Trauma Symptoms and Social Support Mediate the Impact of Violence Exposure on Parenting Competence Among Substance-Dependent Mothers

Abstract

Women with substance use disorders (SUDs) experience high rates of violence exposure and posttraumatic stress disorder (PTSD), which are associated with parenting anxiety and lower parenting satisfaction among mothers. Although social support may buffer the impact of violence and PTSD on parenting, violence exposure and PTSD may impair mothers’ ability to create, perceive, and utilize social support. We examined the impact of violence exposure, trauma symptoms, and interpersonal support on parenting competence among 291 mothers with substance dependence, using ordinary least squares regression and path analysis. Greater violence exposure and trauma symptoms were associated with lower parenting competence. Greater interpersonal support was associated with greater parenting competence. Trauma symptoms and interpersonal support sequentially mediated the impact of violence exposure on parenting competence, suggesting one pathway through which violence exposure may affect parenting among substance-dependent mothers. Implications for practice include the need to utilize trauma-informed interventions that modify social support.

Keywords

violence exposure PTSD social support alcohol and drugs parenting and mediators

Introduction

High rates of violence exposure and posttraumatic stress symptoms among women with substance dependence have been well documented (Brady, Killeen, Brewerton, & Lucerini, 2000; L. R. Cohen & Hien, 2006). Rates of interpersonal violence exposure range from 47% to 90% of women in substance abuse treatment (El-Bassel, Gilbert, Schilling, & Wada, 2000; Engstrom, El-Bassel, Go, & Gilbert, 2008; Gilbert, El-Bassel, Schilling, & Friedman, 1997; Schneider, Burnette, Ilgen, & Timko, 2009) and rates of co-occurring posttraumatic stress disorder (PTSD) have ranged from 30% to 80% (Hien, Cohen, Miele, Litt, & Capstick, 2004; Najavits, Weiss, & Shaw, 1997). Women with drug dependence report rates of intimate partner violence (IPV) that range from 42% to 60%, and these rates are more than twice as high as rates reported by non–drug-dependent women (Easton, Swan, & Sinha, 2000; El-Bassel et al., 2004). Women who are exposed to violence are also more likely to have problems with drugs or alcohol than non–violence-exposed women (Miller, 1998). This has implications for parenting, as 73% of women entering treatment for SUDs are mothers of children below the age of 18 years (Substance Abuse and Mental Health Services Administration, 2009).

According to the process model of parenting (Belsky, 1984), contextual stressors and supports influence both parenting practices and perceptions of one’s parenting. Although violence exposure may be one contextual parenting stressor, social support may offer contextual support for parenting. Among mothers with SUDs, social support, both general and specific to parenting, may positively influence parenting practices (Brown, Hicks, & Tracy, 2016). However, little is understood about the pathways through which social support, violence exposure, and trauma-related symptoms affect parenting competence among mothers with SUDs. The purpose of this study was to test one pathway through which trauma-related symptoms and social support may sequentially mediate the influence of violence exposure on parenting competence among mothers with SUDs.

The Process Model of Parenting

According to Belsky’s (1984) process model of parenting, interactions across three distinct psychosocial domains influence parenting behaviors. These domains include parents’ personal characteristics, such as psychopathology, addiction, PTSD symptoms, or developmental history. A second domain of influence on parenting are the contextual sources of support and stress such as social support and community violence. Child characteristics is a third domain that may include child temperament or developmental disorders. This model proposes that parenting behavior is a function of interacting influences across these three contextual domains. Exposure to violence is one contextual stressor that may interact with social supports and trauma symptoms to influence parenting.

Empirical literature highlights the associations between violence exposure and mothers’ parenting behaviors. Previous research has identified links between community violence and inconsistent parenting (Grant et al., 2005), community and IPV exposure and increased depression and aggression (Mitchell et al., 2010), IPV and low parenting morale (Malta, McDonald, Hegadoren, Weller, & Tough, 2012), IPV and parenting stress (Renner & Boel-Studt, 2013), and between community violence exposure and aggressive parenting behaviors (Zhang & Anderson, 2010). Although the direct effects of violence exposure on parenting processes have been identified, the pathways through which violence exposure affects parenting competence across ecological levels have not been specified. In Figure 1, we specify one possible pathway by which violence exposure may affect parenting competence through a sequential mediating pathway that includes trauma symptoms and social support.

Figure 1.

Conceptual model: Impact of violence exposure on parenting competence via trauma symptoms and social support.

