Maternal Childhood Sexual Trauma and Early Parenting: Prenatal and Postnatal Associations

Trauma History Questionnaire: validation with novel samples of incarcerated women and perinatal women

Trauma exposure is associated with numerous negative outcomes, many of which are amplified within at-risk populations. Two under-researched and at-risk populations, incarcerated women and perinatal women, both report high rates of trauma, psychopathology, and PTSD compared to the general population. One common measure of trauma exposure in various populations, including incarcerated women and perinatal women, is the Trauma History Questionnaire (THQ). However, no known studies have validated the THQ within these two unique, understudied populations. Using data from two studies of incarcerated women and one study of perinatal women, researchers explored indices of THQ construct, predictive, and convergent validity. The study also included between-sample comparisons, highlighting differences in trauma incidence between the included samples. Analyses supported statistically significant relations between THQ scores and Severity of Violence Against Women Scale (SVAWS), depressive symptoms, PTSD, and psychological distress. Prenatal women's THQ scores were also predictive of later postpartum depressive symptoms. Significantly higher THQ scores were found within the incarcerated samples compared to the perinatal sample. The study results provide further information about trauma within incarcerated and perinatal populations, as well as increase understanding of the utility of trauma assessments within these vulnerable groups.

Parenting stress and competence among mothers of young children with substance use disorders: The roles of trauma and reflective functioning

Posttraumatic stress symptoms are prominent in the lives of parents of young children with substance use disorders (SUD). Parenting experiences, particularly stress and competence, impact parenting behaviors and concomitant child growth and development. Factors that promote positive experiences of parenting, such as parental reflective functioning (PRF), and protect the mother and child from negative outcomes are crucial to understand to develop effective therapeutic interventions. The current US study analyzed baseline data from a parenting intervention evaluation to examine how length of substance misuse, PRF, and trauma symptoms were associated with parenting stress and parenting sense of competence among mothers in treatment for SUDs. Measures included the Addiction Severity Index, PTSD Symptom Scale-Self Report, Parental Reflective Functioning Questionnaire, Parenting Stress Index/Short Form, and Parenting Sense of Competence Scale. The sample included 54 predominantly White mothers with SUDs who had young children. Two multivariate regression analyses found that (1) lower parental reflective functioning and higher posttraumatic stress symptoms were associated with higher parenting stress, and (2) only higher posttraumatic stress symptoms were associated with lower levels of parenting sense of competence. Findings underscore the importance of addressing trauma symptoms and PRF when aiming to improve parenting experiences for women with an SUD.

Childhood Maltreatment and Mental Health Problems: A Systematic Review and Meta-Analysis of Quasi-Experimental Studies

OBJECTIVE

Childhood maltreatment is associated with mental health problems, but the extent to which this relationship is causal remains unclear. To strengthen causal inference, the authors conducted a systematic review and meta-analysis of quasi-experimental studies examining the relationship between childhood maltreatment and mental health problems.

METHODS

A search of PubMed, PsycINFO, and Embase was conducted for peer-reviewed, English-language articles from database inception until January 1, 2022. Studies were included if they examined the association between childhood maltreatment and mental health problems using a quasi-experimental method (e.g., twin/sibling differences design, children of twins design, adoption design, fixed-effects design, random-intercept cross-lagged panel model, natural experiment, propensity score matching, or inverse probability weighting).

RESULTS

Thirty-four quasi-experimental studies were identified, comprising 54,646 independent participants. Before quasi-experimental adjustment for confounding, childhood maltreatment was moderately associated with mental health problems (Cohen's d=0.56, 95% CI=0.41, 0.71). After quasi-experimental adjustment, a small association between childhood maltreatment and mental health problems remained (Cohen's d=0.31, 95% CI=0.24, 0.37). This adjusted association between childhood maltreatment and mental health was consistent across different quasi-experimental methods, and generalized across different psychiatric disorders.

