Child & Youth Care Forum

, Volume 46, Issue 5, pp 685–701 | Cite as

Does Maternal Parenting Stress Mediate the Association Between Postpartum PTS Symptoms and Children’s Internalizing and Externalizing Problems? A Longitudinal Perspective

  • Paola Di Blasio
  • Elena Camisasca
  • Sarah Miragoli
  • Chiara Ionio
  • Luca Milani
Original Paper

Abstract

Background

The research carried out in the last years outlined that childbirth could be considered as a sufficient stressor for the insurgence of posttraumatic stress (PTS) symptoms with important consequences for the child care.

Objectives

In a longitudinal perspective, this study focused on PTS symptoms after childbirth to understand their impact on maternal parenting stress and children’s adjustment. First, we investigated whether childbirth-related PTS symptoms, at 87 h and 3 months postpartum, were associated with parenting stress and children’s adjustment at 18 months. Second, we explored, at 18 months, the predictive effects of postpartum PTS symptoms on children’s adjustment and verified the mediational effect of parenting stress this association.

Methods

Eighty-eight women participated and completed the following questionnaires: PPQ (for assessing maternal PTS symptoms at 87 h, 3 and 18 months postpartum), PSI-SF (for maternal parenting stress at 18 months) and CBCL (for children’s adjustment at 18 months).

Results

Findings outlined that more PTS symptoms at 3 months are associated with greater levels of parental distress and they predicted children’s adjustment at 18 months. Moreover, maternal parenting stress explained the predictive effects of childbirth-related PTS symptoms on children’s adjustment. More precisely parental distress partially mediated the association between PTS symptoms and children’s internalizing behaviors, while the perception of the difficult child fully mediated the effects of PTS symptoms on externalizing behaviors.

Conclusion

This study was consistent with the idea that women may experience childbirth-related chronic distress and child adjustment was connected to different sources of parenting stress.