Parenting Competence

The construct of parenting competence incorporates both parenting self-efficacy and parenting satisfaction (Johnston & Mash, 1989). Within the parenting domain, efficacy refers specifically to the parenting role, and a parent who believes that her efforts to soothe or discipline her child will result in successful outcomes, whereas satisfaction refers to the degree of personal fulfillment a parent experiences when executing his or her role as a parent. Previous studies have linked parenting competence to actual parenting behaviors. Mothers with low competence were found to use more punitive and physical methods of disciplining their children (Mash, Johnston, & Kovitz, 1983; Teti & Gelfand, 1991) and to display less warmth (Izzo, Weiss, Shanahan, & Rodriguez-Brown, 2000), poorer limit setting, and harsher discipline (MacPhee, Fritz, & Miller-Heyl, 1996) than mothers with higher parenting competence. Parenting competence has been found to be lower among mothers with SUDs than among those without (Borelli, Goshin, Joestl, Clark, & Byrne, 2010), and this has been associated with harsh and insensitive parenting practices among mothers with SUDs (Suchman, Mayes, Conti, Slade, & Rounsaville, 2004).

Trauma Symptoms and Parenting

Among women exposed to violence, prevalence rates of PTSD range from 31% to 84.4% (Jones, Hughes, & Unterstaller, 2001), and the development of PTSD is more likely with greater severity and frequency of violence (Woods, 2000). Women who have experienced multiple incidents of victimization during adulthood have been found to have greater rates and severity of PTSD (Messman-Moore, Long, & Siegfried, 2000). Given the high rates of violence exposure and posttraumatic stress symptoms among women with SUDs, this has implications for parenting behaviors and parenting competence.

Trauma symptoms may affect parenting through multiple pathways. Links between trauma exposure and parenting stress and depression are well established (Harmer, Sanderson, & Mertin, 1999). In addition, higher rates of trauma exposure have been linked to decreased parenting satisfaction, reports of child neglect, use of physical punishment, and a history of protective service reports (Banyard, Williams, & Siegel, 2003). However, other than the work of Libby, Orton, Beals, Buchwald, and Manson (2008), who identified links between abuse in childhood and adult parenting satisfaction, the associations between trauma symptoms and parenting competence have not been examined. Trauma symptoms may also affect parenting through the erosion of social support. Mothers with a higher frequency of aversive childhood experiences used social support less than the general population (Harmer et al., 1999); and, Ruscio (2001) found that women with more severe trauma histories experienced less satisfaction with their social support, which was then related to less structured parenting.

Social Support

Current theory regarding trauma exposure and social support has focused on the social causation versus social selection model (see Dohrenwend, 2000). Social causation models, such as the stress-buffering hypothesis (S. Cohen & Wills, 1985), posit that social support precedes negative life events and in some way mitigates (either directly or indirectly through moderation) the impact of pernicious circumstances on outcomes such as well-being. Consistent with the social causation model of social support applied to parenting, Cutrona and Troutman (1986) found that women who reported higher levels of social support at prenatal assessment also reported higher levels of parenting efficacy 3 months later, and concluded that when new mothers could rely on their social support networks for a variety of needs, their self-confidence in mothering was supported. For mothers at risk due to substance dependence, social support decreased the risk of child maltreatment (Beeman, 1995; Thompson, 1995), decreased parenting stress, and increased parenting self-efficacy (Muslow, Caldera, Pursley, Reifman, & Huston, 2002).

The social selection model posits that social support is “itself determined by mental health and distress” (Shallcross, Arbisi, Polusny, Kramer, & Erbes, 2016, p. 167); distress may in fact lead to the erosion of social support as unhealthy individuals are no longer selected into robust social connections. Examining the relations between social support and posttraumatic stress, researchers (Kaniasty & Norris, 2008; Platt, Lowe, Galea, Norris, & Koenen, 2016) found support for both social causation and social selection. Among veterans, Shallcross and colleagues (2016) found that symptoms of PTSD had an impact on social support while being influenced by social support. Among survivors of natural disasters, Kaniasty and Norris (2008) found support for the social causation model of distress in the early aftermath of a disaster, whereas social selection appeared to influence distress in the 12 to 18 months following the disaster.

