Complex posttraumatic stress disorder in intergenerational trauma transmission among Eritrean asylum-seeking mother-child dyads

Background: Traumatic stress among forcibly displaced people has a variety of adverse consequences beyond individual mental health, including implications for poor socioemotional developmental outcomes for their children post-displacement. 


Objective: This study explored the intergenerational transmission of maternal ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) and depression among asylum-seeking mothers for their children's internalizing and externalizing difficulties. 


Method: Participants were 127 trauma-affected Eritrean mothers of preschool-aged children in Israel. The severity of child difficulties was compared between mothers with probable ICD-11 CPTSD (94.5% comorbid depression), ICD-11 PTSD (48.5% comorbid depression), unimorbid depression, and healthy mothers, using multivariate analyses of variance, while controlling for children's direct exposure to adverse life experiences.

Results: Probable ICD-11 CPTSD and PTSD were present in 23.6% and 26.0% of mothers, respectively. Relative to maternal PTSD, CPTSD was significantly and strongly associated with elevated child internalizing symptoms (d = 2.44) and marginally significantly, although strongly, associated with child externalizing symptoms (d = 1.30). Post-hoc exploratory analyses documented that, relative to maternal PTSD and depression, CPTSD and depression comorbidity was marginally significantly but strongly associated with child internalizing (SMD = .67), but not externalizing symptoms (SMD = .35). 


Conclusions: Findings implicate maternal CPTSD and comorbid depression in child socio-emotional development and inform clinical assessment, prevention, and intervention to attenuate poor development among children in unstable post-displacement settings.


  • Trauma among forcibly displaced people has a variety of aversive multisystemic consequences, compromising the socioemotional development of non-exposed children.
  • ICD-11 complex posttraumatic stress disorder (CPTSD) and comorbid depression may be functionally important to elevated risk for maternal intergenerational trauma transmission, even relative to ICD-11 posttraumatic stress disorder (PTSD).
  • To effectively attenuate intergenerational transmission of trauma post-displacement, efforts and resources should be invested in maternal mental health care as well as socio-culturally adapted, trauma-sensitive parenting training.
Rahel Bachem, Yafit Levin, Kim Yuval, Nora Korin Langer, Zahava Solomon and Amit Bernstein | 2024
In: European journal of psychotraumatology ; ISSN:2000-8066 | 15 | 1 | 2300588
Asylum Seekers, Children, Complex PTSD, Depressive Disorders, Epidemiology, Eritreans, Females, Historical Trauma, Intergenerational Effects, Migrants, Mother-child relationships, Posttraumatic Stress Disorder, Psychotrauma, PTSD (en)