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Intergenerational Trauma in Refugee Families: A Systematic Review


Although a robust literature describes the intergenerational effects of traumatic experiences in various populations, evidence specific to refugee families is scattered and contains wide variations in approaches for examining intergenerational trauma. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, the purpose of this systematic review was to describe the methodologies and findings of peer-reviewed literature regarding intergenerational trauma in refugee families. In doing so we aimed to critically examine how existing literature characterizes refugee trauma, its long-term effects on descendants, and psychosocial processes of transmission in order to provide recommendations for future research. The results highlight populations upon which current evidence is based, conceptualizations of refugee trauma, effects of parental trauma transmission on descendants’ health and well-being, and mechanisms of transmission and underlying meanings attributed to parental trauma in refugee families. Greater methodological rigor and consistency in future evidence-based research is needed to inform supportive systems that promote the health and well-being of refugees and their descendants.

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Fig. 1


  1. 1.

    United Nations High Commissioner on Refugees (UNHCR): population statistics. UNCHR, 2015. Available from

  2. 2.

    Fazel M, Reed RV, Panter-Brick C, Stein A. Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet. 2012;379(9812):266–82.

    Article  PubMed  Google Scholar 

  3. 3.

    Kirmayer LJ, Narasiah L, Munoz M, Rashid M, Ryder AG, Guzder J, Hassan G, Rousseau C, Pottie K. Common mental health problems in immigrants and refugees: general approach in primary care. Can Med Assoc J. 2011;183(12):E959–E967.

    Article  Google Scholar 

  4. 4.

    Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA. 2005;294(5):571–9.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Weine S, Muzurovic N, Kulauzovic Y, Besic S, Lezic A, Mujagic A, Muzurovic J, Spahovic D, Feetham S, Ware N, Knafl K, Pavkovic I. Family consequences of refugee trauma. Fam Process. 2004;43(2):147–60.

    Article  PubMed  Google Scholar 

  6. 6.

    Dekel R, Goldblatt H. Is there intergenerational transmission of trauma? The case of combat veterans’ children. Am J Orthopsychiatry. 2008;78(3):281.

    Article  PubMed  Google Scholar 

  7. 7.

    Bezo B, Maggi S. Living in “survival mode:” Intergenerational transmission of trauma from the Holodomor genocide of 1932–1933 in Ukraine. Soc Sci Med. 2015;134:87–94.

    Article  PubMed  Google Scholar 

  8. 8.

    Han M. Relationship among perceived parental trauma, parental attachment, and sense of coherence in Southeast Asian American college students. J Fam Soc Work. 2005;9(2):25–45.

    Article  Google Scholar 

  9. 9.

    George M. A theoretical understanding of refugee trauma. Clin Soc Work J. 2010;38(4):379–87.

    Article  Google Scholar 

  10. 10.

    Hein J. Refugees, immigrants, and the state. Annu Rev Sociol. 1993;43–59.

  11. 11.

    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.

    Article  PubMed  Google Scholar 

  12. 12.

    Braga LL, Mello MF, Fiks JP. Transgenerational transmission of trauma and resilience: a qualitative study with Brazilian offspring of Holocaust survivors. BMC Psychiatry. 2012;12(1):134–44.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Lev-Wiesel R. Intergenerational transmission of trauma across three generations: a preliminary study. Qual Soc Work. 2007;6(1):75–94.

    Article  Google Scholar 

  14. 14.

    Fridman A, Bakermans-Kranenburg MJ, Sagi-Schwartz A, Van IJzendoorn MH. Coping in old age with extreme childhood trauma: aging Holocaust survivors and their offspring facing new challenges. Aging & Ment. Health (London). 2011;15(2):232–42.

    Google Scholar 

  15. 15.

    Kellermann NPF. Perceived parental rearing behavior in children of Holocaust survivors. Isr J Psychiatry Relat Sci. 2015;38(1):58–68.

    Google Scholar 

  16. 16.

    Letzter-Pouw S, Shrira A, Ben-Ezra M, Palgi Y. Trauma transmission through perceived parental burden among Holocaust survivors’ offspring and grandchildren. Psychol Trauma. 2013;6(4):420–9.

    Article  Google Scholar 

  17. 17.

    Sagi-Schwartz A, Van Ijzendoorn MH, Grossmann KE, Joels T, Grossmann K, Scharf M, Koren-Karie N, Alkalay S. Attachment and traumatic stress in female Holocaust child survivors and their daughters. Am J Psychiatry. 2003;160(6):1086–92.

    Article  PubMed  Google Scholar 

  18. 18.

    Shrira A, Palgi Y, Ben-Ezra M, Shmotkin D. Transgenerational effects of trauma in midlife: evidence for resilience and vulnerability in offspring of Holocaust survivors. Psychol Trauma. 2012;3(4):394–402.

    Article  Google Scholar 

  19. 19.

    Shrira A. Transmitting the sum of all fears: Iranian nuclear threat salience among offspring of Holocaust survivors. Psychol Trauma. 2015;7(4):364–71.

    Article  PubMed  Google Scholar 

  20. 20.

