Correlates and Predictors of Mothers’ Adaptation and Trauma Symptoms Following the Unveiling of the Sexual Abuse of Their Child

Abstract

Child sexual abuse (CSA) can severely affect the mental health of children and their parents. While correlates of recovery have been documented in children, factors exacerbating parents’ adaptation to their child’s unveiling of CSA deserves further attention. Parents’ history of abuse has been inconsistently identified as a predictor of their distress in reaction to their child’s abuse disclosure. This study proposes a mediation model that explores various processes underlying mother’s psychological distress (posttraumatic stress disorder [PTSD], dissociation, and their comorbidity) following their children’s unveiling of CSA. It investigates the influence of mother’s own CSA, as well as of her exposure to additional forms of past and current victimization, on her reaction to the child’s CSA disclosure, while considering coping mechanisms as mediators (avoidance, problem solving, search for social support, and feeling of guilt). Data were collected through self-report measures completed by 298 mothers of children who had recently disclosed CSA. Path analyses revealed that mother’s exposure to interparental violence as a child acted as a primary predictor of dissociation and of its comorbidity with PTSD, while a history of CSA was directly and exclusively linked to dissociation. Being exposed to recent partner violence was indirectly related to trauma symptoms, with coping mechanisms acting as mediators. This study outlines the relationship between mother’s psychological distress and her cumulative, past, and current exposure to various forms of victimization. Exposure to interparental violence as a child represents a particularly important factor for identifying mothers most in need of support, as it is a significant predictor of dissociation and of its comorbidity with PTSD.

Keywords

child sexual abuse mothers PTSD dissociation coping mechanisms

Introduction

Child sexual abuse (CSA) is a serious social problem affecting several young victims and their parents. Self-report prevalence estimates indicate that approximately 20% of women and 8% of men report that they were victims of this crime before the age of 18 (Stoltenborgh, van, Ijzendoorn, Euser, & Bakermans-Kranenburg, 2011), with some of these victims becoming parents that reencounter CSA through their child’s experience. Independent of their personal history, parents who are informed that their child has been a victim of CSA have been described as experiencing numerous emotional, cognitive, and adaptive challenges in their parenting role (Banyard, Englund, & Rozelle, 2001). Parents often depict the unveiling as a shock (Elliott & Carnes, 2001), after which many report experiencing significant psychological distress (Baril & Tourigny, 2015), especially if families are already confronted with other important life stressors (Massat & Lundy, 1998).

Timely Care for Mothers and Children

Psychotherapies for children exposed to trauma, which are identified as best practices (e.g., trauma-focused cognitive behavioral therapy (TF-CBT; Cohen, Mannarino, & Deblinger, 2006), include the active participation of a parent. Mothers’ mental health and emotional availability can therefore play a crucial role in facilitating children’s recovery following CSA. Supportive mothers can enable validation and recognition; they are essential observers of the child’s functioning and they can play a motivating and mobilizing role in treatment (Daignault, Cyr, & Hébert, 2017). Their support has been identified as an important predictor of adaptation both in studies conducted with children (Cyr, Zuk, & Payer, 2011) and retrospective studies with adults (Godbout, Brière, Sabourin, & Lussier, 2014). Consequently, more empirical research needs to be conducted to guide the identification of mothers who are at greater risk of experiencing significant psychological distress and most in need of therapeutic support. The present study therefore proposes a mediation model that investigates the influence of mother’s own CSA as well as her past and more recent exposure to other forms of interpersonal violence on her level of distress following CSA disclosure, while considering coping mechanisms as mediators.

Mothers react differently to their child’s disclosure of CSA. To understand variability between individuals, theoretical models outline the influence of factors at the personal, familial, community, and social levels that are influential before, during, and long after the occurrence of victimization (Bolen, 2003; Cicchetti & Toth, 1995; Spaccarelli, 1994). At the personal and family level, findings reveal that between 35% and 65% of mothers of children who report CSA, have themselves been sexually victimized (Collin-Vézina & Cyr, 2003; Deblinger, Lippmann, Stauffer, & Finkel, 1994; Hébert, Daigneault, Collin-Vézina, & Cyr, 2007; Leifer, Shapiro, & Kassem, 1993; Runyan et al., 1992). They are found to suffer from depression, anxiety, posttraumatic stress disorder (PTSD), and dissociation, along with resulting interpersonal, parental, and conjugal difficulties (Baril & Tourigny, 2015). In one recent study assessing mother’s reaction to the CSA disclosure of their child, 41% of mothers reported symptoms of depression that reached the clinical range. This percentage was twice as high as the one observed in the general population (Cyr et al., 2014). A few studies also observed the presence of PTSD symptoms among mothers of children with CSA histories (Dyb, Holen, Steinberg, Rodriguez, & Pynoos, 2003), with approximately 30% of the sample experiencing PTSD symptoms (Cyr, McDuff, & Wright, 1999) and 13% meeting the diagnostic criteria for PTSD (Cyr et al., 2014). The reoccurrence of CSA from one generation to the next has become an important area of research (Baril & Tourigny, 2015). For mothers with an unresolved history of victimization, disclosure of their child’s CSA may exacerbate an already tenuous situation and potentially reactivate mother’s symptoms associated with her own CSA experience (Baril & Tourigny, 2015).

