The Role of Maternal Self-efficacy in the Link Between Childhood Maltreatment and Maternal Stress During Transition to Motherhood

Abstract

The transition to motherhood is a significant developmental milestone in many women’s lives. This transitional period may be more stressful for women with a history of childhood maltreatment (CM) than for women without such a history. This study tested whether parental self-efficacy (PSE) accounts for the link between CM and parental stress in mothers transitioning to motherhood. The study used a convenience sample of 1,306 first-time mothers of children aged two years or younger. Mothers filled out online self-report questionnaires assessing history of CM, PSE, and prenatal stress. Consistent with the hypotheses, exposure to CM was directly associated with greater parental stress. Also, PSE partially mediated the associations between CM and parental stress, such that mothers with a history of childhood abuse reported a lower level of PSE, which in turn was associated with greater parental stress. In conclusion, the study highlights the important role of negative cognitions related to parenting for maternal dysfunction following exposure to childhood abuse. These findings suggest a need to incorporate preventive interventions designed to promote PSE for mothers exposed to CM. Such programs may alleviate parental stress and further support the healthy development of the child.

Keywords

childhood maltreatment maternal self-efficacy maternal stress transition to motherhood

Introduction

Childhood maltreatment (CM) is a worldwide public health problem. CM includes sexual, physical, and/or emotional abuse, as well as neglect occurring in a relationship of responsibility, trust, or power that harms, or has the potential to harm, children’s health, survival, development, or dignity (The World Health Organization; WHO, 2017). The World Health Organization (2017) indicated that 23% of children around the world experience physical abuse, 36% and 26% of children experience emotional and sexual abuse, respectively, and 16% of children experience neglect.

A large body of research has shown the long-term effects of CM on parental functioning (Ehrensaft et al., 2015; MacIntosh & Ménard, 2021; Madigan et al., 2019), including harsh (Kim et al., 2010; Liu et al., 2021), ineffective (DiLillo & Damashek, 2003), and maltreating parenting (Pears & Capaldi, 2001). Mothers exposed to CM also tend to be less available to their child (Ehrensaft et al., 2015) and are more likely to reject or withdraw from their child (for a review see Greene et al., 2020). Also, a history of CM in mothers is associated with more difficulties establishing secure mother-child attachment bonds (for a review, see Madigan et al., 2019).

CM predicts greater parental stress (Ammerman et al., 2013; Pereira et al., 2012; Schuetze & Eiden, 2005), a term referring to a negative mental appraisal in response to the discrepancies between perceived parenting requirements and available resources (Abidin, 1995). Parental stress is a specific case of a stress reaction to challenging events. Stress is a result of the interplay between the subjective evaluation of the situation as threatening and a perceived lack of a person’s coping abilities and resources (Lazarus & Folkman, 1987). Similarly, parental stress develops when the requirements of parenting are perceived as high, demanding, and taxing, and the extant resources are perceived as insufficient to fulfil them (Abidin, 1990). In this process, mothers weigh the parenting requirements against the available mental and physical resources, such as adequate housing, knowledge, or support, and other basic survival needs (e.g., food, safe living) (Deater-Deckard & Scarr, 1996).

A history of CM in mothers predicts greater maternal stress (Ammerman et al., 2013; Pereira et al., 2012; Schuetze & Eiden, 2005), which can lead to dysfunctional parenting (Dyba et al., 2019; Venta et al., 2016). Specifically, parental stress is associated with ineffective parent-child interaction, insecure attachment style (Robson, 1997), and violent and neglectful behaviors (Nijssens et al., 2018). Furthermore, parental stress may affect children’s normative development (Milgrom et al., 2004) and well-being (Deater-Deckard, 2004; Ward & Lee, 2020). It is therefore important to understand the process by which exposure to CM affects parental stress, especially during infancy, when children are more vulnerable to the effects of maternal stress and poor parenting (Hammen et al., 2012). Therefore, this study aimed to test a mediation model between exposure to CM and parental stress in women transitioning to motherhood. We tested our research question on Israeli mothers. Data from a large-scale nationally representative study indicated that 48% of Jewish Israeli girls experience CM (29.8% emotional abuse, 17.7% sexual abuse, 12.8% physical neglect, 12.2% physical abuse, and 15.8% emotional neglect) (Lev-Wiesel & Isikovich, 2016). The high CM rates together with the high fertility rates in Israel compared with other OECD countries (OECD, 2021) stress the need to examine the effects of CM on parental functioning in Israeli mothers.

