Trauma Exposure,Post-traumatic Stress Symptoms,and Indices of Parenting

Abstract

Previous studies have reported that trauma exposure and post-traumatic stress symptoms (PTSS) may increase the risk for parenting difficulties, yet it is not clear whether trauma exposure and PTSS independently contribute to parenting-related indices or whether there is an indirect effect of trauma exposure on parenting-related outcomes through PTSS. Further, the associations between PTSS and parenting outcomes utilizing the most recent Diagnostic and Statistical Manual (DSM-5) post-traumatic stress disorder (PTSD) criteria are unknown. The aims of the current study were to determine: (a) whether trauma exposure and PTSS are related to parenting indices; (b) if trauma exposure is associated with parenting factors indirectly through PTSS; and (c) whether the DSM-5 PTSD symptom clusters are each linked with parenting outcomes. Participants were 225 trauma-exposed parents (M_age = 36.81; SD = 8.32) from a Midwestern University or Amazon’s Mechanical Turk (MTurk). Cumulative trauma had an indirect effect on parental satisfaction, support, involvement, limit-setting, and autonomy via PTSS. The specific PTSD symptom clusters also demonstrated distinct ties to parenting outcomes. Higher levels of alterations in reactivity and arousal symptoms were associated with lower parental support and satisfaction, as expected. Avoidance symptoms were also inversely related to parental autonomy. However, a positive relationship was noted between intrusion symptoms and support, and changes in cognitions and mood were unrelated to parenting indices. PTSS may better explain decrements in aspects of parenting than trauma exposure. Certain types of PTSD symptoms, particularly trauma-related changes in reactivity and arousal, may be relevant in understanding and improving parenting outcomes among trauma-exposed parents.

Keywords

PTSD trauma-exposed parents parenting parental support parental satisfaction

Parental functioning may be, understandably, negatively impacted among many parents who have experienced trauma. Trauma exposure has been associated with poorer indices of parenting including lower levels of parental satisfaction, poor parent–child relationship quality, and greater use of corporeal punishment and abuse potential (Banyard et al., 2003; Cohen et al., 2008; Sprang et al., 2013). For instance, higher levels of maternal trauma exposure have corresponded with lower levels of parental satisfaction and use of more severe physical discipline strategies (Banyard et al., 2003). Similarly, cumulative trauma has been tied to maternal abuse potential, punitiveness, and both psychological and physical aggression (Cohen et al., 2008). In addition to behavioral indices, trauma exposure may be related to more negative parenting-related cognitions. For example, mothers who experienced sexual abuse have endorsed lower levels of parental confidence than controls (Cole & Woolger, 1989; Douglas, 2000; Fitzgerald et al., 2005).

However, the majority of these studies did not account for level of post-traumatic stress symptoms (PTSS). Therefore, it is unclear whether trauma exposure and PTSS both contribute to parenting-related difficulties as well as if the reported associations are better understood as a function of the parents’ current level of trauma-related symptoms rather than trauma exposure per se. It is important to examine trauma exposure and PTSS in relation to parenting for several reasons. First, trauma exposure is not an automatic path to PTSD, and many trauma survivors experiencing resilience in the aftermath of trauma (Bonanno et al., 2006; Bonanno & Mancini, 2012). Next, many individuals do not develop full PTSD, but still may suffer from significant feelings of distress that may remit over time but often partially linger and may ultimately continue to affect the trauma-exposed individual to some degree throughout their life (Tedeschi & Calhoun, 2004). It is possible that this general distress experienced in the aftermath of trauma exposure may contribute to parenting-related difficulties rather than PTSS. This distinction is necessary as the aftermath of trauma exposure is not limited to PTSD, but instead is a risk factor for a range of other mental health issues including mood and anxiety disorders, and substance misuse. It is therefore critical to determine whether PTSS specifically have a negative impact on parenting, or if trauma exposure independently has a similar deleterious effect on parenting.

Similar to the research regarding trauma exposure and aspects of parenting, higher levels of PTSS have been tied to parenting difficulties, including lower levels of parental satisfaction and parental functioning, reduced familial engagement, and poorer parent–child relationship quality (Berz et al., 2008; Cohen et al., 2011; Cross et al., 2018; Gewirtz et al., 2010; Khaylis et al., 2011; Ruscio et al., 2002; Samper et al., 2004; Sayers et al., 2009). Higher levels of PTSS have also corresponded with increased risk for child maltreatment (Chemtob et al., 2013; Cross et al., 2018; Pears & Capaldi, 2001). Examination of the symptoms of PTSD engenders an empathic approach to parents suffering from PTSS and reiterates that many PTSD symptoms likely make parenting more challenging. Intrusive trauma reminders and the natural desire to avoid these reminders may make it difficult to participate in family activities and interact with one’s children (Galovski, & Lyons, 2004; Solomon, 1993). Trauma reminders may also result in bouts of emotional dysregulation in the presence of one’s children, which may be distressing and/or frightening to the children. Parents who feel emotionally numb or distant from others may have a harder time connecting with their child(ren) and may receive less satisfaction from these interactions (Berz et al., 2008; Samper et al., 2004). These symptoms may also make it difficult for parents to express warmth to their children (Berz et al., 2008; Ruscio et al., 2002; Sayers et al., 2009). Symptoms of hyperarousal, irritability, and increased levels of aggression may increase the probability of more negative parent–child interactions (Berz et al., 2008; Ruscio et al., 2002; Samper et al., 2004; Sayers et al., 2009). Further, these symptoms may make children fearful of upsetting their parent (Maloney, 1988).