CSA History and Interpersonal Violence

Over the past 10 to 15 years, the influence of mother’s history of CSA has been inconsistently found to exert a negative influence on various outcomes such as mother’s health (Roberts, O’Connor, Dunn, Golding, & ALSPAC Study Team, 2004), as well as various maternal care behaviors including mother’s availability to provide support (Cyr et al., 2003), her parenting skills (Kim, Trickett, & Putnam, 2010; Santa-Sosa, Steer, Deblinger, & Runyon, 2013), and attachment behaviors (Lewin & Bergin, 2001). Addressing the association between a history of CSA in mothers and parental practices, Barrett’s (2009) study outlined the importance of controlling for mothers’ actual or recent victimization. The results of Barret’s study indicated that the CSA of mothers no longer predicted parental practices when they controlled for the presence of other forms of victimization in the women’s childhood and adult life. This is particularly relevant as women who report CSA appear to be at greater risk to be exposed to partner violence when compared to non-CSA victims (Widom, Czaja, & Dutton, 2014). Hébert and her colleagues (2007) also conducted a study assessing factors linked to psychological distress in mothers of children who experienced CSA as well as partner violence. They found that more than half of their sample reported experiencing psychological distress and that history of CSA and current partner violence are positively related to clinical scores of psychological distress. A longitudinal study conducted by Banyard and Williams (2007) also outlined the influence of more recent victimization on the psychological health of mothers who report CSA. Structured and open-ended interviews indicated that additional exposure to violence over the past 7 years was associated with low resilience (anxiety, depression, and dissociation) in a sample of 80 women, while social and community support were associated with positive functioning.

The Comorbidity of PTSD, Depression, and Dissociation as Indicators of Distress Intensity

A considerable number of mothers with a history of unresolved trauma have also been found to experience comorbid mental health problems, mainly PTSD and depression symptoms or diagnoses (Ammerman, Putnam, Chard, Stevens, & Van Ginkel, 2012; Jobe-Shields, Swiecicki, Fritz, Stinnette, & Hanson, 2016). Clinically speaking, such comorbidity is more often expected in mothers with a CSA history and can be particularly significant when it concerns the mothers of children who have been recently victimized. Ammerman et al. (2012) observed that mothers benefiting from a home visitation program who experienced concurrent depression and PTSD also reported lower overall functioning and more parenting difficulties than mothers who did not develop PTSD. Of interest is the fact that mothers experiencing such comorbidity were likewise more likely to have been victims of CSA. On the contrary, Jobe-Shields et al. (2016) recently examined the influence of the co-occurrence effect of depression and PTSD on the parenting practices of nonoffending caregivers (n = 96) of children with CSA histories. Although mother’s history of CSA was not documented, 14% of the mothers reported PTSD symptoms that reached the clinical range, 17% of the mothers were clinically depressed, and 6% presented depression and PTSD comorbidity. This research indicates that only a small percentage of mothers of children exposed to CSA experience PTSD and depression comorbidity and that comorbid symptomatology is not associated with inconsistent discipline. To our knowledge, no studies explored the occurrence and comorbidity of trauma-related symptoms of PTSD and dissociation in mothers of CSA children and whether this co-occurrence is more likely for mothers with a CSA history and/or other forms of victimization.

Although dissociation symptoms have been less frequently explored in the literature than depression or PTSD symptoms, such reactions may present as markers of vulnerability and may contribute to better understanding maintenance of the cycles of violence within relationships (Daisy & Hien, 2014) and between generations (Abramovaite, Bandyopadhyay, & Dixon, 2015). Dissociation has been identified as a mediator between a history of child maltreatment and revictimization (Zamir, Szepsenwol, Englund, & Simpson, 2018) and the perpetration of partner violence in women (Daisy & Hien, 2014). According to a literature review conducted by Collin-Vézina and Cyr on the intergenerational repetition of sexual victimization, mothers who described dissociative symptoms (suppression of emotions or denial) following their own CSA may be more inclined to react in similar ways to manage the emotions brought by their child’s CSA, which may result in less vigilance and compassion. Research therefore suggests that maternal trauma and distress, and the repression of negative affect could influence later parenting practices and favor the use of avoidance strategies, as well as the intergenerational transmission of violence (Babcock Fenerci, Chu, & DePrince, 2016; Collin-Vézina & Cyr, 2003).

Coping Mechanisms

Coping mechanisms may play an important role in the level of psychological distress experienced by mothers (Hébert et al., 2007). Long-term reliance on avoidance coping has been associated with psychological distress and PTSD symptoms (Hébert et al., 2007; Pineles et al., 2011), whereas the use of problem-solving strategies (McDonagh et al., 2005) and the search of social support (Hyman, Gold, & Cott, 2003; Jonzon & Lindblad, 2004) have been associated with more positive adaptation. In addition to coping mechanism, recurrent feelings related to an internal attribution of blame, of guilt, and shame, as well as a poor sense of self-efficacy could also influence mother’s adaptation. Regarding mother’s attributions concerning her victimization, according to the most recent Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) conceptualization of PTSD, mothers’ feelings of guilt and shame may be present regarding past or recent victimization (Courtois, 2008) or may be exacerbated by the CSA of their child, and exert an influence on levels of symptomatology (Feiring, Taska, & Chen, 2002). Similarly, a disclosure of CSA by their child may be associated with a feeling of helplessness in parents, one that may affect their feelings of self-efficacy (Bandura, 1982) and lead to more psychological distress. On the contrary, feelings of empowerment (knowing what to do and feeling confident about it) may play a protective role (Hébert et al., 2007).