Keywords

Parenting stress Postpartum PTS Child Internalizing Externalizing 

References

  1. Abidin, R. R. (1995). Parenting stress index: Professional manual (3rd ed.). Odessa, FL: Psychological Assessment Resources.Google Scholar
  2. Achenbach, T. M., & Rescorla, L. (2000). Manual for the ASEBA preschool forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.Google Scholar
  3. Alcorn, K. L., O’Donovan, A., Patrick, J. C., & Devilly, G. J. (2010). A prospective longitudinal study of the prevalence of posttraumatic stress disorder resulting from childbirth events. Pyschological Medicine, 40, 1849–1859. doi:10.1017/S0033291709992224.CrossRefGoogle Scholar
  4. Ammerman, R. T., Putnam, F. W., Chard, K. M., Stevens, J., & Van Ginkel, J. B. (2012). PTSD in depressed mothers in home visitation. Psychological Trauma: Theory, Research, Practice, and Policy, 4(2), 186. doi:10.1037/a0023062.CrossRefGoogle Scholar
  5. Andersen, L. B., Melvaer, L. B., Videbech, P., Lamont, R. F., & Joergensen, J. S. (2012). Risk factors for developing post-traumatic stress disorder following childbirth: A systematic review. Acta Obstetricia et Gynecologica Scandinavica, 91(11), 1261–1272. doi:10.1111/j.1600-0412.2012.01476.x.CrossRefPubMedGoogle Scholar
  6. Ayers, S., Eagle, A., & Waring, H. (2006). The effects of childbirth-related posttraumatic stress disorder on women and their relationships: A qualitative study. Psychology, Health and Medicine, 11, 389–398. doi:10.1080/13548500600708409.CrossRefPubMedGoogle Scholar
  7. Ayers, S., & Pickering, A. D. (2001). Do women get posttraumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth, 28(2), 111–118. doi:10.1046/j.1523-536X.2001.00111.x.CrossRefPubMedGoogle Scholar
  8. Bailham, D., & Joseph, S. (2003). Post-traumatic stress following childbirth: A review of the emerging literature and directions for research and practice. Psychology, Health and Medicine, 8(2), 159–168. doi:10.1080/1354850031000087537.CrossRefGoogle Scholar
  9. Ballard, C. G., Stanley, A. K., & Brockington, I. F. (1995). Posttraumatic stress disorder (PTSD) after childbirth. British Journal of Psychiatry, 166, 525–528.CrossRefPubMedGoogle Scholar
  10. Beck, C. T. (2004). Posttraumatic stress disorder due to childbirth: The aftermath. Nursing Research, 53(4), 216–224.CrossRefPubMedGoogle Scholar
  11. Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748. doi:10.1037/0022-006X.68.5.748.CrossRefPubMedGoogle Scholar
  12. Brugha, T. S., Morrell, C. J., Slade, P., & Walters, S. J. (2011). Universal prevention of depression in women postnatally: Cluster randomized trial evidence in primary care. Psychological Medicine, 41, 739–748. doi:10.1017/S0033291710001467.CrossRefPubMedGoogle Scholar
  13. Callahan, K. L., Scaramella, L. V., Laird, R. D., & Sohr-Preston, S. L. (2011). Neighborhood disadvantage as a moderator of the association between harsh parenting and toddler-aged children’s internalizing and externalizing problems. Journal of Family Psychology, 25(1), 68. doi:10.1037/a0022448.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Camisasca, E., & Di Blasio, P. (2014). Lo stress genitoriale media l’associazione tra Mind-mindedness materna e adattamento psicologico dei figli? Uno studio pilota (Does parenting stress mediate the association between maternal Mind-mindedness and children’s psychological adjustment? A pilot study). Psicologia Clinica dello Sviluppo, 18(3), 479–490. doi:10.1449/78369.Google Scholar
  15. Camisasca, E., Miragoli, S., & Di Blasio, P. (2016a). Conflittualità genitoriale e sintomatologia da stress post-traumatico nei figli: uno studio esplorativo (Parental conflict and posttraumatic stress symptoms in children: An exploratory study). Maltrattamento e abuso all’infanzia, 18(2), 141–151. doi:10.3280/MAL2016-002008.Google Scholar
