Psychosocial consequences of growing up as Austrian occupation children in post-World-War II Austria

ABSTRACT

Background: During the post-World War II occupation of Austria, approximately 20,000–30,000 ‘children born of war’ (CBOW), also called occupation children were born through intimate contacts between Austrian women and occupation soldiers. Research on other CBOW populations indicates that CBOW mostly grow up under difficult conditions, sometimes with strong long-term mental health consequences.

Objective: To examine whether comparable psychosocial consequences can be found in Austrian occupation children (AOC), a first quantitative study was carried out.

Method: Child maltreatment, post-traumatic stress disorder, depression and somatization, and general life satisfaction were assessed in a sample of 98 AOC using self-report instruments. Results were compared to a sample of German occupation children (GOC; N = 146).

Results: High prevalence of above threshold full (10.2%) and partial (14.3%) PTSD, somatic (16.3%) and depressive (11.1%) symptomatology were found in AOC. They were at high risk of child maltreatment (e.g. emotional abuse: 53.6%), which was associated with current symptomatology. Notably, AOC tended to report high levels of general life satisfaction. No differences were found between GOC and AOC.

Conclusions: Findings highlight the complex and long-term effects of developmental conditions and childhood maltreatment on mental health of CBOW, even decades later. Findings of high life satisfaction provide evidence of resilience and maturation processes across the lifespan.

HIGHLIGHTS

• Austrian occupation children show a notable vulnerability to childhood maltreatment and its long-term consequences, including a high prevalence of above threshold PTSD, somatic, and depressive symptomatology.

• Findings on the psychosocial consequences of growing up as occupation children in Austria after World War II are consistent with previous studies in similar populations and can be generalized as more or less typical common experiences of children born of war.

• Despite psychological distress, occupation children showed surprising levels of life satisfaction, suggesting potential resilience.

1. Introduction

Children Born of War (CBOW) are a war-affected group that has always existed in different countries across the world but has long been ignored – both by the affected societies and by the scientific community. Nevertheless, recent years have witnessed significant strides in understanding the specific vulnerabilities emanating from their unique range of challenges. CBOW are conceived by (foreign) enemies, occupying forces or peacekeeping soldiers and born to local mothers. Their vulnerabilities encompass direct association with the (former) enemy/occupier/peacekeeper, illegitimate birth status, upbringing amidst economic, educational and social adversity, and often experiencing persistent and pervasive discrimination and stigmatization (Lee, 2017; Lee et al., 2022; Theidon et al., 2023). With specific reference to children conceived as a result of conflict-related sexual violence and sexual exploitation in the context of armed conflict, a recent policy report summarizes what has been observed and proven for CBOW, irrespective of the nature of their biological parents’ relationships (Kahn & Denov, 2019; Lee, 2017; Neenan, 2017; Seto, 2013). It emphasizes their elevated ‘risk of violence, abuse, abandonment, discrimination, and marignalisation at the hands of both family and communities’ and their lack of ‘access to resources, family, protection, and education or livelihood activities’ (Rohwerder, 2019, p. 2).

An extensively researched historical conflict in terms of empirical work on CBOW is the Second World War (WWII), with research on children conceived in relationships that span the full range of parental relationships: from love affairs between local women and foreign/occupation soldiers, to transactional relationships of more or less constrained consent to sexual exploitation, abuse and violence (Ericsson & Simonsen, 2005; Hamilton, 2013; Mühlhäuser, 2010; Roeger, 2017; Virgili, 2009; Westerlund, 2011). Although there are no precise figures on how many CBOW were born during the war or in the post-war occupation, estimates for northern Europe, where the German occupation authorities kept records of the children of German soldiers during the Second World War, suggest tens of thousands (Mochmann & Larsen, 2008). Research confirms their vulnerability, as evidenced by increased rates of adverse outcomes among Norwegian children fathered by German soldiers, including higher suicide rates, poorer health, less education and lower incomes compared to the general Norwegian population of the same age (Ellingsen, 2004, as cited in Mochmann & Larsen, 2008).

Within this existing research, a study on German occupation children (GOC) after WWII in Germany was the first to examine the psychosocial effects of growing up as an occupation child (Glaesmer et al., 2012; Kaiser et al., 2015a). Findings indicate heightened exposure to potentially traumatic events (PTE; Kaiser et al., 2015b), rendering them vulnerable to child maltreatment (Glaesmer et al., 2017), experiences of stigmatization and discrimination (Assmann et al., 2015) and difficult attachment experiences (Kaiser et al., 2016). Additionally, these specific experiences were associated with self-reported probable mental disorders (depression, somatization, PTSD), which highlights their potential long-term impact. Notably, despite the adversity, study results also showed that the level of life satisfaction in GOC was similar to that of the general German population (Kaiser & Glaesmer, 2016), suggesting resilience and pointing towards a more complex and nuanced picture of coping with these specific experiences.

