Child & Youth Care Forum

, Volume 44, Issue 5, pp 655–669 | Cite as

Self-Reported Emotional and Behavioral Problems, Family Functioning and Parental Bonding Among Psychiatric Outpatient Adolescent Offspring of Croatian Male Veterans with Partial PTSD

  • Iris Sarajlić Vuković
  • Vlatka Boričević MaršanićEmail author
  • Branka Aukst Margetić
  • Ljubica Paradžik
  • Domagoj Vidović
  • Gordana Buljan Flander
Original Paper



Posttraumatic stress disorder (PTSD) in male veterans has been linked with impaired family relationships and psychopathology in their children. Less is known about symptoms in children of veterans with partial PTSD.


To compare mental health problems, family functioning and parent–child bonding among adolescent offspring of male veterans with no PTSD, partial PTSD and full PTSD, and to examine the relationship between adolescent mental health problems and family factors.


Consecutive outpatient adolescent offspring (12–18 years) of Croatian male veterans with no PTSD, partial PTSD and full PTSD matched for age, sex, educational level, family income, parental employment, nationality, and residential area reported on emotional and behavioral problems, family functioning and parent–child bonding.


The full PTSD group reported higher levels of total behavior problems, family functioning problems and parental control than the partial PTSD group, which in turn, reported higher levels than the no PTSD group. The partial and full PTSD groups reported comparable levels of emotional and behavioral problems, and parental care. The partial and no PTSD groups did not differ on maternal care, which was significantly higher in these groups than in the full PTSD group. Higher levels of emotional and behavioral symptoms were associated with lower levels of maternal care in the partial PTSD group.


Adolescent offspring Male veterans Partial PTSD Behavior problems Family functioning Parental bonding 



This research received no specific grant from any funding agency in the public, commercial or non-for-profit sectors.

Conflict of interest

The authors declare that there is no conflict of interest.


