CLEVELAND, Ohio — Mothers with post-traumatic stress disorder (PTSD) were more likely to report physically or psychologically abusing their children than those who were depressed, according to new research reported Monday in JAMA Pediatrics.
Children of mothers with PTSD were also exposed to the highest lifetime average number of traumatic events, compared to the children of mothers who were depressed, had no diagnosis, or were both depressed and had suspected PTSD. Exposure to trauma in childhood has been associated with many negative outcomes, including depression, poor quality of life, smoking, suicide attempts, adolescent pregnancy, STDs, and alcoholism.
The research, conducted by a team at the New York University School of Medicine and Maimonides Medical Center in Brooklyn, New York, involved 97 mothers of children ages 3 to 5 years old. Most of the mothers were single parents who were between 22 and 30 years old and were recruited at a pediatric visit in an urban setting.
Most research on PTSD, depression and child abuse and neglect has ignored that the two mental disorders are often linked. About 6.8 percent of adults have PTSD, according to the the National Comorbidity Survey Replication, a nationally-representative mental health survey. The same survey revealed that about one quarter of depressed women have PTSD and 48.4 percent of women with PTSD have depression.
In the current study, women who showed signs of both PTSD and depression together (10 percent of mothers, referred to as comorbid) reported higher levels of PTSD severity and higher levels of physical and psychological aggression toward their children compared to mothers without a suspected mental health diagnosis (72 percent of mothers). Comorbid mothers also reported the highest level of parenting stress.
Mothers in the study answered questions about their own mental health, parenting stress, and their child’s exposure to traumatic events. To assess abuse or neglect, the researchers used a tool called the Conflict Tactics Scale. The scale includes questions on nonviolent discipline, psychological aggression, minor physical assault, severe physical assault, very severe physical assault, and neglect.
More than one in four children nationwide experience a serious traumatic event before age 16, according to the federally-funded National Child Traumatic Stress Network (NCTSN). Previous research has shown a link between depression in mothers and child abuse and neglect. In the current study, severity of a mother’s depression predicted how likely a child was to be at risk of abuse or neglect.
The researchers acknowledge their results may not generalize to other children in other settings, and that self-report of abuse, neglect and trauma to children can be unreliable. “The effects of maternal depression and PTSD on parenting should be evaluated by direct observation of behavior,” they write.
But, they say, the research may have value in identifying children at risk of abuse or neglect.
“Because pediatric primary care is accessed by a very large proportion of families of young children, screening for maternal PTSD and depression in this setting may improve the identification and prevention of child maltreatment,” the authors wrote.