History of Maltreatment in Childhood and Subsequent Parenting Stress in At-Risk, First-Time Mothers: Identifying Points of Intervention During Home Visiting
Home visiting is an effective preventive intervention that can improve parenting outcomes for at-risk, new mothers, thereby optimizing subsequent child development. A history of maltreatment in childhood is common in mothers participating in home visiting, yet the extent to which such a history is related to parenting outcomes during home visiting is unknown. The current study evaluated whether mothers with a history of maltreatment in childhood respond less favorably to home visiting by examining the direct and indirect pathways to subsequent parenting stress, a key parenting outcome affecting child development. First-time mothers (N = 220; age range = 16–42) participating in one of two home visiting programs, Healthy Families America or Nurse Family Partnership, were evaluated at enrollment and again at 9-and 18-month post-enrollment assessments. Researchers administered measures of maternal history of maltreatment in childhood, depressive symptoms, social support, and parenting stress. Maternal history of maltreatment in childhood predicted worsening parenting stress at the 18-month assessment. Mediation modeling identified two indirect pathways, one involving social support at enrollment and one involving persistent depressive symptoms during home visiting, that explained the relation between a history of maltreatment in childhood and parenting stress at the 18-month assessment. Ways to improve the preventive effects of home visiting for mothers with a history of maltreatment in childhood through the identification of relevant intervention targets and their ideal time of administration are discussed.
KeywordsChild maltreatment Home visiting Depression Social support Parenting stress
The authors express thanks to all the organizations contributing to Every Child Succeeds. We also wish to thank Alonzo T. Folger, Ph.D., for his assistance in preparing this manuscript. This study is supported by Grant R40 MC 06632-01 (Ammerman) from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services. Angelique R. Teeters is currently with TriHealth, Group Health Physicians, Cincinnati, Ohio. The authors acknowledge the participation and support of the United Way of Greater Cincinnati, Kentucky HANDS, and Ohio Help Me Grow.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
- Abidin, R. R. (1995). The parenting stress index professional manual. Odessa: Psychological Assessment Resources.Google Scholar
- Astuto, J., & Allen, L. (2009). Home visitation and young children: An approach worth investing in? Society for Research in Child Development, Social Policy Report, 23, 3–22.Google Scholar
- Avellar, S., Paulsell, D., Sama-Miller, E., Del Grosso, P., Akers, L., & Kleinman, R. (2016). Home visiting evidence of effectiveness review: executive summary. Washington D.C.: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.Google Scholar
- Barnes, J., Aistrop, D., Allen, E., Barlow, J., Elbourne, D., Macdonald, G., Melhuish, E., Petrou, S., Pink, J., Snowdon, C., Spiby, H., Stuart, J., & Sturgess, J. (2013). First steps: Study protocol for a randomized controlled trial of the effectiveness of the Group Family Nurse Partnership (gFNP) program compared to routine care in improving outcomes for high-risk mothers and their children and preventing abuse. Trials, 14, 285. doi: 10.1186/1745-6215-14-285.CrossRefPubMedPubMedCentralGoogle Scholar
- Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio: Psychological Corporation.Google Scholar
- Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., Stokes, J., Handelsman, L., Medrano, M., Desmond, D., & Zule, W. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27, 169–190. doi: 10.1016/S0145-2134(02)00541-0.CrossRefGoogle Scholar
- Green, B. L., Tarte, J. M., Harrison, P. M., Nygren, M., & Sanders, M. B. (2014). Results from a randomized trial of the Healthy Families Oregon accredited statewide program: Early program impacts on parenting. Children and Youth Services Review, 44, 288–298. doi: 10.1016/j.childyouth.2014.06.006.CrossRefGoogle Scholar
- Mayberry, L. J., Horowitz, J. A., & Declercq, E. (2007). Depression symptom prevalence and demographic risk factors among U.S. women during the first 2 years postpartum. Journal of Obstetric, Gynecologic, and Neonatal Nursing: Clinical Scholarship for the Care of Women, Childbearing Families, & Newborns, 36, 542–549. doi: 10.1111/j.1552-6909.2007.00191.x.CrossRefGoogle Scholar
- Muthén, L. K., & Muthén, B. O. (1998-2012). Mplus user’s guide (v.7). Los Angeles: Muthén & Muthén.Google Scholar
- National Children’s Alliance. (2014). NCA National Statistics – Statistical Report 2014. Retrieved from http://www.nationalchildrensalliance.org/sites/default/files/download-files/2014NationalAnnual_0.pdf.
- O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women: Evidence report and systematic review for the US Preventive Services Task Force. JAMA, 315, 388–406. doi: 10.1001/jama.2015.18948.CrossRefPubMedGoogle Scholar
- Olds, D. L. (2010). The nurse-family partnership: From trials to practice. In A. J. Reynolds, A. J. Rolnick, M. M. Englund, & J. A. Temple (Eds.), Childhood programs and practices in the first decade of life: A human capital integration (pp. 49–75). New York: Cambridge University Press.CrossRefGoogle Scholar
- Sedlak, A. J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., & Greene, A. (2010). Fourth National Incidence Study of Child Abuse and Neglect (NIS-4): Report to Congress. Washington, DC: US Dept. of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, National Center on Child Abuse and Neglect.Google Scholar
- Shenk, C. E., Putnam, F. W., Rausch, J. R., Peugh, J. L., & Noll, J. G. (2014). A longitudinal study of several potential mediators of the relationship between child maltreatment and posttraumatic stress disorder symptoms. Development and Psychopathology, 26, 81–91. doi: 10.1017/s0954579413000916.CrossRefPubMedPubMedCentralGoogle Scholar
- Steele, H., Bate, J., Steele, M., Dube, S. R., Danskin, K., Knafo, H., Nikitiades, A., Bonuck, K., Meissner, P., & Murphy, A. (2016). Adverse childhood experiences, poverty, and parenting stress. Canadian Journal of Behavioural Science/Revue Canadienne des Sciences du Comportement, 48, 32–38. doi: 10.1037/cbs0000034.CrossRefGoogle Scholar
- Stith, S. M., Liu, T., Davies, L. C., Boykin, E. L., Alder, M. C., Harris, J. M., Som, A., McPherson, M., & Dees, J. E. M. E. G. (2009). Risk factors in child maltreatment: A meta-analytic review of the literature. Aggression and Violent Behavior, 14, 13–29. doi: 10.1016/j.avb.2006.03.006.CrossRefGoogle Scholar
- Teeters, A. R., Ammerman, R. T., Shenk, C. E., Goyal, N. K., Folger, A. T., Putnam, F. W., & Van Ginkel, J. B. (2016). Predictors of maternal depressive symptom trajectories over the first 18 months in home visiting. American Journal of Orthopsychiatry, 86, 415–424. doi: 10.1037/ort0000159.CrossRefPubMedGoogle Scholar
- Wisner, K. L., Sit, D. K., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., Eng, H. F., Luther, J. F., Wisniewski, S. R., Costantino, M. L., Confer, A. L., Moses-Kolko, E. L., Famy, C. S., & Hanusa, B. H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70, 490–498. doi: 10.1001/jamapsychiatry.2013.87.CrossRefPubMedPubMedCentralGoogle Scholar