School Mental Health

, Volume 11, Issue 4, pp 777–789 | Cite as

How Do Parent Psychopathology and Family Income Impact Treatment Gains in a School-Based Intervention for Trauma?

  • Anna Maria RosEmail author
  • Stephanie K. Brewer
  • Tali Raviv
  • Catherine DeCarlo Santiago
Original Paper


The current study examined the impacts of parent psychopathology and family socioeconomic status on symptom reduction for children participating in Bounce Back, a school-based intervention for elementary students exposed to trauma. Participants in this study were 52 first through fourth graders (Mage= 7.76; 65% male) who were predominately Latinx (82%). Schools were randomly assigned to immediate treatment or waitlist control. Children whose parents reported higher socioeconomic status showed steeper declines in symptoms compared to lower socioeconomic status. Further, children of parents who endorsed high PTSD symptoms reported attenuated treatment effects, whereas children of parents who endorsed high hostility reported enhanced treatment effects. Although Bounce Back is an effective intervention for reducing PTSD symptoms and improving coping skills among children exposed to trauma and other ongoing stressors, treatment gains are attenuated for children from families with low socioeconomic status, and parent psychopathology also impacts treatment effects. The effectiveness of Bounce Back may vary based on socioeconomic status and parent psychopathology. Future research should examine methods of tailoring Bounce Back for children coping with economic stress and parent psychopathology.


Trauma School-based trauma intervention Parent psychopathology Poverty Complex trauma Elementary school intervention PTSD Depression Parent PTSD Parent depression Parent hostility 



Funding was provided by American Psychological Foundation, Illinois Children’s Health Care Foundation, and Ann & Robert H. Lurie Children’s Hospital of Chicago Child Advocacy Board.