Childhood Maltreatment and the Transition to Motherhood

The first two years of motherhood are termed the “nurturing stage” (Galinsky, 1981). This transitional phase to motherhood is considered a “normative crisis” (George, 1993), during which parents often experience high levels of parental stress (Leavitt et al., 2017). Despite the joy and satisfaction of being a parent, parenting comes with intensive intellectual, emotional, and physical investment. The role of parents involves ongoing responsibilities for treatment, care, protection, and provision of the child’s needs (Coleman & Karraker, 1998). The transition to parenthood requires significant changes, including adaptation to unfamiliar childcare responsibilities and reconciliation between tasks related to motherhood versus tasks related to other roles in their lives (Cowan & Cowan, 1995).

The transition to motherhood is a significant developmental milestone in the lives of many women (Cowan & Cowan, 1995), but for CM victims, becoming a mother can be an especially stressful transitional period. Several studies have demonstrated a link between a history of CM and greater parental stress, including a study involving first-time mothers (Ammerman et al., 2013), a longitudinal study tracking mothers with a history of childhood sexual abuse from before to after their first birth (Schuetze & Eiden, 2005), and a study using a community sample of mothers (Pereira et al., 2012). Higher levels of parental stress were also found in mothers who experienced childhood neglect compared with a control group of mothers not reporting childhood neglect (Ethier et al., 1995). Also, adverse childhood experiences, including sexual and physical abuse, are associated with parental stress (Lange et al., 2019), even when accounting for socioeconomic status (Steele et al., 2016). Despite consistent findings linking CM and parental stress, questions remain as to what explains this link.

Childhood Maltreatment and Parental Self-efficacy

One factor that may explain the link between CM and parental stress is parental self-efficacy (PSE). In general, self-efficacy is a person’s self-perception concerning one’s ability to meet and cope with the tasks and challenges required to achieve his/her goals (Bandura, 1989). PSE is a specific case of the larger concept of self-efficacy, referring to a parent’s belief in their ability to fulfill parental roles and take care of the child's physical and emotional needs successfully (Teti & Gelfand, 1991).

Bandura’s social learning theory posits how the experience of CM may impair PSE in mothers. Self-efficacy develops through the observation and modeling of behaviors, attitudes, and emotional reactions of significant others. Parents are central role models through which a child acquires behaviors and cognitions (Bandura, 1978a). Abusive or neglectful parents model aggressive parenting that establishes the attitudes and behaviors the child may hold in adulthood as a parent (DiLillo & Damashek, 2003). The absence of a positive parental role model may impair the capacity to perceive oneself as an effective parent in adulthood (Pears & Capaldi, 2001). The link between CM and PSE has been shown in several studies. Lower PSE levels were found in mothers with histories of childhood sexual abuse compared with their nonabused counterparts (Cohen, 1995; Fitzgerald et al., 2005). CM was also associated with lower PSE in mothers of young children (Bailey et al., 2012) and in at-risk mothers (Caldwell et al., 2011), including mothers with a history of substance abuse (for reviews, see Raynor, 2013), and adolescent mothers (Milan et al., 2004).

Parental Self-efficacy and Parental Stress

A person's self-efficacy can affect subjective stress (Bandura, 1989), and lower PSE can intensify parental stress (Bandura et al., 2011) in direct and indirect ways. Specifically, maternal stress is provoked by the perceived gap between parenting requirements and coping resources (Abidin, 1990). Perceiving maternal roles as less threatening and more manageable may reduce the sense of stress (Abidin, 1995). However, individuals low in PSE tend to perceive themselves as less capable of dealing with threats, as well as less optimistic and motivated to cope with challenges (Coleman & Karraker, 1998; Mash & Johnston, 1990). Mothers with low PSE report a lower sense of control as well as decreased confidence in their ability to adaptably cope with challenges related to motherhood (Seah & Morawska, 2016).