It is well established that childhood adversity, lack of social support, stressful living conditions after trauma, and a young age at trauma exposure, significantly increase the risk of developing PTSD (Brewin et al., 2000). Child maltreatment is defined as ‘any act, series of acts, or a failure to act by caregivers that may result in actual, threatened, or potential harm to a child’ (Häuser et al., 2011; Witt et al., 2019, p. 287), whether intentional or not (Gilbert et al., 2009). Because of its complex and cumulative effects on the developing child, child abuse and neglect is one of the greatest risk factors for poor mental and physical health in childhood and across the entire lifespan (Gilbert et al., 2009; Glaesmer et al., 2017; Shonkoff et al., 2009).

In Austria an estimated 20,000–30,000 occupation children were born post-WWII, as a result of more or less consensual relationships between local women and Allied soldiers, brief affairs, but also rapes (Stelzl-Marx, 2015). They were often considered ‘children of the enemy’, even though the fathers were no longer officially enemies. Many Austrian Occupation Children (AOC) faced various forms of discrimination and stigmatization, and the background of their conception remained a taboo for many AOC (Stelzl-Marx & Satjukow, 2015). The majority grew up without their biological father, who often did not know that they had fathered a child or were transferred before the child was born. Others absented themselves, sometimes with false promises. After the withdrawal of the troops following the Austrian State Treaty in 1955, there was no more contact with the biological fathers in most cases, particularly in the case of Soviet soldiers (Stelzl-Marx, 2015).

For AOC, there are numerous historical texts describing the hardships they have experienced during childhood and adolescence as well as oral history studies with AOC revealing their experiences, related effects, and stress responses (Rohrbach & Wahl, 2019; Schretter & Stelzl-Marx, 2022; Stelzl-Marx & Satjukow, 2015). To date, however, the psychosocial consequences of growing up under these developmental conditions have not been investigated. To fill this gap, we conducted a quantitative study of the psychosocial consequences of growing up as an occupation child in post-World-War II Austria. The aim of this paper is to report the main quantitative results of this study: the self-reported prevalence of above threshold PTSD, depressive, and somatoform symptomatology; the frequency of child maltreatment; the association between child maltreatment and current symptomatology (PTSD; depressive and somatoform symptomatology); and general life satisfaction in AOC. A further aim was to compare these mental health outcomes to those assessed in the respective sample of GOC.

The political and structural parallels observed in the post-war periods in Germany and Austria suggest similarities between GOC and AOC within their respective generational contexts, i.e. that the populations grew up under similar conditions and are thus well suited for comparison. Using data from the GOC project as a comparative sample, we acknowledge the challenges of studying this cohort, given its status as a hidden population characterized by elusive sample sizes and methodological complexities. In addition, there is a lack of data from a representative population study in Austria. Furthermore, both studies use identical standardized instruments, selected with the intention of comparing different CBOW populations, thus ensuring comparability between the two cohorts. Against the background that GOC differ substantially from the general population of the same age cohort with respect to childhood maltreatment and mental distress, we expect similar differences for AOC and the Austrian general population of the same age.

2. Methods

2.1. Subjects and study protocol

Samples are drawn from two projects; one on GOC, the other on AOC, whereas the GOC data serve as the comparison sample. Inclusion criteria for both samples were a year of birth between 1945 and 1966, biological father a soldier of a foreign occupying force; for GOC mother of German nationality; for AOC mother of Austrian nationality. To ensure comparability of both samples, identical standardized instruments were used. The recruitment strategy for both samples included a broad outreach strategy. The call for participation was distributed via press releases and various national and international networks (e.g. www.gi-trace.org). The data of GOC were collected between March and December 2013 within the project ‘’Occupation Children’: Identity development, stigmatization, and psychosocial consequences of growing up as a German occupation child’ (Kaiser, 2017). Of 184 questionnaires sent out, 164 were returned; nine were excluded because they did not meet the GOC definition (participation rate = 88.6%; corrected for neutral dropouts). As the aim of the German study was to identify inherent differences between GOC and the general German population, the results were compared with a birth cohort-matched sample of the German population collected in 2007. The AOC data were collected in the follow-up project conducted in cooperation with Barbara Stelzl-Marx, head of the Ludwig Boltzmann Institute for Research on Consequences of War, Austria. Between October 2013 and January 2014 study materials were mailed to AOC, including an adapted two-part questionnaire, study information, and consent form for participation in the study. In addition to the broad outreach strategy, Prof. Dr. Stelzl-Marx, who specializes in research on occupation children fathered by Soviet soldiers, also sent study material to AOC contacts from previous research. Of 161 questionnaires sent out, 107 were returned; seven were excluded because they did not meet the AOC definition (participation rate = 64.9%; corrected for neutral dropouts). After exclusion due to missing data, outliers in age and non conformity with the definition of the respective group, a total of N = 146 GOC and N = 98 AOC were included for analyses.

2.2. Instruments

2.2.1. List of traumatic events

In line with the trauma list of the PTSD module (Perkonigg et al., 2000) of the Munich Composite International Diagnostic Interview (M-CIDI; Wittchen and Pfister, 1997), eight potentially traumatizing events were provided (e.g. ‘You were the victim of a rape’) and an open question about ‘another terrible event or a catastrophe’. In addition, a war-related event was added (‘You were driven out of your homeland’).

