Maternal PTSD and Children's Adjustment: Parenting Stress and Emotional Availability as Proposed Mediators

The role of parental stress on emotional and behavioral problems in offspring: a systematic review with meta-analysis

OBJECTIVE

Empirical evidence underscores an association between parental stress and emotional and behavioral problems in offspring. However, a comprehensive systematic review or meta-analysis on this topic is lacking. Thus, this study aims to address the scientific inquiry: Is there a relationship between parental stress and emotional/behavioral problems in children?

SOURCES

This systematic review with a meta-analysis surveyed PubMed, PsycINFO, and the Biblioteca Virtual em Saúde between August and September 2021. The present search combined terms (school-age children) AND (parental stress OR parenting stress OR family stress) AND (emotional and behavioral problems OR internalizing and externalizing problems). Eligibility criteria encompassed cross-sectional, cohort, and case-control studies published within the last five years, exploring the association between parental stress (stressful life events and parenthood-related stress disorders) and emotional/behavioral problems in school-age children. PROSPERO ID CRD42022274034.

SUMMARY OF THE FINDINGS

Of the 24 studies meeting all inclusion criteria (n = 31,183) for the systematic review, nine were eligible for inclusion in the meta-analysis. The meta-analysis revealed an association between parental stress and emotional problems (COR: 0.46 [95 % CI: 0.27 - 0.61], p < 0.001, Heterogeneity = 89 %) as well as behavioral problems (COR: 0.37 [95 % CI: 0.27 - 0.46], p < 0.001, Heterogeneity = 76 %).

CONCLUSIONS

These findings indicate that parental stress predicts emotional/behavioral problems in school-age children. Since these problems are related to long-term negative effects in adulthood, these results are crucial for preventing mental health problems in offspring and for screening and managing parental stress.

A qualitative account of mothers of pediatric heart transplant recipients' experience at a pilot mindfulness-based retreat: insights for implementation

OBJECTIVE

To explore participants' shared experience attending a pilot mindfulness-based retreat (MBR) intervention supporting the psychological well-being of mothers of pediatric heart transplant (HTx) recipients.

METHODS

A qualitative description approach was used within a larger hybrid mixed-methods pilot study evaluating the implementation-effectiveness of a 2-day MBR tailored specifically for a pediatric HTx population. A purposive sample of mothers was recruited from a leading Canadian pediatric HTx center, and each represented a primary, female-identifying caregiver, sharing residence with a pediatric HTx recipient of at least 4 months post-transplant. Two focus groups were conducted after and 16 individual interviews 3 months after the MBR to elicit participants' in-depth experience attending the MBR. Reflexive thematic data analysis led to theme development through an iterative process with consensus among team members.

RESULTS

Sixteen mothers of pediatric HTx recipients (mean patient age 9.8 years; mean time post-transplant 8.2 years) participated in the MBR held in Ontario, Canada. Qualitative findings illuminated mothers' shared experience attending the MBR, reflecting three themes that describe key intervention elements beyond those affiliated with mindfulness practice alone: "respite," "readiness," and "relationships." Findings highlight acceptability and appropriateness as distinct yet interrelated implementation outcomes.

CONCLUSIONS

Elements of "respite," "readiness," and "relationships" are key components of the MBR experience that offer valuable intervention and clinical considerations related to mothers' psychological well-being. Aligning intervention acceptability and appropriateness through tailored strategies may aid implementation. Future research considering maternal readiness relative to support intervention participation is warranted.

Examining Interpersonal Traumas Across Low Income Latinx Mother-Youth Dyads: Associations Between Maternal Child Abuse Exposure and Racial Discrimination with Mother and Youth Psychopathology

Child abuse has intergenerational consequences for psychopathology, however, there remains a paucity of research regarding how these experiences affect Latinx families, particularly those at risk for additional negative life events, such as racial discrimination. This study aims to contribute to this gap in the literature by examining the impact maternal child abuse exposure has on youth and maternal psychopathology, as well as whether these associations are moderated by racial discrimination, in a sample of 224 Latinx mother-youth dyads. Hierarchical regressions revealed small but significant maternal child abuse exposure x racial discrimination interactions for youth depression and anxiety, but not maternal depression or anxiety, which were solely positively associated with maternal child abuse exposure. Findings highlight the multifarious, and at times convergent, nature of trauma and oppression among Latinx families, as well as the impact across generations. Future work is needed to further elucidate developmental pathways of intergenerational trauma in understudied populations.

Reducing risk factors for child maltreatment: The Parenting-STAIR open pilot study

BACKGROUND

Despite a large body of evidence linking the impact of trauma, parenting, and child maltreatment recidivism, current child welfare services often do not target maternal trauma and post-traumatic stress disorder (PTSD). Moreover, there is little evidence that traditional family preservation services (FPS) lower the rates of repeat incidences of child abuse and neglect. The novel intervention, Parenting-STAIR (P-STAIR), seeks to address maternal mental health and parenting skills in order to reduce punitive parenting behaviors.

OBJECTIVE

This study analyzes the effects of P-STAIR on child maltreatment risk.

PARTICIPANTS AND SETTING

P-STAIR was administered to 112 child welfare-involved mothers in New York City (NYC). The mothers were between 18 and 52 years old (M = 31.1, SD = 6.6) and were referred from 4 child welfare preventive service agencies in NYC.

METHODS

To evaluate change over time in indicators of maltreatment risk, two-tailed paired sample t-tests compared 1) pre- and post-treatment scores and 2) pre-treatment and 3-month follow-up scores.

RESULTS

Among the 71 mothers who completed treatment, significant improvements from baseline to post-assessment and pre- to 3-month follow-up were observed across total scores on the CTSPC and the AAPI-2. Improvements were evident in nonviolent disciple, psychological aggression, expectations, empathy, and parent-child family roles at both the post-assessment and 3-month follow-up which are proximal outcomes of P-STAIR (CTSPC: pre-post nonviolent disciple d = 0.70; pre-post psychological aggression d = 0.34; pre-follow-up nonviolent disciple d = 0.42; pre-follow-up psychological aggression d = 0.36; AAPI-2; pre-post expectations d = 0.31; pre-post empathy d = 0.39; pre-post parent-child roles d = 0.47; pre-follow-up expectations d = 0.33; pre-follow-up empathy d = 0.42; pre-follow-up parent-child roles d = 0.66).

CONCLUSIONS

The improvement in indicators of maltreatment risk demonstrates promising support for the utility of P-STAIR within the child welfare system.

Mothers with a history of trauma and their children: a systematic review of treatment interventions

Introduction

Mothers with a history of trauma frequently face significant challenges in their relationships with their children. Therefore, it is crucial for trauma-exposed mothers and their young children to receive adequate trauma-informed treatment. This review aimed to examine the effects of trauma-informed interventions on improving the mother-child relationship among mothers with a history of trauma and their young children under 6 years old.

Methods

The study analyzed 15 articles that met the eligibility criteria, encompassing a sample size of 1,321 mothers. The systematic GRADE approach was used to rate the certainty of evidence in this systematic review.

Results

The study found that while some interventions demonstrated small to large effects, the quality of evidence was only moderate. The most promising interventions were Parent-Child Interaction Therapy (PCIT), Child-Parent Psychotherapy (CPP), and Maternal Empowerment Program (MEP), which all included elements of psychotherapy, psychoeducation, and skills training.