    Wiseman H, Metzl E, Barber JP. Anger, guilt, and intergenerational communication of trauma in the interpersonal narratives of second generation Holocaust survivors. Am J Orthopsychiatry. 2006;76(2):176–84.

    Article  PubMed  Google Scholar 

  21. 21.

    Wiseman H. On failed intersubjectivity: recollections of loneliness experiences in offspring of Holocaust survivors. Am J Orthopsychiatr. 2008;78(3):350–8.

    Article  Google Scholar 

  22. 22.

    Giladi L, Bell TS. Protective factors for intergenerational transmission of trauma among second and third generation Holocaust survivors. Psychol Trauma. 2012;5(4):384–91.

    Article  Google Scholar 

  23. 23.

    Yehuda R, Halligan SL, Grossman R. Childhood trauma and risk for PTSD: relationship to intergenerational effects of trauma, parental PTSD, and cortisol excretion. Dev Psychopathol. 2001;13(3):733–53.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Yehuda R, Bell A, Bierer LM, Schmeidler J. Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors. J Psychiatr Res. 2008;42(13):1104–11.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Weinberg MK, Cummins RA. Intergenerational effects of the Holocaust: subjective well-being in the offspring of survivors. J Intergener Relatsh. 2013;11(2):148–61.

    Google Scholar 

  26. 26.

    Vaage AB, Thomsen PH, Rousseau C, Wentzel-Larsen T, Ta TV, Hauff E. Paternal predictors of the mental health of children of Vietnamese refugees. Child Adolesc Psychiatr Ment Health. 2011;5(2):1–11.

    Google Scholar 

  27. 27.

    Spencer JH, Le TN. Parent refugee status, immigration stressors, and Southeast Asian youth violence. J Immigr Minor Health. 2006;8(4):359–68.

    Article  PubMed  Google Scholar 

  28. 28.

    Lin NJ, Suyemoto KL, Kiang PNC. Education as catalyst for intergenerational refugee family communication about war and trauma. Commun Disord Q. 2009;30(4):195–207.

    Article  Google Scholar 

  29. 29.

    Daud A, Skoglund E, Rydelius PA. Children in families of torture victims: transgenerational transmission of parents’ traumatic experiences to their children. Int J Soc Welf. 2005;14(1):23–32.

    Article  Google Scholar 

  30. 30.

    Daud A, Klinetberg B, Rydelius PA. Resilience and vulnerability among refugee children of traumatized and non-traumatized parents. Child Adolesc Psychiatr Mental Health. 2008;2(7).

  31. 31.

    Ellis BH, MacDonald HZ, Lincoln AK, Cabral HJ. Mental health of Somali adolescent refugees: the role of trauma, stress, and perceived discrimination. J Consult Clin Psychol. 2008;76(2):184–93.

    Article  PubMed  Google Scholar 

  32. 32.

    Miller KE, Rasmussen A. War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Soc Sci Med. 2010;70(1):7–16.

    Article  PubMed  Google Scholar 

  33. 33.

    Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365(9467):1309–14.

    Article  PubMed  Google Scholar 

  34. 34.

    Van Ijzendoorn MH, Bakermans-Kranenburg MJ, Sagi-Schwartz A. Are children of Holocaust survivors less well-adapted? A meta-analytic investigation of secondary traumatization. J Trauma Stress. 2003;16(5):459–69.

    Article  PubMed  Google Scholar 

  35. 35.

    Hollifield M, Eckert V, Warner TD, Jenkins J, Krakow B, Ruiz J, Westermeyer J. Development of an inventory for measuring war-related events in refugees. Compr Psychiatry. 2005;46(1):67–80.

    Article  PubMed  Google Scholar 

  36. 36.

    Eisenbruch M. From post-traumatic stress disorder to cultural bereavement: diagnosis of Southeast Asian refugees. Soc Sci Med. 1991;33(6):673–80.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Pedersen D. Political violence, ethnic conflict, and contemporary wars: broad implications for health and social well-being. Soc Sci Med. 2002;55(2):175–90.

    Article  PubMed  Google Scholar 

  38. 38.

    Hollifield M, Warner TD, Lian N, Krakow B, Jenkins JH, Kesler J, Stevenson J, Westermeyer J. Measuring trauma and health status in refugees: a critical review. JAMA. 2002;288(5):611–21.

    Article  PubMed  Google Scholar 

  39. 39.

    Taku K, Cann A, Calhoun LG, Tedeschi RG. The factor structure of the posttraumatic growth inventory: a comparison of five models using confirmatory factory analysis. J Trauma Stress. 2008;21(2):158–64.

    Article  PubMed  Google Scholar 

  40. 40.

    Weingarten K. Witnessing the effects of political violence in families: mechanisms of intergenerational transmission and clinical interventions. J Marital Fam Ther. 2004;30(1):45–59.

    Article  PubMed  Google Scholar 

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Correspondence to Cindy C. Sangalang.

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All listed authors have reviewed and approved this manuscript, report no conflicts of interest, and will accept responsibility for its content.

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Sangalang, C.C., Vang, C. Intergenerational Trauma in Refugee Families: A Systematic Review. J Immigrant Minority Health 19, 745–754 (2017).

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  • Intergenerational trauma
  • Refugees
  • Families