2.2.2. Posttraumatic diagnostic scale (PDS)

The PDS (Foa et al., 1997; German version: Ehlers et al., 1996) is a self-report screening instrument for probable PTSD according to DSM-IV which assesses individual symptoms of PTSD, individual’s reaction to PTE and presence of impairments. This older version of PDS, rather than the DSM-V-compliant version, was chosen to ensure comparability with the instruments used in the comparison samples. Self-reported PTSD was considered likely if DSM-IV criteria A, B, C, and D were met. A symptom was considered to be present if an item was rated at least 1 on a 4-point scale ranging from a minimum of 0 (‘Not at all or just once in the last month’) to a maximum of 3 (‘5 or more times a week’). For probable ‘full PTSD’, participants had to meet criteria A1 and A2 and rate at least 1–5 intrusion items, 3–7 avoidance items, and 2–5 hyperarousal items as present. Self-reported ‘Partial PTSD’ was considered probable according to Hauffa et al. (2011), if criterion A1 was met as well as at least one symptom from a minimum of two clusters (B, C, or D). Criterion A was assessed using the M-CIDI trauma list. Symptom sum score determined the severity level. Reliability and validity were confirmed for the German version (Griesel et al., 2006; Wittmann et al., 2021). We found a very good (ω = .947) reliability in our study.

2.2.3. Patient Health Questionnaire (PHQ-9 and PHQ-15)

The PHQ (Spitzer et al., 1999) screens for common mental disorders in primary care. German subscales for depression (PHQ-9) and somatization (PHQ-15) were applied (Loewe et al., 2002). This older PHQ version was used to ensure comparability between the two samples. The PHQ-9 contains nine items assessing depressive symptoms over the past four weeks (Gräfe et al., 2004; Kroenke et al., 2001). Items are based on DSM-IV criteria for major depression, response categories range from 0 (‘Not at all’) to 3 (‘Almost every day’). Self-reported ‘Major depression’ (MD) was considered likely, if at least five of the nine symptom criteria were answered with ‘more than half of the day’, while one of the symptoms must include items 1 or 2. For probable ‘Other Depressive Disorder’, two to four symptom criteria must be present ‘more than half of the day’, including items 1 or 2. High values for the sensitivity and specificity have been reported (Wittkampf et al., 2007), as well as a good internal consistency and retest reliability (Kroenke et al., 2001). The questionnaire showed a very good reliability (ω = .911) in our study.

The PHQ-15 contains 13 somatic symptoms and two items from the depression module (Kroenke et al., 2002). The item ‘menstrual pain’ was excluded due to an expected average age of the sample beyond the average onset of menopause. The response categories ranged from 0 (‘Not affected’) to 2 (‘Strongly affected’). Self-reported ‘Somatoform Disorder’ was probable if at least three questions were answered with ‘strongly affected’. Good values for diagnostic accuracy (Van Ravesteijn et al., 2009), high internal consistency and good retest reliability (Kroenke et al., 2002) were observed. Reliability in our study can be considered as good (ω = .843).

2.2.4. Childhood Trauma Questionnaire (CTQ)

The German version of the CTQ (Bernstein et al., 2003) is a 28-item self-report instrument with five subscales to assess emotional, physical and sexual abuse, and emotional and physical neglect. The items are rated on a 5-point scale ranging from 1 (‘never true’) to 5 (‘very often true’). In line with Glaesmer et al. (2017), threshold values suggested by Walker et al. (1999) were applied. Internal consistencies of the original version ranged from α = .61 to α = .96 (Bernstein et al., 2003). The original five-factor structure was replicated for the German version (Klinitzke et al., 2012), albeit with moderate model fit. In particular, the ‘physical neglect’ scale correlated very highly with the other factors and showed weak internal consistency compared to other subscales. In this study, the reliability for the general scale was very good (ω = .940), for the subscales, with the exception of physical neglect, it ranged from ω = .867 for emotional abuse to ω = .950 for sexual abuse. With ω = .615 the physical neglect subscale showed a questionable internal consistency.

2.2.5. Satisfaction With Life Scale (SWLS)

The German version of the SWLS (Diener et al., 1985; German version: Schumacher, 2003) was used to assess general life satisfaction. The SWLS measures affective and cognitive-evaluative components of life satisfaction with five items answered on a 7-point Likert scale from 1 (‘Do not agree at all’) to 7 (‘Agree completely’). Very high internal consistency has been reported (Glaesmer et al., 2011) and is replicated here (ω = .924).

2.3. Statistical analyses

SPSS Statistics (IBM, version 23.0) was used for statistical data analysis. In addition to descriptive methods, χ²-tests and t-tests were applied to test for differences between the two groups (AOC vs. GOC) in sociodemographic characteristics and development conditions. Multiple linear regression was calculated to test for sum score differences of PHQ-9, PHQ-15 and SWLS between samples. Binary logistic regressions were computed to compare the prevalence of above-threshold PTSD, somatoform and depressive symptomatology and childhood maltreatment between samples. Binary logistic regressions were calculated to test the association between abuse and neglect and above-threshold PTSD, depressive and somatoform symptomatology. All regressions were controlled for age and sex.