  1. Aber, J. L., Gershoff, E. T., Ware, A., & Kotler, J. A. (2004). Estimating the effects of September 11th and other forms of violence on the mental health and social development of New York City’s youth: A matter of context. Applied Developmental Science, 8, 111–129.CrossRefGoogle Scholar
  2. Achenbach, T. M. (1991). Manual for the youth self report and 1991 profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  3. Ahmadzadeh, G. H., & Malekian, A. (2004). Aggression, anxiety, and social development in adolescent children of war veterans with PTSD versus those of non-veterans. Journal of Research in Medical Sciences, 9, 33–36.Google Scholar
  4. Banks, D. M., & Weems, C. F. (2014). Family and peer social support and their links to psychological distress among hurricane-exposed minority youth. American Journal of Orthopsychiatry, 84, 341–352.CrossRefPubMedGoogle Scholar
  5. Beckham, J. C., Braxton, L. E., Kudler, H. S., Feldman, M. E., Lytle, B. L., & Palmer, S. (1997). Minnesota multiphasic personality inventory profiles of Vietnam combat veterans with posttraumatic stress disorder and their children. Journal of Clinical Psychology, 53, 847–852.CrossRefPubMedGoogle Scholar
  6. Blake, D., Weathers, F., Nagy, D., Kaloupek, G., Klauminzer, D., Charney, D., et al. (1990). Clinician-administrated PTSD scale (CAPS). Boston: National Center for Posttraumatic Stress Disorder, Behavioral Sciences Division.Google Scholar
  7. Blanchard, E. B., Hickling, E. J., Taylor, A. E., Loos, W. R., & Gerardi, R. J. (1994). Psychological morbidity associated with motor vehicle accidents. Behaviour Research and Therapy, 32, 283–290.CrossRefPubMedGoogle Scholar
  8. Bokszczanin, A. (2008). Parental support, family conflict and overprotectiveness: Predicting PTSD symptom levels in adolescents 28 months after a natural disaster. Anxiety Stress and Coping, 21, 325–335.CrossRefGoogle Scholar
  9. Boričević Maršanić, V., Aukst Margetić, B., Jukić, V., Matko, V., & Grgić, V. (2014a). Self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans. European Child and Adolesceng Psychiatry, 23, 295–306.Google Scholar
  10. Boričević Maršanić, V., Aukst Margetić, B., Zečević, I., & Herceg, M. (2014b). The prevalence and psychosocial correlates of suicide attempts among inpatient adolescent offspring of croatian PTSD male war veterans. Child Psychiatry and Human Development, 45, 577–587.CrossRefPubMedGoogle Scholar
  11. Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32, 513–531.CrossRefGoogle Scholar
  12. Carlier, I. V., & Gersons, B. P. (1995). Partial posttraumatic stress disorder (PTSD): The issue of psychological scars and the occurrence of PTSD symptoms. Journal of Nervous and Mental Disorders, 183, 107–109.CrossRefGoogle Scholar
  13. Carrión, V. G., Weems, C. F., Ray, R., & Reiss, A. L. (2002). Towards an empirical definition of pediatric PTSD: The phenomenology of PTSD symptoms in youth. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 166–173.Google Scholar
  14. Carty, J., O’Donnell, M. L., & Creamer, M. (2006). Delayed-onset PTSD: A prospective study of injury survivors. Journal of Affective Disorders, 90, 257–261.CrossRefPubMedGoogle Scholar
  15. Caselli, L. T., & Motta, R. W. (1995). The effect of PTSD and combat level on Vietnam veterans’ perceptions of child behavior and marital adjustment. Journal of Clinical Psychology, 51, 4–12.CrossRefPubMedGoogle Scholar
  16. Cohen, E., Zerach, G., & Solomon, Z. (2011). The implication of combat-induced stress reaction, PTSD, and attachment in parenting among war veterans. Journal of Family Psychology, 25, 688–698.CrossRefPubMedGoogle Scholar
  17. Costa, N. M., Weems, C. F., & Pina, A. A. (2009). Hurricane Katrina and youth anxiety: The role of perceived attachment beliefs and parenting behaviors. Journal of Anxiety Disorders, 23, 935–941.CrossRefPubMedGoogle Scholar
  18. Cukor, J., Wyka, K., Jayasinghe, N., & Difede, J. (2010). The nature and course of subthreshold PTSD. Journal of Anxiety Disorders, 24, 918–923.CrossRefPubMedGoogle Scholar
  19. Davidson, A. C., & Mellor, D. J. (2001). The adjustment of children of Australian Vietnam veterans: Is there evidence for the transgenerational transmission of war-related trauma? Australian and New Zealand Journal of Psychiatry, 35, 345–351.CrossRefPubMedGoogle Scholar
  20. Davidson, J., Smith, R., & Kudler, H. (1989). Familial psychiatric illness in chronic posttraumatic stress disorder. Comprehensive Psychiatry, 30, 339–345.CrossRefPubMedGoogle Scholar
