Epigenetic changes damage mental health but are treatable

OVERVIEW

The trauma from violence, conflict, disasters or pandemics is not felt only by their immediate sufferers. Trauma can be inherited, for example by babies born to mothers suffering stress in pregnancy.  It can even change gene expression and thus pass between generations. Without effective interventions, trauma can compound in future generations, weakening societies’ ability to thrive. Building intergenerational equity requires us to address the mental health of individuals and the resilience of societies to break the cycle of inherited trauma.

SIGNALS

Violent tragedies, from genocide to slavery to conflicts across the world today, demonstrate that trauma leaves a legacy of damage to the descendants of those who experienced it. How trauma is passed down epigenetically through generations, influencing gene expression381 in future generations, is still debated, but intergenerational trauma has been linked to depression, mental disorders and mortality rates.

Rwandans continue to suffer from the collective trauma of the genocide of 1994. Four generations of people in Bosnia and Herzegovina are affected by traumas of the wars of the last century; even those born after the war can inherit the traumas of parents who were witnesses, victims or perpetrators of violence. Yazidi survivors of the 2014 genocide suffered higher psychological stress and suicidality than Yazidis not exposed to violence. Mothers who experienced the Holocaust showed changes in the activity of a DNA segment regulating the stress response – changes that appeared also in their children. Apartheid discrimination and violence suffered by pregnant women in South Africa affected their unborn children years later. 155,000 pregnant women are suffering during war in Gaza.

It is not only conflict that inflicts trauma. Natural disasters increase the prevalence of mental health disorders. COVID-19 stress physically altered teenagers’ brains in ways previously only seen in children experiencing chronic adversity. The trauma women suffer from gender-based violence, which remains one of the commonest violations of human rights, and conflict-related sexual violence, affects the health and well-being of their children, with high social and economic costs for women, their families and societies. Breaking the cycle of intergenerational trauma not only matters for individuals’ mental health and their chances to thrive, it is essential to building healthy, resilient societies.

SO WHAT FOR DEVELOPMENT?

With conflicts at their highest since World War II, two billion people are today exposed to the trauma of war. Many conflicts persist through generations. Preventing conflict would end intergenerational trauma before it’s even created.

Trauma is a development issue that goes far beyond a single sector and a single generation. Inherited trauma, untreated, impairs a person’s cognitive development and damages their educational and professional chances, destroying human capital that is vital to development. Yet research suggests that the effects of trauma on children’s brains, once considered permanently damaging, are in fact amenable to treatment, underlining the importance of mental healthcare. This is a serious challenge for low- and middle-income countries, where only 0.3% of public health spending is allocated to mental health, compared to 3.4% in high-income countries.

Sierra Leone’s transitional justice model, which included a Truth and Reconciliation Commission as well as a formal prosecution mechanism, has helped keep the peace in Sierra Leone. But years after the civil war and the Ebola epidemic, people continue to suffer the effects of trauma from both, while mental health services remain very limited. 

Rwanda’s success in treating survivors of the 1994 genocide through community-based approaches, such as integrating mental health services into primary care, shows that effective trauma treatment and resilience-building is possible, even with limited resources. Rwanda’s social healing programme, including community dialogues and restorative justice, has been effective in building a unified Rwandan identity.