3. Results

3.1. Samples

Ninety-eight AOC were included in the analysis and compared with a sample of GOC (N = 146). Table 1 provides an overview of the socio-demographic characteristics of both samples. Although the inclusion criteria for both samples referred to the year of birth between 1945 and 1966, there are significant differences in the distribution of this variable. No AOC matched the youngest birth cohort. In both samples, the majority of participants were born in the early years after the Second World War. The samples differed in distribution of levels of formal education: More GOC reported the highest level of education, a university degree, or a professional school degree, whereas more AOC reported the second highest level of education, the Matura (Austrian university entrance qualification) and a vocational school degree. Furthermore, samples differed significantly in terms of origin of the participants’ biological father: More AOC reported their father was a member of the Soviet army, whereas more GOC reported having an American or a French father.

Table 1.

Sociodemographic sample characteristics.

	AOCa (N = 98)		GOCa,1  (N = 146)		AOC vs. GOC
	%	na	%	na	Statistical Tests
Gender  Male  Female	34.7 65.3	34 64	37.0 63.0	53 92	χ² (1) = 0.13
Age M (SD)	65.37 (2.46)		63.42 (5.70)		t (212) = 3.64*** + b
Birth cohorts  1945–1951  1952–1958  1959–1966	89.8 10.2	88 10	76.0 11.6 12.3	111 17 18	χ² (2) = 13.56**+
Living with partner  Yes  No	66.3 33.7	65 33	66.4 33.6	97 49	χ² (1) = 0.00
Personal income  <1000€  1000€ to < 2000€  >2000€	26.1 38.0 35.9	24 35 33	23.2 31.9 44.9	32 44 62	χ² (2) = 1.90
Education  Obligatory graduation  Vocational training degree  Professional school degree  Matura/ Abitur2  University degree	18.9 37.9 1.1 33.7 8.4	18 36 1 32 8	15.8 28.8 19.2 8.2 28.1	23 42 28 12 41	χ² (4) = 48.92***++
Procreation background  Through consensual sexual contact  Through rape  Unknown	74.5 2.0 23.5	73 2 23	75.3 6.8 17.8	110 10 26	χ² (2) = 3.70
Origin of the father  USA  France  Great Britain  Soviet Union  Unknown	39.8 12.2 25.5 16.3 6.1	39 12 25 16 6	48.6 22.6 21.9 4.1 2.7	71 33 32 6 4	χ² (4) = 16.09 **+

Notes: Cramer's effect size V for chi-square tests and Cohen's d (1992) For t-test: + V ≥ 0.1 or d ≥ 0.2 (small effect), ++ V ≥ 0.3 or d ≥ 0.5 (medium effect), +++ V ≥ 0.5 or d ≥ 0.8 (strong effect).

^aSample size varied by missing data.

^bBecause of significant results in Levene's test for variance homogeneity (p < .001), t-test results are reported with Welch correction.

¹Original data in Kaiser, Kuwert & Glaesmer (2015).

²Austrian/ German university entrance qualification.

*p < .05, **p < .01, ***p < .001.

3.2. Specific conditions of growing up in AOC and GOC

Table 2 compares the growing up conditions of the two samples. The majority of AOC and GOC described their relationship with their mother as ‘very good’ to ‘good’, with the proportion of AOC reporting a rather poor relationship increasing to almost one-fifth of respondents in late childhood. By the time they reached school age, 58.9% (n = 56) had moved at least once. In 37.9% (n = 22) of these cases, the move was accompanied by a change of (primary) caregiver. No differences were found between the samples.

Table 2.

Specific conditions of growing up.

	Until school age					Until the age of 14
	AOC (N = 98)		GOC1 (N = 146)		AOC vs. GOC	AOC (N = 98)		GOC1 (N = 146)		AOC vs. GOC
	%	n	%	n	Statistical test	%	n	%	n	Statistical test
Relationship with mother2  Very good – good  Partly  Rather bad – bad	72.1 19.1 8.8	49 13 6	60.7 28.6 10.7	68 32 12	χ² (2) = 2.50	56.8 24.3 18.9	42 18 14	51.3 30.1 18.6	58 34 21	χ² (2) = 0.78
Change of residenceb  Never  Once  Two – three times  Four times or more	41.1 38.9 14.7 5.3	39 37 14 5	44.4 26.8 19.0 9.9	63 38 27 14	χ² (3) = 4.92	54.1 21.4 17.3 7.1	53 21 17 7	40.3 36.1 16.7 6.9	58 52 24 10	χ² (3) = 6.61
Change of primary caregiverc  Yes, in many cases  Yes, in some cases  No, not at all	31.0 6.9 62.1	18 4 36	35.1 11.7 53.2	27 9 41	χ² (2) = 1.40	34.1 9.1 58.6	15 4 25	24.7 9.9 65.4	20 8 53	χ² (2) = 1.26

Notes: ¹Original data in Kaiser et al. (2016).

^aHow would you describe the relationship with the indicated most important caregivers in your childhood up to school entry/ from school entry up to the age of 14?

^bHow often did you move during your childhood before school entry/ from school entry until the age of 14?