Research has outlined that mothers can be struggling with challenges of their own following disclosure of their child’s CSA and they may need various levels of support to find ways to cope effectively and be available and supportive to their child. The present study proposes a trauma-focused conceptual framework to explore various processes underlying mother’s symptoms of PTSD, of dissociation, and of their co-occurrence, while exploring the influence of mothers’ past and current victimization and of coping mechanisms.

Objectives

The present study intends to clarify variability in the needs of mothers of children who have disclosed CSA. The first objective aims to document whether the mother’s mental health varies as a function of her own experiencing of CSA, as defined by trauma-related symptoms, namely, PTSD and dissociation as well as their co-occurrence; and in contrast to a more general measure of psychological distress. Second, this study aims to test a mediation model that explores various processes underlying mothers’ psychological distress (PTSD, dissociation, and their co-occurrence) following children’s unveiling of CSA. It investigates the influence of mother’s own CSA as well as of her exposure to additional forms of past and current victimization on her reaction to the child’s CSA disclosure, while considering coping mechanisms as mediators (avoidance, problem solving, search for social support, and feeling of guilt).

Method

Participants and Procedures

The sample consisted of 298 Canadian French-speaking nonoffending mothers recruited between 2006 and 2016 in four different intervention sites within the province of Quebec, Canada. Families were recruited as their child was receiving services following the disclosure of the CSA to authorities, either to child protection services or the police. The research questionnaires and procedures used in each site were the same. However, data was unavailable to perform analyses per site to verify whether there were variations in the outcomes measured in each site. Mothers were aged between 23 and 56 years (M = 35.78, SD = 6.29) and had between one and 10 children (M = 3.10, SD = 1.5). At the time of the study, 58% were involved in a romantic relationship. Many children came from single-parent families (52%), while 19% lived with both parents. Most nonoffending caregivers had reached a college or university level of education (50.1%). Familial socioeconomic status was low (less than Can$40,000) for most of the families (68.6%). Written informed consent was obtained from mothers after explaining their participation in the study. This study received the approbation of the Human Research Review Committee of the Université du Québec à Montréal and the Ethics comity of Centre Hospitalier Universitaire Ste-Justine. Nonoffending mothers of children who have been sexually abused completed questionnaires with assistance in the intervention setting.

Measures

Psychological distress (internally displaced persons [IDP])

The 14-item version of the Psychological Distress Scale of the Quebec Health Survey (Préville, Boyer, Potvin, Perrault, & Légaré, 1992) was used to evaluate mothers’ level of psychological distress. This scale is a translation of the 29-item psychiatric symptom index (Ilfeld, 1976). Each item is rated on a frequency scale (1 = never and 4 = very often). The global score of this scale covers four dimensions: anxiety, depression, irritability, and cognitive problems. Ilfeld (1976) reported an alpha coefficient of .91 for the index. In the present study, the scale provided satisfactory internal consistency (α = .91).

PTSD symptoms

The Modified PTSD Symptom Scale–Self-Report (MPSS-SR; Falsetti, Resick, Resnick, & Kilpatrick, 1992; Falsetti, Resnick, Resick, & Kilpatrick, 1993) was used to assess the frequency (4-point scale) and the severity (0 = not distressing to 4 = extremely distressing) of 17 symptoms representing the criteria B, C, and D of the DSM-IV (4th ed.; APA, 1994). The DSM-IV criteria are still used in this study as the majority of data were collected over the past 10 years. Falsetti et al. (1992) reported high internal consistency of the total score for clinical and community samples. Concurrent validity is reported to be satisfactory as it correlates with structured interviews. The scale provided satisfactory internal consistency (α = .91).

Dissociation

The Dissociative Experiences Scale–II (DES-II; Carlson & Putnam, 1993) is a self-report measure assessing dissociation on a continuum, ranging from normal dissociative experiences (daydreaming) to clinical dissociation. Its original version is comprised of 28 items, compiling into an overall score or into three subscales: (a) depersonalization/derealization, (b) amnestic dissociation, (c) absorption and imaginative involvement. A short six-item version was administered to participants. Five of the six original items are derived from the absorption and imaginative involvement subscale (Items 14, 18, 20, 22, and 23) and one item is derived from the amnestic dissociation subscale (Item 25). This choice of items is supported by a study conducted by Giesbrecht, Merckelbach, and Geraerts (2007) in which it was found that the absorption and imaginative involvement subscales of the DES-II are the ones on which SA victims score more frequently as they best discriminate victims of sexual abuse from those who are not. Such items refer to less extreme dissociation and are reactions that are more commonly observed than items in the other two subscales. The clinical cutoff for this shorter version of the scale was maintained at a score of 30, which could possibly result in a higher rate of mothers receiving a clinical diagnosis considering the nature of the cumulated items. In the present study, the six-item scale provided satisfactory internal consistency (α = .79).