Within the parenting domain, very little research has examined social support and parenting from the perspective of social selection. Among mothers experiencing interpersonal violence, Pinto, Correia-Santos, Levendosky, and Jongenelen (2019) identified relations between higher PTSD and lower perceived support and between higher perceived support and lower parenting distress. Social support was also found to positively affect satisfaction with the parenting role among parents who had experienced childhood sexual abuse (Libby et al., 2008). Ammerman, Teeters, Noll, Putnam, and Van Ginkel (2013) found that the relationship between childhood trauma and parenting stress was mediated by social support. The authors viewed social support as a protective factor that was both influenced by the experience of childhood trauma and at the same time influenced parenting stress. Although these studies suggest complex pathways through which social support may mediate the effects of trauma and violence exposure on parenting competence, other than Ammerman and colleagues (2013), no studies have examined the relationships between social support, violence exposure, and parenting competence within a social selection framework. In addition, no authors have examined this within a sample of mothers with SUDs.

The Present Study

The purpose of this study was to examine the impact of violence exposure, trauma-related symptomatology, and interpersonal support on parenting competence among substance-dependent mothers. Informed by the process model of parenting (Belsky, 1984) and the social selection perspective on social support (Dohrenwend, 2000), we generated the following hypotheses:

Hypothesis 1: Greater violence exposure and greater trauma-related symptomatology would be associated with lower parenting competence.

Hypothesis 2: Greater interpersonal support would be associated with greater parenting competence.

Hypothesis 3: Trauma symptoms and interpersonal support would sequentially mediate the impact of violence exposure on parenting competence such that violence exposure would lead to greater trauma symptoms, which would erode social support and decrease parenting competence.

Method

Recruitment

Funded by the National Institute on Drug Abuse, data were collected as part of a longitudinal, survey-design, university-based study on the social networks of women in treatment for substance dependence. Women were interviewed at four time points. Data used in this study were collected at Time 1 (approximately 1 week post intake) and at Time 2 (1 month following the first interview). Women were recruited from three intensive outpatient women-only substance abuse treatment programs. Women were informed of the study by their intake worker and enrolled in the study at the time of treatment intake. Participants were eligible if they were in substance abuse treatment with one of the participating treatment sites and carried a diagnosis of substance dependence as determined by the county intake procedures. In addition, participants were required to be at least 18 years of age, and to not be diagnosed with a major thought or psychotic disorder. Research interviews were conducted by trained research assistants. Measures were administered using laptop computers and research assistants also read all questions aloud to participants to account for various levels of literacy. Participants were provided with a US$35 gift card as incentive for participation. Approval for this study was obtained through the Case Western Reserve University Institutional Review Board prior to sample recruitment.

Measures

Recent exposure to violence was measured using the Exposure to Violence Scale–Adult Version (Singer & Song, 1995), a 22-item self-report measure designed to measure the frequency of respondents’ experiencing and witnessing violence over the prior year, on a 5-point Likert-type scale ranging from 0 to 5. Frequency of specific violent acts including slapping/hitting/punching, beatings, knife attacks, and shootings were assessed across three distinct domains—home, work or school, and neighborhood. Response options are never, once or twice, several times during the year, at least once a month, at least once a week, and almost every day. Possible total scale scores range from 0 to 110, and higher scores represent greater violence exposure. Previously reported alphas have ranged from .68 to .87 (Singer, Anglin, Song, & Lunghofer, 1995), and was .87 in this sample.

The Parenting Sense of Competence Scale (PSOC) was used to measure parenting efficacy and satisfaction. This is a 17-item scale with a two-factor structure: satisfaction, which assesses the degree to which an individual enjoys his or her role as a parent; and efficacy, which assesses an individual’s perceived competence in his or her role as a parent (Ohan, Leung, & Johnston, 2000). Sample items on the PSOC include statements such as “My mother was better prepared to be a good mother than I am” and “Being a parent makes me tense and anxious,” and are measured on a 6-point Likert-type scale ranging from 1 to 6, strongly disagree to strongly agree. Higher scores represent greater parenting competence, with a total scale score range between 17 and 102. Cronbach’s alpha for the total parenting competence scale was reported to be .80 (Ohan et al., 2000) and was .78 in this sample.

Severity of trauma symptoms was measured using the Trauma Symptom Checklist (Briere & Runtz, 1989), a 40-item self-report measure that assesses the trauma-related symptomatology in adults resulting from trauma in childhood or adulthood (Briere & Runtz, 1989; Elliott & Briere, 1992). Each item on the TSC-40 is a symptom, and response options describe the frequency of occurrence of each symptom over the past 2 months on a 4-point Likert-type scale with 0 = never and 3 = often, with a total scale range of 0 to 120. Higher scores represent greater trauma-related symptomatology. The total scale score was used for this study, with a reported Cronbach’s alpha of .89 (Briere & Runtz, 1989) and an alpha of .93 in this sample.

