Parental support, family conflict, and overprotectiveness: Predicting PTSD symptom levels of adolescents 28 months after a natural disaster

Background: Many studies have reported the comorbidity of posttraumatic stress disorder (PTSD) and depression in children. However, the underlying relationship between PTSD and depression remains unclear.Objective: This study examines the relationship between PTSD and depressive symptoms in children who survived the Wenchuan earthquake in China.Methods: In total, 301 children were assessed at four months and then followed up at 29, 40 and 52 months after the disaster. The ages of the children ranged from 9.6–14.6 years old, and the sample included 157 males and 144 females. The children were assessed by using the University of California at Los Angeles PTSD reaction index for DSM-IV for PTSD symptoms and the Children’s Depression Inventory for depressive symptoms.Results: Comorbid PTSD and depressive symptoms were prevalent in 4.0, 3.3, 3.7 and 5.1% of the participants at times 1, 2, 3 and 4, respectively. The cross-lagged analysis indicated that PTSD symptoms at time 1 predicted depressive symptoms at time 2; depressive symptoms at time 1 predicted PTSD symptoms at time 2; depressive symptoms at time 2 predicted PTSD symptoms at time 3; and depressive symptoms at time 3 predicted PTSD symptoms at time 4. The findings also showed that being female, poor parental relationships and trauma exposure were risk factors for PTSD or depressive symptoms.Conclusions: The results suggest that the causal relationship between PTSD and depressive symptoms changes over time; the effects of PTSD symptoms tend to decrease, while those of depressive symptoms tend to increase. Two stages of the relationship between PTSD and depressive symptoms were observed, namely, that PTSD and depressive symptoms first influenced each other and then that depressive symptoms predicted PTSD. The results of our study also suggest that females with poor parental relationships and a high degree of trauma exposure are more likely to require intervention.

Section: Introductionmentioning

confidence: 99%

Posttraumatic stress and depressive symptoms in children after the Wenchuan earthquake

Cheng

Liang

et al. 2018

“…However, the majority of studies examining how social support impacts youth distress post-disaster are correlational and retrospective, and do not include bidirectional models. As an example, Bokszczanin (2008) found that parent social support predicted levels of PTSS among adolescents 28 months after a flood. Assessments in that study were completed at one timepoint only.…”

Section: Discussionmentioning

confidence: 99%

“…At the same time, social support may be an important protective factor that buffers children from experiencing significant symptoms of distress (Jieling & Xinchun, 2017; Ma et al, 2011). Inadequate social support is a significant risk factor for PTSS in response to multiple types of disasters, including floods, tornados, hurricanes, earthquakes, fires, and man-made disasters (Bokszczanin, 2008, 2012; Danielson et al, 2017; La Greca et al, 2013). This is an important association among adults as well, as demonstrated by a meta-analysis of risk factors for Posttraumatic Stress Disorder among adults, which found lack of social support to have stronger effects than pre-trauma factors on Posttraumatic Stress Disorder (Brewin, Andrews, & Valentine, 2000).…”

mentioning

confidence: 99%

The relationship between social support and posttraumatic stress symptoms among youth exposed to a natural disaster

Lai

Osborne

Piscitello

et al. 2018

Background: Children are a vulnerable population following a natural disaster, due to their age and dependence on adults. The primary presenting problem children report after disasters is posttraumatic stress symptoms (PTSS). Prior research suggests that PTSS is inversely related to social support, which is often disrupted after a disaster. Objective: This study examined the relationship between social support (from parents, teachers, and peers) and PTSS in children affected by Hurricane Katrina. The research contributes to the literature by examining the mechanisms that drive this relationship over time. Methods: In this study, 426 children were followed over four timepoints, beginning 3–7 months after Hurricane Katrina and concluding 25–27 months post-hurricane. Three path models analysed the relationship between social support (from parents, teachers, and peers, measured by the Social Support Scale for Children) and PTSS (measured by the UCLA PTSD Reaction Index). Covariates included child age, minority status, gender, perceived life threat, and actual life threat. Nonsignificant paths were trimmed from the final models. Global fit indices were examined to determine model fit. Results: In the parent and peer social support models, PTSS exhibited statistically significant effects on social support from one wave to the next. In the teacher model, this was only true between Waves 2 and 3. Social support showed a statistically significant effect on PTSS between Wave 2 and Wave 3 in the peer model (standardized estimate = −0.26, p < .0001). No paths from social support to PTSS were significant in the parent and teacher models. Conclusion: Findings support a social selection model in which PTSS undermine social support, particularly in the first two years post-disaster. If these findings are replicated, this suggests that, in cases of limited funding, PTSS should be prioritized, given their cascading effects on social support.

“…In terms of the existing evidence base, parental overprotection and encouragement of avoidant coping (e.g., avoiding trauma reminders, discouraging trauma-related discussion) have previously been associated with poor child psychological adjustment following trauma (Bokszczanin, 2008; Ehlers, Mayou, & Bryant, 2003; Henry, Tolan, & Gorman-Smith, 2004). Based on cognitive models of PTSD (e.g., Ehlers & Clark, 2000), such coping styles have been hypothesized to increase children’s perception that they are very vulnerable or damaged by the event – a key predictor of poor psychological adjustment (Meiser-Stedman, Dalgleish, Glucksman, Yule, & Smith, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Evidence for the relationship between maladaptive parenting responses (e.g. overprotection, encouragement of avoidant coping) and child PTSS is more robust (e.g., Bokzczanin et al, 2008; Ehlers et al, 2003); nonetheless, our understanding of the relationship between parenting and child PTSS is hampered by the fact that many studies to date have utilized non-validated measures of post-trauma parenting responses.…”

Section: Introductionmentioning

confidence: 99%

The Parent Trauma Response Questionnaire (PTRQ): development and preliminary validation

Williamson

Hiller

Meiser‐Stedman

et al. 2018

Background: Following a child’s experience of trauma, parental response is thought to play an important role in either facilitating or hindering their psychological adjustment. However, the ability to investigate the role of parenting responses in the post-trauma period has been hampered by a lack of valid and reliable measures. Objectives: The aim of this study was to design, and provide a preliminary validation of, the Parent Trauma Response Questionnaire (PTRQ), a self-report measure of parental appraisals and support for children’s coping, in the aftermath of child trauma. Methods: We administered an initial set of 78 items to 365 parents whose children, aged 2–19 years, had experienced a traumatic event. We conducted principal axis factoring and then assessed the validity of the reduced measure against a standardized general measure of parental overprotection and via the measure’s association with child post-trauma mental health. Results: Factor analysis generated three factors assessing parental maladaptive appraisals: (i) permanent change/damage, (ii) preoccupation with child’s vulnerability, and (iii) self-blame. In addition, five factors were identified that assess parental support for child coping: (i) behavioural avoidance, (ii) cognitive avoidance, (iii) overprotection, (iv) maintaining pre-trauma routines, and (v) approach coping. Good validity was evidenced against the measure of parental overprotection and child post-traumatic stress symptoms. Good test–retest reliability of the measure was also demonstrated. Conclusions: The PTRQ is a valid and reliable self-report assessment of parenting cognitions and coping in the aftermath of child trauma.