In addition to this direct link, PSE can provoke parental stress indirectly through maternal behavior. Bandura’s reciprocal determinism theory posits that one’s cognition, one’s behaviors, and others’ behaviors mutually influence each other (Bandura, 1982). As such, self-efficacy can directly affect behaviors (Bandura et al., 2003), and PSE can directly affect parental behaviors (Bandura, 1982). Indeed, PSE is associated with parental functioning, including expression of warmth and control (Izzo et al., 2000), positive engagement, supervision (Bogenschneider et al., 1997), sensitivity (Bohlin & Hagekull, 1987), responsiveness (Gondoli & Silverberg, 1997), discipline style (Sanders & Woolley, 2005), and decreased hostile parenting (Hill & Bush, 2001). Although adaptive actions reduce the sense of threat, thereby reducing stress, repeated failures at a particular task may increase the perception of threat and, consequently, intensify stress (Bandura, 2006).

Research has shown that lower PSE is associated with higher parental stress in community samples of mothers from the United State and Israel (David & Khatib, 2021; Smith, 2017), and in parents of toddlers at different ages, from 6 (Seah & Morawska, 2016) to 36 months old (Fox & Gelfand, 1994; Sevigny & Loutzenhiser, 2010). Negative associations between PSE and parental stress have also been shown in parents dealing with challenging conditions, such as parents of children with ADHD, parents of children with special needs (Ben-Naim et al., 2019), and mothers living in poverty (Raikes & Thompson, 2005). Although CM can disrupt the perceived PSE (Bailey et al., 2012), to the best of our knowledge, research on the associations between PSE and parental stress of mothers with a CM history is lacking.

The Current Study

In sum, employing social learning theory (Bandura, 1977) and reciprocal determinism theory (Bandura, 1982), exposure to a negative parental model in childhood (i.e., abusive behaviors) may preclude the development of a belief in one’s own ability to provide effective parenting (Bandura, 1977). The transactional theory of stress and coping (Folkman et al., 1979) and Abidin (1995) further postulated that perceived insufficient resources to cope with parental tasks and demands may provoke parental stress. Individuals with high self-efficacy tend to perceive themselves as more capable of dealing with threats and are therefore likely to experience less stress than individuals with low self-efficacy (Lazarus & Folkman, 1987). This theoretical framework has been supported by research showing associations between CM and greater maternal stress (Ammerman et al., 2013; Pereira et al., 2012; Schuetze & Eiden, 2005), as well as lower PSE (Bailey et al., 2012; Fitzgerald et al., 2005; Milan et al., 2004). Furthermore, PSE was found to be associated with lower maternal stress (Raikes & Thompson, 2005; Seah & Morawska, 2016). However, the indirect effect of CM on maternal stress through PSE has yet to be studied. In this study, we hypothesized that PSE would mediate the effects of CM on parental stress during the transition to motherhood, such that exposure to CM would be associated with lower PSE, which in turn would be associated with greater parental stress.

Method

Participants

The study sample included 1,306 native Hebrew-speaking Israeli first-time mothers within two years of giving birth. Participants ranged in age from 22 to 46 years, with an average age of 31.07 years (SD = 4.23). Most of the mothers were married (87.1%), with an average of 4.56 years of marriage (SD = 2.57). Nearly 50% reported an average or higher than average family income level ($4,000), as indicated by the Israeli Central Bureau of Statistics (Central Bureau of Statistics, 2016). The majority of participants held at least a Bachelor’s degree (81.6%), were born in Israel (83%), and considered themselves secular (65.8%). Mothers reported a mean of 1.15 children per family (SD = 0.35).

Procedure

The study sample was recruited using convenience sampling. The study was advertised on social media (e.g., Facebook) and online parenting groups. First, mothers who were interested in participating were asked to fill out a short online screening questionnaire (using software provided by Qualtrics) designed to assess compatibility with sample criteria: native Hebrew-speaking, first-time mothers to a child aged two years or under. Mothers who met the research criteria were automatically referred to complete an online survey, in which they were first asked to indicate consent to participate in the study. Initially, 2,526 mothers completed the screening form, of which 1,306 mothers met inclusion criteria and completed the online questionnaire. Participants were offered the opportunity to participate in a raffle for three gift cards worth $45. Mothers who completed the survey were asked to leave their contact information (telephone number and email address) in a separate form, attached with a link. IRB approval was obtained from the Hebrew University of Jerusalem, Israel. Data were collected from April to May 2018.

Measures

Childhood abuse.

