Maternal Age at Holocaust Exposure and Maternal PTSD Independently Influence Urinary Cortisol Levels in Adult Offspring

Abstract

Background: Parental traumatization has been associated with increased risk for the expression of psychopathology in offspring, and maternal posttraumatic stress disorder (PTSD) appears to increase the risk for the development of offspring PTSD. In this study, Holocaust-related maternal age of exposure and PTSD were evaluated for their association with offspring ambient cortisol and PTSD-associated symptom expression.

Method: Ninety-five Holocaust offspring and Jewish comparison subjects received diagnostic and psychological evaluations, and 24 h urinary cortisol was assayed by RIA. Offspring completed the parental PTSD questionnaire to assess maternal PTSD status. Maternal Holocaust exposure was identified as having occurred in childhood, adolescence, or adulthood and examined in relation to offspring psychobiology.

Results: Urinary cortisol levels did not differ for Holocaust offspring and comparison subjects but differed significantly in offspring based on maternal age of exposure and maternal PTSD status. Increased maternal age of exposure and maternal PTSD were each associated with lower urinary cortisol in offspring, but did not exhibit a significant interaction. In addition, offspring PTSD-associated symptom severity increased with maternal age at exposure and PTSD diagnosis. A regression analysis of correlates of offspring cortisol indicated that both maternal age of exposure and maternal PTSD were significant predictors of lower offspring urinary cortisol, whereas childhood adversity and offspring PTSD symptoms were not.

Conclusion: Offspring low cortisol and PTSD-associated symptom expression are related to maternal age of exposure, with the greatest effects associated with increased age at exposure. These effects are relatively independent of the negative consequences of being raised by a trauma survivor. These observations highlight the importance of maternal age of exposure in determining a psychobiology in offspring that is consistent with increased risk for stress-related pathology.

Keywords: Holocaust; PTSD; cortisol; intergenerational; maternal; offspring; risk; trauma.

Figure 1

Twenty-four-hour urinary cortisol excretion based on maternal age at Holocaust exposure in control subjects and Holocaust offspring. Estimated marginal means ± SEM for urinary cortisol levels (microgram per day) are presented for comparison subjects (white bar) and Holocaust survivor offspring grouped according to whether offspring’s mother was a child (age 0–11; solid blue bar), adolescent (age 12–18; speckled gold bar), or adult (diagonally striped red bar) at Holocaust exposure (age 18 or older). Statistical significance was set at p < 0.05.

Figure 2

Relationship of maternal age at Holocaust exposure with offspring 24-h urinary cortisol excretion. A partial correlation between maternal age at Holocaust exposure and Holocaust offspring cortisol level controlling for offspring age, gender, and current depressive disorder diagnosis (r = −0.347, df = 59, p = 0.006) is depicted using linear regression and unstandardized residuals that were added to the raw values. Data points are colored for ease of interpretation to associate with the child (blue), adolescent (gold), and adult (red) maternal age of exposure groups. The total number of subjects included in this analysis is 64. The correlation coefficients are denoted and the statistical significance was set at p < 0.05.

Figure 3

Influence of maternal age at Holocaust exposure and maternal PTSD on offspring 24-h urinary cortisol excretion and lifetime PTSD-related symptom severity. Offspring cortisol (A) and offspring lifetime clinician-administered PTSD scale (CAPS) total score (B) are depicted based on maternal age at Holocaust and maternal PTSD status. Maternal PTSD − offspring are depicted with light blue, checkered bars and maternal PTSD + offspring are represented with solid purple bars. Data were adjusted for age, gender, and diagnosis of current depressive disorder and are represented as estimated marginal means ± SEM. *, versus PTSD – was statistically significant. Statistical significance was set at p < 0.05.