Partner violence (Conflict Tactics Scale [CTS])

A brief 16-item version of the CTS (Straus, Hamby, Boney-McCoy, & Sugarman, 1996) was completed by mothers regarding their current or recent experience of partner violence. If participants reported no current partner, they were asked to answer items about their ex-partner (over the past 2 years). Items relating to severe forms of physical violence were used and rated on a 5-point scale: 0 = never happened, 1 = once, 2 = 2 to 5 times, 3 = 6 to 10 times, 4 = more than 10 times. Internal consistency of the scale proved satisfactory (α = .84). Two other questions were derived from this scale to assess the mother’s experience of CSA and her exposure to family violence as a child. For instance, regarding CSA, mothers were asked, “During your childhood, have you experienced a situation in which you were sexually abused?” If so, mothers were asked to specify whether they disclosed the abuse at the time and whether they received professional help regarding the sexual abuse.

Family Empowerment Scale (FES)

The 12-item shortened version of the FES was used (Koren, DeChillo, & Friesen, 1992). This scale was originally conceptualized to measure perception of competence of a parent of an emotionally disabled child. In the present study, questions were formulated in relation to a sexually abused child (Hébert & Parent, 1999). Questions are evaluated on a 5-point Likert-type scale (1 = not true at all to 5 = very true). Three subscales were used from this scale: Empowerment (five items; for example, “I feel confident in my ability to help my child grow and develop”), Feeling of guilt (three items; for example, “I feel I should have been able to prevent the abuse”) and Perception of support provided (four items; for example, “I did everything I could to help my child”). Singh et al. (1995) report adequate reliability and validity estimates for this scale. In the present study, the three subscales provided fair internal consistency with Cronbach’s alpha coefficients ranging from .67 to .78 and the Cronbach’s alpha coefficient for the global 12-item scale being .67.

Ways of Coping Questionnaire (CTS)

A brief 21-item version of the Way of Coping Questionnaire (Bouchard, Sabourin, Lussier, Wright, & Richer, 1995; Folkman & Lazarus, 1988) was used to assess coping mechanisms used by mothers after the CSA disclosure. Each item is coded on a 4-point Likert-type scale, with higher scores indicating increased use of strategies. Three subscales were used: seeking social support, avoidance coping, and problem solving. The French versions of the three subscales were found to be reliable in the present study with internal consistency coefficients ranging from .64 to .74. The global 21-item scale also provided adequate internal consistency (α = .73).

Analyses

As a preliminary step, the correlation between the dependent variables (measures of mother’s health) and the following variables was assessed: family income, parental educational levels, parental occupational status, number of types of child maltreatment, parent and child gender, and gender and intra- versus extrafamilial abuse of the child. Since correlations between the dependant variables and CSA variables, child gender, and intervals between disclosure and evaluation were not significant, these variables excluded from further analyses. For the first objective, which was to document mothers’ mental health following the disclosure of their child’s SA, chi-square tests were used to test relationships between categorical variables. These cross tabulations assessed the distribution of two categorical variables simultaneously and investigated the association between the mothers’ trauma-related symptoms, defined as being clinically significant or not, and her own experience of CSA. For the second objective, path analyses were conducted to explore the role of mothers’ past and recent victimization and of their coping mechanisms in predicting intensity of distress as assessed by the level of dissociation, PTSD, and by their co-occurrence. Path analyses also allowed to determine if mothers’ victimization exerts an influence on coping mechanisms and whether coping in turn impact levels of distress. Contrary to a single multiple regression model, that can only specify one response variable at a time, path analysis estimates as many regression equations as needed to relate the hypothesized relations among variables in the explanation model. As a preliminary step to the path analysis, the correlations between all predictors, mediators, and outcome variables were assessed and only significant predictors and mediators were included in the path analysis models.

Results

Sample Characteristics and Comparison Analyses

Table 1 presents sociodemographic caracteristics and past and current violence exposure percentages for the entire sample and as a function of mother’s history of CSA. Results indicate that a majority (51.4%) of mothers had themselves been sexually abused before reaching adulthood, 45.3% of the mothers were currently or recently experiencing partner violence, and 18% were exposed to interparental violence as a child. Mothers with a CSA history were also more likely to have been exposed to interparental violence during childhood (21.7%) than mothers with no such history (13.2%). Sociodemographic characteristics of the families were compared as a function of mother’s CSA experience. Chi-square tests indicated no difference between the two groups for all of the variables studied, including mothers’ actual occupation, mothers’ level of education, ethnic group, and family structure. As for exposure to violence, chi-square tests also indicated no difference between the two groups for current or recent partner violence. However, in terms of exposure to interparental violence, there was a significant difference between mothers reporting a history of CSA (21.7%) and those with no history (13.2%; χ² = 4,621, p = .032).

Table 1.

Means, Standard Deviation, and Characteristics of the Sample for the Whole Sample and as a Function of Mothers’ History of CSA.