CONCLUSIONS

These findings are consistent with a small, causal contribution of childhood maltreatment to mental health problems. Furthermore, the findings suggest that part of the overall risk of mental health problems in individuals exposed to maltreatment is due to wider genetic and environmental risk factors. Therefore, preventing childhood maltreatment and addressing wider psychiatric risk factors in individuals exposed to maltreatment could help to prevent psychopathology.

The Relationship Between a Lifetime History of Sexual Victimization and Perinatal Depression: A Systematic Review and Meta-Analysis

BACKGROUND

The association between a lifetime history of sexual victimization and the well-being of women during the perinatal period has received increasing attention. However, research investigating this relationship has yet to be systematically reviewed or quantitatively synthesized.

AIM

This systematic review and meta-analysis aims to calculate the pooled effect size estimate of the statistical association between a lifetime history of sexual victimization and perinatal depression (PND).

METHOD

Four bibliographic databases were systematically searched, and reference harvesting was conducted to identify peer-reviewed articles that empirically examined associations between a lifetime history of sexual victimization and PND. A random effects model was used to ascertain an overall pooled effect size estimate in the form of an odds ratio and corresponding 95% confidence intervals (CIs). Subgroup analyses were also conducted to assess whether particular study features and sample characteristic (e.g., race and ethnicity) influenced the magnitude of effect size estimates.

RESULTS

This review included 36 studies, with 45 effect size estimates available for meta-analysis. Women with a lifetime history of sexual victimization had 51% greater odds of experiencing PND relative to women with no history of sexual victimization (OR = 1.51, 95% CI [1.35, 1.67]). Effect size estimates varied considerably according to the PND instrument used in each study and the racial/ethnic composition of each sample.

CONCLUSION

Findings provide compelling evidence for an association between a lifetime history of sexual victimization and PND. Future research should focus on screening practices and interventions that identify and support survivors of sexual victimization perinatally.

A Systematic Review of the Effect of Parental Adverse Childhood Experiences on Parenting and Child Psychopathology

Adverse childhood experiences (ACEs) are defined as early exposure to maltreatment and household dysfunction. Researchers have demonstrated the link between ACEs and negative psychological, behavioral, interpersonal, and health outcomes. A growing area of interest in the ACE literature concerns the relationship between ACEs, parenting, and child psychopathology due to the intergenerational effect of ACEs. Emotional availability and discipline strategies are two domains of parenting that can increase understanding of the associations between ACEs, parenting, and child psychopathology from an attachment framework because they are both salient during early childhood and directly influence a child's later behavior. This paper utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to elucidate the relationships between parental ACEs, parents' emotional availability and discipline strategies, and children's psychopathology. PubMed, PSYCINFO, and Psychology and Behavioral Sciences Collection were used to access the literature on June 16, 2020, and 26 studies met the inclusion criteria. Results from this review suggested that there is a direct association between ACEs and parental emotional availability and discipline techniques. Depression and dissociation were identified as potential mediators. There was support for the direct association between parental ACEs and children's internalizing and externalizing difficulties. Maternal anxiety and depressive symptoms, emotional availability, attachment, and children's maltreatment experiences were found to be possible mediators. Recommendations are proposed to address limitations within the literature to further expand upon the research of ACEs, parenting, and child psychopathology.

Exploring maternal adversity and childhood outcomes among low-income rural families

BACKGROUND

Research has linked adversity among mothers to poorer outcomes among their offspring. However, additional inquiry is warranted particularly in rural communities where risk factors for adversity are prevalent.

OBJECTIVE

This study had two objectives: (1) to describe and compare relationships between individual and cumulative maternal adversity with childhood outcomes; and, (2) to determine if mother-child attachment mediated the relationship between maternal adversity and childhood outcomes.

PARTICIPANTS AND SETTING

A convenient sample of 140 women with low socio-economic status (SES) were recruited through Head Start programs in the rural Midwest.