The Interpersonal Support Evaluation List–Short Form (ISEL-SF; S. Cohen & Hoberman, 1983), a 16-item measure was included in the study protocol as an index of general perceived social support. The ISEL-SF has a 4-point Likert-type scale with 0 = definitely true, 1 = probably true, 2 = probably false, and 3 = definitely false (scored 0-3), with an aggregate score ranging from 0 to 48, with higher scores representing higher perceived social support. Sample items include statements such as, “When I need suggestions on how to deal with a personal problem, I know someone I can turn to,” and “If I were sick, I could easily find someone to help me with my daily chores.” Previous literature reported a Cronbach’s alpha of .83 (Payne et al., 2012), which was the same for this sample.

Number of problems with children, including number of children’s behavioral, mental health, physical/medical, or learning problems as reported by the mothers, was included as a covariate. Mothers were asked the following five questions: “Have you ever been told by a medical or school professional that any of your children has a (1) medical condition, (2) learning disability, (3) mental health disorder, (4) behavioral disorder, and (5) any other problem.” Response options were “yes/no” to each question, and responses were combined across the five questions to produce a composite scale titled “number of child problems,” with a possible range of 0 to 5. Mothers’ race, a dichotomous variable coded as Black African American or non-Black African American, was also included as a covariate.

Exposure to violence and trauma symptom data were collected during Time 1 data collection, within 1 week of intake to substance abuse treatment. Information on participant race and number of problems with children were also collected at Time 1. Social support data and parenting competence were gathered at Time 2, 1 month after Time 1 data collection.

Data Analysis

Descriptive statistics including skewness and kurtosis were used to examine variable distributions, and bivariate correlations were examined to test for multicolinearity. Kline (2005) suggests that variables be transformed when their distributions contain skew >3 and kurtosis >10. For all variables in this study, skew was <3 and kurtosis was <10. Covariates were chosen for inclusion in the regression model if they were significantly correlated with the dependent variable, and based on previous literature that identified associations between parenting competence and age, race, education level, dual disorders, and problems with children (Coleman & Karraker, 2000; Zayas, Jankowski, & McKee, 2005). However, age, dual disorder, and education level were not significant in the final regression model, and were removed from the model in the interest of parsimony.

Ordinary least squares regression with hierarchical entry was utilized to examine the specific variance in parenting competence accounted for by the primary variables of interest individually—violence exposure, trauma symptoms, and social support. Participant race, number of problems with children, and violence exposure were entered in the first regression block. The trauma symptom variable was entered in the second regression block, and interpersonal support was added in the third block. These regression models allowed us to examine Hypothesis 1—that violence exposure and trauma symptoms would be negatively associated with parenting competence, and Hypothesis 2—that interpersonal support would be positively associated with parenting competence. Order of entry for the variables of interest was based on the position of each variable in the mediated model (see Figure 1), exposure to violence first, then trauma symptoms second, and social support third. Block entry was used to identify the amount of variance in the dependent variable accounted for by each addition to the model, and the associated change in R² with the addition of each variable.

To examine the hypothesized sequential mediation of trauma symptoms and interpersonal support in the association between violence exposure and parenting competence (while controlling for participant race and number of child problems), we used path analysis in Mplus Version 6 (Muthén & Muthén, 1998-2010). A bias corrected bootstrap procedure was used to assess mediated effects, using 1,000 bootstrap samples. This method provided confidence intervals (CIs) for the indirect effects and was a preferred method due to its lower Type 1 error rate and high power to detect mediation (MacKinnon, Lockwood, & Williams, 2004). For indices of model fit, we used the comparative fit index (CFI, preferably ≥.90), the root mean square error of approximation (RMSEA, preferably ≤.10), and the standardized root mean square residual (SRMR, preferably ≤.15; Weston & Gore, 2006).

Missing Data

The present study utilized data from all women who completed Time 1 and Time 2 interviews and were currently raising children below the age of 18, a total of 291 women. Of these, data were complete for 235 women. Full information maximum likelihood estimator was used to impute missing values, in accordance with Schafer and Graham’s (2002) recommendations for data missing at random or missing completely at random. The proportion of data present to estimate each pairwise association ranged from 81% to 100% covariance coverage estimates.