Discussion

The study underscores the importance of understanding the needs of mother-child dyads affected by trauma and tailoring interventions to meet those needs. Overall, the literature suggests that interventions combining psychotherapeutic, psychoeducational, and skills-training components are most effective in improving mother and child-related outcomes for mothers with a history of trauma and their young children. The review provides recommendations for future research and emphasizes the importance of considering the mother-child relationship in trauma-informed interventions.

Subjective Stress Appraisals Over Time: the Evolving Structure of the COVID-19 Stressor Scale

The COVID-19 Stressors Scale measures individuals' appraisals of stressors related to the pandemic. Measurement of perceptions of stressors is necessary to understand the socioemotional impacts of not only the COVID-19 pandemic, but other disasters. The study examined the factor structure of the scale among adults in the U.S. over six time points. A shortened version was used, and the fit was examined over time. The results of the study show contextual appraisals change over time and offer important implications for the measurement of stressfulness of disasters, a critical step in designing and assessing impacts of social programs aimed to reduce the deleterious effects of disasters.

Children of trauma survivors: Influences of parental posttraumatic stress and child-perceived parenting

BACKGROUND

Research has established a negative association between parental posttraumatic stress symptoms (PTSS), including subthreshold symptoms, and child physical and behavioral health outcomes. Such intergenerational transmission of risk has multiple possible mechanisms, including lack of positive parenting, increased negative parenting, shared environmental and contextual risks, and potential biological components such as shared genetics or even transmission of epigenetic risk.

METHOD

This study examined 93 parent-child dyads (n = 171 participants total) from a mixed Urban-Suburban US metropolitan area to investigate the relations between parental PTSS and child-perceived parenting and child PTSS. We sought to examine interactions between parental PTSS and parenting on child PTSS.

RESULTS

We found an association between parent and child PTSS, consistent with prior literature showing increased risk for children of trauma survivors. Interestingly, we found effects of positive parenting on diminished child PTSS symptoms only in parents without PTSS, whereas the effect of positive parenting on buffering child symptoms was absent in parents with PTSS.

LIMITATIONS

The present findings are tempered by the use of self-report data to assess parent and child PTSS, which is not as reliable as clinician assessment of symptoms. Further, the use of survey data limits what is known about the extent of trauma exposure in parents and children, and different measures were used to assess PTSS in parents and kids, which limits comparability of these reported symptoms.

DISCUSSION

Limitations notwithstanding, findings suggest joint attention paid to parenting practices and to a parent's recovery, even from subthreshold symptoms of PTSS, as two different but important ways to support trauma survivor parents in their efforts to most optimally parent and protect their children from intergenerational risk.

Emotional neglect and parents' adverse childhood events

INTRODUCTION

Emotional neglect means that the child's emotional and developmental needs are not fulfilled by the parents or other caregivers. Adverse childhood events (ACEs) are a risk factor for mental health problems and impaired parenting skills. The objective here was to examine whether parents' ACEs increase the child's risk of experiencing emotional neglect.

METHODS

The participants in the present study were members of the Northern Finland Birth Cohort 1986 (NFBC1986). Emotional neglect experiences were measured in 190 members of this cohort by means of the Trauma and Distress Scale (TADS), and ACEs in both parents were measured with a specific questionnaire. A linear regression model was used to examine the association between parents' ACEs and the children's emotional neglect scores.

RESULTS

The children's mean emotional neglect score was 8.11 on a scale from 5 to 25. There was no significant difference between males (mean 8.01) and females (mean 8.19). Only father's ACEs were associated with child's emotional neglect score. In the linear regression model, the children's emotional neglect scores increased by 0.3 points for father's ACE.

CONCLUSIONS

Our findings suggest that father's ACEs may increase the child's risk of experiencing emotional neglect. It seems that childhood adversities are transferred from parents to children, but larger samples would be needed to confirm these findings.

Parenting stress and children's trauma symptoms over the course of TF-CBT: Examining differences between relative and foster/adoptive caregivers

BACKGROUND

Through Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), the gold standard in children's trauma treatment, caregivers participate in sessions parallel to the child. However, much of the research examining the impact of this caregiver involvement has focused on biological or relative caregivers, despite the high prevalence of trauma and trauma symptoms among youth in foster care and high rates of parenting stress among foster/adoptive caregivers.

OBJECTIVE

The current study examined differences among relative and foster/adoptive caregivers' levels of parenting stress throughout the course of TF-CBT and how these differences were associated with child trauma symptoms throughout treatment.

PARTICIPANTS AND SETTING

Participants were 130 caregiver-child dyads (84 = foster/adoptive; 46 = biological/relative) who completed TF-CBT in either an academic-based clinic or an associated mental health agency. Providing clinicians were trained in TF-CBT, participated in case consultation, and received ongoing clinical supervision.

METHODS

Children and caregivers completed baseline measures prior to beginning treatment and termination measures at the completion of treatment.

RESULTS

Prior to treatment, foster/adoptive caregivers reported greater dysfunction in their parent-child interactions and relative caregivers reported greater personal stress. These differences were not seen at treatment termination, and significant reductions in child trauma symptoms and caregiver parenting stress were evidenced from pre to post treatment. Significant covariation between child trauma symptoms and relative caregiver parenting stress at termination was also found.

CONCLUSIONS

There were different profiles of parenting stress for relative versus foster/adoptive caregivers, but treatment completion attenuated group differences in parenting stress over the course of treatment.

Study protocol: development and randomized controlled trial of a preventive blended care parenting intervention for parents with PTSD

BACKGROUND

Children of parents with post-traumatic stress disorder (PTSD) are at increased risk of adverse psychological outcomes. An important risk mechanism is impaired parental functioning, including negative parenting behavior, perceived incompetence, and lack of social support. Several parenting interventions for trauma-exposed parents and parents with psychiatric disorders exist, but none have specifically targeted parents with PTSD. Our objective is to evaluate the effectiveness of a blended care preventive parenting intervention for parents with PTSD.

METHODS

The intervention was adapted from an existing online intervention, KopOpOuders Self-Help. In co-creation with parents with PTSD and partners, the intervention was adapted into KopOpOuders-PTSD, by adding PTSD-specific content and three in-person-sessions with a mental health prevention professional. Effectiveness will be tested in a randomized controlled trial among N = 142 parents being treated for PTSD at Arkin Mental Health Care (control condition: treatment as usual, n = 71; intervention condition: treatment as usual + intervention, n = 71). Online questionnaires at pretest, posttest, and three-month follow-up and ecological momentary assessment at pretest and posttest will be used. Intervention effects on primary (parenting behavior) and secondary outcomes (perceived parenting competence, parental social support, parenting stress, child overall psychological problems and PTSD symptoms) will be analyzed using generalized linear mixed modeling. We will also analyze possible moderation effects of parental PTSD symptoms at pretest on primary and secondary outcomes.

DISCUSSION

This study protocol describes the randomized controlled trial of KopOpOuders-PTSD, a blended care preventive parenting intervention for parents with PTSD. Findings can contribute to understanding of the effectiveness of parenting support in clinical practice for PTSD.

TRIAL REGISTRATION

This protocol (Version 1) was registered on 11-02-2022 at ClinicalTrials.gov under identification number NCT05237999.