  16. Camisasca, E., Miragoli, S., & Di Blasio, P. (2016b). Families with distinct levels of marital conflict and child adjustment: Which role for maternal and paternal stress? Journal of Child and Family Studies, 25(3), 733–745. doi:10.1007/s10826-015-0261-0.CrossRefGoogle Scholar
  17. Camisasca, E., Procaccia, R., Miragoli, S., Valtolina, G. G., & Di Blasio, P. (2017). Maternal mind-mindedness as a linking mechanism between childbirth-related post-traumatic stress symptoms and parenting stress. Health Care for Women International. doi:10.1080/07399332.2017.1296840.PubMedGoogle Scholar
  18. Costa, N. M., Weems, C. F., Pellerin, K., & Dalton, R. (2006). Parenting stress and childhood psychopathology: An examination of specificity to internalizing and externalizing symptoms. Journal of Psychopathology and Behavioral Assessment, 28(2), 113–122. doi:10.1007/s10862-006-7489-3.CrossRefGoogle Scholar
  19. Creedy, D. K., Shochet, I. M., & Horsfall, J. (2000). Childbirth and the development of acute trauma symptoms: Incidence and contributing factors. Birth, 27(2), 104–111. doi:10.1046/j.1523-536x.2000.00104.CrossRefPubMedGoogle Scholar
  20. Davies, J., Slade, P., Wright, I., & Stewart, P. (2008). Posttraumatic stress symptoms following childbirth and mothers’ perceptions of their infants. Infant Mental Health Journal, 29(6), 537–554. doi:10.1002/imhj.20197.CrossRefPubMedGoogle Scholar
  21. DeMier, R. L., Hynan, M. T., Harris, H. B., & Manniello, R. L. (1996). Perinatal stressors as predictors of symptoms of posttraumatic stress in mother and infants at high risk. Journal of Perinatology, 16, 276–280.PubMedGoogle Scholar
  22. Denham, S., Workman, E., Cole, P., Weissbrod, C., Kendziora, K., & Zahn-Waxler, C. (2000). Prevention of externalizing behaviour problems from early to middle childhood: The role of parental socialization and emotion expression. Development and Psychopathology, 12(1), 23–45.CrossRefPubMedGoogle Scholar
  23. Di Blasio, P., Camisasca, E., Caravita, S. C. S., Ionio, C., Milani, L., & Valtolina, G. G. (2015a). The effects of expressive writing on postpartum depression and posttraumatic stress symptoms. Psychological Reports, 117(3), 856–882. doi:10.2466/02.13.PR0.117c29z3.CrossRefPubMedGoogle Scholar
  24. Di Blasio, P., Caravita, S. C. S., Camisasca, E., & Milani, L. (2011). Parenting stress and posttraumatic stress symptoms after childbirth. A longitudinal study. Giornale di Psicologia dello Sviluppo, 3, 41–55.Google Scholar
  25. Di Blasio, P., & Ionio, C. (2005). Postpartum stress symptoms and child temperament: A follow-up study. Journal of Prenatal and Perinatal Psychology and Health, 19(3), 185–198.Google Scholar
  26. Di Blasio, P., Miragoli, S., Camisasca, E., Di Vita, A. M., Pizzo, R., & Pipitone, L. (2015b). Emotional distress following childbirth: An intervention to buffer depressive and PTSD symptoms. Europe’s Journal of Psychology, 11(2), 214–232. doi:10.5964/ejop.v11i2.779.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Dishion, T. J., Shaw, D., Connell, A., Gardner, F., Weaver, C., & Wilson, M. (2008). The family check-up with high-risk indigent families: Preventing problem behavior by increasing parents’ positive behavior support in early childhood. Child Development, 79(5), 1395–1414. doi:10.1111/j.1467-8624.2008.01195.x.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Elmir, R., Schmied, V., Wilkes, L., & Jackson, D. (2010). Women’s perceptions and experiences of a traumatic birth: A meta-ethnography. Journal of Advancing Nursing, 66(10), 2142–2153. doi:10.1111/j.1365-2648.2010.05391.x.CrossRefGoogle Scholar
  29. Engelhard, I. M., van den Hout, M. A., & Arntz, A. (2001). Posttraumatic stress disorder after pregnancy loss. General Hospital Psychiatry, 23(2), 62–66. doi:10.1016/S0163-8343(01)00124-4.CrossRefPubMedGoogle Scholar
