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Long-term neurostructural and psychological effects of war stress in two generations of civilians from the former Yugoslavia
Monika Fňašková, Pavel Říha, David Ulčák, Marek Preiss, Markéta Nečasová, Nikola Wolframová, Vojtěch Svoboda, Martin Lamoš & Ivan Rektor
The long-term neurobiological and psychological effects of war-related stress on civilians remain understudied. This study focuses on survivors of the war in the former Yugoslavia (G1) who now reside in the Czech Republic and on the children of survivors (G2) who were born after the conflict. Participants from G1, G2, and a control group (CG) with no war experience underwent structural MRI, answered a semi-structured interview, and completed psychological questionnaires (PTGI, PCL-5, SWSL, MSPSS, Brief-COPE). Voxel-based morphometry was used to assess brain volume differences. Compared to CG, G1 showed reduced grey matter volume in regions associated with PTSD and autobiographical memory, including Crus II, parahippocampal gyrus, middle temporal gyrus, and fusiform gyrus. Psychologically, G1 reported higher PTSD symptoms, lower life satisfaction, and greater post-traumatic growth. G2 showed no structural brain changes but scored higher on post-traumatic growth than CG, with no significant differences in other psychological measures. The findings suggest long-lasting neuroanatomical and psychological effects of war stress in directly exposed individuals (G1). Although G2 showed no brain alterations, the increased post-traumatic growth may indicate subtle adaptation effects of growing up in a post-war environment, but not necessarily only in a maladaptive sense.
Long-term psychological effects of war trauma and migration: an interpretative phenomenological analysis of Balkan war survivors
Markéta Nečasová, Marek Preiss, David Ulčák, Ivan Rektor, Alice Prokopová, Monika Fňašková
The wars following the breakup of Yugoslavia led to mass displacement, violence, and long-term psychological suffering among civilians. While clinical responses to war-related trauma and refugee experiences have been widely studied, less is known about how survivors make sense of these events decades later and how trauma and emigration continue to shape their identity, relationships, and wellbeing. This study examines the long-term psychological impacts of war and migration among civilian survivors of the Balkan wars resettled in the Czech Republic, with attention to meaning-making processes decades after the original events. We conducted an interpretative phenomenological analysis of in-depth, semi-structured interviews with four adult civilian survivors of the Balkan wars, all of whom experienced emigration and long-term resettlement. Participants described wartime life as isolating, marked by survival-focused coping. They highlighted the importance of close relationships, routines, and developmental stage in shaping how they endured this period. Decades later, they reported persistent vigilance, moral reflection, and existential questioning, alongside posttraumatic growth. Migration was perceived as a prolonged, transformative process reshaping identities and relationships to cultural roots. Intergenerational impact emerged, with participants reflecting on survival strategies transmitted to their children. The findings suggest that war trauma and migration are not discrete events but temporally extended, relational processes, unfolding across the lifespan. This perspective advances psychological understanding of trauma trajectories, identity reconstruction, and intergenerational adaptation.
Travelers between cultures: The war and post-war generations
Marek Preiss, Monika Fnaskova, Markéta Nečasova, Nikola Doubkova, Nikola Wolframova, Vojtěch Svoboda, David Ulcak, Edel Sanders, Ivan Rektor
War in the former Yugoslavia still reverberates in the lives of the generations that lived through it. The aim of this study was to compare a cohort that had direct experience of the war (first generation, G1, n = 89) with those born after the war (second generation, G2, n = 30). All participants stay or live in the Czech Republic. We used an individualized approach, with a structured interview of 91 questions, supplemented by quantitative methods to measure traumatic stress (PCL-5), adverse childhood experiences (ACEs) and centrality of the event (CES). G1 had a higher mean ACE score compared to G2, and the two generations did not differ in centrality of the event and trauma symptom severity, in the rate of psychiatric outpatient care use, psychiatric hospitalizations, diagnosed PTSD, current psychiatric medication use and in illicit drug use. A number of signs were indicative of good resilience, including the ability to move internationally, which implies language proficiency, and the ability to earn a sufficient income. G1 and G2 respondents represent a group of educated individuals with their mental health mostly matching that of the general population, as well as people who have success in their professional and personal lives.