  21. Dekel, R., Goldblatt, H., Keidar, M., Solomon, Z., & Polliack, M. (2005). Being a spouse of a PTSD veteran. Family Relations, 54, 24–36.CrossRefGoogle Scholar
  22. Dekel, R., & Solomon, Z. (2006). Secondary traumatization among wives of Israeli POWs. Social Psychiatry and Psychiatric Epidemiology, 41, 27–33.CrossRefPubMedGoogle Scholar
  23. Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster family assessment device. Journal of Marital and Family Therapy, 9, 171–180.CrossRefGoogle Scholar
  24. Figley, C. R. (1983). Catastrophes: An overview of family reactions. In C. R. Figley & H. I. McCubin (Eds.), Coping with catastrophe. Stress and the family (Vol. II). New York: Brunner/Mazel.Google Scholar
  25. Frančišković, T., Stevanović, A., Jelušić, I., Roganović, B., Klarić, M., & Grković, J. (2007). Secondary traumatization of wives of war veterans with posttraumatic stress disorder. Croatian Medical Journal, 48, 177–184.PubMedCentralPubMedGoogle Scholar
  26. Freudenstein, O., Zohar, A., Apter, A., Shoval, G., Weizman, A., & Zalsman, G. (2011). Parental bonding in severely suicidal adolescent inpatients. European Psychiatry, 26, 504–507.CrossRefPubMedGoogle Scholar
  27. Galovski, T., & Lyons, J. A. (2004). Psychological sequelae of combat violence: A review of the impact of PTSD on the veteran’s family and possible interventions. Aggressive and Violent Behavior, 9, 477–501.CrossRefGoogle Scholar
  28. Gewirtz, A., Forgatch, M., & Wieling, E. (2008). Parenting practices as potential mechanisms for child adjustment following mass trauma. Journal of Marital and Family Therapy, 34, 177–192.CrossRefPubMedGoogle Scholar
  29. Guy, W. (1976). Clinical global impressions. In W. Guy (Ed.), Early clinical drug evaluation unit assessment manual for psychopharmacology. Bethesda, MD: National Institute of Mental Health.Google Scholar
  30. Hagan, J. F. (2005). Psychosocial implications of disaster and terrorism on children: A guide for the paediatrician. Pediatrics, 116, 787–795.CrossRefPubMedGoogle Scholar
  31. Harkness, L. L. (1991). The effect of combat-related PTSD on children. National Center for PTSD Clinical Newsletter, 2, 12–13.Google Scholar
  32. Harkness, L. L. (1993). Transgenerational transmission of war-related trauma. In J. P. Wilson & B. Raphael (Eds.), International handbook of traumatic stress syndromes. New York: Plenum.Google Scholar
  33. Hathway, S. R., & McKinley, J. C. (1989). Minnesota multiphasic personality inventory (1st ed.). Mineapolis, MN: University of Minnesota.Google Scholar
  34. Jacobsen, L. K., Sweeney, C. G., & Racusin, G. R. (1993). Group psychotherapy for children of fathers with PTSD: Evidence of psychopathology emerging in the group process. Journal of Child and Adolescent Group Therapy, 3, 103–120.CrossRefGoogle Scholar
  35. Jordan, B. K., Marmar, C. R., Fairbank, J. A., Schlenger, W. E., Kulka, R. A., Hough, R. L., & Weiss, D. S. (1992). Problems in families of male Vietnam veterans with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 60, 916–926.CrossRefPubMedGoogle Scholar
  36. Keane, T. M., Caddell, J. M., & Taylor, K. L. (1988). Mississippi scale for combat-related posttraumatic stress disorder: Three studies in reliability and validity. Journal of Consulting and Clinical Psychology, 56, 85–90.CrossRefPubMedGoogle Scholar
  37. Kelley, M. L., Self-Brown, S., Le, B., Bosson, J. V., Hernandez, B. C., & Gordon, A. T. (2010). Predicting posttraumatic stress symptoms in children following Hurricane Katrina: A prospective analysis of the effect of parental distress and parenting practices. Journal of Traumatic Stress, 23, 582–590.PubMedCentralCrossRefPubMedGoogle Scholar
  38. Kilic, E. Z., Ozguven, H. D., & Sayil, I. (2003). The psychological effects of parental mental health on children experiencing disaster: The experience of Bolu earthquake in Turkey. Family Process, 42, 485–495.CrossRefPubMedGoogle Scholar
  39. Kozarić-Kovačić, D., & Kocijan-Hercigonja, D. (2001). Assessment of post-traumatic stress disorder and comorbidity. Military Medicine, 166, 677–680.PubMedGoogle Scholar
  40. Laor, N., Wolmer, L., & Cohen, D. J. (2001). Mothers’ functioning and children’s symptoms 5 years after a SCUD missile attack. American Journal of Psychiatry, 158, 1020–1026.CrossRefPubMedGoogle Scholar
  41. Leckman, J. F., Sholomskas, D., Thompson, W. D., Belanger, A., & Weissman, M. M. (1982). Best estimate of lifetime psychiatric diagnosis: A methodological study. Archives of General Psychiatry, 39, 879–883.CrossRefPubMedGoogle Scholar