Nevertheless, several studies have not observed a relationship between PTSS and parenting-related difficulties (Blow et al., 2013; Cohen et al., 2008; Cross et al., 2018; Gewirtz et al., 2014). Further, PTSS may not consistently exhibit negative links across parenting indices. In a sample of predominantly Black mothers, maternal PTSS were related to higher child abuse potential and levels of parental distress, but not to increased dysfunctional parent–child interactions or perceived child difficulty (Cross et al., 2018). Discrepancies between studies may be a function of differences in sample types as well as aspects of parenting examined. Nonetheless, these studies indicate that despite parents’ experiences of trauma and trauma-related psychopathology, some trauma-exposed parents exhibit resiliency, and PTSS may not uniformly increase the risk for adverse parenting-related indicators. These discrepant findings also signal the need for additional work in this area that assesses multiple aspects of parenting.

As most studies have not accounted for trauma exposure and PTSS concurrently, it is unclear if the observed associations between trauma exposure, PTSS, and parenting are the result of trauma exposure or parents’ current level of trauma-related difficulties. Only a handful of studies have examined both trauma exposure and PTSD in the context of parenting. An observational study of military families reported that longer deployments were associated with less effective parenting and lower levels of positive involvement; however, neither combat exposure nor PTSD symptoms were related to parenting behaviors (Davis et al., 2015). Sprang et al. (2013) observed that trauma exposure was a better predictor of increased parental distress, more negative perceptions of one’s children, and heightened risk for a negative parent–child relationship than a PTSD diagnosis or other trauma-related disorders. Similarly, another study reported that higher levels of cumulative trauma exposure were linked to parental abuse potential, aggression, and punitiveness, whereas a PTSD diagnosis was unrelated (Cohen et al., 2008). The lack of a relationship between PTSD and parenting in these studies may have been a function of examining PTSD in a dichotomous manner, which may restrict important variance. Examination of PTSD symptoms continuously in relation to aspects of parenting may provide novel information. Further, neither of these studies investigated whether there is an indirect effect of trauma exposure on aspects of parenting through PTSS. Although trauma exposure seems relevant in understanding parental functioning among trauma-exposed parents, given the relatively consistent ties between level of PTSS and indices of parenting (see meta-analysis by Birkley et al., 2016), it is possible that poorer parenting outcomes following trauma exposure are a function of PTSS rather than having experienced a traumatic event.

The PTSD symptom clusters have also been examined in relation to parenting to determine if the specific clusters evince differing ties to aspects of parenting and these studies have revealed that the PTSD clusters do not have equivalent links to parenting outcomes. It is important to note that the work to date has utilized the DSM-4 conceptualization of PTSD, which included three symptom clusters (i.e., re-experiencing, avoidance/numbing, and hyperarousal). The avoidance/emotional numbing and hyperarousal clusters appear to exhibit the most consistent ties to parental difficulties, whereas re-experiencing symptoms have generally been unrelated (Berz et al., 2008; Kulka et al., 1990; Ruscio et al., 2002; Samper et al., 2004). Still, there are inconsistent findings regarding hyperarousal and avoidance/numbing symptoms. Among female Vietnam veterans, only hyperarousal symptoms were significantly associated with parental satisfaction (Berz et al., 2008). Conversely, the avoidance/numbing symptom cluster was most strongly tied to parental satisfaction among male Vietnam veterans (Samper et al., 2004). Study discrepancies may be the result of gender differences as it is possible that certain symptom clusters are more negatively tied to parenting challenges for women than men. A meta-analysis examining the relationship between parent–child/family functioning and DSM-4 symptom clusters revealed moderate to large effects for emotional numbing and avoidance, and small effects for intrusion symptoms (Birkley et al., 2016). Collectively, the prior work indicates the importance of disentangling the specific associations between the PTSD symptom clusters and different aspects of parenting. If certain symptoms (i.e., hypervigilance, emotional numbing) are more clinically indicated for certain parenting-related treatment foci (i.e., increasing parenting satisfaction), this may help inform prevention and treatment efforts.

As noted, most of the studies in this area were conducted or published prior to DSM-5. Significant changes were made in the DSM-5 operationalization of PTSD (American Psychiatric Association [APA], 2013), including the reorganization of symptoms into four symptom clusters (i.e., intrusion, avoidance, negative alterations in cognitions and mood, and negative alterations in arousal and reactivity), as well as the introduction of new symptoms (e.g., aggression, changes in cognitions). Nonetheless, to the authors’ knowledge, there is currently no information regarding the ties between PTSS and aspects of parenting utilizing this new conceptualization, and the newly added symptom cluster of negative alterations in mood and cognition has yet to be examined in the context of parenting. The inclusion of a symptom cluster encompassing negative alterations in beliefs regarding oneself and others stems from work indicating that PTSD is associated with negative changes in beliefs, particularly related to self-esteem, intimacy, and trust (Janoff-Bulman, 1992; McCann & Pearlman, 1990; Resick et al., 2016)—cognitive themes that seem quite relevant to parental functioning. Further, trauma-related changes in cognitions may generalize to parenting-related beliefs, such as negatively coloring perceptions of one’s child, or engendering feelings that one is not an effective or a “good” parent, which may increase the risk for parenting difficulties. These beliefs may also increase fears regarding the child’s safety, which may influence parental monitoring. PTSD also now includes a symptom regarding increases in aggressive behavior, which may have relevance to parental discipline. The changes to the PTSD conceptualization may then have implications for understanding parental functioning among trauma-exposed parents. Thus, it is important to extend the previous literature to determine if trauma exposure, PTSS, and the DSM-5 PTSD symptom clusters relate to indices of parenting.