Patterns of Stress and Wellbeing Among Families Enrolled in Early Head Start/Head Start During COVID-19

The COVID-19 pandemic disproportionately affected low-income families in the U.S., particularly those with young children (Kalluri et al., 2021). This longitudinal study describes the resources, stress, and health and wellbeing of low-income families enrolled in an Early Head Start/Head Start program for two cumulative program years before and during the height of the COVID-19 pandemic. We found having more resources (higher income, higher education levels, full time employment) prior to the onset of COVID-19 was correlated with better wellbeing and lower stress throughout the pandemic. Implications and directions for future research include understanding the specific types of supports that programs like EHS/HS provided during COVID-19 and how families benefitted from them.

Effects of maternal trauma and associated psychopathology on atypical maternal behavior and infant social withdrawal six months postpartum

Maternal psychopathology given a history of maltreatment and domestic violence exposure increases the risk for child psychopathology. Infant social withdrawal is one warning sign of adverse developmental outcomes including child anxiety and depression. It remains unclear how maternal trauma-related psychopathology might affect infant social withdrawal six-months postpartum.

METHODS

One-hundred ninety-five women and their six-month-old infants were studied in an at-risk community sample. Maternal trauma history, posttraumatic stress (PTSD) and major depressive (MDD) disorders were assessed. Maternal and infant behaviors were coded from videotaped interactions.

RESULTS

Maternal trauma was correlated with atypical maternal behavior (AMB) and infant social withdrawal (p ≤ .001). PTSD and MDD, and comorbid PTSD/MDD predicted increased AMB (p ≤ .001) but only maternal MDD was predictive of infant social withdrawal (p ≤ .001). Effects of maternal MDD on infant withdrawal were mediated by AMB.

CONCLUSIONS

At six-months postpartum, maternal MDD was associated with infant withdrawal. AMB is an important target for early intervention.

Childbirth related PTSD and its association with infant outcome: A systematic review

INTRODUCTION

Maternal postnatal mental health problems may negatively impact child development. Postpartum research has mainly focused on the impact of maternal depression and anxiety due to their high prevalence (13-25 % and 10-18 %, respectively). However, maternal childbirth-related PTSD (CB-PTSD) could be another important risk factor in child development (estimated prevalence: 4.7 %).

OBJECTIVE

We investigated whether maternal CB-PTSD (symptoms) are associated with a negative mother-child relationship and/or child developmental outcome for children aged 0-5 years. Furthermore, we examined whether maternal trauma-focused therapy can positively impact mother and child outcomes.

METHODS

We performed a systematic review by searching three databases (Embase, Medline, PsycInfo). Search terms involved: 'birth or delivery modes', 'PTSD psychological trauma', and 'child development or child behavior'. Two independent reviewers evaluated all eligible papers.

RESULTS

Thirty-five papers (30 samples) were included and qualitatively reported. Results suggest a negative association of maternal CB-PTSD (symptoms) with mother-infant attachment and child behavior. However, confounding factors may explain this association. The evidence on associations with breastfeeding, sleeping, socio-emotional development, and weight gain is insufficient. Research investigating the effect of maternal trauma-focused therapy on a child's outcome is scarce, contradictory, and of low quality.

CONCLUSION

This systematic review suggests that maternal CB-PTSD may be associated with an increased number of problems in mother-infant attachment and child behavior, but other domains remain scarcely investigated and methodologic issues are present (cross-sectional study design, influence of confounding variables, sample representativeness, diversity in assessment tools). Our results support a multidisciplinary approach to providing early prevention and screening of the maternal mental health state.

Intergenerational effects of maternal PTSD: Roles of parenting stress and child sex

OBJECTIVES

Parental posttraumatic stress disorder (PTSD) increases children's risk for emotional and behavioral problems. We examined parenting stress and parenting behavior quality as mediators of the relation between maternal PTSD and problematic child behaviors in a sample at high risk for trauma exposure. We also examined whether child sex moderated this association.

METHOD

Participants were 141 African American mother-child dyads (children aged 8-12). Mothers reported PTSD severity, parenting stress, and child behavior (externalizing, internalizing, and emotional self-control). Parenting behavior quality (accounting for factors including parental warmth and engagement) was assessed from an observational parent-child interaction task.

RESULTS

Parenting stress, but not observed parenting behavior quality, mediated the relation between maternal PTSD severity and child behaviors. Child sex moderated this association, such that the effect was stronger for girls.

CONCLUSIONS

Maternal PTSD may be associated with negative child behavior outcomes, and this relation appears to be mediated by increased parenting stress. Stress-reducing interventions for parents with PTSD could improve child outcomes, especially for girls. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Development and validation of the parents' cognitive perception inventory of disaster effects on children's well-being (PCP-DCWB)

BACKGROUND

Parents' cognition about the type and nature of consequences a disaster may pose on the children's psychosocial health, could be a major protective factor against the long-term overwhelming complications. Given the lack of a reliable instrument to measure parents' cognition about disasters' effects on children's well-being, this study was conducted to develop and validate the parents' cognitive perception inventory of disaster effects on children's well-being (PCP-DCWB).

METHODS

In this cross-sectional study 300 parents of the survived primary school aged children from the Iran's northwest earthquake on August 2012 were recruited in the city of Varzegan. Exploratory factor analysis (EFA) was applied to identify the subcomponents and Cronbach's alpha and Guttmann Split-half coefficients were calculated to assess the internal consistency reliability of the scale.

RESULTS

Structural indicators of the Kaiser-Meyer-Olkin measure (0.69) and Bartlett's test of Sphericity (P < 0.001, df = 153, X² = 618.35) verified interpretability of the EFA output. Applying principal component analysis and direct oblimin rotation in the EFA four latent factors were identified (i.e., perception about child overall mental health, coping with trauma's long-term effects, children or parents' continuing memory of past disaster and perception about behavioral and educational problems) which explained 49.32% of the total variance. The estimated Cronbach's alpha and split-half reliability coefficients (0.71 and 0.52 respectively) supported good internal consistency of the instrument.

CONCLUSION

The study findings revealed sound psychometric attributes of the PCP-DCWB to be applied in assessment of parents' cognition about psychological impacts of a traumatic event on the survived children. The instrument application can shed light on level of pre-disaster preparations in local, national and international scales and help effectiveness assessment of interventions that target maintenance of psycho-social well-being among disaster-affected survivors over time.

Mindfulness-based retreat for mothers of paediatric heart transplant recipients: protocol for a pilot intervention study

INTRODUCTION

Mothers are often the primary caregivers for children requiring heart transplantation. Given that a mother's ability to successfully cope with the demands of her caregiving role may be predictive of positive familial psychosocial outcomes, it is critical that maternal coping is assessed and supported in paediatric healthcare. Mindfulness-based programmes are proposed as one intervention that may enhance quality of life, improve distress tolerance and coping and reduce social isolation in caregiving populations. This pilot study aims to investigate: (1) the implementation success of a mindfulness-based retreat (MBR), and (2) the effectiveness of a MBR at improving quality of life, distress tolerance, coping and perceived social support for mothers of paediatric heart transplant recipients.

METHODS AND ANALYSIS

A convergent parallel, mixed-method design is proposed for this pilot, exploratory study. Twenty mothers will participate in this pilot MBR held at a resort in Ontario, Canada. Quantitative data will be obtained using five standardised instruments completed at three time points: (T1) 24-hours prior to the intervention, (T2) immediately on completion of the intervention, and (T3) three months post-intervention. Qualitative data will be collected from all participants both through semi-structured focus groups at T2 and individual telephone interviews at T3. Focus groups and individual interviews will be transcribed verbatim for thematic analysis. Quantitative and qualitative data will be merged and compared during interpretation to ensure that the intervention implementation and effectiveness of the MBR retreat are described with comprehensive accuracy. The primary outcomes will be feasibility in relation to implementation effectiveness and participants' perception of social support for efficacy of the MBR intervention.