Results

Participants

This sample consisted of 291 mothers diagnosed with substance dependence. Women’s average age was 36.12 years and ranged from 18 to 58 years. More than half, 62.6% (n = 184) identified as Black African American, one was Caribbean, four identified as Puerto Rican, two as Other Latino, five as bi- or multiracial, and 92 as White/Caucasian. More than 70% (n = 212) were diagnosed with a dual disorder of substance dependence and mental health disorder. Primary drugs of addiction for this sample included alcohol (46%), marijuana (39%), and cocaine (56%). In terms of marital status, 62.5% of women were unmarried and never married; 30.2% were widowed, separated, or divorced; and 7.2% were currently married. Nearly 40% of the women in this sample never completed high school and 15% completed some post–high school education. Income level was low for the sample as a whole, 72.5% of women received government assistance such as welfare, food stamps, Women Infants and Children, or social security disability, whereas only 8.6% reported having a job either on or off the books.

Descriptive statistics and correlations for variables used in the multivariate analyses are summarized in Table 1. During the past year, 45.2% of women were victims of violence in their homes, 44.2% in their neighborhoods, and 9.9% at work or school. Additional information on rates and types of violence exposure for this sample are summarized in Table 2.

Table 1.

Descriptive Data and Correlations for Study Variables.

Variable	M	SD	Sample Range	Possible Range	Alpha	1	2	3	4	5
1. Violence exposure	5.76	8.42	0-52	0-110	.87	—	.372**	−.145*	−.201**	.116*
2. Trauma symptoms	43.16	21.50	0-102	0-120	.93		—	−.299**	−.224**	.221**
3. Social support	33.91	8.29	3-48	0-48	.83			—	.386**	−.085
4. Parenting competence	65.38	10.94	35-91	17-102	.78				—	−.172**
5. Child problems	.92	1.11	0-4	0-5	—					—

p < .05. **p < .01.

Table 2.

Frequency and Types of Violence Exposure at Home, Work, and Neighborhood Combined.

Violence Type	M (SD)	Sample Range	Possible Range	Percent of Women (n)
Violence exposure as a victim
Threat of physical harm	0.74 (1.58)	0-15	0-15	34.0 (99)
Slapped, punched, or hit	0.60 (1.22)	0-10	0-15	32.0 (93)
Beaten or mugged	0.41 (1.04)	0-8	0-15	23.0 (67)
Forced to do a sexual act	0.41 (0.961)	0-5	0-5	22.3 (65)
Stabbed with a knife	0.10 (0.430)	0-5	0-5	7.5 (22)
Shot at or shot with a gun	0.03 (0.191)	0-2	0-5	22.0 (64)
Total exposure (victim)	1.75 (3.28)	0-26	0-30	45.4 (132)
Violence exposure as a witness
Threat of physical harm	1.28 (2.24)	0-15	0-15	41.6 (121)
Slapped, punched, or hit	1.26 (2.01)	0-12	0-15	44.7 (130)
Beaten or mugged	1.00 (1.74)	0-10	0-15	37.5 (109)
Forced to do a sexual act	0.12 (0.439)	0-4	0-5	8.2 (24)
Stabbed with a knife	0.18 (0.54)	0-4	0-5	12.0 (35)
Shot at or shot with a gun	0.23 (0.658)	0-4	0-5	14.8 (43)
Total exposure (witness)	3.54 (5.53)	0-30	0-30	52.2 (152)

Results of Bivariate Analyses

Bivariate correlations were examined using the Pearson product moment correlation coefficient. As shown in Table 1, exposure to violence was moderately positively correlated with trauma symptoms and number of problems with children, and moderately negatively correlated with interpersonal support and parenting competence. Trauma symptoms were moderately negatively correlated with interpersonal support and parenting competence, and positively correlated with number of child problems. Interpersonal support was moderately positively correlated with parenting competence. An independent samples t test was used to identify differences between Black and non-Black mothers in the dependent variable, parenting competence, and found that non-Black mothers reported significantly higher parenting competence (M = 67.89, SD = 10.43) than Black mothers (M = 64.04, SD = 10.93, t = 2.82, p = .005)

Regression Results

Exposure to violence was significantly and negatively associated with parenting competence in the first model (B = −0.276, p < .01) and the second model (B = −0.202, p < .05; see Table 3). Trauma symptoms, added in the second model, were significantly negatively associated with parenting competence (B = −0.085, p < .05), and accounted for an R²Δ of .023 (p = .014) when added to the model in the second step. The final regression model significantly predicted parenting competence, F(6, 291) = 11.94, p = .000, and R² = .21, as shown in Table 3; and R²Δ = .088, p = .000, when interpersonal support was added to the final model. Greater interpersonal support was associated with greater parenting competence (B = 0.433, p < .001). Although greater violence exposure and trauma symptoms predicted lower parenting competence in the second model, this relationship lost significance when the social support variable was added in the final model. Race remained significant across all three models; Black women reported significantly lower parenting competence than non-Black women (B = −4.037, p < .01).