The Present Study

Very few studies have examined both cumulative trauma and PTSD, and those that did tended to investigate PTSD dichotomously (Cohen et al., 2008; Sprang et al., 2013), which may be limiting in terms of revealing more nuanced relationships. Work is needed to determine whether trauma exposure and PTSS are both associated with parenting-related difficulties and whether there is an indirect effect of cumulative trauma on parenting via PTSS. Further, much of the prior research has relied on mostly male, military samples (e.g., Berz et al., 2008; Gewirtz et al., 2010; Ruscio et al., 2002; Samper et al., 2004; Sayers et al., 2009) and the relations between trauma exposure, PTSS, and parenting may function differently by gender as well as in civilian samples. Finally, despite the notable changes to the PTSD construct in DSM-5, there is a dearth of research utilizing the DSM-5 conceptualization of PTSD in the context of parenting. The aims of the current study were to: (a) replicate the associations between both trauma exposure and PTSS and indices of parenting (i.e., parental satisfaction, support, involvement, limit-setting, autonomy, communication); and (b) investigate if there is an indirect effect of trauma exposure on aspects of parenting through PTSS while also updating the current state of the literature to include the most recent DSM conceptualization of PTSD using a civilian sample. Consistent with the prior literature, it was hypothesized that cumulative trauma and PTSS would both be negatively related to each of the examined parenting indices (i.e., satisfaction, support, involvement, communication, limit-setting, autonomy). If trauma exposure is negatively associated with parenting in a similar manner to PTSS, this might suggest that even parents who do not exhibit PTSS may also be at risk for poorer parenting practices. Indirect effects of cumulative trauma exposure through PTSS were expected for each of the parenting indices, with higher levels of PTSS corresponding with lower levels of parental support, involvement, effective communication, limit-setting, and autonomy. Improved understanding of the relationships between trauma exposure, PTSS, and parenting indices may help to disentangle whether trauma exposure or PTSS is most relevant in understanding risk for negative parenting outcomes among trauma-exposed parents.

As the DSM-4 PTSD symptom clusters have previously been found to exhibit differing ties to parenting-related indices (Berz et al., 2008; Ruscio et al., 2002; Samper et al., 2004; Sayers et al., 2009), a secondary aim was to investigate whether each of the DSM-5 PTSD symptom clusters were related to aspects of parenting. In accordance with findings from the prior DSM-4 literature (Berz et al., 2008; Kulka et al., 1990; Ruscio et al., 2002; Samper et al., 2004), the avoidance and negative alterations in arousal and reactivity symptom clusters were expected to be related to aspects of parenting while intrusion symptoms were anticipated to be unrelated. As the negative alterations in cognitions and mood cluster is new in DSM-5, but includes some symptoms previously included in the avoidance and hyperarousal cluster which have been implicated in increased risk for negative parenting-related outcomes, it was hypothesized that increases in these symptoms would be tied to more negative parenting indices.

Method

Participants

Two hundred and twenty-five trauma-exposed parents recruited either from Amazon’s Mechanical Turk (MTurk) (76.4%) or a psychology subject pool at a Midwestern University (23.6%) participated in the study. Participant’s mean age was 36.81 (SD = 8.32, range = 19–55), and 63.7% of the sample were women (36.3% men). Approximately half of the sample was White (54.3% White, 23.9% Asian, 16.8% Black, 2.2% Biracial/Multiracial, 2.2% Native American, and 0.5% Middle Eastern) and 8% identified as Hispanic/Latino. Participant’s marital status was as follows: 68% married, 15.6% single, 8.4% divorced, 5.3% committed relationship, 1.3% separated, and 1.3% widowed. Annual household income was rated categorically in groupings of $10,000 (e.g., < $10,000, $10,000–$19,999); mean income was 5.18 (SD = 3.24), which corresponds to $40,000–$49,999.

Mean number of traumatic events was 3.07 (SD = 2.82; range = 1–13). Rates of trauma exposure were as follows: 49.3% witnessed serious accident, 48.9% unexpected death of a loved one, 32% serious accident, 28.9% natural disaster, 25.3% serious illness, 25.3% domestic violence, 22.6% physical assault, 20% physical abuse, 16.8% witnessed robbery/attack, 15.6% sexual abuse, 14.2% neglect, 12.4% sexual assault, and 11.6% robbery/attacked (M = 3.07; SD = 2.82; range 0–13). MTurk workers tended to be older, were more likely to be male, and reported experiencing fewer traumatic events than the undergraduate students (ps < .05). Racial status and income did not differ between recruitment sources.

Procedures

To increase the external validity of the study, two recruitment sources were utilized: a psychology subject pool at a Midwestern University and Amazon’s MTurk. MTurk utilizes an internet platform to allow participants to complete jobs (i.e., surveys) for compensation. MTurk workers are much more representative of the US population than undergraduate samples in terms of demographics and education (Buhrmester et al., 2011; Chandler & Shapiro, 2016 for a review). Study inclusion criteria were: (a) ages 18–55; (b) parent of a living child under the age of 18 who lives with you on at least a part-time basis; (c) endorsement of at least one PTSD Criterion A event on the Life Stressor Checklist-Revised (LSC-R; Wolfe & Kimerling, 1997). MTurk workers were also limited to be those residing in the USA and those with Master status, which is awarded to workers who consistently demonstrate a high degree of success across a larger number of jobs and is associated with improved data quality (Cheung et al., 2017). Participants self-selected into a study regarding traumatic exposure and parenting. Attention checks were utilized to help ensure good data quality and the data was cleaned prior to conducting the analyses. MTurk workers were compensated for their time, and the students received undergraduate course credit. All study procedures were approved by the University of Missouri-St. Louis IRB.