ETHICS AND DISSEMINATION

This study received Institutional Research Ethics Board approval from The Hospital for Sick Children (Number: 1000064719). Informed consent will be obtained prior to participant enrolment. Findings will be disseminated via conference presentations and submitted for publication in a peer-reviewed journal.

The mental health and wellbeing of spouses, partners and children of emergency responders: A systematic review

Emergency responders (ERs), often termed First Responders, such as police, fire and paramedic roles are exposed to occupational stressors including high workload, and exposure to trauma from critical incidents, both of which can affect their mental health and wellbeing. Little is known about the impact of the ER occupation on the mental health and wellbeing of their families. The aim of the current study was to investigate what mental health and wellbeing outcomes and experiences have been researched internationally in ER families, and to examine the prevalence and associated risk and protective factors of these outcomes. We conducted a systematic review in accordance with an a priori PROSPERO approved protocol (PROSPERO 2019 CRD42019134974). Forty-three studies were identified for inclusion. The majority of studies used a quantitative, cross-sectional design and were conducted in the United States; just over half assessed police/law enforcement families. Themes of topics investigated included: 1) Spousal/partner mental health and wellbeing; 2) Couple relationships; 3) Child mental health and wellbeing; 4) Family support and coping strategies; and 5) Positive outcomes. The review identified limited evidence regarding the prevalence of mental health and wellbeing outcomes. Family experiences and risk factors described were ER work-stress spillover negatively impacting spousal/partner wellbeing, couple relationships, and domestic violence. Traumatic exposure risk factors included concerns family had for the safety of their ER partner, the negative impact of an ER partners’ mental health problem on the couples’ communication and on family mental health outcomes. Protective factors included social support; however, a lack of organisational support for families was reported in some studies. Study limitations and future research needs are discussed. Progressing this area of research is important to improve knowledge of baseline needs of ER families to be able to target interventions, improve public health, and support ER’s operational effectiveness.

Understanding links between maternal perinatal posttraumatic stress symptoms and infant socioemotional and physical health

Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother-infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.

Children academic stress, mothers’ anxiety and Mother-Child relationship during COVID-19 in China

In this study, the researcher aims to examine and provide some knowledge of COVID-19 impact on mother-child relationship, children perceived academic stress and mothers' anxiety among families in mainland China (N = 1512). The researcher confirms that mental health symptoms resulting from Covid-19 are significant, with extensive impacts on mothers' anxieties, children's academic stress, and mother-child conflict and closeness. The researcher also show significant link between students' tremendous academic stress and students completing their final grade. The author highlights the need for health policies to expand families' psychological well-being especially in crisis time.

The relationship of maternal and child methylation of the glucocorticoid receptor NR3C1 during early childhood and subsequent child psychopathology at school-age in the context of maternal interpersonal violence-related post-traumatic stress disorder

INTRODUCTION

Interpersonal violent (IPV) experiences when they begin in childhood and continue in various forms during adulthood often lead to chronic post-traumatic stress disorder (PTSD) that is associated in multiple studies with hypocortisolism and lower percentage of methylation of the promoter region of the gene coding for the glucocorticoid receptor (NR3C1). This prospective, longitudinal study examined the relationship of NR3C1 methylation among mothers with IPV-related PTSD and their toddlers and then looked at the relationship of maternal NR3C1 methylation and child psychopathology at school age.

METHODS

Forty-eight mothers were evaluated for life-events history and post-traumatic stress disorder via structured clinical interview when their children were ages 12-42 months (mean age 26.7 months, SD 8.8). Their children's psychopathology in terms of internalizing symptoms and externalizing behaviors was evaluated using the Child Behavior Checklist at ages 5-9 years (mean age 7 years, SD 1.1). Percentage of methylation for the NR3C1 gene promoter region was assessed from DNA extracted from maternal and child saliva using bisulfite pyrosequencing. Data analysis involved parametric and non-parametric correlations and multiple linear and logistic regression modeling.

RESULTS

Logistic regression models using child NR3C1 methylation as the dependent variable and maternal NR3C1 methylation and PTSD group status as predictors, as well as the interaction indicated that all three of these significantly predicted child NR3C1 methylation. These findings remained significant when controlling for child age, sex and maternal child abuse history. Overall, maternal NR3C1 methylation when children were toddlers was negatively and significantly associated with child externalizing behavior severity at school age.

DISCUSSION

We found that correlations between mothers and their children of NR3C1 methylation levels overall and at all individual CpG sites of interest were significant only in the IPV-PTSD group. The latter findings support that NR3C1 methylation in mothers positively and statistically significantly correlates with NR3C1 methylation in their children only in presence of IPV-PTSD in the mothers. This maternal epigenetic signature with respect to this glucocorticoid receptor is significantly associated with child behavior that may well pose a risk for intergenerational transmission of violence and related psychopathology.

Parenting Stress Moderates the Relation between Parental Trauma Exposure and Child Anxiety Symptoms

Trauma exposure can lead to poor psychological health not only for those directly affected, but also for their children. Additional research is needed to understand mechanisms in the intergenerational sequelae of traumatic stress. The current study examined parenting stress as a moderator of the association between parents' lifetime trauma exposure and school-aged children's internalizing symptoms (N = 139 dyads). Results of multiple regression analyses showed that the relationships between parental trauma exposure and child separation anxiety and harm avoidance were significant when parenting stress was moderate to high, but not when parenting stress was low. Parental trauma exposure was not significantly associated with child depressive symptoms. Clinical implications include the importance of screening and addressing parents' trauma exposure and parenting stress in the context of child and family mental health services. Further research is needed to explicate the mechanisms linking parents' trauma exposure with child anxiety symptoms.

Elucidating posttraumatic stress symptom dimensions and health correlates among postpartum women

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with interpersonal dysfunction and adverse maternal health during the perinatal period (extending from conception through one year postpartum). However, PTSD is a heterogeneous disorder, and little is known about which aspects of this disorder may be particularly deleterious to the health of new mothers. Such data may inform more personalized approaches to PTSD prevention and treatment among postpartum women.

METHODS

Using confirmatory factor analysis, we compared three models of PTSD symptom structure-the four-factor dysphoria model, four-factor emotional numbing model, and five-factor dysphoric arousal model-in 1,663 postpartum women from the Community and Child Health Network (CCHN). We examined associations between PTSD symptom dimensions of the best-fitting model with four correlates relevant to maternal health and functioning-parenting stress, partner relationship stress, relationship satisfaction, and contraceptive use.

RESULTS

Though all models fit well, the five-factor dysphoric arousal model provided optimal fit. Symptom dimensions from this model-re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal-evidenced differential associations with the maternal health indicators. Numbing symptoms were most strongly associated with indicators of poor interpersonal functioning, whereas dysphoric arousal symptoms were most strongly related to low-efficacy contraceptive use.

LIMITATIONS

Our cross-sectional study assessed DSM-IV PTSD symptoms.