Variables	Total Sample(N = 298)	With CSA51.4% (n = 152)	Without CSA48.6% (n = 144)
Variables	M (SD) or n (%)	M (SD) or n (%)	M (SD) or n (%)
Age of the mother	35.8 (6.29)	36.0 (6.4)	35.6 (6.2)
Female child victims	219 (73%)	111 (73%)	106 (73%)
Other ethnic origin than Canadian	37 (16%)	13 (8%)	23 (16%)
Full-time employment	97 (33%)	40 (26%)	56 (38%)
College or university education	151 (51%)	70 (46%)	80 (55%)
Family structure
Child lives with biological parents	57 (19%)	28 (18%)	28 (19%)
Single-parent family	155 (52%)	87 (57%)	67 (46%)
Step family	86 (28%)	37 (24%)	49 (34%)
Number of children	3.1 (1.5)	3.3 (1.6)	2.9 (1.4)
Annual family income
<Can$40,000	194 (68%)	109 (71%)	84 (58%)
Exposure to other forms of victimization
Current or recent partner violence (n = 215)^a	135 (45%)	68 (44%)	66 (45%)
Exposure to interparental violence (n = 282)	52 (18%)	33 (21%)	(13%)

Note. CSA = Child sexual abuse.

Only mothers who were currently or recently in a relationship (in the last 2 years) answered this question.

Table 2 presents the mental health of mothers following the disclosure of the CSA of their child, as a function of past CSA experience. While more than half of the sample reported experiencing psychological distress, only a quarter of the sample reported PTSD symptoms and dissociation that reach a clinical level. Mothers experiencing co-occurring PTSD and dissociation represented 9.4% of the sample.

Table 2.

Percentages of Clinical Scores for the Total Sample and as a Function of Mother’s Experience of CSA.

Symptomatology	Total Sample	Mother With CSA	Mother Without CSA	χ²	p value
Psychological distress	57.8% (n = 171)	62% (n = 93)	53.5% (n = 77)	2,191	.139
PTSD	23.9% (n = 69)	22.6% (n = 33)	25.4% (n = 36)	0.299	.585
Dissociation	22.9% (n = 67)	28% (n = 42)	17.7% (n = 25)	4,325	.038
PTSD and dissociation	9.4% (n = 27)	11% (n = 16)	7.9% (n = 11)	0.770	.380

Note. CSA = Child sexual abuse; PTSD = posttraumatic stress disorder.

According to chi-square analyses, there were no significant differences between mothers who have experienced CSA and those who have not regarding their psychological distress and PTSD symptoms. However, there was a statistically significant relationship between maternal dissociation and a history of CSA, with 20% of CSA mothers reporting scores of dissociation that reached the clinical range compared with (17.7%) in non-CSA mothers. Yet, the size of the effect was small (φ = 0.122). In terms of rates of co-occurrence (PTSD and dissociation comorbidity), no differences were found between mothers with or without a history of abuse.

Path Analyses

Table 3 presents the correlational matrix for predictors, mediators, and outcome variables considered for the path analyses. Dissociation was positively associated with past exposure to CSA and past exposure to family violence but negatively related with current or recent partner violence. PTSD and its co-occurrence with dissociation were positively associated with past exposure to family violence. In terms of intermediary variables (mediators), correlational analyses indicated that mother’s perception of support provided to the child was not significantly associated with her symptomology, thus excluding this variable from further analyses. Avoidance coping appeared to be positively related to PTSD and dissociation, as is also the mother’s feeling of guilt. A nonexpected result indicated that mother’s feeling of empowerment was positively related to her score of dissociation in bivariate analyses.

Table 3.

Correlation Matrix for Predictors, Mediators, and Outcome Variables.

	Variables	1	2	3	4	5	6	7	8	9	10	11
Victimization	1. Childhood sexual abuse
	2. Exposure to interparental violence during childhood	.128*
	3. Partner violence	−.147*	−.143*
Coping	4. Seeking social support	.040	−.018	.147*
	5. Problem solving	.020	.020	−.193**	.444***
	6. Avoidance coping	.079	.144*	−.019	.044	.197***
	7. Feeling of guilt	.044	.009	−.073	−.027	.044	.202***
	8. Perception of support provided	−.031	−0.131*	−.037	.197***	.223***	.005	.147*
	9. Empowerment	−.045	−.040	−.062	.199***	.247***	−.099	−.071	.509***
Symptomatology	10. PTSD	.052	.123*	−.121	.099	.059	.272***	.305**	.059	−.043
	11. Dissociation	.190***	.199***	−.163*	.071	.072	.284***	.125*	−.077	.180**	.383***
	12. Co-occurrence dissociation and PTSD	.052	.148*	−.084	.136*	.123*	.251***	.087	.032	−.006	.450***	.423**

Note. PTSD = posttraumatic stress disorder.

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

Path analyses were conducted to study experienced violence as a predictor of the mother’s mental health following the disclosure of the CSA of her child, with mother’s coping mechanisms as independent variables. Table 3 indicated that feelings of empowerment were significantly and positively associated with dissociation and were therefore maintained in the path analysis. As presented in Figures 1 and 2, two models were constructed but only significant associations are represented. The first model aimed to predict mothers’ mental health and the second, the comorbidity of PTSD and dissociation. Missing values were handled using full information maximum likelihood.

Figure 1.

Mediation hypothesis of mother’s level of PTSD and dissociation.

Figure 2.

Mediation hypothesis of mother’s level of PTSD and dissociation co-occurrence.