Measures

Demographics

Participants completed a demographics questionnaire to assess for basic background information, such as age, gender, race, ethnicity, and household income.

Trauma Exposure

The Life Stressor Checklist-Revised (LSC-R; Wolfe & Kimerling, 1997) assesses a variety of traumatic events and significant life stressors including having a family member jailed, caring for someone with a serious illness, and expected death of a loved one. Only individuals who experienced a Criterion A were included in the study (e.g., natural disaster, sexual abuse/assault, physical abuse/assault, serious accident, witnessed violence, unexpected death of a loved one). A cumulative trauma variable was created by summing the number of Criterion A events experienced. The LSC-R has previously established satisfactory indices of test-retest reliability and validity (Wolfe & Kimerling, 1997).

PTSS

The post-traumatic stress disorder checklist-civilian 5 (PCL-5; Weathers et al., 2013) is a 20-item self-report measure that assesses DSM-5 PTSD symptoms experienced in the last month. The items are on a 0 (not at all) to 4 (extremely) Likert scale with total scores for PTSD ranging from 0 to 80. A cutoff score of 33 was used to indicate probable PTSD. Satisfactory psychometric properties have been reported (Weathers et al., 2013). Internal consistency for the current sample was excellent, α = .96 total score, range αs = .92–.94 for the PTSD symptom clusters.

Parenting

The Parent–Child Relationship Inventory (PCRI; Gerard, 1994) is a 78-item self-report measure that assesses parents’ attitudes about parenting and their relationships with their child. Items are rated on a 1 (strongly agree) to 4 (strongly disagree) Likert scale, with higher scores corresponding with more positive parenting. The measure is comprised of seven subscales: Parental Support subscale includes 9 items related to the amount of emotional and social support; Parental Satisfaction subscale measures the degree of satisfaction the parent associates with parenting utilizing 10 items; Involvement subscale consists of 14 items related to the parent’s level of interest in and degree of knowledge he/she has about his/her child; Communication subscale contains 9 items assessing the parent’s ability to effectively talk and empathize with his/her child; Limit-setting subscale consists of 12 items related to parent’s use of appropriate discipline; Autonomy subscale is comprised of 10 items assessing parent’s ability to foster child’s independence; and Role Orientation subscale includes 9 items related to beliefs about parenting gender roles. Each of the subscales produces a total score, with higher scores inidicating more positive parenting characteristics and lower scores indicating poorer parenting characteristics. The measure also includes two validity indicators of social desirability and inconsistency to help ensure valid responding. Adequate psychometric properties have been reported (Gerard, 1994). In the present study, each of the PCRI subscales except for the Role Orientation subscale were used. We excluded the Role Orientation subscale as we did not have a priori hypotheses regarding this subscale. Satisfactory reliabilities were found in the current sample, Cronbach’s αs = .89–.94.

Data Analyses

All data analyses were conducted using SPSS 24. Missing data was imputed for cases in which there was missing data (<2% cases) using mean imputation. Potential covariates such as recruitment source, age, sex, minority status, marital status, and income were examined, using zero-order bivariate correlations for continuous variables and independent samples t-tests for the categorical variables. Due to low cell sizes of non-white racial groups, race was dichotomized into white (n = 119) and minority status (n = 106). If a factor was found to correspond with a dependent variable (DV), that variable was included in the regression model for that DV. The first set of hypotheses that cumulative trauma and PTSS would be associated with more negative parenting-related outcomes and that there would be an indirect effect of cumulative trauma on parenting indices through PTSS were tested using the simple indirect effects model (PROCESS Model 4) in the PROCESS macro (Hayes, 2017). Models were run separately for each of the aspects of parenting. PROCESS Model 4 uses ordinary least squares (OLS) regression to calculate total, direct, and indirect effects. Indirect effects were calculated as the product of the a and b paths. PROCESS used percentile based procedures for identifying confidence intervals (CIs). The distribution of indirect effects calculated from 5,000 bootstrapped samples were examined and values falling at the 2.5 and 97.5 percentile ranks were identified as the lower and upper limits of the 95% CI. An a priori power analysis using G * Power indicated that a sample size of 74 would provide 80% statistical power to detect a medium effect size. A multivariate regression was also computed to test the hypotheses that the avoidance and trauma-related changes in both feelings and thoughts and arousal and reactivity clusters would be associated with aspects of parenting whereas the intrusion cluster would be unrelated.

Results

Preliminary Analyses

Bivariate correlations for the variables of interest are presented in Table 1. Mean PTSS was 20.80 (SD = 17.52) and 24.8% had PCL-5 scores at or above clinical cutoff. The students reported higher levels of cumulative trauma, t(223) = –3.96, p = .001, but equal levels of PTSS. Mturk workers indicated lower levels of parental satisfaction and involvement, t(223) = –2.13, p = .03; t(223) = 2.35, p = .01, respectively. Participant’s age was positively correlated with limit-setting (r = .14, p = .03) and autonomy (r = .20, p = .002). Women reported higher levels of support, satisfaction, and appropriate limit-setting, but less effective communication than men (ps < .05). Members of a racial minority group reported lower levels of parental satisfaction, involvement, appropriate limit-setting, and autonomy (ps < .05), but not communication. Income was also correlated with parental support, satisfaction, involvement, limit-setting, and autonomy (Range rs = .19–.28), but not with communication. Thus, recruitment source, age, gender, minority status, and income were included as covariates in the models when indicated.