CONCLUSIONS

PTSD symptoms among postpartum women are best-represented by five factors. Numbing symptoms (e.g., restricted affect, detachment) are most strongly associated with interpersonal difficulties, whereas dysphoric arousal symptoms (e.g., agitation, irritability) are linked with low-efficacy contraceptive use. Screening for these symptoms may help promote the health of new mothers.

The COVID-19 Pandemic and Its Impact on Families' Mental Health: The Role Played by Parenting Stress, Parents' Past Trauma, and Resilience

International research has evidenced the psychological impact of the COVID-19 pandemic on families, and the key role played by parenting stress levels. Although significant associations with parents' past trauma and resilience have been shown, this study aimed to explore their complex interplay on the relationship between parents' peritraumatic distress due to COVID-19, parenting stress, and children's psychopathological difficulties. We recruited 353 parents with children aged two to 16 years via an online survey during the Italian second wave of COVID-19. Parents' peritraumatic distress due to COVID-19, parenting stress, past trauma and resilience, and children's psychological difficulties were assessed through self-report and report-form questionnaires. Parents' past traumas significantly predicted peritraumatic distress due to COVID-19 and children's psychological difficulties. The relationship between past traumas and children's psychological difficulties was serial mediated by parents' peritraumatic distress and parenting stress. Direct and total effects of parent's resilience on parent's peritraumatic distress were not significant, but there were significant indirect effects via parenting stress and via parents' peritraumatic distress and parenting stress, indicating inconsistent mediation. This study evidenced the key risk and protective role played by, respectively, parents' past traumas exposure and resilience on the relationship between parents' psychological difficulties due to COVID-19, parenting stress, and children's psychological difficulties, with important clinical implications.

Parental Internalizing Psychopathology and PTSD in Offspring after the 2012 Earthquake in Italy

Post-traumatic stress disorder (PTSD) is common in youths after earthquakes, with parental psychopathology among the most significant predictors. This study investigated the contribution and the interactional effects of parental internalizing psychopathology, the severity of exposure to the earthquake, and past traumatic events to predict PTSD in offspring, also testing the reverse pattern. Two years after the 2012 earthquake in Italy, 843 children and adolescents (9-15 years) living in two differently affected areas were administered a questionnaire on traumatic exposure and the UCLA PTSD Reaction Index. Anxiety, depression, and somatization were assessed in 1162 parents through the SCL-90-R. General linear model showed that, for offspring in the high-impact area, predictors of PTSD were earthquake exposure, past trauma, and parental internalizing symptoms, taken individually. An interaction between earthquake exposure and parental depression or anxiety (not somatization) was also found. In the low-impact area, youth PTSD was only predicted by earthquake exposure. The reverse pattern was significant, with parental psychopathology explained by offspring PTSD. Overall, findings support the association between parental and offspring psychopathology after natural disasters, emphasizing the importance of environmental factors in this relationship. Although further research is needed, these results should be carefully considered when developing mental health interventions.

Warm Connections: Integration of Infant Mental Health Services into WIC

Low-income women experience disproportionately high rates of adverse maternal mental health outcomes, such as pregnancy-related depression, and have less access to behavioral health support. Adverse maternal mental health affects children through compromising bonding, impeding early childhood development, and increasing risks of child maltreatment. Integrated behavioral health approaches can improve access to behavioral health services by locating services in community-based settings routinely accessed by low-income families. Warm Connections is an innovative integrated behavioral health program delivered in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and rooted in an infant and early childhood mental health (IECMH) framework. This exploratory study describes Warm Connections and provides evaluation results from its pilot implementation. Findings suggest Warm Connections may reduce distress and increase parenting efficacy among low-income mothers and support further research of this program's feasibility.

Short-term impacts of COVID-19 on family caregivers: Emotion regulation, coping, and mental health

Background

The negative mental health impact of coronavirus disease 2019‐related stressors may be heightened for those caring for children, who bear responsibity for their welfare during disasters.

Aim

Based on the Transactional Model of Stress and Coping, we inquired whether caregivers' emotion regulation and coping behavior were associated with posttraumatic stress symptoms (PTSS).

Materials & Methods

Data were collected through a national online survey in April 2020, and again 60 days later.

Results:Of the 801 longitudinal cases, 176 (63.6% female; mean age = 33.5) reported caring for minors in their homes during the pandemic. Over 20% of caregivers experienced clinically concerning PTSS, rates higher than their noncaregiving counterparts. Regression analysis indicates caregivers' baseline mental health symptoms and emotion regulation predicted PTSS 60 days later.

Discussion

Implications for needed parenting supports among families experiencing traumatic stress are provided.

Conclusion

Anxiety symptoms at baseline were the most significant and consistent contributor to all models and were significantly higher among those with clinically concerning levels of PTSS suggesting a clear intervention target.

Mothers’ Accounts of Attending to Educational and Everyday Needs of Their Children at Home during COVID-19: The Case of the UAE

From March 2020 until July 2020, the UAE implemented mandatory distance learning due to COVID-19, which meant that children had to continue their learning remotely at home. Though schools concerted exemplary efforts to ensure that children received all that was necessary through advanced technology platforms and interfaces, the duty of ensuring that children continued to engage in successful learning fell solely on parents. This paper is based on a self-report study conducted during this first period of distance learning where parents were invited to anonymously complete a survey and then be interviewed. The paper relies on interviews as its main data source. Interview transcripts once transcribed were thematically analysed. One recurring theme in the data was gender differences in domestic and other duties as well as attending to the educational needs of children. Mothers, irrespective of cultural or educational background, disproportionately seemed to be the caretakers of the home and of children’s educational needs. Mothers spoke of their mental health concerns, pressures of time management, and negative effects on their own work. This paper makes an original contribution by exploring parental experiences of emergency remote learning and what these reflect about parental ethnotheories in the UAE.

The Association between Child and Parent Psychiatric Disorders in Families Exposed to Flood and/or Dioxin

Associations of disaster mental health sequelae between children and their parents have been demonstrated, but not using full diagnostic assessment. This study examined children and their parents after a series of disasters in 1982 to investigate associations of their psychiatric outcomes. Members of 169 families exposed to floods and/or dioxin or no disaster were assessed in 1986–1987 with structured diagnostic interviews. This vintage dataset collected several decades ago provides new information to this field because of the methodological rigor that is unparalleled in this literature. Disaster-related PTSD and incident postdisaster disorders in children were associated, respectively with disaster-related PTSD and incident postdisaster disorders in the chief caregiver and mother. More flood-only than dioxin-only exposed parents reported great harm by the disaster, but neither children nor parents in these two groups differed in incident psychiatric disorders. Although this study did not determine the direction of causal influences, its findings suggest that clinicians working with disaster-exposed families should work with children and adult members together, as their mental health outcomes may be intertwined.

Pandemic-Related Stress Symptoms Among Norwegian Parents of Adolescents in Grades 6 to 8

We investigated pandemic-related stress symptoms during the first COVID-19 lockdown period in spring 2020 among parents of adolescents that were 11 to 13 years old in the study period. We also investigated whether parental stress symptoms were associated with family situation and family activities during lockdown. Altogether 147 couples reported about their own trauma-related stress symptoms following the outbreak of the pandemic. Among the respondents, 9.5% of the mothers and 10.2% of the fathers had scores over cutoff on the screener (IES-6) measuring stress symptoms, a non-significant gender difference. Scores on the screener were not associated with family contamination or lockdown consequences. Family activities during lockdown did not impact the pandemic stress symptom levels. Whereas, the experience of the COVID-19 pandemic pose a stressor to most people, it is unlikely to be a criterion A event for other than directly affected families.