^cIf you changed your place of residence during your childhood before school entry/ from school entry until the age of 14, did this also result in a change of caregiver?

3.2.1. Mental distress in AOC and GOC

A comparison of mental distress and PTSD in both samples is shown in Table 3. The questionnaire data suggest evidence of probable self-reported partial or full PTSD in 24.5% (n = 24) of AOC, 11.1% (MD or ODS, n = 10) with above-threshold depressive symptoms and 16.3% (n = 16) above-threshold somatoform symptoms. No differences were found between samples, neither concerning the likelihood of having above threshold full PTSD, partial PTSD, depressive (MD or ODS) and somatoform symptomatology, nor in the severity of depressive, somatoform or PTSD symptoms.

Table 3.

Mental distress and posttraumatic stress load of AOC and GOC.

	AOC (N = 98)			GOC1 (N = 146)			AOC vs. GOC
	Women (N = 34)	Men (N = 64)	Total	Women (N = 92)	Men (N = 53)	Total
	% (n)	% (n)	% (n)	% (n)	% (n)	% (n)	Statistical Tests
Full PTSD	12.5 (8)	5.9 (2)	10.2 (10)	13.0 (12)	9.3 (5)	11.6 (17)	1.03 [0.43–2.46]b
Partial PTSD	14.1 (9)	14.7 (5)	14.3 (14)	16.3 (15)	20.4 (11)	17.8 (26)	0.88 [0.42–1.82]b
PDS (mean/SD)	7.50 / 10.09	4.50 / 7.11	6.38 / 9.15	10.04 / 11.38	8.68 / 12.56	9.74 / 11.84	−0.10 [−5.61–1.38]c
PHQ-9 (mean/SD)	5.68 / 6.15	3.53 / 4.47	4.87 / 5.65	6.54 / 5.73	4.30 / 5.80	5.72 / 5.84	−0.45 [−1.85–1.17]c
Major Depression	10.7 (6)	5.9 (2)	8.9 (8)	10.1 (9)	9.8 (5)	10.0 (14)	1.24 [0.46-3.31]b
Other Depressive disorder	1.8 (1)	2.9 (1)	2.2 (2)	3.4 (3)	3.9 (2)	3.6 (5)	0.82 [0.14–4.76]b
PHQ-15 (mean/SD)	6.28 / 5.25	5.94 / 3.73	6.15 / 4.70	8.54 / 5.81	4.96 / 4.46	7.15 / 5.59	−0.06 [−2.06-0.77]c
Somatoform disorder	18.8 (12)	11.8 (4)	16.3 (16)	20.7 (19)	7.4 (4)	15.8 (23)	1.17 [0.56–2.42]b

Notes: ^aSample size varied due to missing data.

^bBinary logistic regression controlled for age and sex, odds ratio and 95% confidence interval [CI] of study group is reported.

^cLinear regression analysis with age, sex, and study group as predictors, the standardized beta and 95% confidence interval [CI] for study group is reported; PHQ-9 – sum score, PHQ-15 – sum score, and PDS buzzer score each served as the dependent variable.

¹Original data in Kaiser, Kuwert, Brähler et al. (2015).

3.3. Experiences of child maltreatment in AOC and GOC

Table 4 provides a comparison of experiences of child maltreatment in both samples. More than half of AOC reported having experienced emotional abuse or physical neglect. More than a third reported physical abuse or emotional neglect and almost a quarter had suffered sexual abuse. The results for GOC show a similar distribution, no differences between samples were found. 72.3% (n = 72) of AOC reported having experienced at least one type of maltreatment, 39.3% (n = 39) reported having experienced three or more types of maltreatment.

Table 4.

Prevalence of childhood maltreatment in AOC and GOC.

CTQ	AOC (N = 98)						GOC1 (N = 146)						Regression analysis AOC vs. GOC OR [CI]a
	Men		Women		Total		Men		Women		Total
	%	N	%	n	%	n	%	n	%	n	%	n
Emotional abuse	39.4	13	60.9	39	53.6	52	55.8	29	57.0	49	56.5	78	1.01 [0.59–1.73]
Physical abuse	26.5	9	39.1	25	34.7	34	49.1	26	36.0	31	41.0	57	1.23 [0.71–2.12]
Sexual abuse	8.8	3	33.3	21	24.7	24	17.3	9	30.2	26	25.4	34	0.89 [0.51–1.80]
Emotional neglect	32.4	11	43.5	27	39.6	38	43.1	22	44.6	37	44.0	59	1.08 [0.62–1.87]
Physical neglect	55.9	19	54.7	35	55.1	54	67.3	35	57.6	49	61.3	84	1.20 [0.71–2.06]

Notes: ^aLogistic regression controlled for age and sex, odds ratio (OR), and 95% confidence interval [CI] of the study group are provided.

¹Original data in Glaesmer et al. (2017).