Table 1.

Intercorrelations Among Variables of Interest.

1. Cumulative trauma

–

2. Total PTSS

.31^***

–

3. Intrusion

.26^***

.90^***

–

4. Avoidance

.19^**

.75^***

.64^***

–

5. Feelings and thoughts

.28^***

.94^***

.82^***

.65^***

–

6. Arousal and reactivity

.33^***

.92^***

.76^***

.61^***

.85^***

–

7. Satisfaction

–.03

–.28^***

–.25^***

–.14^*

–.24^***

–.32^***

–

8. Support

–.19^**

–.30^***

–.18^**

–.15^*

–.32^***

–.35^***

.43^***

–

9. Involvement

.03

–.18^**

–.14^*

–.07

–.17^**

–.20^**

.76^***

.37^***

–

10. Communication

.10

–.01

.01

–.03

–.01

.43^***

.17^*

.59^***

–

11. Autonomy

–.12

–.31^***

–.29^***

–.28^***

–.25^***

.20^**

.16^*

.20^**

–.04

–

12. Limit-setting

–.03

–.26^***

–.21^**

–.14^*

–.27^***

.54^***

.59^***

.43^***

.13*

.41^***

–

Note. ^*p < .05. ^**p < .01. ^***p < .001. PTSS = post-traumatic stress symptoms.

Cumulative Trauma and PTSS Regression Models

Parental Satisfaction

The regression model for parental satisfaction was significant, F(5,217) = 8.11, p < .001, r² = .39 (see Table 2). In partial support of the hypotheses, a main effect was found for PTSS, but not cumulative trauma. PTSS were inversely related to parental satisfaction. Racial minorities endorsed lower levels of parental satisfaction, as did participants who reported lower levels of household income. Parental satisfaction did not differ by recruitment source or gender. A significant indirect effect of cumulative trauma on parental satisfaction via PTSS was noted.

Table 2.

Regression Models for Cumulative Trauma, PTSS, and Aspects of Parenting.

	B	SE	t	p	95% CI
Parental satisfaction
Cumulative trauma -> Parental satisfaction	.25	.29	.86	.38	([–.32] – .[82])
Cumulative trauma -> PTSS	2.13	.40	5.27	<.001	(1.33 – 2.92)
Recruitment source -> Parental satisfaction	2.34	1.93	1.21	.22	([–1.46] – [6.16])
Gender -> Parental satisfaction	2.09	1.60	1.30	.19	([–1.05] – [5.24])
Minority status -> Parental satisfaction	−5.55	1.59	−3.48	<.001	([–8.68] – [–2.41])
PTSS -> Parental satisfaction	–.16	.04	−3.48	<.001	([–.25] – [–.06])
Indirect effect	–.34	.12		.002	([–.63] – [–.14])
Parental support
Cumulative trauma -> Parental support	–.28	.22	−1.28	.20	([–.72] – [.15])
Cumulative trauma -> PTSS	2.13	.40	5.27	<.001	([1.33] – [2.92])
Gender -> Parental support	2.55	1.22	2.09	.03	([.14] – [4.96])
Income -> Parental support	.53	.17	2.96	.003	([.17] – [.88])
PTSS -> Parental support	–.12	.03	−3.42	<.001	([–.18] – [–.05])
Indirect effect	–.25	.09		.002	([–.48] – [–.10])
Communication
Cumulative trauma -> Communication	.36	.22	1.65	.09	([–.06] – [.79])
Cumulative trauma -> PTSS	1.88	.39	4.77	<.001	([1.10] – [2.66])
Gender -> Communication	−4.88	1.23	−3.94	<.001	([–7.32] – [–2.44])
PTSS -> Communication	–.03	.03	–.98	.32	([–.10] – [.03])
Indirect effect	–.06	.07		.34	([–.22] – [.05])
Involvement
Cumulative trauma -> Involvement	.35	.33	1.07	.28	([–.29] – [1.00])
Cumulative trauma -> PTSS	2.12	.40	5.30	<.001	([1.33] – [2.91])
Recruitment source -> Involvement	−8.96	2.69	−3.32	.001	([–14.27] – [–3.65])
Minority status -> Involvement	−3.37	1.80	−1.86	.06	([–6.94] – [.18])
PTSS -> Involvement	–.11	.05	−2.18	.02	([–.21] – [–.01])
Indirect effect	–.24	.12		.01	([–.53] – [–.04])
Limit-setting
Cumulative trauma -> Limit-setting	.22	.24	.90	.36	([–.26] – [.71])
Cumulative trauma -> PTSS	1.80	.39	4.52	<.001	([1.01] – [2.59])
Age -> Limit-setting	.14	.08	1.70	.08	([–.02] – [.31])
Gender-> Limit-setting	2.90	1.38	2.09	.03	([.17] – [5.63])
Minority status-> Limit-setting	−2.30	1.43	−1.61	.10	([–5.13] – [.51])
Income-> Limit-setting	.36	.22	1.62	.10	([–.07] – [.79])
PTSS -> Limit-setting	–.14	.04	−3.55	<.001	([–.22] – [–.06])
Indirect effect	–.25	.10		.003	([–.51] – [–.10])
Autonomy
Cumulative trauma -> Autonomy	–.07	.18	–.40	.68	([–.43] – [.28])
Cumulative trauma -> PTSS	1.81	.39	4.56	<.001	([1.03] – [2.60])
Age -> Autonomy	.14	.06	2.37	.01	([.02] – [.27])
Minority status -> Autonomy	−3.23	1.05	−3.08	.002	([–5.31] – [–1.16])
Income -> Autonomy	.32	.16	2.00	.04	([.01] – [.65])
PTSS -> Autonomy	–.11	.02	−3.87	<.001	([–.17] – [–.05])
Indirect effect	–.20	.07		.005	([–.37] – [–.09])

Note. PTSS = post-traumatic stress symptoms.