  42. Levendosky, A. A., & Graham-Bermann, S. A. (2000). Behavioral observations of parenting in battered women. Journal of Family Psychology, 14, 80–94.CrossRefPubMedGoogle Scholar
  43. Lieberman, A. F., Van Horn, P., & Ozer, E. J. (2005). Preschooler witnesses of marital violence: Predictors and mediators of child behavior problems. Developmental Psychopathology, 17, 385–396.CrossRefGoogle Scholar
  44. Marshall, R. D., Olfson, M., Hellman, F., Blanco, C., Guardino, M., & Struening, E. L. (2001). Comorbidity, impairment, and suicidality in subthreshold PTSD. American Journal of Psychiatry, 158, 1467–1473.CrossRefPubMedGoogle Scholar
  45. McFarlane, A. C. (1987). The relationship between patterns of family interaction and psychiatric disorder in children. Australian and New Zealand Journal of Psychiatry, 21, 383–390.CrossRefPubMedGoogle Scholar
  46. Mollica, R. F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard Trauma Questionnaire. Validating a crosscultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disorders, 180, 111–116.CrossRefGoogle Scholar
  47. Norris, F. H., Friedman, M. J., & Watson, P. J. (2002). 60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research. Psychiatry, 65, 240–260.CrossRefPubMedGoogle Scholar
  48. Parker, G., Tupling, H., & Brown, L. B. (1979). A parental bonding instrument. British Journal of Medical Psychology, 52, 1–10.CrossRefGoogle Scholar
  49. Parsons, J., Kehle, T. J., & Owen, S. V. (1990). Incidence of behavior problems among children of Vietnam veterans. School Psychology International, 11, 253–259.CrossRefGoogle Scholar
  50. Pat Horenczyk, R. (2003). The impact of ongoing terrorist attacks on the adolescent population in Jerusalem and the Jerusalem area. In M. Caspi (Ed.), Children anxiety as result of the terrorist events. Jerusalem: Israeli Knesset, research and information center.Google Scholar
  51. Pat-Horenczyk, R., Peled, O., Miron, T., Brom, D., Villa, Y., & Chemtob, C. (2007). Risk-taking behaviors among Israeli adolescents exposed to recurrent terrorism: Provoking danger under continuous threat? American Journal of Psychiatry, 164, 66–72.CrossRefPubMedGoogle Scholar
  52. Pat-Horenczyk, R., Qasrawi, R., Lesack, R., Haj-Yahia, M., Peled, O., Shaheen, M., et al. (2009). Posttraumatic symptoms, functional impairment and coping among adolescents on both sides of the Israeli–Palestinian conflict: A cross-cultural approach. Applied Psychology: An International Review, 58, 688–708.CrossRefGoogle Scholar
  53. Pfefferbaum, B., Seale, T. W., Brandt, E. N, Jr, Pfefferbaum, R. L., Doughty, D. E., & Rainwater, S. M. (2003). Media exposure in children one hundred miles from a terrorist bombing. Annals of Clinical Psychiatry, 15, 1–8.CrossRefPubMedGoogle Scholar
  54. Pfefferbaum, B. J., Weems, C. F., Scott, B. G., Nitiéma, P., Noffsinger, M. A., Pfefferbaum, R. L., et al. (2013). Research methods in child disaster studies: A review of studies generated by the September 11, 2001, Terrorist Attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina. Child and Youth Care Forum, 42, 285–337.PubMedCentralCrossRefPubMedGoogle Scholar
  55. Pynoss, R. S., & Eth, S. (1985). Children traumatized by witnessing acts of personal violence: Homicide, rape or suicide behavior. In S. Eth & R. S. Pynoss (Eds.), Post-traumatic stress disorder in children. Washington, DC: American Psychiatric Press.Google Scholar
  56. Qouta, S., Punamaki, R. L., & El Sarraj, E. (2008). Child development and mental health in war and military violence: The Palestinian experience. International Journal of Behavioral Development, 32, 310–321.CrossRefGoogle Scholar
  57. Rosenheck, R., & Fontana, A. (1998). Warrior fathers and warrior sons: Intergenerational aspects of trauma. In Y. Danieli (Ed.), International handbook of multigenerational legacies of trauma (pp. 225–242). New York: Plenum.CrossRefGoogle Scholar
  58. Rosenheck, R., & Nathan, P. (1985). Secondary traumatization in children of Vietnam veterans. Hospital and Community Psychiatry, 36, 538–539.PubMedGoogle Scholar
  59. Rudan, V., Begovac, I., Szirovicza, L., Filipović, O., & Skočić, M. (2005). The child behavior checklist, teacher report form and youth self report problem scales in a normative sample of Croatian children and adolescents aged 7–18. Collegium Antropologhicum, 29, 17–26.Google Scholar
  60. Ruscio, A. M., Weathers, F. W., King, L. A., & King, D. W. (2002). Male war-zone veterans’ perceived relationships with their children: The importance of emotional numbing. Journal of Traumatic Stress, 15, 351–357.CrossRefPubMedGoogle Scholar