The Childhood Trauma Questionnaire (CTQ; Bernstein et al., 1994) was used to assess a maternal history of childhood abuse. This is a widely used self-report measure that assesses the frequency of different types of childhood abuse (physical, sexual, and emotional) and neglect (emotional and physical). For example, emotional abuse is measured by items such as, “People in my family said hurtful or insulting things to me.” Participants rated each item on a 5-point Likert-type scale, ranging from 1 (never true) to 5 (very often true). The CTQ demonstrates good internal consistency, test-retest reliability, and convergent validity (Bernstein et al., 1994). In our data, the reliability (Cronbach alpha) coefficients of CTQ subscales were adequate (Cronbach’s α = .81-.96), except for physical neglect (Cronbach’s α = .50), which was therefore excluded. Finally, the reliability of the entire scale was good (Cronbach’s α = .88). Each subscale was summed and a dichotomous variable indicating exposure to any childhood abuse was obtained using the guidelines suggested by the developers of the CTQ scale (Bernstein et al., 1998). Exposure to childhood abuse was indicated by any of the following cases: sexual abuse scale was scored 6 or higher, physical abuse scale was scored 8 or higher, emotional abuse scale was scored 9 or higher, or emotional neglect was scored 10 or higher. Parents who endorsed at least one form of maltreatment were classified as exposed to childhood abuse (coded as 1), and the rest were included in the nonabused group (coded as 0).

Parental self-efficacy.

PSE was assessed using an 8-item scale taken from the larger 17-item Parenting Sense of Competence Scale questionnaire (PSOC; Gibaud-Wallston & Wandersmann, 1978). Participants rated the degree of their agreement with each item related to their self-perception of their parenting efficacy (e.g., “Motherhood is something that can be tackled and any problem easily solved”) on a Likert-like scale ranging from 1 (strongly disagree) to 6 (strongly agree). An average score was calculated, such that a higher score indicates a higher level of PSE. In previous research, the scale has shown convergent validity (Gibaud-Wallston & Wandersmann, 1978) and reliability (Gilmore & Cuskelly, 2009). In the current study, the reliability coefficient of the scale was satisfactory (Cronbach’s α = .82).

Parental stress.

The Parenting Stress Index-Short Form Questionnaire (PSI-SF; Abidin, 1995) is a 36-item self-report measure assessing three aspects of parental stress: (a) parental distress (e.g., “I feel trapped in my responsibilities as a parent”), (b) parent-child dysfunctional interaction (e.g., “When I do things for my children, I feel that my efforts are underestimated”), and (c) the child’s difficulties (e.g., “There are some things my child does that are unacceptable to me”). Participants rated the degree of their agreement with each item on a 5-point scale ranging from 1 (very much disagree) to 5 (very much agree). An average score was calculated for the entire scale, with a greater average score indicating a higher parental stress level. Prior studies indicated convergent validity (Haskett et al., 2006) and excellent internal consistency (Reitman et al., 2002). In the current sample, the reliability coefficient of the scale was high (Cronbach’s α = 0.91).

Sociodemographic background.

Mothers completed a brief questionnaire assessing sociodemographic factors, including the age of the mother, country of birth, marital status, economic level (1 = very low to 5 = very high), education level (1= high school education to 6 = advanced academic degree), religious affiliation, number of children, and number of years married or cohabiting.

Data Analysis

A preliminary analysis was conducted using SPSS 25. For the mediation analysis, we used Preacher and Hayes’s (2004) PROCESS macro for SPSS (Model 4). PROCESS employs a regression-based, path-analytical framework, estimating path coefficients in a mediation model and generating bias-corrected bootstrapped confidence intervals (CI) for total, direct, and indirect effects between child abuse and parental stress through PSE. The indirect effect reflects the amount by which the total effect of the independent variable (i.e., child abuse) on the dependent variable (i.e., parental stress) is decreased when the mediator (PSE) is included in the analysis. This technique tests whether the effect of child abuse on parental stress is mediated through an indirect effect of PSE. In our analyses, we used the bootstrapping method based on 5,000 samples to obtain 95% bias-corrected CI. When the 95% CI does not include zero, it indicates a significant conditional indirect effect. PROCESS produces and presents a partially standardized form of coefficients for dichotomous independent variables. We controlled for demographic covariates (i.e., age, economic level, and education level) that were identified as associated with the dependent (parenting stress) and mediator variables (PSI). There were no missing data.

Results

A preliminary analysis indicated that 6.8% of participating mothers reported a childhood history of physical abuse, 15.6% reported sexual abuse, 24.9% reported emotional abuse, and 34.8% reported emotional neglect. Finally, a total of 49% indicated exposure to at least one form of CM.