Parental Support

For parental support, the model was significant, F(3,219) = 9.41, p < .001, r² = .11. A direct effect for PTSS and parental support, but not cumulative trauma, was observed, with higher levels of PTSS corresponding with lower reported levels of parental support. Women and individuals with higher incomes also endorsed higher levels of support. Results revealed a significant indirect effect of cumulative trauma on parental support via PTSS.

Parental Communication

The parental communication model was significant, F(2,220) = 12.05, p < .001, r² = .08, but neither cumulative trauma nor PTSS were directly related to parental communication, nor was there an indirect effect for cumulative trauma through PTSS on communication. However, men endorsed higher levels of effective communication than women.

Parental Involvement

The model accounted for a significant amount of variance in parental involvement, F(4,218) = 10.17, p < .001, r² = .15. PTSS was inversely associated with levels of parental involvement, whereas a main effect for cumulative trauma was not observed. Recruitment source, minority status, and income were unrelated to involvement. However, there was a significant indirect effect of cumulative trauma on parental involvement via PTSS.

Parental Limit-Setting

The regression model for limit-setting was significant, F(5,217) = 6.10, p < .001, r² = .12. Gender and PTSS were directly related to appropriate limit-setting. Specifically, women and individuals with lower levels of PTSS indicated more appropriate limit-setting. No main effects were revealed for age, minority status, income, and cumulative trauma with limit-setting. Nonetheless, there was an indirect effect for cumulative trauma through PTSS on limit-setting.

Parental Autonomy

The model for parental autonomy was significant, F(4,218) = 7.24, p < .001, r² = .20. Older participants, Whites, individuals with higher reported incomes, and those with lower levels of PTSS endorsed higher levels of appropriate parental autonomy. A main effect was again not observed for cumulative trauma and parental autonomy. Still, an indirect effect was noted for cumulative trauma through PTSS on parental autonomy.

PTSD Symptom Clusters

A multivariate regression was utilized to examine the PTSD symptom clusters in relation to the indices of parenting that were significantly related to PTSS in the regression models (i.e., each of the variables except for parental communication; see Table 3). Reported income was tied to levels of PTSS and was included as a covariate, whereas recruitment source and participant’s age, gender and minority status were unrelated to PTSS and therefore not included in the model.

Table 3.

Multivariate Regression Results for PTSD Symptom Clusters and Parenting Indices.

	B	SE	95% CI	p	Partial eta²
Parental satisfaction
Income	.95	.24	([.48] – [1.43])	.001	.06
Intrusion	–.30	.28	([–.86] – [.26])	.29	.005
Avoidance	.19	.47	([–.74] – [1.12])	.68	.001
Cognitions and mood	.35	.25	([–.15] – [.86])	.16	.009
Arousal and reactivity	–.79	.27	([–1.33] – [–.25])	.004	.04
Parental support
Income	.58	.17	([.23] – [.93])	.001	.05
Intrusion	.47	.21	([.05] – [.88])	.02	.02
Avoidance	.19	.34	([–.49] – [.88])	.58	.001
Cognitions and mood	–.32	.19	([–.70] – [.04])	.08	.01
Arousal and reactivity	–.51	.20	([–.91] – [–.11])	.01	.03
Involvement
Income	.62	.27	([.08] – [1.16])	.02	.02
Intrusion	.03	.32	([–.60] – [.68])	.91	.001
Avoidance	.32	.53	([–.73] – [1.38])	.55	.002
Cognitions and mood	–.005	.29	([–.58] – [.57])	.98	<.001
Arousal and reactivity	–.50	.31	([–1.11] – [.11])	.11	.01
Limit-setting
Income	.54	.21	([.11] – [.96])	.01	.02
Intrusion	.003	.25	([–.50] – [.50])	.99	.001
Avoidance	.17	.42	([–.65] – [1.01])	.67	.003
Cognitions and mood	–.19	.23	([–.64] – [.26])	.40	.004
Arousal and reactivity	–.28	.24	([–.76] – [.19])	.24	.008
Autonomy
Income	.62	.16	([.31] – [.94])	.001	.06
Intrusion	–.31	.19	([–.69] – [.05])	.09	.01
Avoidance	–.72	.31	([–1.34] – [–.10])	.02	.02
Cognitions and mood	–.02	.17	([–.36] – [.30])	.87	<.001
Arousal and reactivity	.13	.18	([–.21] – [.49])	.44	.003

Note. PTSD = post-traumatic stress disorder; CI = confidence interval.

For parental statisfaction, income and trauma-related changes in reactivity and arousal symptoms were related to higher levels of reported parental satisfaction. Main effects were not revealed for the other PTSD symptom clusters and parental satisfaction. For parental support, trauma-related changes in reactivity and arousal were directly tied to lower levels of support as anticipated and a statistical trend was noted for changes in trauma-related changes in cognitions and mood. However, a positive main effect was also unexpectedly noted between intrusion symptoms and levels of perceived parental support. None of the PTSD symptoms clusters were related to either parental involvement or limit-setting. For autonomy, higher levels of avoidance symptoms were associated with lower levels of autonomy, and a statistical trend was noted for intrusion symptoms.

