressed adults are known to be biased towards negative cognitions and memories [11] and could, thus, describe their own past more negatively compared to non-depressed adults. Longitudinal designs are needed in order to provide further insights. The present study used proxies if the target was unable to conduct the interview. Some studies indicate that proxies tend to overestimate the psychological burden of older adults (e.g. [25]). Nevertheless, information given by long-term partners, children or close affiliates may contribute to a more representative picture of the very old population.