Descriptive statistics (i.e., means and standard deviations) and correlations of the research variables are presented in Table 1. Exposure to CM was significantly and negatively associated with PSE and positively associated with parental stress. PSE was negatively associated with parental stress. Higher education and the age of the mother were associated with lower PSE, and higher economic levels were associated with greater parental stress.

Table 1.

Means, Standard Deviations, and Zero-Order Correlations of the Study Variables.

	1	2	3	4	5	6	7	M	SD
1. Child abuse	–							27.18	8.47
2. PSE	–.126**	–						4.73	0.67
3. PSI	.253**	–.468**	–					1.94	0.47
4. Education	–.100**	–.113**	–.023	–
5. Economic level	.049	–.049	.149**	–.244**	–
6. Relationship duration	.030	–.015	.020	.106**	–.103**	–		4.56	2.57
7. Age of the mother	.115**	–.127**	.053	.206**	–.060*	.143**	–	31.07	4.23

Note. *p < .05; **p < .01.

Mediation Analyses

Figure 1 presents the mediation analysis of the effects of child abuse on parental stress through PSE. The figure shows that the total effect was statistically significant, such that exposure to childhood abuse was associated with greater parental stress (β = .49, SE = 0.025, p < .001, 95% CI, 0.18-0.28). Next, bootstrapping analysis examining the significance of the indirect effect between childhood abuse and parental stress through PSE showed that zero was not included in the 95% CI (β = 0.11, SE = 0.024, 95% CI [.06, .16]), indicating a significant indirect association between childhood abuse and parental stress through PSE. Childhood abuse was associated with a lower level of PSE (β = –.25, SE = 0.037, p < .001, 95% CI [–0.24 to –0.09]). In turn, greater PSE was associated with lower parental stress (β = –.44, SE = 0.017, p < .001, 95% CI [–0.34 to –0.27]). In this mediation model, the direct effect between childhood abuse and parental stress was significant. However, compared to the initial model (i.e., the total effect), it was reduced in magnitude (β = .38, SE = 0.018, p < .001, 95% CI [0.13-0.22]). This result suggests that the effect between child abuse and parental stress was partly mediated by PSE. In this model, economic level was significantly and positively associated with parental stress (β = .14, SE = 0.015, p < .001, 95% CI [0.05-0.11]), whereas maternal education and age were not significant predictors of parental stress. Education level (β = –.12, SE = 0.018, p < .001, 95% CI [–0.11 to –0.04]), economic level (β = –.07, SE = 0.022, p < .05, 95% CI [–0.11 to –0.02]) and age of the mother (β = –.09, SE = 0.004, p < .01, 95% CI [0.02-0.01]) were negatively associated with PSE. In total, the model explained 27% of the variance in parental stress and 4.5% of PSE.

Figure 1.

Note. PSE = parental self-efficacy. Covariate included effects of economic status, education, and age of the mother on PSE and parental stress. Child abuse (0 = no child abuse; 1 = exposure to child abuse or neglect). Entries are partially standardized coefficients.

Discussion

CM is often committed by caregivers, who are entrusted to provide safety and protection (U.S. Department of Health & Human Services, 2017). Consistent findings have pointed to immediate and lifelong adverse effects of CM (Afifi & MacMillan, 2011), including its link with poor parenting quality (DiLillo & Damashek, 2003). As such, for CM victims, becoming a mother for the first time may be particularly stressful (Deater-Deckard, 2004). Our study aimed to examine a possible mechanism underlying the effects of CM on parental stress during the transition to motherhood. We tested whether PSE accounts for the link between exposure to CM and parental stress in first-time mothers transitioning to parenthood. Our hypothesis was partly supported: PSE partially mediated the link between CM and parental stress. Specifically, exposure to CM was associated with lower PSE, which in turn was associated with greater parental stress. In this mediation model, the effect of CM on parental stress was still evident.

Thus far, research on parental stress has largely focused on the effects of current stressors on parental stress (Mori et al., 2009; Rao & Beidel, 2009). The present study, however, suggests that there are long-term effects of CM on current maternal function, and supports previous findings indicating that the transition to motherhood can be particularly stressful for women with CM histories (Pereira et al., 2012; Schuetze & Eiden, 2005). Through this process, the recurrence of poor parenting may be perpetuated. Understanding the mechanisms by which patterns of parenting are transmitted across generations is crucial for prevention purposes.

