Impact of early lifetime trauma in later life: depression among Holocaust survivors 60 years after the liberation of Auschwitz.

RATIONALE: Holocaust survivors, who experienced trauma 60 years ago, provide an opportunity to explore the impact of early lifetime trauma in later life and, in particular, the interplay of depression and posttraumatic stress disorder (PTSD). In this study, the authors contrast depressed Holocaust survivors (HD), nondepressed Holocaust survivors (HND), and older depressed persons (CD). METHODS: The sample consisted of 36 consecutive Holocaust survivors (mean age: 79 years) treated in a primary care practice, among whom 20 (56%) were diagnosed as having a major depressive disorder and 16 as nondepressed; 18 depressed non-Holocaust Jewish primary care patients served as controls (mean age: 84 years). The authors examined nine clinical and social variables. The Kruskal-Wallis, Mann-Whitney U, and chi(2) tests were used to contrast the groups. The authors used a conservative significance level of .01. RESULTS: In contrast to the CD group, the HD group was significantly older, more likely to report PTSD and guilt symptoms, to have higher Beck Anxiety Inventory (BAI) and Brief Psychiatric Rating Scale (BPRS) scores, and to have more impaired social functioning. In contrast to the HND group, the HD group was significantly more likely to report PTSD and guilt feelings, to have higher Hamilton Depression Scale (HAM-D), BAI, and BPRS scores, and to have more impaired social functioning. In contrast to the CD group, the HND group was significantly more likely to have PTSD symptoms and to have lower HAM-D and BPRS scores. CONCLUSIONS: The prevalence of depression and PTSD symptoms were very high among survivors. Depressed survivors had significantly worse psychologic and social functioning than depressed controls. Depressed survivors had more PTSD symptoms than nondepressed survivors, although it is unclear as to the causal direction of the relationship between depression and PTSD.