Table 5 shows associations between the different types of child maltreatment and mental distress for AOC only. Three of five subtypes of abuse and neglect were significantly associated with an above-threshold somatoform symptomatology: physical (OR = 3.86) and sexual abuse (OR = 14.78) and physical neglect (OR = 4.51). Participants who reported physical (OR = 9.34) and sexual abuse (OR = 42.74) in childhood were significantly more likely to report PTSD symptomatology. None of the subtypes of child maltreatment showed a significant association with an above-threshold depressive symptomatology. The experience of sexual abuse showed the strongest association with psychological distress in the form of above-threshold somatoform or PTSD symptomatology compared with other types of abuse and neglect. Findings on the association between child maltreatment and psychological distress in the German sample are reported in Glaesmer et al. (2017).

Table 5.

Association of experience of child maltreatment with depressive disorders, somatoform disorder and posttraumatic stress disorder in AOC (N = 98).

	Emotional abusea			Physical abusea			Sexual abusea			Emotional neglecta			Physical neglecta
	+ % (n)	-% (n)	OR (CI)b	+ % (n)	-% (n)	OR (CI)b	+ % (n)	-% (n)	OR (CI)b	+ % (n)	-% (n)	OR (CI)b	+ % (n)	-% (n)	OR (CI)b
Depressive disorders (n = 10)c, f	80.0 (8)	20.0 (2)	3.69 [0.71–12.29]	50.0 (5)	50.0 (5)	1.85 [0.48–7.11]	40.0 (4)	60.0 (6)	2.63 [0.60–11.57]	66.7 (6)	33.3 (3)	2.87 [0.65–12.65]	70.0 (7)	30.0 (3)	2.10 [0.50–8.75]
Somatoform disorder (n = 16)c, f	75.0 (12)	25.0 (4)	2.66 [0.77–9.26]	62.5 (10)	37.5 (6)	3.86 [1.24–12.08]* ++	66.7 (10)	33.3 (5)	14.78 [3.47–62.88] *** +++	56.3 (9)	43.8 (7)	2.06 [0.68–6.24]	81.3 (13)	18.8 (3)	4.51 [1.17–17.39]* ++
PTSD (n = 10)c, f	80.0 (8)	20.0 (2)	3.98 [0.76–20.77]	80.0 (8)	20.0 (2)	9.34 [1.83–47.60] **+++	88.9 (8)	11.1 (1)	42.74 [3.95–462.07] **+++	100 (9)	0.0	-	70.0 (7)	30.0 (3)	2.08 [0.50–8.65]

Notes: ^aAssessed with CTQ, classification (+/-) based on Walker et al. (1999); ^bLogistic regression with depressive disorders/ somatoform disorder/ PTSD as dependent variable, emotional abuse/ physical abuse/ sexual abuse/ emotional neglect/ physical neglect as predictors, controlled for gender and age. Odds ratio (OR) and 95% confidence interval [CI] for e.g. emotional abuse +/ – are reported; ^cMajor Depression and Other Depressive disorder are combined to a dichotomous variable, both assessed with PHQ-9; Somatoform disorder assessed with PHQ-14 (menstruation item excluded); PTSD full picture assessed with PDS; ^fSample size differs due to missing data.

*p < .05, ** p < .01, *** p < .001; effect size according to Cohen (1992): + f > 0.10 (small effect) or ++ f > 0.25 (medium effect) or +++ f > 0.40 (strong effect).

3.4. General life satisfaction

Table 6 shows means and standard deviations of the SWLS for both subsamples. No difference between AOC and GOC regarding mean values were found.

Table 6.

General life satisfaction among AOC and GOC.

	AOC (N = 97)a			GOC1  (N = 140)a			Regression analysis Stand. β + [CI]b
	Men (N = 33)	Women (N = 64)	Total	Men (N = 53)	Women (N = 87)	Total
(Mean / SD)	(28.70 / 5.81)	(24.70 / 8.44)	(26.06 / 7.85)	(25.09 / 7.00)	(24.38 / 6.93)	(24.65 / 6.94)	−0.10 [−3.29-0.31]

Notes: ^aSample size varies due to missing data; ^bLinear regression analysis with age, sex, and study group as predictors; the standardized beta and 95% confidence interval [CI] for ‘study group’ are reported; SWLS – scale sum score served as the dependent variable.

¹Original data in Kaiser and Glaesmer (2016).

4. Discussion

The study marks a significant advancement in understanding the psychosocial impact of the specific developmental circumstances CBOW faced after WWII, shedding light on their relevance in contemporary conflict and post-conflict settings. It represents the first quantitative investigation into the psychosocial ramifications of growing up as an occupation child in post-WWII Austria, drawing upon data from 98 AOC compared with 146 GOC.

There were notable socio-demographic differences between the two samples, mainly due to historical factors. While the age distribution across all birth cohorts for GOC can be explained by the prolonged presence of occupying forces in Germany, the main period of occupation in Austria is depicted with almost 90% of AOC born between 1945 and 1951, resulting in a higher average age of AOC in our study. Additionally, the greater proportion of AOC descended from Soviet soldiers can be attributed to the recruitment strategy involving contacts of Prof. Dr. Barbara Stelzl-Marx, who specializes in research on occupation children fathered by Soviet soldiers.