Associations Between Maternal Post-traumatic Stress Disorder and Traumatic Events With Child Psychopathology: Results From a Prospective Longitudinal Study

Introduction: Exposure to interpersonal violence (IPV) can lead to post-traumatic stress disorder (PTSD) in mothers, and in turn adversely affect the mother-child relationship during early development, as well as the mental health of their children. Our objectives are to assess: (1) the association of maternal IPV-PTSD to child psychopathology, (2) the association of maternal IPV independently of PTSD to child psychopathology, and (3) the relationship between child exposure to violence to the psychopathology of these children. Methods: We used data from the longitudinal Geneva Early Childhood Stress Project. The sample included 64 children [mean age at Phase 1 = 2.4 (1.0-3.7) years] of mothers with or without IPV-PTSD. Data on mothers was collected during Phase 1, using the Clinical Administered PTSD Scale (CAPS), the Brief Physical and Sexual Abuse Questionnaire (BPSAQ) and the Conflict Tactics Scale (CTS2). Modules of a semi-structured diagnostic interview, and the Violence Exposure Scale were used to collect information on child at Phase 2, when children were older [mean age = 7.02 (4.7-10)]. Results: A higher CAPS score in mothers when children were toddler-age was associated with an increased risk of symptoms of attention deficit/hyperactivity disorder (ADHD; β = 0.33, p = 0.014) and PTSD in school-age children. The association between maternal IPV-PTSD and child PTSD (β = 0.48, p < 0.001) symptoms remained significant after adjustment for potential confounders. Among children, exposure to violence was associated with an increased risk of symptoms of generalized anxiety (β = 0.37, p = 0.006), major depressive (β = 0.24, p = 0.039), ADHD (β = 0.27, p = 0.040), PTSD (β = 0.52, p < 0.001), conduct (β = 0.58, p = 0.003) and oppositional defiant (β = 0.34, p = 0.032) disorders. Conclusion: Our longitudinal findings suggest that maternal IPV-PTSD during the period of child development exert an influence on the development of psychopathology in school-aged children. Mothers' IPV was associated with child psychopathology, independently of PTSD. Child lifetime exposure to violence had an additional impact on the development of psychopathology. Careful evaluation of maternal life-events is essential during early childhood to reduce the risk for the development of child psychopathology. Early efforts to curb exposure to violence in children and early intervention are both needed to reduce further risk for intergenerational transmission of trauma, violence, and related psychopathology.

Mediation of Mothers' Anxiety and Parenting in Children's Behavior Problems during COVID-19

The outbreak of COVID-19 is affecting the lives of millions of families around the world. The current study was carried out in Israel, following the pandemic's initial outbreak and during the resulting enforced quarantine, confining parents and children to their homes. A sample of 141 Israeli mothers with at least one child between the ages of 3 and 12 (M = 6.92, SD = 2.55) participated as volunteers. About half the sample (50.7%) consisted of girls. Most mothers were cohabiting with a spouse (93%). Mothers completed online questionnaires about their perceptions about the health and economic threats of COVID-19, availability of social support, their anxiety symptoms, hostile/coercive and supportive/engaged parenting behavior, and their children's behavior problems. Results showed expected significant associations between the mothers' reports about having little social support, their anxiety symptoms, hostile/coercive and supportive/engaged parenting behavior, and children's externalizing problems. Likewise, expected significant associations were found between mothers' perceptions about the health and economic threats of COVID-19, their anxiety symptoms, hostile/coercive parenting behavior, and children's internalizing and externalizing problems. Importantly, maternal anxiety and hostile/coercive parenting behavior mediated the associations between lack of support, negative perceptions about the health and economic threats of COVID-19, and children's behavior problems. These findings stress the importance of mothers' mental health and parenting behaviors for children's socioemotional adaptation in the context of COVID-19. Implications of the findings for family interventions intended to help parents and children at this time are suggested.

Multiple Traumas, Maternal Depression, Mother-Child Relationship, Social Support, and Young Children's Behavioral Problems

This study examined whether maternal depression, mother-child relationships, and maternal perceived social support mediate the associations between child's exposure to multiple traumatic events and behavioral problems. We recruited a representative sample of 904 Israeli (Jewish and Arab) mothers and their 2- to 6-year-old children. Data collection was conducted through structured face-to-face interviews with the mothers between July and November 2011. All measures were completed by the mothers. We used the child's and mother's exposure to political violence questionnaires, Child Behavior Checklist (CBCL), a short version of the Parental Acceptance-Rejection Questionnaire (PARQ), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Medical Outcomes Study (MOS) Social Support Survey. The research study model was tested using path analysis. The model showed a very good fit to the data, suggesting that maternal rejection, maternal depression, and social support play an important role in child's behavioral problems in the context of multiple traumatic events. Higher levels of maternal rejection were significantly associated with greater children behavior problems. Maternal rejection mediated the associations between maternal depressive symptoms and child's behavioral problems. Maternal perceived social support mediated the associations between child's exposure to multiple traumatic events and child's behavioral problems; child's exposure to multiple traumatic events was associated with lower levels of maternal perceived social support. In turn, lower levels of perceived social support were associated with higher levels of behavioral problems. In conclusion, in accordance with the "social stress framework," social support has a mediation role in the association between exposure to traumatic events and child's behavioral problems. Thus, enhancing social support to mothers to young children in the context of multiple traumatic events is essential for children resiliency.

Parenting in Times of War: A Meta-Analysis and Qualitative Synthesis of War Exposure, Parenting, and Child Adjustment

This mixed methods systematic review and meta-analysis sheds more light on the role parenting practices play in children's adjustment after war exposure. Specifically, we quantitatively examined whether parenting behavior explained some of the well-known associations between war exposure and children's adjustment. In addition, we meta-synthesized qualitative evidence answering when and why parenting practices might change for war-affected families. We searched nine electronic databases and contacted experts in the field for relevant studies published until March 2018, identifying 4,147 unique publications that were further screened by title and abstract, resulting in 158 publications being fully screened. By running a meta-analytic structural equation model with 38 quantitative studies (N = 54,372, M_age = 12.00, SD_age = 3.54), we found that more war-exposed parents showed less warmth and more harshness toward their children, which partly mediated the association between war exposure and child adjustment, that is, post-traumatic stress symptoms, depression and anxiety, social problems, externalizing behavior, and lower positive outcomes (e.g., quality of life). War exposure was not associated with parents' exercise of behavioral control. By meta-synthesizing 10 qualitative studies (N = 1,042; age range = 0-18), we found that the nature of war-related trauma affected parenting differently. That is, parents showed harshness, hostility, inconsistency, and less warmth in highly dangerous settings and more warmth and overprotection when only living under threat. We conclude that it is both how much and what families have seen that shapes parenting in times of war.