  1. Barmish, A. J., & Kendall, P. C. (2005). Should parents be co-clients in cognitive-behavioral therapy for anxious youth? Journal of Clinical Child and Adolescent Psychology,34(3), 569–581. Scholar
  2. Beeber, L. S., Perreira, K. M., & Schwartz, T. (2008). Supporting the mental health of mothers raising children in poverty. Annals of the New York Academy of Sciences,1136(1), 86–100. Scholar
  3. Berman, S. L., Weems, C. F., Silverman, W. K., & Kurtines, W. M. (2000). Predictors of outcome in exposure-based cognitive and behavioral treatments for phobic and anxiety disorders in children. Behavior Therapy,31(4), 713–731. Scholar
  4. Birmaher, B., Brent, D. A., Kolko, D., Baugher, M., Bridge, J., Holder, D., et al. (2000). Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder. Archives of General Psychiatry,57(1), 29–36. Scholar
  5. Bolger, N., Davis, A., & Rafaeli, E. (2003). Diary methods: Capturing life as it is lived. Annual Review of Psychology,54(1), 579–616. Scholar
  6. Bonanno, G. A., Galea, S., Bucciarelli, A., & Vlahov, D. (2007). What predicts psychological resilience after disaster? The role of demographics, resources, and life stress. Journal of Consulting and Clinical Psychology,75(5), 671–682. Scholar
  7. Chaudron, L. H., Kitzman, H. J., Peifer, K. L., Morrow, S., Perez, L. M., & Newman, M. C. (2005). Prevalence of maternal depressive symptoms in low-income Hispanic women. The Journal of Clinical Psychiatry,66(4), 418–423. Scholar
  8. Cohen, J. A., & Mannarino, A. P. (2008). Trauma-focused cognitive behavioural therapy for children and parents. Child and Adolescent Mental Health,13(4), 158–162. Scholar
  9. Conger, R. D., Conger, K. J., Elder, G. H., Lorenz, F. O., Simons, R. L., & Whitbeck, L. B. (1992). A family process model of economic hardship and adjustment of early adolescent boys. Child Development,63(3), 526–541. Scholar
  10. Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry,64(5), 577–584. Scholar
  11. Creswell, C., Willetts, L., Murray, L., Singhal, M., & Cooper, P. (2008). Treatment of child anxiety: An exploratory study of the role of maternal anxiety and behaviours in treatment outcome. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice,15(1), 38–44. Scholar
  12. Crowe, K., & McKay, D. (2017). Efficacy of cognitive-behavioral therapy for childhood anxiety and depression. Journal of Anxiety Disorders,49, 76–87. Scholar
  13. De Los Reyes, A., & Kazdin, A. E. (2005). Informant discrepancies in the assessment of childhood psychopathology: A critical review, theoretical framework, and recommendations for further study. Psychological Bulletin,131(4), 483–509. Scholar
  14. Deng, S., Lopez, V., Roosa, M. W., Ryu, E., Burrell, G. L., Tein, J. Y., et al. (2006). Family processes mediating the relationship of neighborhood disadvantage to early adolescent internalizing problems. The Journal of Early Adolescence,26(2), 206–231. Scholar
  15. Derogatis, L. R., & Spencer, P. M. (1993). Brief symptom inventory: BSI. Upper Saddle River, NJ: Pearson.Google Scholar
  16. Dorsey, S., McLaughlin, K. A., Kerns, S. E., Harrison, J. P., Lambert, H. K., Briggs, E. C., et al. (2017). Evidence base update for psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psychology,46(3), 303–330. Scholar
  17. Eckshtain, D., Marchette, L. K., Schleider, J., Evans, S., & Weisz, J. R. (2018). Parental depressive symptoms as a predictor of outcome in the treatment of child internalizing and externalizing problems. Journal of Abnormal Child Psychology. Scholar
  18. Engelhard, I. M., Arntz, A., & Van den Hout, M. A. (2007). Low specificity of symptoms on the post-traumatic stress disorder (PTSD) symptom scale: A comparison of individuals with PTSD, individuals with other anxiety disorders and individuals without psychopathology. British Journal of Clinical Psychology,46(4), 449–456. Scholar
  19. Evans, G. W., & Kim, P. (2013). Childhood poverty, chronic stress, self-regulation, and coping. Child Development Perspectives,7(1), 43–48. Scholar
  20. Farr, S. L., Bitsko, R. H., Hayes, D. K., & Dietz, P. M. (2010). Mental health and access to services among US women of reproductive age. American Journal of Obstetrics and Gynecology,203(6), 542–551. Scholar
  21. Feeny, N. C., Foa, E. B., Treadwell, H. R., & March, J. (2004). Posttraumatic stress disorder in youth: A critical review of the cognitive and behavioral treatment outcome literature. Professional Psychology: Research and Practice,35(5), 466–476. Scholar