Generally, results indicate that the associations between experienced interpersonal violence and mothers’ reported symptoms were influenced by the coping mechanisms they used. In terms of PTSD symptoms, as presented in Figure 1, a significant indirect effect of partner violence on PTSD symptoms was observed, through mother’s search of social support (β = .10, p < .05, d = –.274); the effect of experienced partner violence being negative on reliance on social support (β = –.18, p < .01). A complete mediation was hence described: current partner violence was associated with less reliance on social support, which in turn was directly related to presenting more PTSD symptoms. Partner violence was also negatively associated with mothers’ use of problem solving (β = –.18, p < .01), but this relationship was not related to mothers’ PTSD symptoms. Another significant indirect effect (β = .23, p < .005, d = 2,008) was obtained as exposure to interparental violence during childhood was also related with greater PTSD symptoms reported by the mother, through her use of avoidance coping. Perceived guilt was also a strong predictor of the mother’s PTSD symptoms (β = .27, p < .005), but it was not a mediator of the experienced violence.

In terms of dissociation, first, mother’s past CSA had a direct influence on the level of dissociation she presented (β = .14, p < .01). Second, exposure to family violence as a child had a direct effect on the mother’s score of dissociation (β = .12, p < .05), but a significant indirect effect was obtained between dissociation and exposure to family violence through mother’s use of avoidance coping (β = .29, p < .005, d = –.012). Thus, the association between experienced violence and coping strategies explained 14% of the variance observed in the PTSD symptoms of the mother and 13% of the variance observed in the dissociation she presented. The overall model explained 27% of the variance observed in the mother’s mental health.

Figure 2 presents the same model used to predict the presence of comorbid PTSD and dissociation in mothers’ symptomatology. As for the model presented in Figure 1, this model also showed a significant indirect effect of partner violence on the co-occurrence of PTSD and dissociation presented by the mother, through mother’s reliance on social support (β = .13, p < .05, d = .081). More specifically, partner violence was negatively associated with reliance on social support (β = –.18, p < .005), which in turn was associated with a mother’s co-occurrence of PTSD and dissociation symptoms. Recent or current partner violence was also negatively associated with the mother’s reliance on problem-solving coping (β = –.18, p < .005), but this relationship was not associated with co-occurrence. Exposure to interparental physical violence as a child also had a direct effect on mother’s co-occurrence (β = .12, p < .05), but this effect was stronger when influenced by the level of avoidance the mother reported (β = .23, p < .005). History of CSA and the mother’s sense of guilt were not associated with co-occurrence. The overall model explained 9% of the variance observed in the mother’s co-occurrence.

Discussion

When children are victims of CSA, systemic interventions involving the nonoffending parent are most often recommended to optimize recovery (Cohen et al., 2006). Mothers’ reaction and adaptation to the child’s disclosure of sexual abuse can therefore have a decisive influence on children’s response postdisclosure and on therapeutic outcomes. The high prevalence rate of mothers’ past and current exposure to victimization speaks of the importance of understanding its influence. The present study relied on a cross-sectional research design to identify exacerbating factors that may influence mothers’ adaptation postdisclosure. Although most commonly used, this type of research design does not allow the researchers to control for the child and mother’s adaptation previous to the abuse or to the child’s disclosure. Subsequently, the contribution of this study was to test a mediation model exploring the various processes underlying mothers’ distress and different needs following the child’s CSA disclosure, rather than isolating the unique influence of CSA disclosure on mothers’ adaptation.

With regard to mothers’ exposure to victimization, our findings reveal that mothers with a CSA history were more prone to have been exposed to interparental violence. On the contrary, mothers with a CSA history were not more likely to be exposed to current or recent partner violence than mothers with no CSA. This last finding is discordant with those of Widom et al. (2014) who had found that women who are victims of CSA are more often victims of partner violence than non-CSA victims. Such discordance may be explained by our focus on recent or current partner violence rather than life exposure to partner violence. It could also be explained by a difference in methodology as the CSA was determined from court records in Widom et al. (2014) study and not self-reported like in the current study.

In terms of mental health, results outline the advantage of using different measures assessing mothers’ distress to obtain a clear picture of the continuum of difficulties as our prevalence rates of distress vary considerably between a general measure of psychological distress (57.8%) and trauma-related symptoms (22% to 23%). Our results regarding the percentage of mothers reporting psychological distress and trauma-related symptoms appear higher than the ones observed by Jobe-Shields et al. (2016), which was conducted with a similar population and context. While their study did not account for mothers’ history of CSA, they found that 14% of the mothers reported PTSD symptoms, whereas a quarter of the mothers (23.9%) report PTSD symptoms in our sample. This discrepancy may be related to the fact that by first asking mothers to recall their past traumas, such as CSA, it may have led them to report more symptoms in relation to their child’s abuse, either because this type of questioning can lead to more self-disclosure or because questioning can at times lead to symptom recurrence or intensification. Regarding mothers’ exposure to CSA, it was expected that the disclosure of their child’s CSA may potentially reactivate an unresolved trauma, thereby resulting in the experiencing of more psychological distress (Baril, Tourigny, Hébert, & Cyr, 2008). Results indicated that the only difference that was found between mothers with and without a CSA history was the level of dissociation, which was higher in mothers with a CSA history. Along with other studies, our results underline the relevance of systematically documenting other forms of concurrent, past, and current victimization to more efficiently identify mothers with the greatest needs (Banyard & Williams, 2007; Barrett, 2009; Collin-Vézina, Cyr, Pauzé, & McDuff, 2004).