Daily Stress Variability in Two Generations of Survivors of the War in the Former Yugoslavia
Nikola Doubková, Filip Zlámal, Monika Fňašková, Marek Preiss, Markéta Nečasová, Nikola Wolframová, Vojtěch Svoboda, David Ulčák, Ivan Rektor
The war in the former Yugoslavia had a profound impact on millions of civilians, leaving long-lasting psychological consequences. This study aimed to examine stress sensitivity and variability in the daily lives of survivors using a longitudinal design. First-generation survivors (G1; n = 79), second-generation survivors born after the war (G2; n = 28), and a non-war-exposed control group (n = 60) participated. The baseline assessment included measures of stress- and trauma-related symptoms, life satisfaction, and coping mechanisms. Daily perceived stress was then monitored over 21 consecutive days using the experience sampling method. Although there were no group differences in baseline measures or mean daily stress levels, variability in daily stress showed distinct generational patterns. G1 exhibited lower variability compared to both controls and G2, which showed the highest variability. Variability was significantly associated with trauma-related symptoms, dysfunctional coping, and life satisfaction. This study showed that the lasting psychological consequences of the war in the former Yugoslavia may not be reflected in elevated daily stress levels or baseline psychopathology but rather may be subtly expressed through altered perceptions and sensitivity to daily stress, even decades after the war. These findings provide novel support for the latent vulnerability hypothesis.
War and women: An analysis of Ukrainian refugee women staying in the Czech Republic
Marek Preiss, Monika Fňašková, Sofiia Berezka, Tetiana Yevmenova, Radek Heissler, Edel Sanders, Petra Winnette, Ivan Rektor
In addition to the loss of life, Russian aggression against Ukraine, which began in February 2022, also brings interpersonal losses resulting from the need to emigrate. Parallel to the fighting men, women bear most of the burden of caring for the family. Using in-depth interviews supplemented by questions about adverse childhood experiences and administration of The Centrality of Events Scale and the PTSD Checklist – PCL-5 with 43 Ukrainian women (18–60 years old), we analyzed adaptation to the situation of emigration and the association of their war and earlier experiences with the level of traumatization. Women were interviewed shortly after emigration to the Czech Republic (3–42 week afterward). High levels of adverse childhood experiences and post-traumatic stress symptoms were found. The war was perceived as a currently negative central event associated with traumatic stress symptoms, and 79% of the sample expressed the opinion that the war had changed them. The results of this study suggest an intertwining of previous life experiences with the current need and ability to adapt.
Lifelong effects of prenatal and early postnatal stress on the hippocampus, amygdala, and psychological states of Holocaust survivors
Monika Fňašková, Pavel Říha, Markéta Nečasová, Marek Preiss, Ivan Rektor
This study focuses on hippocampal and amygdala volume, seed-based connectivity, and psychological traits of Holocaust survivors who experienced stress during prenatal and early postnatal development. We investigated people who lived in Central Europe during the Holocaust and who, as Jews, were in imminent danger. The group who experienced stress during their prenatal development and early postnatal (PreP) period (n = 11) were compared with a group who experienced Holocaust-related stress later in their lives: in late childhood, adolescence, and early adulthood (ChA) (n = 21). The results of volumetry analysis showed significantly lower volumes of both hippocampi and the right amygdala in the PreP group. Seed-based connectivity analysis revealed increased connectivity from the seed in the right amygdala to the middle and posterior cingulate cortex, caudate, and inferior left frontal operculum in the PreP group. Psychological testing found higher levels of traumatic stress symptoms (TCS-40) and lower levels of well-being (SOS-10) in the PreP group than in the ChA group. The results of our study demonstrate that extreme stress experienced during prenatal and early postnatal life has a profound lifelong impact on the hippocampus and amygdala and on several psychological characteristics.
Wellbeing and national identity in three generations of Czech and Slovak Holocaust survivors
Preiss M, Fňašková M, Nečasová M, Heissler R, Bob P, Prokopová A, Šamánková D, Sanders E, Rektor I.
Posttraumatic Stress and Posttraumatic Growth in Three Generations of Czech and Slovak Holocaust Survivors
Marek Preiss, Dita Šamánková, Jiří Štipl, Monika Fňašková, Markéta Nečasová, Petr Bob, Radek Heissler, Alice Prokopová, Tereza Heřmánková, Veronika Juričková, Edel Sanders, Eva Wagenknechtová and Ivan Rektor
The psychological consequences of trauma related to the Holocaust have been primarily studied in samples derived from Israel, North America, and Western Europe. Few studies have examined postcommunist countries in Central and Eastern Europe. The present study focused on three generations living in the Czech Republic and Slovakia after World War II (WWII): Holocaust survivors (71-95 years of age), their children (30-73 years of age), and their grandchildren (15-48 years of age). We compared scores on measures of posttraumatic stress symptoms (PTSS; the Posttraumatic Stress Disorder Checklist-Civilian Version) and posttraumatic growth (PTG; the Posttraumatic Growth Inventory) derived from three focal samples with scores from age-matched comparison participants. Higher PTSS scores emerged for Holocaust survivors in all generations, η2P=.087 but only participants in the first generation reported higher PTG scores relative to the comparison group, with small effect sizes for the overall group differences, η2P=.029. These results are discussed in the historical and political context of postwar Czechoslovakia.