Table 3.

OLS Regression: Impact of Violence Exposure, Trauma Symptoms, and Social Support on Parenting Competence.

Variables	Model 1			Model 2			Model 3
Variables	B ^a	SE (B)	β^b	B	SE (B)	β	B	SE (B)	β
Constant	71.072	1.275		74.391	1.898		57.032	3.887
Race	−4.429**	1.431	−0.195	−4.887**	1.427	−0.215	−4.037**	1.368	−0.178
Child problems	−1.185	0.610	−0.122	−0.932	0.612	−0.096	−0.944	0.582	−0.097
Violence exposure	−0.276**	0.085	−0.204	−0.202*	0.089	−0.149	0.170	0.085	−0.126
Trauma symptoms				−0.085*	0.035	−0.166	0.041	0.034	−0.080
IP support							0.433***	0.086	0.312
				R²Δ = .023, p = .014			R²Δ = .088, p = .000
	R² = .095, p = .000; F(4, 291) = 8.13			R² = .12, p = .000; F(5, 291) = 7.75			R² = .21, p = .000; F(6, 291) = 11.94

Note. OLS = ordinary least squares; IP = interpersonal.

Unstandardized coefficient.

Standardized coefficient.

p < .05. **p < .01. ***p < .001.

Mediation Results

The hypothesized sequential mediation model (Figure 1), with trauma symptoms and interpersonal support mediating the relationship between violence exposure and parenting competence, fit the data well. The CFI was 1.00, SRMR was 0.02, and RMSEA was 0.00, all within the parameters suggested by Weston and Gore (2006). In addition, χ²(6) = 99.46, p < .001, supporting the fit of this mediated model to the data. In addition to the overall model fit, the standardized coefficients for each link in this mediated pathway were statistically significant as shown in Table 4. Greater violence exposure was associated with greater trauma symptoms, B = 0.35, p < .001, 95% CI = [0.575, 1.076]. Greater trauma symptoms were associated with lower interpersonal support (B = −0.28, p < .001, 95% CI = [−0.154, −0.076]). Lower interpersonal support was associated with lower parenting competence (B = −0.36, p < .001, 95% CI = [0.314, 0.591]), and greater violence exposure was associated with lower parenting competence (B = −0.16, p < .05, 95% CI = [−0.339, −0.064]). Results supported our hypothesis that trauma symptoms and interpersonal support mediated the relationship between violence exposure and parenting competence (B = −0.043, SE = 0.015, β = −2.936, p = .003).

Table 4.

Path Coefficients for Sequential Mediation Model.

	Standardized Estimate	Unstandardized Estimate	Standard Error (Unstandardized)	t (Unstandardized Estimates/SE)	95% Lower CI	95% Upper CI
Direct effects
a. EXP to TSC	.35	.86	0.15	5.80***	0.575	1.076
b. TSC to ISEL	−.28	−.11	0.02	−4.62***	−0.154	−0.076
c. ISEL to PSOC	−.36	.45	0.09	5.36***	0.314	0.591
d. EXP to PSOC	−.16	−.20	0.09	−2.32*	−0.339	−0.064
Indirect effect
a × b × c	.04	−.04	0.02	−2.94**	−0.074	−0.023

Note. CI = confidence interval; EXP = Exposure to Violence Scale; TSC = Trauma Symptom Checklist; ISEL = Interpersonal Support Scale; PSOC = Parenting Sense of Competence Scale.

p < .05. **p < .01. ***p < .001.