This study contributes to the theoretical literature by showing that PSE partly accounts for the relationship between CM and parental stress. Our findings are in line with the social learning theory (Bandura, 1977) and reciprocal determinism (Bandura, 1982), postulating that exposure to a negative parental model in childhood (e.g., abusive behaviors) may result in negative perceptions of one’s ability to provide effective parenting (Bandura, 1977). Furthermore, because CM is considered a complex trauma, theory and research regarding the development of PSE in the context of CM should consider a trauma-informed perspective. The shattered assumptions theory postulates that CM is a trauma that can break basic beliefs about self-worth, including being a positive, moral, and decent individual deserving a good life. Maltreatment violates basic beliefs about being successful, effective, and in control over positive or negative events (Janoff-Bulman, 1989, 1992). Our research is in line with the above theories, as well as with research indicating that child abuse is associated with lower levels of PSE (Bailey et al., 2012; Fitzgerald et al., 2005).

Mothers in our study who reported a higher level of PSE indicated lower parental stress. This finding is consistent with the transactional theory of stress and coping, postulating that low PSE—directly and indirectly—increases parental stress. In general, stress is a product of the interplay between the assessment of a situation as threatening and the perceived available resources to handle it (Abidin, 1995; Folkman et al., 1979). As such, mothers who appraise maternal roles as less threatening and more manageable are likely to experience a lower sense of stress (Abidin, 1995). In contrast, mothers low in PSE tend to perceive themselves as less capable of dealing with challenges or threats (Coleman & Karraker, 1998), including those related to motherhood (Seah & Morawska, 2016).

In the current study, PSE only partially mediated the link between CM and parental stress. The direct link between CM and parental stress may be explained by a range of risk factors involved in this link. Specifically, the actual performance of parenting is another risk factor for parental stress (Deater-Deckard, 2004). CM predicts poor parenting in several ways. First, the social learning theory postulates that observing and imitating negative parental behaviors acquired in an abusive childhood environment (Bandura, 1978b) may result in ineffective parenting performance (Bandura, 1982; DiLillo & Damashek, 2003). Second, CM can lead to the development of an insecure attachment style (Cicchetti & Toth, 2013), which can affect parenting quality later in life (Sroufe in Belsky, 1997). Third, CM can disrupt the development of healthy emotion regulation skills (Cicchetti & Lynch, 1993), which can disrupt the ability to function as an effective parent (Havighurst & Kehoe, 2017). Fourth, women who experienced CM are more likely to exhibit trauma-related distress (Gilbert et al., 2015), which can affect the quality of parental functioning (Ethier et al., 1995; Kaminer et al., 2008; Seng et al., 2011). Dysfunctional parenting can intensify parental stress (Solem et al., 2011). Given that parental stress is stimulated by the perceived threat of a situation that is considered difficult or impossible to handle (Abidin, 1995), it could be that repeated failure to adequately execute parental tasks increases parental stress.

The present study sheds light on the intersection between being a CM victim and being a young mother, both of which pose a risk for social oppression. CM may leave women dealing with trauma-related symptoms (Gilbert et al., 2015) and prejudice (e.g., blaming the victim) (Gibson & Leitenberg, 2001). As women, mothers are more likely to be discriminated against in terms of income and employment, especially after birth and while carrying the majority of the caregiving tasks (Verniers & Vala, 2018). The latter may explain why mothers with a higher education and income in our study reported greater parental stress. Perhaps these mothers maintained more demanding careers that conflicted with their new parental role and subsequently led to more distress and more parental stress (Grice et al., 2007). Although becoming a mother can be stressful for all women, our study showed that the intersection with CM may pose an even greater risk for parental stress. However, because our sample included mostly middle class, native Israeli, married mothers, it is important to study more diverse populations in terms of socioeconomic status, marital status, ethnicity, and sexual identity and to further explore the effects of the interplay between different and simultaneous social identities on maternal functioning in the context of CM.

Limitations and Future Directions

This study showed a new mediation model on the way through which PSE accounts for the link between CM and parental stress in a large sample of Israeli mothers transitioning to motherhood. However, several methodological limitations should be taken into account when interpreting the result. First, using a retrospective, and cross-sectional design is limited in establishing temporal associations and causality between exposure to CM, PSE, and parental stress in adulthood. Second, using retrospective self-report is prone to selection (women with CM histories dropped out) and information bias (e.g., some women failed to recall past abusive relationships). Future prospective longitudinal studies tracking women from early childhood into adulthood may address these limitations.

