Minnesota Nursing magazine

Sarah Hoffman, PhD, MPH, RN

Stopping the transmission of trauma

Creating a family-centered intervention for Karen families
Brett Stursa

For decades, military rule in Burma led to the systematic rape, beating and forced labor of Karen people, causing them to flee to refugee camps in Thailand.

From there, more than 10,000 Karen refugees have resettled in Minnesota, making it home to the largest Karen community in the United States. The Karen people who have resettled in Minnesota bring with them the physical and emotional scars of their life in Burma, which the military government renamed Myanmar in 1989. The physical reminders of torture can include chronic pain and respiratory problems, and the psychological impact can mean living with fear, depression and panic attacks. Research shows that the negative mental health effects caused by war trauma and torture can extend to people who didn’t experience the torture themselves, as children of traumatized parents have higher levels of depression and anxiety.

University of Minnesota School of Nursing researcher Sarah Hoffman, PhD, MPH, RN, is studying how trauma is passed down to the next generation, in hopes of developing an intervention to prevent the intergenerational transmission of trauma. “Trauma has a profound impact on human health. So to understand it, to intervene effectively, is important,” said Hoffman.

Family-centered solutions

While extensive research has been conducted regarding intergenerational trauma, little has been published in relation to refugee migration. “Within the context of torture and within the context of refugee migration, there are relatively few studies that look at intergenerational trauma,” said Hoffman, adding that none of the studies report findings specific to refugee mothers who have experienced torture. “Limited research considers the effectiveness of family-centered interventions to interrupt generational trauma and facilitate healing for women refugee survivors of torture and their children.”

Hoffman sees a family-centered intervention as critical to the holistic recovery of the family. “Torture happens to individuals, but it’s a tactic of war that’s intended to degrade and demean groups. Torture is an assault on collective identity,” said Hoffman. “The interventions that we have to support recovery from experiences of torture, while effective and meaningful, are more individually focused. The idea is to develop a family-centered approach that facilitates collective recovery. As a public health nurse, my lens is the family and the community.”

“Torture happens to individuals, but it’s a tactic of war that’s intended to degrade and demean groups. Torture is an assault on collective identity.”
– Sarah Hoffman, PhD, MPH, RN, University of Minnesota School of Nursing researcher

Hoffman’s mixed methods pilot study will first collect quantitative data to compare patterns of family function and youth adjustment in 100 Karen refugee families where mothers have experienced torture or war trauma. The next step will be qualitative, with in-depth interviews of 30 Karen women. The data will be analyzed to determine the associations between a mother’s exposure to torture or trauma, the perceived severity of these experiences, whether and how a mother chooses to communicate these experiences to her children, and how collectively the family functions.

Hoffman is partnering with the Center for Victims of Torture, an international nonprofit agency headquartered in St. Paul. The center found the prevalence of torture and war trauma was extremely high in the local Karen community, with 27 percent reporting being tortured and 86 percent reporting experiencing war trauma.

Center staff are eager to understand Hoffman’s research findings. “Among the populations we work with, family and community well-being are often perceived as being as important or more important than one’s own health and well-being,” said Maria Vukovich, PhD, research associate at the center. “Although there is a central role for specialized individual care, family-centered interventions are greatly needed and may be more aligned with values and backgrounds of many resettled refugees and immigrants.”

Building on previous research

Hoffman’s current research builds on research she conducted in refugee camps on the Thailand-Burma border for her PhD dissertation. The work there and additional interviews with Karen refugees who resettled in Minnesota informed a series of ethnographic case studies. “A really prominent experience women talked about was mothering,” said Hoffman. “It was an important part of their narrative from the beginning. Their children were often the reason for migration and pursuing resettlement.”

Hoffman then developed a parenting intervention for Karen parents with adolescent children in partnership with the Karen Organization of Minnesota. She analyzed the physical correlates of torture using cross sectional data collected during the initial refugee health screening exams. Hoffman recently received Grant in Aid funding to expand this inquiry to a five-year retrospective analysis of Karen refugee health.

Hoffman’s current project, focused on maternal style of communication post-trauma, is the first time she will focus on the intergenerational component of trauma. She expects to have the research findings needed to inform an intervention completed in 2019 and will seek additional funding to develop the intervention.

Funding for the research is provided through University of Minnesota Building Interdisciplinary Research Careers in Women’s Health award. The research is supported through the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health.

“Women are so influential to the ways in which their children witness trauma and how collective memory plays out,” said Hoffman. “While we would like to interrupt the transmission of trauma, collective cultural memory is very important. One of the things I think about, as I watch women interact with their children and as I watch younger interpreters interact with an older generation that was impacted by the war, is how it is also important not to forget—so that the narratives of those who survived war are honored and not brushed away.”