Discussion

The growing literature regarding trauma exposure, PTSS, and parenting largely indicates that both trauma exposure and PTSS may increase the risk for parenting difficulties (Berz et al., 2008; Gewirtz, et al., 2010; Khaylis et al., 2011; Sayers et al., 2009). Still, findings have been inconsistent (e.g., Blow et al., 2013; Cohen et al., 2008; Cross et al., 2018; Gewirtz et al., 2014) and the majority of the prior research has not accounted for both cumulative trauma exposure and PTSS simultaneously, making it unclear if trauma exposure and PTSS are similarly tied to decrements in parenting. Evidence that both trauma exposure and PTSS are related to indices of parenting may help identify parents at risk for parenting difficulties, particularly as trauma exposure generally does not result in PTSD but may still have a negative impact on parenting. Further, the prior literature has utilized the DSM-4 PTSD criteria, and work is needed to update the literature using the revised conceptualization of PTSD. This is especially important as PTSD symptom clusters may not be equally tied to aspects of parenting (Berz et al., 2008; Ruscio et al., 2002; Samper et al., 2004), and the clusters have changed considerably in DSM-5.

Interestingly, no main effects were observed for cumulative trauma and any of the indices of parenting. This is in contrast to one previous study that reported that trauma exposure was related to decrements in parenting-related outcomes (Sprang et al., 2013). Study differences may be the result of different measurements of cumulative trauma or sample types. However, PTSS were positively associated with each of the aspects of parenting except communication, even after accounting for level of trauma exposure. Specifically, higher levels of PTSS were tied to lower levels of parental satisfaction, support, and involvement as well as more challenges regarding limit-setting and autonomy. These findings are consistent with prior studies that have reported associations between PTSS and parental satisfaction, support and involvement (Gewirtz et al., 2010; Samper et al., 2004); however, the link between PTSS and difficulties with limit-setting and autonomy are novel findings. Parents with PTSS may find it harder to establish effective limits and struggle with appropriate levels of child autonomy for several reasons, such as negative trauma-related beliefs regarding the child’s safety or behavior resulting in parents being over or underprotective. Prior studies have reported that parents with PTSS have more challenges in appropriate discipline more broadly (Cohen et al., 2008), including higher levels of child abuse potential (Chemtob et al., 2013; Cohen et al., 2008; Pears & Capaldi, 2001). These findings indicate some specific parent–child difficulties that could be targeted in treatment, as well as potential mechanisms by which caregiving is altered in the context of PTSS. It is important to note that PTSS was not related to less effective communication, indicating a possible area of preserved strength that can be leveraged and emphasized in clinical interventions.

Further, indirect effects of cumulative trauma through PTSS on all but the communication subscale were observed, in partial support of the hypotheses. Although the data utilized in the present study is cross-sectional and causality cannot be determined, the results collectively illustrate that levels of trauma-related difficulties, rather than trauma exposure itself, may better explain the increased risk for negative parenting outcomes among trauma-exposed parents. Prior research in this area has not tested whether trauma exposure is related to parenting factors indirectly through PTSS. However, Sprang et al. (2013) found that trauma exposure was a better predictor of parenting difficulties than PTSD. Differences in findings may be the result of examining PTSD categorically versus dimensionally, or may be due to sample types. As the present study utilized the new DSM-5 conceptualization of PTSD, these findings bolster the notion that PTSD may be a stronger risk factor for parenting challenges than trauma exposure.

The prior literature has concluded that there are differences in the links between the various DSM-4 PTSD symptom clusters and aspects of parenting (e.g., Berz et al., 2008; Birkley et al., 2016; Samper et al., 2004). Here, the DSM-5 PTSD symptom clusters also exhibited different relationships with indices of parenting. Intrusion symptoms were not anticipated to correspond with parenting domains; however, these symptoms were positively related to levels of parental support. Further, avoidance symptoms were expected to be tied to aspects of parenting, but these difficulties were only related to levels of parental autonomy. Perhaps the presence of avoidance symptoms may alter parental willingness to let their children be autonomous and create challenges in helping children become independent due to significant efforts to cope and avoid trauma triggers. However, it is unclear why avoidance symptoms would not be related to other aspects of parenting such as involvement and communication and this finding may be spurious. Further, it is unknown, if parents with avoidance symptoms would overly limit or overly promote a child’s independence. This pattern of findings regarding the intrusion and avoidance clusters is interesting as avoidance symptoms, but not intrusion symptoms, have previously been be implicated in more negative parenting outcomes (Berz et al., 2008; Kulka et al., 1990; Ruscio et al., 2002; Samper et al., 2004). Avoidance symptoms have been thought to be particularly relevant to parenting challenges due to the emotional numbing that was previously included in this cluster. However, as emotional numbing is now part of the alterations in feelings and thoughts cluster, study discrepancies may be a function of differences in the PTSD symptom clusters between versions of the DSM.

The trauma-related changes in feelings and thoughts cluster is new to DSM-5 and has not previously been investigated in relation to parenting outcomes, to the authors’ knowledge. Nonetheless, despite expectations, higher levels of negative changes in feelings and thoughts were only marginally associated with parental support. Negative trauma-related thoughts often involve others, such as increased difficulties trusting and being close to others. Therefore, parents who are experiencing negative cognitions following trauma exposure may also be somewhat more likely to perceive others as being less supportive with regard to parenting. Or this finding may be spurious. The lack of significant relations with other parenting domains was unexpected, particularly as the cluster includes changes in behavior which were anticipated to be linked with aspects of parental behavior such as involvement. It may be that parental behaviors are less tied to trauma-related changes in thoughts and feelings than one’s overall level of trauma symptoms. Additionally, the negative alterations in mood encapsulated in this symptom cluster were expected to negatively impact parenting similarly to what has been found in depressed mothers (Lovejoy et al., 2000). However, other studies regarding depressed mothers have found that the association between depression and parenting may be due to variation across individuals or unobserved time-invariant characteristics (Turney, 2011), which the present study did not account for. Trauma-related changes in feelings and thoughts may be less relevant in understanding risk for parenting challenges compared to changes in arousal and reactivity, which was significantly related to parental support and satisfaction.

