Transgenerational consequences of PTSD: risk factors for the mental health of children whose mothers have been exposed to the Rwandan genocide

Abstract

Background: Understanding how parental Posttraumatic Stress Disorder (PTSD) may or may not affect the development and mental health in the offspring is particularly important in conflict regions, where trauma-related illness is endemic. In Rwanda, organised atrocities and the genocide against the Tutsi of 1994 have left a significant fraction of the population with chronic PTSD. The aim of the present investigation was to establish whether PTSD in mothers is associated with symptoms of depression, anxiety, and aggressive and antisocial behaviour in their children.

Methods: A community sample of 125 Rwandan mothers who experienced the genocide of 1994 and their 12-year-old children were interviewed. Using a structured interview, symptoms of maternal PTSD and children's depression, anxiety, and aggressive and antisocial behaviour were assessed by trained and on-site supervised local B.A. psychologists. The interview also included a detailed checklist of event types related to family violence.

Results: In showing that a maternal PTSD was not associated with child's psychopathology, the results contradict the assumption of straight "trans-generational trauma transmission". Instead, a child's exposure to maternal family violence posed a significant risk factor for a negative mental health outcome. Furthermore, it was not maternal PTSD-symptoms but mother's exposure to family violence during her own childhood that was associated with the magnitude of adversities that a child experiences at home.

Conclusions: Contrary to a simple model of a trans-generational transmission of trauma, neither maternal PTSD nor maternal traumatic experiences were directly associated with symptoms of anxiety, depression, or antisocial and aggressive behaviour in the children. Instead, the present results suggest a relationship between parental child rearing practices and children's mental health. Furthermore, the study details the "cycle of violence", showing a significant link between maternal violence against a child and its mother's experience of childhood maltreatment.

Figures

Figure 1

Diagram illustrating the causal pathways of the tested hypothesis.

Figure 2

Scatter plot and Pearson correlation coefficient for maternal traumatic experiences (number of event types) and children’s psychopathology score. r = - .01, p = .94.

Figure 3

Boxplot and t-values of t-Test for independent samples with maternal PTSD diagnosis as group variable and children’s psychopathology score as dependent variable. t = - 1.61, p = .11.

Figure 4

Scatter plot and Pearson correlation coefficient for children’s exposure to maternal violence (number of event types) and children’s psychopathology score. r = .59, p < .001.

Figure 5

Boxplot and t-values of t-Test for independent samples with maternal PTSD diagnosis as group variable and children’s experienced maternal violence at home (sum score of event types) as dependent variable. t = - .73, p = .46.

Figure 6

Scatter plot and Pearson correlation coefficient for children’s experienced maternal violence at home (sum score of event types) and family violence experienced by the mother during her own childhood (sum score of event types). r = .23, p < .01.

Figure 7

Diagram illustrating the complexities of the investigation. The child with all its strength and vulnerabilities should be the central focus of the investigation. Depending on various factors, e.g. genetic predispositions, children may be strengthened or may become more vulnerable by the knowledge of parental traumatic experiences [45]. Second, the mental health status of the child’s caretakers – in most cases the biological parents – must be considered. The parent itself may not only show PTSD in consequence of the experience of traumatic events, but develop also other pathological behaviour patterns, symptoms (e.g. complex traumatization, depression), or specific personality configurations. It must be considered that people exposed to traumatic events don’t only report negative consequences in their lives. Some show positive changes in their self-perception, in their perception of others and in the objective and meaning of their lives [62,63]. Third, the family context in general must be respected. It implies the impact of siblings or general family functioning, such as patterns of communication, parenting capacity, stress-coping strategies or general worldviews [45,46]. Fourth, the influence of the extra familial support system needs to be taken into account, such as peers, level of integration in the community, which may e.g. concern prejudice of minorities such as refugees or immigrants [45].