Lifelong impact of extreme stress on the human brain: Holocaust survivors study
Monika Fňašková, Pavel Říha, Marek Preiss, Petr Bob, Markéta Nečasová, Eva Koriťáková and Ivan Rektor
Background: We aimed to assess
the lifelong impact of extreme stress on people who survived the Holocaust. We
hypothesised that the impact of extreme trauma is detectable even after more
than 70 years of an often
complicated and stressful post-war life.
Methods: Psychological testing was performed on 44 Holocaust survivors (HS;
median age 81.5 years; 29 women; 26 HS were under the age of 12 years in 1945)
and 31 control participants without a personal or family history of the
Holocaust (control group (CG); median 80 years; 17 women). Magnetic resonance
imaging (MRI) using the 3T Siemens Prisma scanner was performed on 29 HS
(median 79 years; 18 women) and 21 CG participants (median 80 years; 11 women).
The MRI-tested subgroup that had been younger than 12 years old in 1945 was
composed of 20 HS (median 79 years; 17 women) and 21 CG (median 80 years; 11
women).
Results: HS experienced significantly higher frequency of depression symptoms,
posttraumatic stress symptoms, and posttraumatic growth, and lower levels of
well-being. The MRI shows a lifelong neurobiological effect of extreme stress.
The areas with reduced grey matter correspond to the map of the impact of stress
on the brain structure: insula, anterior cingulate, ventromedial cortex
including the subgenual cingulate/orbitofrontal cortex, temporal pole,
prefrontal cortex, and angular gyrus. HS showed good adjustment to post-war
life conditions. Psychological growth may contribute to compensation for the
psychological and neurobiological consequences of extreme stress. The reduction
of GM was significantly expressed also in the subgroup of participants who
survived the Holocaust during their childhood.
Conclusion: The lifelong psychological and neurobiological changes in people
who survived extreme stress were identified more than 70 years after the
Holocaust. Extreme stress in childhood and young adulthood has an irreversible
lifelong impact on the brain.
Holocaust history is not reflected in telomere homeostasis in survivors and their offspring
Klára Konečná, Martin Lyčka, Lucie Nohelová, Monika Petráková, Monika Fňašková, Eva Koriťáková, Pavla Polanská Sováková, Sylva Brabencová, Marek Preiss, Ivan Rektor, Jiří Fajkus and Miloslava Fojtová
Telomeres, nucleoprotein structures at the ends of eukaryotic chromosomes, are crucial for the maintenance of genome integrity. While the lengths of telomeres at birth are determined genetically, many factors including environmental and living conditions affect the telomere lengths during a lifespan. In this context, extreme and long-term stress has been shown to negatively impact telomeres and their protective function, with even offspring being influenced by the stress experienced by parents. Using quantitative PCR, the relative lengths of telomeres of survivors of the Holocaust during World War II and two generations of their offspring were analyzed. These data were related to those of control groups, persons of comparable age without a strong life stress experience. In contrast to previous studies of other stress-exposed groups, the relative lengths of telomeres were comparable in groups of persons exposed to Holocaust-related stress and their progenies, and in control groups. Interestingly, shorter telomeres of Holocaust survivors of the age under 12 in the year 1945 compared to Holocaust survivors of the age above 12 were detected. Our results are discussed with respect to certain exceptionality of persons having been able to cope with an extreme stress more than 70 years ago and living to a very old age.
No Evidence of Persistence or Inheritance of Mitochondrial DNA Copy Number in Holocaust Survivors and Their Descendants
Na Cai, Monika Fňašková, Klára Konečná, Miloslava Fojtová, Jiří Fajkus, Eve Coomber, Stephen Watt, Nicole Soranzo, Marek Preiss and Ivan Rektor
Mitochondrial DNA copy number has been previously shown to be elevated with severe and chronic stress, as well as stress-related pathology like Major Depressive Disorder (MDD) and post-traumatic stress disorder (PTSD). While experimental data point to likely recovery of mtDNA copy number changes after the stressful event, time needed for full recovery and whether it can be achieved are still unknown. Further, while it has been shown that stress-related mtDNA elevation affects multiple tissues, its specific consequences for oogenesis and maternal inheritance of mtDNA has never been explored. In this study, we used qPCR to quantify mtDNA copy number in 15 Holocaust survivors and 102 of their second- and third-generation descendants from the Czech Republic, many of whom suffer from PTSD, and compared them to controls in the respective generations. We found no significant difference in mtDNA copy number in the Holocaust survivors compared to controls, whether they have PTSD or not, and no significant elevation in descendants of female Holocaust survivors as compared to descendants of male survivors or controls. Our results showed no evidence of persistence or inheritance of mtDNA changes in Holocaust survivors, though that does not rule out effects in other tissues or mitigating mechanism for such changes.