The trauma-related changes in arousal and reactivity was the only cluster that was significantly related to multiple parenting indices, with higher levels of these symptoms being associated with decreased levels of parental satisfaction and support. This finding is consistent with prior work in this area that has reported that hyperarousal symptoms were uniquely related to negative parenting outcomes (e.g., Berz et al., 2008). Increases in irritability, difficulties sleeping, and feeling “on edge” may make it more challenging to enjoy parent–child interactions and receive needed emotional and concrete parenting-related support. It is also important to note that parental levels of effective involvement and limit-setting were not uniquely related to any of the PTSD symptom clusters but were associated with levels of PTSS. Therefore, it may be that parental behavior regarding involvement and discipline is less differentially impacted by specific PTSD symptom clusters, but is linked to level of trauma-related symptoms more broadly.

Taken together, there appears to be distinctions in the relations between PTSS, the PTSD symptom clusters, and aspects of parenting. Additional studies that examine other aspects of parenting, such as parental sense of competence and efficacy, perceived level of child’s difficulty, use of ineffective discipline methods, and quality of the parent–child relationship may help to more fully understand the associations between PTSS and parenting. Further, studies that include observational methods are critical, particularly as one sample of sexually abused mothers did not find differences in observed parenting problems compared to controls, despite differences in self-report measures (Fitzgerald et al., 2005). It is also important to consider the child’s vantage point of the parent–child relationship for a more comprehensive understanding of parental functioning. Work should also aim to determine if there are specific symptoms within the clusters that are drivers of more negative parental functioning.

Limitations and Conclusions

There are several study limitations that should be discussed. Foremost, the study used a cross-sectional design; therefore, the temporal relations between the variables of interest cannot be determined. Parental difficulties may have begun before the trauma exposure and onset of PTSS. Indeed, it is possible that parental challenges could increase one’s vulnerability to developing trauma-related difficulties following exposure to trauma. Longitudinal research is needed to help disentangle the timing of trauma exposure, PTSS, and aspects of parenting. Relatedly, general distress, either trauma-related or not, may contribute to parenting-related difficulties rather than, or in addition to, PTSS. Some research has found that PTSD may be best understood by a two-factor model of PTSD and post-traumatic general dysphoria (Hunt et al., 2018), and the negative changes in cognition and mood symptom cluster may be particularly related to levels of general distress rather than trauma-related symptoms. In the present study, we were unable to assess whether the relations observed study are a function of PTSS or general distress.

Further, the sample was predominately recruited from MTurk and was 63.7% female and 52.9% White. Therefore, the sample was not representative of the US population of parents. Racial differences were unable to be more fully explored in the current study due to small cell sizes. These results may not generalize to a sample of parents recruited from the community, particularly as minority status was a covariate in the study.

Further, the study did not assess for certain family variables such as number of children, age of children, and other adults in the home, which may be important to include to better contextualize the relations between trauma exposure, PTSS, and parenting. The study also relied upon self-report measures, which may introduce biases. Trauma exposure was measured using an instrument that precludes a precise determination of whether the individual experienced a Criterion A event and meets criteria for PTSD. Participants may have been reluctant to divulge trauma exposure, trauma-related difficulties, and parenting difficulties. Others may have experienced a traumatic event, and be exhibiting PTSS, but may not conceptualize themselves as being a trauma survivor. Studies that include clinician-administered measures of trauma exposure and PTSD would greatly strengthen confidence in the findings.

The findings from the current study nevertheless add to the emerging literature regarding trauma exposure, PTSD, and parental functioning. Study strengths include the assessment of both trauma exposure and PTSS, multiple aspects of parenting, and the use of the DSM-5 criteria. The results indicate that PTSS, but not trauma exposure, may correspond with decrements in parenting. Further, the results from the study are the first investigation of the DSM-5 PTSD symptom clusters that indicate the importance of the trauma-related changes in arousal and reactivity cluster, similar to previous research using the DSM-4 criteria. Thus, for trauma-exposed parents, mitigating PTSS seems critical, and it is possible that targeting trauma-related changes in arousal and reactivity symptoms in particular may be most impactful in bolstering parental functioning following trauma exposure. This information may be critical in informing existing PTSD treatment as well as developing or adapting interventions targeted at improving parenting outcomes for parents struggling with PTSS. Additionally, the novel findings regarding the link between PTSS and both limit-setting and autonomy among trauma-exposed parents suggests additional parenting areas that might be clinically relevant and may benefit from intervention or support.

Footnotes

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) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Rachel Wamser-Nanney

Authors Biographies

Rachel Wamser-Nanney, PhD, is an assistant professor in the Department of Psychological Sciences at the University of Missouri—St. Louis. Her research program is broadly focused on traumatic stress.

Julia Sager, MA, is a doctoral clinical psychology graduate student in the Department of Psychological Sciences at the University of Missouri—St. Louis. Her research interests include traumatic stress and its impact on relationships and families.

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