  22. Finkelhor, D., Turner, H. A., Shattuck, A., & Hamby, S. L. (2015). Prevalence of childhood exposure to violence, crime, and abuse: Results from the national survey of children’s exposure to violence. JAMA Pediatrics,169(8), 746–754. Scholar
  23. Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. O. (1993). Reliability and validity of a brief instrument for assessing posttraumatic stress disorder. Journal of Traumatic Stress,6(4), 459–473. Scholar
  24. Ford, J. D., Racusin, R., Rogers, K., Ellis, C., Schiffman, J., & Ribbe, D. et al. (2002). Traumatic Events Screening Inventory for Children (TESI-C) Version 8.4. Dartmouth, VT: National Center for PTSD and Dartmouth Child Psychiatry Research Group.Google Scholar
  25. Garbarino, J. (2001). An ecological perspective on the effects of violence on children. Journal of Community Psychology,29(3), 361–378. Scholar
  26. Goyal, D., Gay, C., & Lee, K. A. (2010). How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers? Women’s Health Issues,20(2), 96–104. Scholar
  27. Grant, K. E., Compas, B. E., Stuhlmacher, A. F., Thurm, A. E., McMahon, S. D., & Halpert, J. A. (2003). Stressors and child and adolescent psychopathology: Moving from markers to mechanisms of risk. Psychological Bulletin,129(3), 447–466. Scholar
  28. Grant, K. E., McCormick, A., Poindexter, L., Simpkins, T., Janda, C. M., Thomas, K. J., et al. (2005). Exposure to violence and parenting as mediators between poverty and psychological symptoms in urban African American adolescents. Journal of Adolescence,28(4), 507–521. Scholar
  29. Gunlicks, M. L., & Weissman, M. M. (2008). Change in child psychopathology with improvement in parental depression: A systematic review. Journal of the American Academy of Child and Adolescent Psychiatry,47(4), 379–389. Scholar
  30. Hudson, J. L., & Rapee, R. M. (2001). Parent-child interactions and anxiety disorders: An observational study. Behaviour Research and Therapy,39(12), 1411–1427. Scholar
  31. Jaycox, L. H., Cohen, J. A., Mannarino, A. P., Walker, D. W., Langley, A. K., Gegenheimer, K. L., et al. (2010). Children’s mental health care following Hurricane Katrina: A field trial of trauma-focused psychotherapies. Journal of Traumatic Stress,23(2), 223–231. Scholar
  32. Jaycox, L. H., Kataoka, S. H., Stein, B. D., Langley, A. K., & Wong, M. (2012). Cognitive behavioral intervention for trauma in schools. Journal of Applied School Psychology,28(3), 239–255. Scholar
  33. Jaycox, L. H., Langley, A. K., & Hoover, S. A. (2018). Cognitive Behavioral Intervention for Trauma in Schools (CBITS). RAND Corporation.Google Scholar
  34. Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research,21(3), 169–184. Scholar
  35. Knox, M., Burkhart, K., & Khuder, S. A. (2011). Parental hostility and depression as predictors of young children’s aggression and conduct problems. Journal of Aggression, Maltreatment & Trauma,20(7), 800–811. Scholar
  36. Kovacs, M. (1992). Children’s depression inventory. North Tonawanda, NY: Multi-Health Systems.Google Scholar
  37. Langley, A. K., Gonzalez, A., Sugar, C. A., Solis, D., & Jaycox, L. (2015). Bounce Back: Effectiveness of an elementary school-based intervention for multicultural children exposed to traumatic events. Journal of Consulting and Clinical Psychology,83(5), 853–865. Scholar
  38. Laor, N., Wolmer, L., Mayes, L. C., Gershon, A., Weizman, R., & Cohen, D. J. (1997). Israeli preschool children under Scuds: A 30-month follow-up. Journal of the American Academy of Child and Adolescent Psychiatry,36(3), 349–356. Scholar
  39. Leijten, P., Raaijmakers, M. A., de Castro, B. O., & Matthys, W. (2013). Does socioeconomic status matter? A meta-analysis on parent training effectiveness for disruptive child behavior. Journal of Clinical Child & Adolescent Psychology,42(3), 384–392. Scholar
  40. McFarlane, A. C. (1987). Family functioning and overprotection following a natural disaster: The longitudinal effects of posttraumatic morbidity. Australia and New Zealand Journal of Psychiatry,21(2), 210–218. Scholar
  41. Neill, E. L., Weems, C. F., & Scheeringa, M. S. (2018). CBT for child PTSD is associated with reductions in maternal depression: Evidence for bidirectional effects. Journal of Clinical Child & Adolescent Psychology,47(3), 410–420. Scholar
  42. Noah, A. J., & Landale, N. S. (2018). Parenting strain among Mexican-origin mothers: Differences by parental legal status and neighborhood. Journal of Marriage and Family,80(2), 317–333. Scholar