Our path analysis models indicate that current or recent partner violence and exposure to interparental violence as a child appear as equally important predictors of mothers’ mental health than mothers’ history of CSA. Indeed, similar to CSA history, exposure to interparental violence came out as an important predictor that is directly related to symptoms of dissociation but that also predicts comorbidity. Results further indicate that dissociation symptoms are more specific to mother’s experience of CSA, and the combined influence of exposure to interparental violence as a child and avoidance behaviors appear as strong predictors of dissociation. Such findings outline the importance of systematically assessing dissociation with this clientele. We generally hope for mothers and fathers to be able to model efficient problem-solving strategies to help children recognize, share, and manage their emotions efficiently, and eventually, mentalize their CSA experience. Unfortunately, for parents who are confronted with dissociative symptoms aiming at remaining disconnected when faced with a certain level of distress, it may be particularly challenging to remain self-aware of their parenting attitudes and to model desirable coping.

With regard to the prediction of PTSD symptoms alone, recent or actual partner violence came out as a predictor when modulated by social support. Exposure to interparental violence as a child also predicts level of PTSD symptoms through its association with avoidance coping. However, CSA history, although associated with dissociation, was not a predictor of PTSD symptoms. This result is unforeseen as it was expected that the recent disclosure of their child’s CSA may reactivate unresolved traumas that could have been expressed by elevated PTSD symptoms (Baril & Tourigny, 2015). Although this finding may be related to the mere passage of time and its healing effect on trauma, results rather indicate that the recent disclosure of their child’s CSA is more directly related to what may be a reactivation of their coping mechanisms than their PTSD symptoms. Mother’s feelings of guilt were exclusively related to the presence of PTSD symptoms and not to her victimization history. This last result is concordant with the DSM-5 (APA, 2013) conceptualization of PTSD, as it often includes a sense of responsibility or guilt regardless of the type of trauma.

In terms of coping mechanisms, results outline that elevated symptoms are related to a combined use of avoidance coping, with a less frequent use of problem-solving strategies and a less frequent search for social support. Although mother’s level of dissociation and comorbidity were directly associated with victimization history, avoidance coping appears as an important factor that may act to maintain this level of distress. In fact, avoidance coping was systematically related to more symptoms of PTSD, dissociation, and to comorbidity. This result is concordant with the objectives of therapeutic interventions in a cognitive behavioral approach, as they are generally oriented toward the reduction of avoidance.

Results also indicate that mothers exposed to partner violence make less frequent use of problem-solving strategies when faced with their child’s disclosure of CSA. The overwhelming potential impact of concurrent forms of violence may explain this reaction as some problems may appear easier to solve when they present one at a time. Results also indicate that mother’s level of PTSD symptoms, and of comorbidity, were positively associated with the mother’s search for social support, indicating that those with more symptoms search for more support. In other words, when in charge of a child who has recently disclosed CSA, although mothers exposed to victimization are less inclined to search for social support, those who do appear to be the ones experiencing more symptoms. Social support therefore appears as an important preventive measure or therapeutic objective for mothers of CSA children.

Implications of the Study

Altogether, these models outline the importance of considering all forms of victimization in mothers’ history and the importance of quickly introducing the use of efficient coping strategies to reduce avoidance and guilt. The individual analyses of the three models stand as a significant contribution to distinguish families that are most in need of additional support and to identify coping mechanisms associated with reoccurring traumas. Clinicians and researchers often hypothesize that mothers who are most in need of support are those who have themselves experienced the same form of victimization. Others perceive that a victimized mother who has recovered from her own victimization may be better equipped to understand and support her child. This study indicates that reoccurring traumatic experiences, rather than sexual abuse per se, may set the stage for more distress and for a greater use of less efficient coping mechanisms. The exploration of the parents’ coping mechanisms in relation to their mental health provides valuable information regarding elements that should be addressed in a systemic mother–child intervention, such as reducing avoidance coping, encouraging the development and use of social support, and increased reliance on efficient problem-solving strategies. Parent’s feelings of guilt also surfaced as an important focus of intervention as they relate to level of PTSD symptoms. It is essential to remind ourselves, as well as agencies providing intervention to families confronted with CSA, that maternal and paternal functioning and mental health are fundamental components of children’s recovery. By their actions, their words, their support, and even their nonverbal communication, mothers and fathers can soothe, validate, motivate, and help bring a positive outlook to the future (Cyr et al., 2011; Daignault et al., 2017; Godbout et al., 2014).

Strengths and Limitations of the Study

This study contributes to our understanding of challenges that mothers’ face when informed that their child has been a victim of CSA. The sample used in the context of this study was comprised of mothers consulting in different intervention sites for their child and exposed to various degrees and forms of violence throughout their life. The study also built on previous research by assessing the influence of comorbidity in the mother’s symptoms and by exploring a trauma-focused symptomatology. One limitation of this study is the fact that we have limited information regarding the context of the mothers’ history of victimization (disclosure, intervention, support), and the cross-sectional design of the study, which precludes conclusion that the symptoms are due to the unveiling of their child’s sexual abuse as the results could also have been present before. However, the information that we had access to in the context of this research relied on self-report measures and specifically represents what is accessible to clinicians in an intervention process. Although this type of measure and context provides support for the ecological validity of the results, self-report measures may be distorted by a number of different factors and can affect the validity of the results, as it would in the assessment and intervention process. For instance, there may be hesitation on the part of the mothers to disclose current exposure to violence as well as past victimization, given the fact that study participants have children who recently disclosed abuse and that child protection may be involved. By considering victimization history as well as coping mechanisms, the models explain between 9% and 27% of the variance. The percentage of variance explained by these factors illustrates the complex dynamic of life experiences between mothers and children. Additional correlates should be considered in future studies to understand variations in parents’ mental health following the disclosure of the CSA of their child, including correlates relative to the child.