Dyadic Profiles of Posttraumatic Stress Symptoms in Mothers and Children Experiencing Intimate Partner Violence

Children who witness intimate partner violence (IPV) develop posttraumatic stress disorder at alarmingly high rates. Research suggests that caregivers' symptoms of posttraumatic stress (PTSS) often co-occur alongside children's PTSS, a phenomenon termed "relational posttraumatic stress." The goal of this study is to use dyad-centered analyses to examine heterogeneity in relational PTSS presentations in mother-child dyads, and to determine factors differentiating relational PTSS profiles. Data were drawn from a sample of 231 IPV-exposed, ethno-racially diverse mother-child dyads, with children ranging from ages 4 to 12. The results of a latent profile analysis indicated that a two-profile model was the best fit with the data. Both profiles indicated similar levels of PTSS across the dyad; however, they differed in overall symptom severity. Parenting and IPV severity significantly predicted profile membership; however, age did not. Results suggest that similarities in PTSS presentation should be expected in mother-child dyads, at least in families who experience IPV.

Initial Challenges of Caregiving During COVID-19: Caregiver Burden, Mental Health, and the Parent-Child Relationship

Research confirms that the mental health burdens following community-wide disasters are extensive, with pervasive impacts noted in individuals and families. It is clear that child disaster outcomes are worst among children of highly distressed caregivers, or those caregivers who experience their own negative mental health outcomes from the disaster. The current study used path analysis to examine concurrent patterns of parents' (n = 420) experience from a national sample during the early months of the U.S. COVID-19 pandemic. The results of a multi-group path analysis, organized by parent gender, indicate good fit to the data [X2(10) = 159.04, p < .01]. Results indicate significant linkages between parents' caregiver burden, mental health, and perceptions of children's stress; these in turn are significantly linked to child-parent closeness and conflict, indicating possible spillover effects for depressed parents and compensatory effects for anxious parents. The impact of millions of families sheltering in place during the COVID-19 pandemic for an undefined period of time may lead to unprecedented impacts on individuals' mental health with unknown impacts on child-parent relationships. These impacts may be heightened for families whose caregivers experience increased mental health symptoms, as was the case for fathers in the current sample.

Post-Traumatic Stress Disorder in Homeless Migrant Mothers of the Paris Region Shelters

Migrant women are disproportionately more likely to experience traumatic events in their country of origin, during migration and after arriving in the host country. Homeless women are more likely to be exposed to multiple victimizations in childhood (emotional or physical maltreatment) and in adulthood (sexual abuse, street victimization). This study’s objective was to describe the factors associated with the likelihood of post-traumatic stress disorder (PTSD) among homeless migrant mothers in the Paris region. Face-to-face interviews were conducted by bilingual psychologists and interviewers in a representative sample of homeless families in the Paris region. PTSD was ascertained using the Mini International Neuropsychiatric Interview (MINI) (n = 691 mothers). We studied PTSD in mothers using weighted Poisson regression. Homeless migrant mothers had high levels of PTSD (18.9%) in the 12 months preceding the study. In multivariate analysis, PTSD was associated with departure from the country of origin because of violence (PR = 1.45 95% CI 1.03; 2.04), depression in the preceding 12 months (PR = 1.82 95% CI 1.20; 2.76), and residential instability (PR = 1.93 95% CI 1.27; 2.93). Homeless migrant mothers have high levels of traumatic events and PTSD. Improvements in screening for depression and PTSD and access to appropriate medical care are essential for this vulnerable group.

Posttraumatic Stress and Parenting Behaviors: The Mediating Role of Emotion Regulation

PURPOSE

Maternal trauma has been linked with problematic parenting, including both harsh and permissive behaviors. However, little is known about mechanisms accounting for this association. The current study examined the potential impact of posttraumatic stress disorder (PTSD) and emotion regulation on dysfunctional parenting behaviors in a sample of community mothers. We hypothesized a mediation model wherein PTSD would be associated with dysfunctional parenting (i.e., lax and overreactive behaviors) indirectly through deficits in maternal emotion regulation.

METHOD

Seventy-eight community mothers of 18- to 36-month-old children were administered the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and 19 mothers met criteria for PTSD. Mothers also completed self-report measures of difficulties with emotion regulation and maternal laxness and overreactivity in parenting.

RESULTS

Results revealed that emotion dysregulation fully mediated relations between PTSD status and lax (but not overreactive) parenting behaviors. Compared to mothers without PTSD, those with PTSD reported greater lax parenting behaviors indirectly through greater emotion dysregulation.

CONCLUSIONS

Mothers with PTSD may struggle to parent assertively when trauma symptoms interfere with emotion regulation abilities. The current study highlights the need to design interventions focused on helping trauma-exposed mothers manage distress, ultimately aiming to enhance parenting effectiveness and improve child outcomes.

Responsive Parenting Buffers the Impact of Maternal PTSD on Young Children

OBJECTIVE

This study investigates maternal responsive parenting behaviors as a theorized buffer to the detrimental impact of maternal PTSD symptoms on young children's depression and anxiety symptoms, disruptive behavior, and stress-related symptoms.

DESIGN

A multi-ethnic sample of 242 trauma-exposed mothers and their preschool-aged children was assessed. Maternal responsive parenting behaviors were observed during standardized parent-child interactions. Maternal and child mental health symptoms were reported by mothers.

RESULTS

Maternal PTSD symptoms were associated with their responsive parenting behaviors and predicted children's mental health symptoms. Responsive parenting was inversely associated with children's depression and stress-related symptoms. Moderation analyses revealed an interactive effect of maternal symptoms and responsive parenting on preschool children's disruptive behavior and stress-related symptoms.

CONCLUSIONS

Responsive parenting behaviors can mitigate the ill effects of maternal PTSD symptoms. Nurturing relationships buffer the impact of maternal PTSD. Helping parents' to sensitively respond to their young children's distress can support positive outcomes in children.

How do Syrian refugee children in Turkey perceive relational factors in the context of their mental health?

Although there has been increasing attention on the impact of risk and resilience factors on refugee children's mental health, there has been limited evidence on the role of parental factors to inform interventions, and this predominantly relies on adult reports. The aim was to investigate the relationship between perceived parenting styles and attachment relationships and child mental health, as reported by 322 Syrian refugee minors aged between 8 and 17 years in Turkey. Child-rated scales included the Children Revised Impact of Event Scale-8 (CRIES-8), Strengths and Difficulties Questionnaire (SDQ), Security Scale and Egna Minnen Betraffande Uppfostran for Children (EMBU-C), and were used as measures of post-traumatic stress disorder (PTSD), general mental health problems, attachment relationships and perceived parenting styles, respectively. Children with secure maternal and paternal attachment perceived their parents as less rejecting, while children with secure paternal attachment also reported their parents as emotionally warmer. Attachment relationships significantly contributed in predicting PTSD after controlling for age and gender, while conduct problems were predicted by lack of emotional warmth, rejection and over-protection by both parents, in addition to insecure attachment relationships. Refugee children's views are essential in establishing their needs and planning interventions. These should address both the impact of trauma and current family relationships.

What are the long-term consequences of youth exposure to firearm injury, and how do we prevent them? A scoping review

The long-term consequences of exposure to firearm injury-including suicide, assault, and mass shootings-on children's mental and physical health is unknown. Using PRISMA-ScR guidelines, we conducted a scoping review of four databases (PubMed, Scopus, PsychINFO, and CJ abstract) between January 1, 1985 and April 2, 2018 for articles describing long-term outcomes of child or adolescent firearm injury exposure (n = 3582). Among included studies (n = 31), most used retrospective cohorts or cross-sectional studies to describe the correlation between firearm injury and post-traumatic stress. A disproportionate number of studies examined the effect of mass shootings, although few of these studies were conducted in the United States and none described the impact of social media. Despite methodologic limitations, youth firearm injury exposure is clearly linked to high rates of post-traumatic stress symptoms and high rates of future injury. Evidence is lacking on best practices for prevention of mental health and behavioral sequelae among youth exposed to firearm injury. Future research should use rigorous methods to identify prevalence, correlates, and intervention strategies for these at-risk youth.