Discussion

Belsky’s (1984) process model of parenting delineated multilevel factors that affect parenting characteristics and behaviors. The social context in which parents and children are embedded is one such factor. Exposure to violence both within families and communities exerts considerable influence on parenting practices. Intensity of violence exposure has been linked to aggressive parenting (Zhang & Anderson, 2010), parental warmth (Westbrook & Harden, 2010), and parental feelings of helplessness in the parenting role (Appleyard & Osofsky, 2003). Whereas a few studies have identified parental depression (Mitchell et al., 2010; Self-Brown et al., 2006) and posttraumatic stress symptoms (Al’Uqdah, Grant, Malone, McGee, & Toldson, 2015) as mediators, few studies have identified the pathways through which violence exposure affects parenting. The current study identified significant determinants of parenting competence, thus identifying potential pathways through which violence exposure may affect parenting.

The results of this study, specifically linear regression results, supported Hypotheses 1 and 2. Greater violence exposure and greater trauma symptoms were directly associated with lower parenting competence, and greater interpersonal support was associated with greater parenting competence. Through the use of path analysis, we identified one pathway through which violence exposure was associated with lower parenting competence, potentially compromising effective parenting behaviors. In support of Hypothesis 3, the impact of violence exposure on parenting competence was mediated through trauma symptoms and interpersonal support, in that, mothers who reported greater violence exposure and trauma symptoms also reported significantly lower interpersonal support, and, in turn, lower parenting competence.

These finding are consistent with previous research (Lerner & Kennedy, 2000) that found links between contextual violence exposure and decreases in global and parenting-specific self-efficacy. Although research has identified the negative impact of violence and trauma symptoms on an individual’s general sense of efficacy, this study identified links between trauma and efficacy specific to the parenting role, in that, trauma symptoms mediated the association between violence exposure and mothers’ sense of parenting competence. It becomes especially important to understand these links within the population of mothers with addictions for whom previous research (Young-Wolff et al., 2014) has identified greater rates of violence exposure and PTSD than women without addictions. Beyond the impact of addictive disorders on parenting, the impact of violence exposure and trauma symptoms on parenting competence may further compromise effective parenting practices in this population.

In this study, violence exposure and trauma-related symptomatology indirectly, through lower interpersonal support, were associated with lower parenting competence. Women with both trauma symptoms and SUDs have reported lower levels of functional social support than their peers with SUDs alone (Brown, Jun, Min, & Tracy, 2013; Dobkin, De Civita, Paraherakis, & Gill, 2002). Trauma exposure, especially interpersonal violence, may limit women’s capacity to build protective supportive social networks (Charuvastra & Cloitre, 2008). This may have significant negative implications for parenting in this population.

Stress and coping models have dominated research on trauma and social support, highlighting the protective value of social support in mitigating the impact of trauma symptoms on various outcomes. Few studies have examined the social selection model of social support, or the ways in which violence exposure and trauma symptoms may be associated with decreased social support. This study offers some support for the less extensively examined social selection model of social support within the domain of parenting, thus offering a new perspective on parenting among mothers with addictions and violence exposure.

The finding that Black mothers reported lower parenting competence than non-Black mothers requires additional consideration. Post hoc analyses using independent samples t tests found no significant differences between Black and non-Black mothers on trauma symptoms, violence exposure, or social support. Both parenting self-efficacy and parenting satisfaction are incorporated within the construct of parenting competence (Johnston & Mash, 1989). In terms of self-efficacy, post hoc analyses revealed lower levels of self-efficacy related to abstinence (t = 3.16, p < .05) as well as parenting among Black mothers compared with non-Black mothers. It appears that lower self-efficacy among Black mothers may not be specific to the parenting domain, may cross life domains, and be associated with some unmeasured variable. Extant literature on efficacy has identified that experiences of racial discrimination erode self-efficacy across multiple domains, including parenting (Brody et al., 2008), coparenting relationships (Murry, Brown, Brody, Cutrona, & Simons, 2001), academic efficacy (Banerjee, Meyer, & Rowley, 2016), and job-related efficacy (Heslin, Bell, & Fletcher, 2012). This may account for the differences in parenting competence observed in this sample. In addition, although education level was not a significant predictor of parenting competence in our regression model, previous research (Coleman & Karraker, 2000) has identified associations between education level and both parenting self-efficacy and parenting satisfaction. In our post hoc analyses examining differences between groups, Black mothers had significantly lower levels of education than non-Black mothers, χ² = 8.33, p < .05, in this sample. Finally, one previous study (DeLisi, Jones-Johnson, Johnson, & Hochstetler, 2014) found that violence exposure had more negative effects on self-efficacy for Black individuals than for White individuals. This may hold true for the current study’s sample as well, with implications for the parenting self-efficacy of Black mothers.