METHODS

Data was gathered using a survey comprised of multiple measures to assess maternal adversity and childhood outcomes (i.e. behavior and attachment). Data were analyzed in SPSS using bivariate and multivariate analyses, including stepwise regression.

RESULTS

Nearly 80 % of respondents experienced at least one adverse childhood experience (ACE) and 48 % reported having one or more traumatic experiences. Higher levels of adversity were associated with increased attention problems, increased emotional reactivity, and decreased harmonious attachment (p < .05, d = 0.37-0.38). Maternal experiences of childhood physical abuse and sexual abuse, as well as witnessing trauma, significantly predicted childhood outcomes, however, the variance accounted for by each type of adversity was small (4%-6%). Maternal adversity was unrelated to mother-child attachment.

CONCLUSIONS

Low-SES mothers in rural communities have significant histories of adversity. It is important to consider individual and cumulative adverse experiences, as well as the mother's perception of events as traumatic. Factors associated with rural communities and Head Start programming, as well as implications for research and practice surrounding maternal adversity and childhood outcomes, are discussed.

Intergenerational effects of childhood maltreatment: A systematic review of the parenting practices of adult survivors of childhood abuse, neglect, and violence

A history of maltreatment in childhood may influence adults' parenting practices, potentially affecting their children. This systematic review examines 97 studies investigating associations of parental childhood victimization with a range of parenting behaviors that may contribute to the intergenerational effects of abuse: abusive parenting, problematic parenting, positive parenting, and positive parental affect. Key findings include: (1) parents who report experiencing physical abuse or witnessing violence in the home during childhood are at increased risk for reporting that they engage in abusive or neglectful parenting; (2) a cumulative effect of maltreatment experiences, such that adults who report experiencing multiple types or repeated instances of victimization are at greatest risk for perpetrating child abuse; (3) associations between reported childhood maltreatment experiences and parents' problematic role reversal with, rejection of, and withdrawal from their children; (4) indirect effects between reported childhood maltreatment and abusive parenting via adult intimate partner violence; and (5) indirect effects between reported childhood maltreatment and lower levels of positive parenting behaviors and affect via mothers' mental health. Thus, childhood experiences of maltreatment may alter parents' ability to avoid negative and utilize positive parenting practices. Limitations of this body of literature include few prospective studies, an overreliance on adults' self-report of their childhood victimization and current parenting, and little examination of potentially differential associations for mothers and fathers.

Prenatal Attachment, Parental Confidence, and Mental Health in Expecting Parents: The Role of Childhood Trauma

INTRODUCTION

Exposure to childhood abuse or neglect may lead to negative outcomes during pregnancy in expecting parents, which may contribute to a negative experience of childbearing and have consequences for the developing fetus. This study examined the associations between exposure to childhood abuse or neglect, psychological symptoms, prenatal attachment, and perception of parental competence in expectant parents.

METHODS

Individuals at low sociodemographic risk were recruited in community perinatal care settings and completed self-report assessment measures of depression, posttraumatic stress disorder, dissociation, personality disorders, perception of parental competence, and prenatal attachment.

RESULTS

There were 322 participants (78% women), including 91 adults with a history of childhood abuse or neglect, Participants who were exposed to childhood abuse or neglect reported significantly higher levels of symptoms on all indices of mental health than nonexposed adults, even when controlling for sociodemographic risks. However, both groups reported similar levels of prenatal attachment and parental confidence. The impact of childhood maltreatment was similar in men and women. Structural equation modeling showed that childhood abuse or neglect leads to poor mental health and that poor mental health, but not childhood maltreatment, is associated with low parental confidence and prenatal attachment.

DISCUSSION

Psychological symptoms are frequent in expectant parents who experienced maltreatment during their childhood. However, childhood abuse or neglect is not associated with their attitude regarding parenthood and the child in the absence of psychopathology. Supporting mental health may be an important target of parental programs offered during pregnancy to women and men with a history of childhood abuse or neglect.