Parent-Reported Child Reactions to the September 11, 2001 World Trade Center Attacks (New York USA) in Relation to Parent Post-Disaster Psychopathology Three Years After the Event

IntroductionParents are a primary support for children following disasters, even though they face numerous challenges in addressing the physical and social consequences of an event. Parents who are directly exposed to a disaster and those who develop psychiatric disorders post-event are likely to be especially challenged and may be limited in their ability to support their children. This Brief Report describes a pilot study of survivors of the September 11, 2001 World Trade Center (New York USA) attacks who reported their own psychosocial consequences and the reactions of their children three years post-event.HypothesesThe primary hypothesis of the study was that children's September 11th reactions would be associated with their parents' psychiatric status. Secondary hypotheses were that the children's disaster reactions would be associated with direct exposure to the disaster in children and/or their parents, parent-child separation due to the disaster, and disaster-related school absence.

METHODS

Approximately three years after the 2001 World Trade Center attacks, 116 parents recruited from disaster-affected or disaster-related organizations were assessed using structured diagnostic interviews and queried about their children's (188 youths, aged three to 17 years at the time of the attacks) posttraumatic stress symptoms and behavioral changes.

RESULTS

Almost one-half of the parents had a post-disaster psychiatric disorder, including major depression in 27% and disaster-related posttraumatic stress disorder (PTSD) in 11%. More than three-fourths of the children had at least one disaster-related posttraumatic stress symptom, and more than one-half experienced at least one post-disaster behavior change. A minority of the children were reported to have increased school behavior problems or a decline in their grades. Key correlates of children's disaster-related posttraumatic stress symptoms and post-disaster behavior changes were parent-child separation due to the disaster and parental post-disaster psychiatric disorders.

CONCLUSION

Because parents provide primary caretaking and support for children post-disaster, addressing the needs of parents is critical to their ability to assist their children. Reducing parents' symptoms should increase their emotional availability and enhance their ability to address the needs of their children. Given the challenges in providing disaster interventions directly to children, especially when resources are limited, addressing parent psychopathology and distress (even in the absence of focusing on children's symptoms) may benefit children. PfefferbaumB, SimicZ, NorthCS. Parent-reported child reactions to the September 11, 2001, World Trade Center attacks (New York USA) in relation to parent post-disaster psychopathology three years after the event. Prehosp Disaster Med. 2018;33(5):558-564.

Prevalence of psychiatric morbidity in United States military spouses: The Millennium Cohort Family Study

BACKGROUND

Approximately half of US service members are married, equating to 1.1 million military spouses, yet the prevalence of psychiatric morbidity among military spouses remains understudied. We assessed the prevalence and correlates of eight mental health conditions in spouses of service members with 2-5 years of service.

METHOD

We employed baseline data from the Millennium Cohort Family Study, a 21-year longitudinal survey following 9,872 military-affiliated married couples representing all US service branches and active duty, Reserve, and National Guard components. Couples were surveyed between 2011 and 2013, a period of high military operational activity associated with Operation Iraqi Freedom and Operation Enduring Freedom. Primary outcomes included depression, anxiety, posttraumatic stress disorder (PTSD), panic, alcohol misuse, insomnia, somatization, and binge eating, all assessed with validated self-report questionnaires.

RESULTS

A total of 35.90% of military spouses met criteria for at least one psychiatric condition. The most commonly endorsed conditions were moderate-to-severe somatization symptoms (17.63%) and moderate-to-severe insomnia (15.65%). PTSD, anxiety, depression, panic, alcohol misuse, and binge eating were endorsed by 9.20%, 6.65%, 6.05%, 7.07%, 8.16%, and 5.23% of spouses, respectively. Having a partner who deployed with combat resulted in higher prevalence of anxiety, insomnia, and somatization. Spouses had lower prevalence of PTSD, alcohol misuse, and insomnia but higher rates of panic and binge eating than service members. Both members of a couple rarely endorsed having the same psychiatric problem.

CONCLUSIONS

One third of junior military spouses screened positive for one or more psychiatric conditions, underscoring the need for high-quality prevention and treatment services.

Treatment expectancy, working alliance, and outcome of Trauma-Focused Cognitive Behavioral Therapy with children and adolescents

BACKGROUND

It has been shown that positive treatment expectancy (TE) and good working alliance increase psychotherapeutic success in adult patients, either directly or mediated by other common treatment factors like collaboration. However, the effects of TE in psychotherapy with children, adolescents and their caregivers are mostly unknown. Due to characteristics of the disorder such as avoidant behavior, common factors may be especially important in evidence-based treatment of posttraumatic stress symptoms (PTSS), e.g. for the initiation of exposure based techniques.

METHODS

TE, collaboration, working alliance and PTSS were assessed in 65 children and adolescents (age M = 12.5; SD = 2.9) and their caregivers. Patients' and caregivers' TE were assessed before initiation of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Patients' and caregivers' working alliance, as well as patients' collaboration were assessed at mid-treatment, patients' PTSS at pre- and post-treatment. Path analysis tested both direct and indirect effects (by collaboration and working alliance) of pre-treatment TE on post-treatment PTSS, and on PTSS difference scores.

RESULTS

Patients' or caregivers' TE did not directly predict PTSS after TF-CBT. Post-treatment PTSS was not predicted by patients' or caregivers' TE via patients' collaboration or patients' or caregivers' working alliance. Caregivers' working alliance with therapists significantly contributed to the reduction of PTSS in children and adolescents (post-treatment PTSS: β = - 0.553; p < 0.001; PTSS difference score: β = 0.335; p = 0.031).

CONCLUSIONS

TE seems less important than caregivers' working alliance in TF-CBT for decreasing PTSS. Future studies should assess TE and working alliance repeatedly during treatment and from different perspectives to understand their effects on outcome. The inclusion of a supportive caregiver and the formation of a good relationship between therapists and caregivers can be regarded as essential for treatment success in children and adolescents with PTSS.

Parental Factors Associated with Child Post-traumatic Stress Following Injury: A Consideration of Intervention Targets

Post-traumatic stress disorder (PTSD) symptoms are relatively common following pediatric traumatic injury and are related to poor long-term child outcomes. However, due to concerns regarding the efficacy of early child preventive interventions, and difficulty intervening with injured and medicated children soon after the event, it is not feasible to provide early psychological interventions to children exposed to traumatic injury. Parental PTSD symptoms and reactions to the child's traumatic injury impact child outcomes and provide potential targets for early intervention to reduce child symptom development without involving the child. The authors conducted a review of the literature using Psycinfo and Pubmed research databases (publication years = 1990-2017) and identified 65 published studies relevant to the topic of the review. The present review considers parent factors [parenting styles, parental post-traumatic pathology (PTS), adaptive and maladaptive coping strategies, and communication regarding the traumatic injury] and their impact on child PTS. We focus specifically on factors amenable to intervention. We further review moderators of these relationships (e.g., child age and gender, parent gender) and conclude that it is unlikely that a one-size-fits-all approach to treatment will be successful. Rather, it is necessary to consider the age and gender of parent child dyads in designing and providing targeted interventions to families following the traumatic injury of a child.