  61. Scarpa, A., Haden, S. C., & Hurley, J. (2006). Community violence victimization and symptoms of posttraumatic stress disorder: The moderating effects of coping and social support. Journal of Interpersonal Violence, 21, 446–469.CrossRefPubMedGoogle Scholar
  62. Scheeringa, M. S., & Zeanah, C. H. (2008). Reconsideration of harm’s way: Onsets and comorbidity patterns of disorders in preschool children and their caregivers following Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology, 37, 508–518.CrossRefPubMedGoogle Scholar
  63. Schiff, M., Pat-Horenczyk, R., & Peled, O. (2010). The role of social support for Israeli adolescents continually exposed to terrorism: Protective or compensatory factors? Journal of Child and Adolescent Trauma, 3, 95–108.CrossRefGoogle Scholar
  64. Solomon, Z., & Lavi, T. (2005). Israeli youth in the second Intifada: PTSD and future orientation. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 1167–1175.CrossRefPubMedGoogle Scholar
  65. Stein, B., Jaycox, L., Elliott, M., Collins, R., Berry, S., Marshall, G., et al. (2004). The emotional and behavioral impact of terrorism on children: Results from a national survey. Applied Developmental Psychology, 8, 184–194.Google Scholar
  66. Stein, M. B., Walker, J. R., Hazen, A. L., & Forde, D. R. (1997). Full and partial posttraumatic stress disorder: Findings from a community survey. American Journal of Psychiatry, 154, 1114–1119.CrossRefPubMedGoogle Scholar
  67. Stein, D., Williamson, D. E., Birmaher, B., Brent, D. A., Kaufman, J., Dahl, R. E., et al. (2000). Parent–child bonding and family functioning in depressed children and children at high risk and low risk for future depression. Journal of American Academy of Child and Adolescent Psychiatry, 39, 1387–1395.CrossRefGoogle Scholar
  68. Tamplin, A., Goodyear, I. M., & Herbert, J. (1998). Family functioning and parent general health in families of adolescents with major depressive disorder. Journal of Affective Disorders, 48, 1–13.CrossRefPubMedGoogle Scholar
  69. Thabet, A. A. M., & Vostanis, P. (2002). Emotional problems in Palestinian children living in a war zone: A crosssectional study. Lancet, 359, 1801–1804.CrossRefPubMedGoogle Scholar
  70. Weems, C. F., & Overstreet, S. (2008). Child and adolescent mental health research in the context of Hurricane Katrina: An ecological-needs-based perspective and introduction to the special section. Journal of Clinical Child and Adolescent Psychology, 37, 487–494.CrossRefPubMedGoogle Scholar
  71. Weems, C. F., Pina, A. A., Costa, N. M., Watts, S. E., Taylor, L. K., & Cannon, M. F. (2007). Pre disaster trait anxiety and negative affect predict posttraumatic stress in youth after Hurricane Katrina. Journal of Consulting and Clinical Psychology, 75, 154–159.CrossRefPubMedGoogle Scholar
  72. Weich, S., Patterson, J., Shaw, R., & Stewart-Brown, S. (2009). Family relationships in childhood and common psychiatric disorders in later life: Systematic review of prospective studies. British Journal of Psychiatry, 194, 392–398.CrossRefPubMedGoogle Scholar
  73. Weiss, D. S., Marmar, C. R., Schlenger, W. E., Fairbank, J. A., Jordan, B. K., & Hough, R. L. (1992). The prevalence of lifetime and partial post-traumatic stress disorder in Vietnam theater veterans. Journal of Traumatic Stress, 5, 365–376.CrossRefGoogle Scholar
  74. World Health Organization. (2003). International statistical classification of diseases and related health problems, 10th revision. Geneva: World Health Organization.Google Scholar
  75. Wyman, P. A., Cowen, E. L., Work, W. C., & Parker, G. R. (1991). Developmental and family milieu correlates of resilience in urban children who have experienced major life stress. American Journal of Community Psychology, 19(3), 405–426.PubMedGoogle Scholar
  76. Zalihic, A., Zalihic, D., & Pivic, G. (2008). Influence of posttraumatic stress disorder of the fathers on other family members. Bosnian Journal of Basic Medical Sciencies, 8, 20–26.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Iris Sarajlić Vuković
    • 1
  • Vlatka Boričević Maršanić
    • 2
    Email author
  • Branka Aukst Margetić
    • 3
  • Ljubica Paradžik
    • 2
  • Domagoj Vidović
    • 4
  • Gordana Buljan Flander
    • 5
  1. 1.Institute of Public Health, “Dr. A. Štampar”ZagrebCroatia
  2. 2.Psychiatric Hospital for Children and AdolescentsZagrebCroatia
  3. 3.Department of PsychiatryUniversity Hospital Center ZagrebZagrebCroatia
  4. 4.Psychiatric Hospital VrapčeZagrebCroatia
  5. 5.Child Protection Center of ZagrebZagrebCroatia

Personalised recommendations