Practice Implications

Although trauma-informed interventions (Najavits, 2002) are becoming integrated into substance abuse treatment protocols, especially in programs that specifically target women (Covington, Burke, Keaton, & Norcott, 2008), findings from this study suggest that interpersonal support should be an additional target for intervention. Current models for intervening with mothers with dual problems of addiction and trauma-related symptomatology have focused primarily on developing skills for coping with affective dysregulation and impulsivity. Such interventions focus minimally if at all on the interpersonal consequences of violence exposure and related symptomatology. The role of social support in mediating the impact of trauma symptoms on parenting perceptions suggests that interventions that reduce the impact of trauma symptoms on social support and social relationships are important to building parenting competence in mothers with addictions. Interventions to enhance interpersonal support in this population should be specifically targeted to reduce trauma-related barriers to creating, perceiving, and utilizing support to enhance successful parenting.

Strengths and Limitations

Previous research on parenting and specifically on perceived parenting competence has focused primarily on White middle-class mothers in two-parent families. This is one of very few studies that examined parenting competence in a population of low-income, primarily single mothers with SUDs. This sample consisted of women who were in treatment for substance dependence at the time of the study. The context of being in active treatment and the use of the treatment centers for conducting the interviews may have affected the women’s responses, possibly encouraging more positive responses to parenting questions than might have occurred in a different context.

Although the percent of women in this sample exposed to violence within the previous year was consistent with previous research on violence exposure among women with substance dependence (Engstrom, El-Bassel, Go, & Gilbert, 2008), the frequency of exposure was relatively low, with frequency averaging a few times over the previous year. In addition, IPV was not specifically examined, so we are unable to tease out the effects of IPV from other types of violence. We also did not include specific measures of childhood abuse and maltreatment or violence exposure that occurred before the previous 12 months. For some of the women in this sample, PTSD symptoms may have resulted from years of violence exposure, including childhood exposure that was not controlled for in this study.

Future Research

The relationships between exposure to traumatic experiences, trauma-related symptomatology, and parenting are complex. Trauma exposure affects parenting through multiple pathways, one of which may be through the erosion of social support caused by trauma-related symptomatology. Future research should examine additional pathways through which traumatic exposure and related symptoms may affect parenting competence, and their effects on actual parenting practices and behaviors. Although research has identified the diminishment of global efficacy in response to trauma exposure, future research should examine the impact of trauma exposure and symptoms on the specific domain of parenting more closely. Future research should also examine parenting competence, and the relationships between violence exposure, trauma symptoms, and parenting competence specific to Black African American mothers. In this sample Black African American mothers reported significantly lower parenting competence than non-Black mothers, and this difference remained across all regression models. Future research might examine these differences and identify predictors of parenting competence specific to Black mothers who were not examined in this study.

Footnotes

Acknowledgements

The authors wish to thank Elizabeth M. Tracy, PhD, of Case Western Reserve University, for use of the dataset used in the analyses discussed in this manuscript, and for support in the development of the framework used.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by Award Number R01DA022994 from the National Institute on Drug Abuse.

Author Biographies

Suzanne Brown is an associate professor with tenure at the Wayne State University School of Social Work. She reveived her PhD from the Mandel School for Applied Social Science at Case Western Reserve University and her MSW from the Smith College School for Social Work. Her research interests include parenting among mothers with substance use disorders and violence exposure, and social support among women with substance use disorders and violence exposure.

Stella Resko is an associate professor with tenure at the Wayne State University School of Social Work, and a faculty affiliate of the Merrill Palmer Skillman Institute at Wayne State. She received her PhD and her MSW from the Ohio State University School of Social Work. Her research interests include substance use disorders across adolescence and adulthood, motivational interviewing, and prevention/intervention with addictive disorders.

Carolyn J. Dayton is an associate professor with tenure at the Wayne State University School of Social Work, and a faculty affiliate of the Merrill Palmer Skillman Institute at Wayne State where she is Associate Director of the Infant Mental Health Program. She received her PhD from Michigan State University and her MSW from the University of Michigan. Her research interests include identifying biological and psychosocial risk and resilience factors that influence parenting processes and early child development among parents exposed to contextual risk.

Carla Barron is a clinical coordinator of the Infant Mental Health Program at Wayne State’s Merrill Palmer Skillman Institute and a doctoral candidate in the doctoral program at the Wayne State University School of Social Work. In her research she examines how the training and supervision received by professionals providing home-based services can affect the therapeutic relationship as well as therapeutic and developmental outcomes.

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