  30. Feeley, N., Zelkowitz, P., Cormier, C., Charbonneau, L., & Lacroix, A. (2011). Posttraumatic stress among mothers of very low birth weight infants at 6 months after discharge from the neonatal intensive care unit. Applied Nursing Research, 24, 114–117. doi:10.1016/j.apnr.2009.04.004.CrossRefPubMedGoogle Scholar
  31. Forcada-Guex, M., Borghini, A., Pierrehumbert, B., Ansermet, F., & Muller-Nix, C. (2011). Prematurity, maternal posttraumatic stress and consequences on the mother-infant relationship. Early Human Development, 87, 21–26. doi:10.1016/j.earlhumdev.2010.09.006.CrossRefPubMedGoogle Scholar
  32. Fosco, G. M., & Grych, J. H. (2008). Emotional, cognitive, and family systems mediators of children’s adjustment to interparental conflict. Journal of Family Psychology, 22(6), 843–854. doi:10.1037/a0013809i.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Frewen, P., Hegadoren, K., Coupland, N. J., Rowe, B. H., Neufeld, R. W., & Lanius, R. (2015). Trauma-related altered states of consciousness (TRASC) and functional impairment I: Prospective study in acutely traumatized persons. Journal of Trauma and Dissociation, 16(5), 500–519. doi:10.1080/15299732.2015.1022925.CrossRefPubMedGoogle Scholar
  34. Frigerio, A. (2000). Child behavior checklist 1½–5. Milano: Editore Ghedini Libraio.Google Scholar
  35. Furukawa, T. A., Horikoshi, M., Kawakami, N., Kadota, M., Sasaki, M., Sekiya, Y., et al. (2012). Telephone cognitive-behavioral therapy for subthreshold depression and presenteeism in workplace: A randomized controlled trial. PLoS ONE, 7(4), e35330. doi:10.1371/journal.pone.0035330.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Gerstein, E. D., Poehlmann-Tynan, J., & Clark, R. (2015). Mother-child interactions in the NICU: Relevance and implications for later parenting. Journal of Pediatric Psychology, 40(1), 33–44. doi:10.1093/jpepsy/jsu064.CrossRefPubMedGoogle Scholar
  37. Guarino, A., Di Blasio, P., D’Alessio, M., Camisasca, E., & Serantoni, M. (2008). Parenting stress index short form: Adattamento Italiano. Firenze: Giunti, Organizzazioni Speciali.Google Scholar
  38. Holditch-Davis, D., Bartlett, T. R., Blickman, A. L., & Miles, M. S. (2003). Posttraumatic stress symptoms in mothers of premature infants. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(2), 161–171. doi:10.1177/0884217503252035.CrossRefPubMedGoogle Scholar
  39. Holmes, E. A., Grey, N., & Young, K. A. (2005). Intrusive images and “hotspots” of trauma memories in posttraumatic stress disorder: An exploratory investigation of emotions and cognitive themes. Journal of Behavior Therapy and Experimental Psychiatry, 36(1), 3–17. doi:10.1016/j.jbtep.2004.11.002.CrossRefPubMedGoogle Scholar
  40. Hughes, H. M., & Huth-Bocks, A. C. (2007). Variations in parenting stress in African-American battered women: Implications for children’s adjustment and family intervention. European Psychologist, 12(1), 62–71. doi:10.1027/1016-9040.12.1.62.CrossRefGoogle Scholar
  41. Huth-Bocks, A. C., & Hughes, H. M. (2008). Parenting stress, parenting behavior, and children’s adjustment in families experiencing intimate partner violence. Journal of Family Violence, 23(4), 243–251. doi:10.1007/s10896-007-9148-1.CrossRefGoogle Scholar
  42. Ionio, C., & Di Blasio, P. (2014). Posttraumatic stress symptoms after childbirth and early mother–child interactions: an exploratory study. Journal of Reproductive and Infant Psychology, 32(2), 163–181. doi:10.1080/02646838.2013.841880.CrossRefGoogle Scholar
  43. James, S. (2015). Women’s experiences of symptoms of posttraumatic stress disorder (PTSD) after traumatic childbirth: A review and critical appraisal. Archives of Women’s Mental Health, 18(6), 761–771. doi:10.1007/s00737-015-0560-x.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Leen-Feldner, E. W., Feldner, M. T., Knapp, A., Bunaciu, L., Blumenthal, H., & Amstadter, A. B. (2013). Offspring psychological and biological correlates of parental posttraumatic stress: Review of the literature and research agenda. Clinical Psychology Review, 33(8), 1106–1133. doi:10.1016/j.cpr.2013.09.001.CrossRefPubMedGoogle Scholar