  43. Oh, S., Salas-Wright, C. P., & Vaughn, M. G. (2018). Trends in depression among low-income mothers in the United States, 2005–2015. Journal of Affective Disorders,235, 72–75. Scholar
  44. Perrin, S., Smith, P., & Yule, W. (2000). Practitioner review: The assessment and treatment of posttraumatic stress disorder in children and adolescents. The Journal of Child Psychology and Psychiatry and Allied Disciplines,41(03), 277–289. Scholar
  45. Pine, D. S., & Cohen, J. A. (2002). Trauma in children and adolescents: Risk and treatment of psychiatric sequelae. Biological Psychiatry,51(7), 519–531. Scholar
  46. Preacher, K. J., Curran, P. J., & Bauer, D. J. (2006). Simple intercepts, simple slopes, and regions of significance in HLM 2-way interactions. Retrieved August 9, 2016 from
  47. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
  48. Rodriguez, N., Steinberg, A., & Pynoos, R. S. (1998). UCLA post traumatic stress disorder reaction index for DSM-IV, child, adolescent, and parent versions. Los Angeles, CA: UCLA Trauma Psychiatry Service.Google Scholar
  49. Ryan, C. (2007). British outpatient norms for the Brief Symptom Inventory. Psychology and Psychotherapy: Theory, Research and Practice,80(2), 183–191. Scholar
  50. Santiago, C. D., Kaltman, S., & Miranda, J. (2013). Poverty and mental health: How do low-income adults and children fare in psychotherapy? Journal of Clinical Psychology,69(2), 115–126. Scholar
  51. Santiago, C. D., Lennon, J. M., Fuller, A. K., Brewer, S. K., & Kataoka, S. H. (2014). Examining the impact of a family treatment component for CBITS: When and for whom is it helpful? Journal of Family Psychology,28(4), 560. Scholar
  52. Santiago, C. D., Raviv, T., Ros, A. M., Brewer, S. K., Distel, L. M., Torres, S. A., et al. (2018). Implementing the Bounce Back trauma intervention in urban elementary schools: A real-world replication trial. School Psychology Quarterly,33(1), 1–9. Scholar
  53. Santiago, C. D., & Wadsworth, M. E. (2009). Coping with family conflict: What’s helpful and what’s not for low-income adolescents. Journal of Child and Family Studies,18(2), 192–202. Scholar
  54. Santiago, C. D., Wadsworth, M. E., & Stump, J. (2011). Socioeconomic status, neighborhood disadvantage, and poverty-related stress: Prospective effects on psychological syndromes among diverse low-income families. Journal of Economic Psychology,32(2), 218–230. Scholar
  55. Smith, P., Perrin, S., Yule, W., & Rabe-Hesketh, S. (2001). War exposure and maternal reactions in the psychological adjustment of children from Bosnia-Hercegovina. The Journal of Child Psychology and Psychiatry and Allied Disciplines,42(3), 395–404. Scholar
  56. Smith, P., Yule, W., Perrin, S., Tranah, T., Dalgleish, T., & Clark, D. M. (2007). Cognitive behavioral therapy for PTSD in children and adolescents: A preliminary randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry,46(8), 1051–1061. Scholar
  57. Southam-Gerow, M. A., Kendall, P. C., & Weersing, V. R. (2001). Examining outcome variability: Correlates of treatment response in a child and adolescent anxiety clinic. Journal of Clinical Child Psychology,30(3), 422–436. Scholar
  58. Steinberg, A. M., Brymer, M. J., Decker, K. B., & Pynoos, R. S. (2004). The University of California at Los Angeles post-traumatic stress disorder reaction index. Current Psychiatry Reports, 6(2), 96–100.CrossRefGoogle Scholar
  59. Valentino, K., Berkowitz, S., & Stover, C. S. (2010). Parenting behaviors and posttraumatic symptoms in relation to children’s symptomatology following a traumatic event. Journal of Traumatic Stress,23(3), 403–407. Scholar
  60. Wadsworth, M. E., & Santiago, C. D. (2008). Risk and resiliency processes in ethnically diverse families in poverty. Journal of Family Psychology,22(3), 399–410. Scholar
  61. Weems, C. F., & Scheeringa, M. (2013). Maternal depression and treatment gains following a cognitive behavioral intervention for posttraumatic stress in preschool children. Journal of Anxiety Disorders,27(1), 140–146. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Loyola University ChicagoChicagoUSA
  2. 2.Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleUSA
  3. 3.Ann & Robert H. Lurie Children’s Hospital Center for Childhood ResilienceNorthwestern University Feinberg School of MedicineChicagoUSA

Personalised recommendations