Our findings underscore the vulnerability of AOC to challenging and potentially burdening developmental circumstances. A majority experienced residential mobility during childhood and adolescence, with one in three cases involving a change in the primary caregiver. A substantial proportion reported multiple forms of abuse and neglect. More than half of the sample reported emotional abuse (53.6%) and physical neglect (55.1%), and a large proportion reported physical abuse (34.7%) and emotional neglect (39.6%). Around a quarter of AOC reported experiences of sexual abuse (24.7%). The likelihood of reporting abuse and neglect was consistent between AOC and GOC. In the German study (Glaesmer et al., 2017), rates of experiencing childhood maltreatment were 4.7–10.8 times higher among occupation children than in the general population of the same age. Only for physical neglect no difference was found, consistent with the scarcity of resources in the post-war period typical of the participants’ upbringing period (Glaesmer et al., 2017). Compared to previous findings from population-based nationwide surveys in Germany, reporting between 31% and 35% of participants having experienced at least one type of maltreatment (Witt et al., 2019), the results for AOC are much higher (72.3%). In other studies of highly vulnerable groups we find comparable prevalence, e.g. in a study of unaccompanied refugee minors, where 63.3% of respondents reported physical maltreatment (Bean et al., 2007), or in a study of Syrian refugee children and adolescents, where a total of 68.6% reported at least one childhood adversity (Karam et al., 2019). Compared to previous research on CBOW populations this is a common finding that reflects the challenges that mothers and families with AOC may face, as well as the potential stigmatizing attitudes in their social environment that may be associated with a willingness to harm. Our findings, including the heightened risk of childhood maltreatment, the instability caused by changing primary caregivers, and the potential long-term psychological distress, resonate with previous quantitative studies on GOC (Glaesmer et al., 2017; Kaiser et al., 2015b), as well as reports on other CBOW born during or in the aftermath of WWII, such as Norwegian and Danish Wehrmacht children (Mochmann & Larsen, 2008). Moreover, experiences beyond the WWII context highlight the enduring hardship faced by CBOW, including stigmatization, rejection, socio-economic marginalization, and identity struggles, such as for Amerasian children fathered during the Vietnam War (Lee et al., 2022b), peacekeeper fathered children in the Democratic Republic of Congo (Wagner et al., 2020), or children born of wartime rape within the Lord’s Resistance Army in Uganda (Denov & Lakor, 2017). Despite the diversity of their growing up circumstances and cultural backgrounds, these children often grapple with similar forms of stigma. Whether facing racist discrimination or the stigma of being labelled as ‘illegitimate’ offspring of the ‘enemy’, they endure a sense of shame associated with their existence. The experiences in childhood and adolescence reported by AOC and GOC are found to varying degrees in different CBOW populations (Carpenter, 2007; Lee, 2017; Lee et al., 2022a; Mochmann & Larsen, 2008), suggesting shared experiences across different historical and contemporary contexts.

That child maltreatment is a major risk factor for childhood and adolescent mental health problems is a well-established finding. Regarding psychological distress assessed in older age, including above-threshold PTSD, somatoform, and depressive symptomatology, no significant differences were observed between AOC and GOC. However, compared to the general German population of the same age, GOC had significantly higher prevalence rates (Kaiser et al., 2015b), suggesting a similar trend for AOC due to population similarities. A cross-national comparison of mental health in later life by Ploubidis and Grundy (2009), found no difference in probable depression between the general German and Austrian populations. The prevalence of above threshold full and partial PTSD (24.5%), somatic (16.3%) or depressive symptomatology (11.1%) among AOC exceeded that of the general German population of the same age (1.4% for full PTSD, 4.0% for somatic and 1.7% for depressive symptomatology; Kaiser et al., 2015b). Compared to other populations of interest, discussed as vulnerable for traumatization and posttraumatic symptomatology, such as the elderly Austrian population who experienced WWII and the occupation, the prevalence of above threshold full and partial PTSD symptomatology in AOC is almost twice as high: Glück et al. (2012) report a prevalence rate of 13.9% for full and subthreshold PTSD in their sample of Austrians born before 1946 (vs. AOC: 24.5%).

In line with previous research, our results show that child maltreatment is a major risk factor for poor mental health and may have effects throughout the life course: physical and sexual abuse were associated with increased odds of above-threshold somatoform and PTSD symptomatology. In addition, experiencing physical neglect also increased the likelihood of somatoform symptomatology. Contrary to previous findings (Glaesmer et al., 2017; Husky et al., 2023), abuse and neglect were not associated with an increased likelihood of depressive symptomatology. On the basis of these findings, we hypothesize that child maltreatment is the most important mediator of psychological distress across the lifespan. Future research on CBOW should address this issue and the underlying processes.