  45. Linden, M. A., Cepeda, I. L., Synnes, A., & Grunau, R. E. (2015). Stress in parents of children born very preterm is predicted by child externalizing behaviour and parent coping at age 7 years. Archives of Disease in Childhood, 100(6), 554–558. doi:10.1136/archdischild-2014-307390.CrossRefPubMedGoogle Scholar
  46. McDonald, S., Slade, P., Spiby, H., & Iles, J. (2011). Posttraumatic stress symptoms, parenting stress and mother-child relationships following childbirth and at 2 years postpartum. Journal of Psychosomatic Obstetrics and Gynecology, 32, 141–146. doi:10.3109/0167482X.2011.596962.CrossRefPubMedGoogle Scholar
  47. Miller-Perrin, C. L., Perrin, R. D., & Kocur, J. L. (2009). Parental physical and psychological aggression: Psychological symptoms in young adults. Child Abuse and Neglect, 33(1), 1–11. doi:10.1016/j.chiabu.2008.12.001.CrossRefPubMedGoogle Scholar
  48. Miragoli, S., Camisasca, E., & Di Blasio, P. (2015). Validation of the child abuse potential inventory in Italy: A preliminary study. SAGE Open, 5(3), 1–11. doi:10.1177/2158244015597044.CrossRefGoogle Scholar
  49. Miragoli, S., Camisasca, E., Di Blasio, P., Milani, L., Ionio, C., Gizzi, N., et al. (2016). Child Abuse Potential Inventory in Italy: A comparative study of abusive and non-abusive parents. Journal of Child Custody, 13(4), 289–306. doi:10.1080/15379418.2016.1250145.CrossRefGoogle Scholar
  50. Moyzakitis, W. (2004). Exploring women’s descriptions of distress and/or trauma in childbirth from a feminist perspective. Evidence Based Midwifery, 2, 8–14.Google Scholar
  51. Nelson, D. A., Yang, C., Coyne, S. M., Olsen, J. A., & Hart, C. H. (2013). Parental psychological control dimensions: Connections with Russian preschoolers’ physical and relational aggression. Journal of Applied Developmental Psychology, 34(1), 1–8. doi:10.1016/j.appdev.2012.07.003.CrossRefGoogle Scholar
  52. Nicholls, K., & Ayers, S. (2007). Childbirth related posttraumatic stress disorder in couples: A qualitative study. British Journal of Health Psychology, 12, 491–509. doi:10.1348/135910706X120627.CrossRefPubMedGoogle Scholar
  53. Olde, E., van der Hart, O., Kleber, R., & Van Son, M. J. (2006). Posttraumatic stress following childbirth: A review. Clinical Psychology Review, 26, 1–16. doi:10.1016/j.cpr.2005.07.002.CrossRefPubMedGoogle Scholar
  54. Owen, A. E., Thompson, M. P., & Kaslow, N. J. (2006). The mediating role of parenting stress in the relation between intimate partner violence and child adjustment. Journal of Family Psychology, 20(3), 505–513. doi:10.1037/0893-3200.20.3.505.CrossRefPubMedGoogle Scholar
  55. Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129(1), 52–73. doi:10.1037/0033-2909.129.1.52.CrossRefPubMedGoogle Scholar
  56. Pardini, D. A., Fite, P. J., & Burke, J. D. (2008). Bidirectional associations between parenting practices and conduct problems in boys from childhood to adolescence: The moderating effect of age and African-American ethnicity. Journal of Abnormal Child Psychology, 36, 647–662. doi:10.1007/s10802-007-9162-z.CrossRefPubMedGoogle Scholar
  57. Parfitt, Y., Pike, A., & Ayers, S. (2013). The impact of parents’ mental health on parent-baby interaction: A prospective study. Infant Behavior and Development, 36(4), 599–608. doi:10.1016/j.infbeh.2013.06.003.CrossRefPubMedGoogle Scholar
  58. Patterson, G. R. (2002). The early development of coercive family process. In J. B. Reid, G. R. Patterson, & J. J. Snyder (Eds.), Antisocial behavior in children and adolescents: A developmental analysis and the Oregon model for intervention (pp. 25–44). Washington, DC: American Psychological Association.Google Scholar
