Family Over-Involvement Mediates PTSD Symptoms in Holocaust Descendants Following the October 7 Attack: A Prospective Study

Family over-involvement, defined as emotions, thoughts, and behaviors indicating an over-protection of family members and preoccupation with family legacy, is recognized as a unique yet underexplored mechanism in the intergenerational effects of trauma. The study examined the role of family over-involvement in predicting post-traumatic stress disorder (PTSD) symptoms among Holocaust descendants following the October 7 attack and during the Israel-Hamas War. Using a longitudinal prospective design, Israeli Jew descendants from two generations (second and third generation to those who were living during WWII) completed questionnaires via a web-based survey company a year before the October 7, 2023 attack (W1, 2022, N = 1071) and two and 9 months during the war (W3, December 2023, N = 582, and W4, July 2024, N = 405). Results showed significantly higher levels of family over-involvement (i.e., descendants' efforts to compensate for their ancestors' suffering, shield ancestors from further suffering, and care for family continuation) in Holocaust descendants relative to comparisons. Path analysis showed that family over-involvement mediated the effect of having a Holocaust background on PTSD symptoms in W3 and the effect of having a Holocaust background on PTSD symptoms in W4 via PTSD symptoms in W3. Moderated mediation analysis revealed that the mediation effect of the compensation subscale of family over-involvement was stronger among the second generation relative to the third generation. The findings have crucial implications by highlighting family over-involvement as a unique interpersonal mechanism behind the intergenerational effects of Holocaust trauma, which clinicians should integrate in multi-generational interventions with Holocaust families, particularly when descendants face adversity.