Despite the notable levels of psychological distress reported among AOC, their overall life satisfaction is intriguing and appears to be marginally higher than the average level in Germany (M = 24.88 vs. M = 26.06 in AOC; Glaesmer et al., 2011). No differences in life satisfaction were found neither between AOC and GOC, nor for GOC and the German population sample of the same age (Kaiser & Glaesmer, 2016). While data for the Austrian general population was not available, we posit that similar trends would likely be observed given the population similarities. These findings provide evidence of resilience and maturation processes across the lifespan of AOC, running parallel to their experiences of hardship. In previous historical qualitative research on AOC this phenomenon has already been observed (Stelzl-Marx, 2016). One concept that could shed light on this process is posttraumatic growth (Tedeschi & Calhoun, 1996), which refers to positive psychological changes resulting from navigating highly challenging life circumstances. It involves a dual process of maturation alongside the posttraumatic stress response to a potentially traumatic event (Maercker & Zoellner, 2004). The majority of CBOW in both studies had experienced traumatic events in their lives, and a quarter of the respondents showed distress in the form of above-threshold PTSD symptoms. Research on the relationship between coping strategies and posttraumatic growth emphasizes the role of positive coping strategies in desirably influencing the maturation process (Anderson et al., 2020; Elderton et al., 2017). Resilience, as the ability to recover from extreme experiences or to maintain a stable personal equilibrium (Tran et al., 2013), can be understood as a concept consisting of different aspects that interact directly or as moderators: personal capacity, mechanism, outcome (Arnold et al., 2023). Research on resilience factors across different topics and target groups has identified relevant environmental factors (e.g. social support and acknowledgement, relationship quality) and personality factors (e.g. positive emotions, humour, and spirituality; Tran et al., 2013). Furthermore, resilience to PTEs is not only a common, it is ‘consistently the majority outcome’ (Bonanno, 2021, p. 2) following adversity or following PTEs, which may further explain this seemingly paradoxical finding.

There have been some studies that have examined factors of positive adaptation, such as resilience and post-traumatic growth in survivors of WWII (Forstmeier et al., 2009). One protective factor found there was a Sense of Coherence (Antonovsky, 1996), a ‘cognitively, behaviorally, and motivationally expressed orientation toward the world that enables the individual to perceive it as comprehensible, manageable, and meaningful’ (Glück et al., 2016, p. 436). This suggests that it is not the stressor itself that is important, but rather the successfully dealing with it. In the process of coping with trauma-related cognitions and appraisals, the attribution of meaning can potentially be supportive. In line with this, contemporary historical research and the emergence of associations and networks of affected individuals have been discussed as empowering factors that positively influence maturation processes, which may be the case in our investigated samples (Kaiser & Glaesmer, 2022; Lloyd et al., 2017). Especially in the case of shameful or taboo topics, as the existence of CBOW is often perceived, public discussion and social recognition can be understood as a prerequisite for posttraumatic growth (Kaiser & Glaesmer, 2022; Maercker et al., 2009). However, the specific mechanisms by which resilience and post-traumatic growth occur in CBOW should be explored in future research.

The strengths of the study lie in its pioneer nature, being the first to report quantitative data on AOC and thereby addressing a hidden population, a population that is difficult for researchers to access (Kaiser et al., 2015a). Nevertheless, it has limitations. First, symptomatology and child maltreatment were self-reported, which may overestimate prevalence. Second, relatively old instruments were used to ensure comparability between the samples. Third, a general limitation refers to our specific sample and mainly concerns the external validity of our findings. Occupation children are a group whose size is difficult to estimate and who are difficult to access, so it was not possible to obtain a representative sample. Thus, the sample is inevitably biased, selective and unrepresentative. The prerequisites for participation were knowledge of the occupation background and relevance of the topic at the time of the call, as well as the willingness to deal with one's own life story with regard to being an occupation child. For this setting, one can argue, there is a chance that occupation children who are severely affected by adverse experiences in childhood and adolescence may not be able or willing to participate in a study like this at all. At the same time, those who are not burdened and for whom the fact that they are occupation children does not play a special role will likely also not be represented in the sample. Therefore, a selection effect in both directions can be expected and suggests that prevalences for psychological distress might not be too far off.

5. Conclusions

The present study contributes to the growing body of evidence on the psychosocial consequences of being an occupation child in post-war societies. Our findings are consistent with historical descriptions and case reports, and thereby strengthen previous evidence on developmental conditions and their pervasive psychosocial impact. The experiences reported by AOC and GOC resonate with those observed in other CBOW populations and can therefore be generalized as more or less typical shared experiences of CBOW in different historical and recent (post-) conflict settings.

Resilience factors, coping strategies, and post-traumatic growth, as well as risk factors and the development and persistence of psychological distress across the lifespan, have hardly been assessed in CBOW and should be explored in future studies. Our findings highlight the importance of understanding CBOW as a vulnerable group in conflict and post-conflict regions who should be supported through targeted interventions at individual, relational, community and societal levels (Anderson, 2022). Especially at times like these, when the number of wars and conflicts has reached new heights, we should turn our attention to this overlooked group.

Funding Statement

The study on GOC was partially funded by a doctoral scholarship granted to Marie Kaiser by the state of Saxony as well as a start-up grant provided by the German ministry of science (BMBF) to Philipp Kuwert at Greifswald University. The publication of the article is funded by the Open Access Publishing Fund of the University of Leipzig, which is supported by the German Research Foundation within the framework of the Open Access Publication Funding Programme.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

Both studies were approved by the ethics committee of the Medical Faculty of the University of Leipzig.