Future studies should assess mother’s depression symptoms more specifically and in co-occurrence with PTSD and dissociation. Mother’s dissociation should be more thoroughly assessed, with the entire measuring instrument. Our sample is thought to be quite homogeneous in terms of support provided by the mother. All mothers sought help for their child at a certain point, which may explain that this factor did not contribute to our model. The next step in research would involve assessing mothers’ mental health in relation to children’s adaptation and coping mechanisms at the time of assessment and throughout the therapeutic process, as well as exploring the influence of a cumulative score of victimization that would consider both the various forms of violence and their frequency.

Future studies should also include both parent figures. Unfortunately, the study was conducted only with mothers and future studies would benefit from the recruitment of more father figures. Indeed, although it is imperative to record both parents’ reaction to their child’s CSA, data were very limited regarding fathers and insufficient to explore the influence of father’s reaction. For this reason, we had to focus our study on the adaptation of mothers.

Conclusion

Our goal was to identify elements that may distinguish mothers who are most in need of therapeutic intervention. Results indicate that having a history of CSA does not come across as the most important predictor. Yet, documenting other forms of victimization and parent’s coping mechanisms are elements that contribute to the elaboration of a clearer picture of the needs of nonoffending parents. Results outline the importance of conducting thorough assessments with parents of children who have been sexually abused, which should include, among other essential factors, parents’ level of dissociation and exposure to interparental violence as a child.

Footnotes

Acknowledgements

The authors wish to thank the children and the parents who participated in this study. Special thanks are extended to the members of the Montreal CAC, Center d’Expertise Marie-Vincent, to the Center d’intervention en abus sexuels pour la famille (CIASF), the Sociopediatric clinic of the Center hospitalier universitaire Sainte-Justine (CHU Sainte-Justine), and the Center Jeunesse Mauricie Center du Québec, as well as to Manon Robichaud for data management.

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 study was supported by a grant from the Social Sciences and Humanities Research Council of Canada (SSHRC) awarded to the second author, Martine Hébert. The study was also supported by infrastructure grants from the Chaire de recherche interuniversitaire Marie-Vincent sur les agressions sexuelles envers les enfants and to the Équipe Violence sexuelle et santé (ÉVISSA) from the Fonds de recherche sur la société et la culture (FQRSC).

ORCID iD

Martine Hébert

Author Biographies

Isabelle V. Daignault is a professor in the School of Criminology at the Université de Montréal, where she also is codirector of the Youth Development and Adjustment Study Center. She is as well a practicing psychologist with children and families exposed to traumas. Her research explores the impact and efficacy of therapeutic and judiciary interventions for sexually abused children and their families within a Child Advocacy Center (CAC). She is a member of the Violence sexuelle et santé research team, coresearcher of the Chaire de recherche interuniversitaire Marie-Vincent sur les agressions sexuelles (Marie-Vincent Inter-University Research Chair on Sexual Abuse Against Children) affiliated to a CAC and a member of the International Centre for Comparative Criminology (CICC).

Martine Hébert, PhD, is a professor in the Department of Sexology at the Université du Québec à Montréal (UQAM) and the Tier 1 Canada Research Chair in Interpersonal Traumas and Resilience. Her research explores the diversity of profiles in sexual abuse survivors and pathways to resilient outcomes. She is the director of the Violence sexuelle et santé research team and cochair of Chaire de recherche interuniversitaire Marie-Vincent sur les agressions sexuelles (Marie-Vincent Inter-University Research Chair on Sexual Abuse Against Children) affiliated to a CAC, and member of the Interdisciplinary Research Centre on Intimate RelationshipProblems and Sexual Abuse (CRIPCAS).

Mireille Cyr, PhD, is a full professor in the Department of Psychology at the Université de Montréal and scientific director of the Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse (CRIPCAS), a research center dedicated to sexual assaults and marital problems, and cochair of Chaire de recherche interuniversitaire Marie-Vincent sur les agressions sexuelles (Marie-Vincent Inter-University Research Chair on Sexual Abuse Against Children) affiliated to a CAC. Her main interests in research include reactions and adaptations of nonoffending mothers as well as their interactions with their sexually abused children, and children’s characteristics influencing their accounts under investigative interview.

Marilou Pelletier is the coordinator of the Youth Development and Adjustment Study Center of the Université de Montréal. She holds a master’s degree in criminology and works as a research professional and as a psychosocial counselor with judiciarized adults. Her research explores the sociojudiciary trajectories of sexually abused children and their mental health and that of their mothers.

Pierre McDuff is a research associate for CRIPCAS, a research center dedicated to sexual assaults and marital problems. His main interests in research include consequences of sexual abuse over the lifetime of the victims, the interactions between investigator and victim in investigative interview, and the long-term effects of child maltreatment on marital life.

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