Trauma Exposure, Post-traumatic Stress Symptoms, and Indices of Parenting

Perceptions of parenthood and child development among parents who experienced child maltreatment

Maltreatment survivors may be at risk for parenting challenges, although the previous literature is inconsistent, has focused on individual maltreatment forms, and has overlooked posttraumatic stress symptoms (PTSS) and other trauma exposure. The current study, thus, aimed to expand this research in four key ways by (a) examining all five maltreatment forms; (b) controlling for other nonmaltreatment trauma exposure to better isolate the role of maltreatment; (c) investigating maltreatment types and PTSS simultaneously; and (d) exploring novel parenting factors, specifically four types of parenting beliefs and developmental knowledge. Trauma-exposed parents (N = 301; Mage = 26.49 years, SD = 8.34, range: 18-69 years; 66.8% female; 59.8% White) participated in the study. A path analytic model indicated that, surprisingly, none of the maltreatment types nor cumulative trauma exposure corresponded with parental beliefs related to one's child, self, partner, or social relationships. PTSS, however, were tied to all four parenting belief types as well as developmental knowledge, βs = -.05-.40. Physical and emotional abuse were linked to less accurate developmental knowledge, β = .02, and maladaptive parenting practices, β = .03. Sexual abuse, neglect, and witnessing domestic violence were not associated with any of the parenting factors. Thus, current trauma symptoms are likely a more critical intervention focus than maltreatment experiences, although physical and emotional abuse may also play a role in parenting knowledge and behaviors. These findings also signal the importance of including all five maltreatment forms and PTSS when conducting research on the interaction between trauma and parenting.

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.

The Role of Parents' Self-Perceptions in the Association Between Posttraumatic Stress Symptoms and Aspects of Parenting

Parents' posttraumatic stress symptoms (PTSS) have been shown to be negatively associated with aspects of parenting, yet the mechanisms that link PTSS to parenting remain unclear. Because PTSS include negative alterations in cognitions, trauma-exposed parents may have skewed perceptions of themselves as parents. However, no studies have examined whether there is an indirect effect of PTSS on parenting through parents' self-perceptions. Path analysis was used to determine (a) whether DSM-5 posttraumatic stress disorder (PTSD) symptom clusters are related to parenting indices (i.e., support, satisfaction, involvement) and self-perceptions, (b) if parental self-perceptions are tied to aspects of parenting, and (c) if there is an indirect effect of PTSS on parenting through parental self-perceptions. Participants were 223 trauma-exposed parents (M_age = 36.92 years, SD = 7.9, 63.7% female) recruited from a midwestern U.S. university or via Amazon's Mechanical Turk. Negative alterations in cognitions and mood were inversely related to parental support, B = -0.41, p = .008, and alterations in arousal and reactivity were inversely associated with parental self-perceptions, B = -1.26, p = .001. Parental self-perceptions were positively related to all parenting indices, Bs = 0.27-0.44. Indirect effects were observed for alterations in arousal and reactivity and parental support, satisfaction, and involvement via parents' self-perceptions, Bs = -0.34 to -0.55. Parental self-perceptions appear to be a potential factor in understanding parenting difficulties for trauma-exposed parents experiencing alterations in arousal and reactivity. Targeting these perceptions may be a point of intervention aimed at improving parenting outcomes among trauma-exposed parents.