Third, because participants were recruited through social media, populations with no access to the Internet were excluded. The vast majority of Israelis use Internet services, but it is less common in underprivileged populations, such as people with disabilities, Ethiopian immigrants, or ultra-orthodox Jews (Israel Internet Association, 2021).

Forth, although the prevalence of CM in the current study is consistent with national epidemiological research conducted in Israel using a large random sample of Israeli children and youth (nearly 50% in both studies) (Lev-Wiesel & Isikovich, 2016), clinical samples indicated a higher rate of approximately 65% of CM (Ammerman et al., 2013). Future research should also include clinical samples of women with documented records of CM.

It also should be noted that using an Israeli sample of mothers may restrict the generalizability of the study in other cultures. Israel is considered a family-centered culture, demonstrated by larger birth rates compared with other developed cultures (Central Bureau of Statistics, 2017). As such, in a society that prioritizes parenthood, women may be more susceptible to parental stress. Studies in other cultures may broaden the generalizability of our findings to larger populations.

Lastly, the generalizability of the current findings is limited to women. To date, research has mostly focused on mothers, and only a few emerging studies have assessed men’s PSE or parental stress (Seah & Morawska, 2016). A recent study found that childhood stressors (i.e., morbidity-mortality and economic unpredictability) predict paternal stress through lower PSE (Szepsenwol et al., 2020). However, stressors such as an unpredictable environment predict parental functioning differentially in men and women (Szepsenwol et al., 2015). Hence, further research on the indirect effects of CM on parental stress through PSE should include men.

Clinical Implications

CM is a global problem (WHO, 2017) that places women at risk of abusing their children (Pears & Capaldi, 2001). It is therefore important to develop prevention interventions tailored to the specific needs of parents with a history of childhood abuse. The transition to parenting is often a stressful time for mothers in general, but it is more so for women who were victims of CM (Deater-Deckard, 2004). Hence, it is important to intervene at this critical juncture to help mothers adaptively adjust to their new roles.

This study may contribute to the clinical literature as well as to policymakers by suggesting that strengthening PSE during the transition to parenting may be one effective way of fostering healthy parenting among mothers exposed to CM. The social learning theory postulates that observing and imitating negative parental behaviors acquired in an abusive childhood environment may result in ineffective parenting (Bandura, 1982; DiLillo & Damashek, 2003), which can intensify parental stress (Solem et al., 2011). Prevention interventions focusing on parenting practices could reduce parental stress both directly through modeling healthy parenting skills and indirectly by improving the perceived PSE. Although several programs are effective in improving PSE (Bloomfield & Kendall, 2007), it is important to adapt the interventions for women with histories of CM. Such programs may foster healthy adjustment to the parental role, parental satisfaction, and reduce parental stress (Coleman & Karraker, 2003).

Finally, it should be noted that our study found that PSE only partially accounts for the link between CM and parental stress, indicating that other factors are involved in the effect of CM on maternal stress, such as insecure attachment style (Cicchetti & Toth, 2013) or trauma-related distress (Gilbert et al., 2015). Therefore, interventions should incorporate additional components to prevent the intergenerational transmission of parental dysfunction.

Footnotes

Acknowledgments

This research was supported by a scholarship from the Tuvali-Elkin foundation.

Declaration of Conflicting Interests

Funding

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

ORCID iDs

Gabriella Bentley

Osnat Zamir

Author Biographies

Gabriella Bentley is a PhD candidate at The Paul Baerwald School of Social Work and Social Welfare at The Hebrew University of Jerusalem, Israel. Her work focuses on trauma in the family context such as, loss of a child, trauma in childhood, and the link to the transition to parenthood. Another area of research is examining risk and protective factors for fear of cancer recurrence and resilience, among breast cancer patients.

Osnat Zamir is an assistant professor at The Paul Baerwald School of Social Work and Social Welfare at the Hebrew University of Jerusalem, Israel. Her work focuses on risk and protective factors for effective parenting and child development in the context of stress, including exposure to breast cancer, the transition to parenthood, and political violence. She is also examining risk and protective factors for healthy marital relationships following exposure to trauma, and prevention interventions for families coping with stress.

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