  59. Pereira, M., Negrao, M., Soares, I., & Mesman, J. (2013). Predicting harsh discipline in at-risk mothers: The moderating effect of socioeconomic deprivation severity. Journal of Child and Family Studies, 22(3), 1–9. doi:10.1007/s10826-013-9883-2.Google Scholar
  60. Pierrehumbert, B., Nicole, A., Muller-Nix, C., Forcada-Guex, M., & Ansermet, F. (2003). Parental posttraumatic reactions after premature birth: Implications for sleeping and eating problems in the infant. Archives of Disease in Childhood-Fetal and Neonatal Edition, 88(5), F400–F404. doi:10.1136/fn.88.5.F400.CrossRefPubMedPubMedCentralGoogle Scholar
  61. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. doi:10.3758/BRM.40.3.879.CrossRefPubMedGoogle Scholar
  62. Reck, C. K., Stehle, E., Reining, K., & Mundt, C. (2009). Maternity blues as a predictor of DSM-IV depression and anxiety disorders in the fi rst three months postpartum. Journal of Affective Disorders, 113(1–2), 77–87. doi:10.1016/j.jad.2008.05.003.CrossRefPubMedGoogle Scholar
  63. Reynolds, J. L. (1997). Posttraumatic stress disorder after childbirth: The phenomenon of traumatic birth. Canadian Medical Association Journal, 156(6), 831–835.PubMedPubMedCentralGoogle Scholar
  64. Serbin, L. A., Kingdon, D., Ruttle, P. L., & Stack, D. M. (2015). The impact of children’s internalizing and externalizing problems on parenting: Transactional processes and reciprocal change over time. Development and Psychopathology, 27(4pt1), 969–986. doi:10.1017/S0954579415000632.CrossRefPubMedGoogle Scholar
  65. Simpson, M., & Catling, C. (2015). Understanding psychological traumatic birth experiences: A literature review. Women and Birth, 29(3), 203–207. doi:10.1016/j.wombi.2015.10.009.CrossRefPubMedGoogle Scholar
  66. Tharner, A., Luijk, M. P. C. M., van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., Jaddoe, V. W. V., Hofman, A., et al. (2012). Infant attachment, parenting stress, and child emotional and behavioral problems at age 3 years. Parenting, 12(4), 261–281. doi:10.1080/15295192.2012.709150.CrossRefGoogle Scholar
  67. van der Kolk, B. (1999). The complexity of adaptation to trauma self-regulation, stimulus discrimination, and characterological development. In B. van der Kolk, A. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 182–213). London: Guilford Press.Google Scholar
  68. van Ee, E., Kleber, R. J., & Jongmans, M. J. (2015). Relational patterns between caregivers with PTSD and their non-exposed children: A review. Trauma, Violence, Abuse, 17(2), 186–203. doi:10.1177/1524838015584355.PubMedGoogle Scholar
  69. Waller, R., Gardner, F., Hyde, L. W., Shaw, D. S., Dishion, T. J., & Wilson, M. N. (2012). Do harsh and positive parenting predict parent reports of deceitful-callous behavior in early childhood? Journal of Child Psychology and Psychiatry, 53(9), 946–953. doi:10.1111/j.1469-7610.2012.02550.x.CrossRefPubMedPubMedCentralGoogle Scholar
  70. Weaver, J. (1997). Childbirth: Preventing posttraumatic stress disorder. Professional Care of Mother and Child, 7, 2–3.PubMedGoogle Scholar
  71. Weems, C. F., & Stickle, T. R. (2012). Mediation, incremental validity, and novel intervention development. Child & Youth Care Forum, 41(6), 509–515. doi:10.1007/s10566-012-9191-9.CrossRefGoogle Scholar
  72. White, T., Matthey, S., Boyd, K., & Barnett, B. (2006). Post-natal depression and posttraumatic stress after childbirth: Prevalence, course and co-occurrence. Journal of Reproductive and Infant Psychology, 24(2), 107–120. doi:10.1080/02646830600643874.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Paola Di Blasio
    • 1
  • Elena Camisasca
    • 2
  • Sarah Miragoli
    • 1
  • Chiara Ionio
    • 1
  • Luca Milani
    • 1
  1. 1.Psychology Department, CRIdeeCatholic University of the Sacred HeartMilanItaly
  2. 2.e-Campus UniversityNovedrateItaly

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