Trauma and Parenting Beliefs : Exploring the Ethnotheories and Socialization Goals of Palestinian Mothers

Parenting beliefs are important to infant wellbeing, but there is a lack of research into their role in war conditions. We examined (1) how maternal traumatic experiences (war events and childhood abuse) and mental health would be associated with parenting beliefs about good childrearing practices (ethnotheories) and desirable child characteristics (socialization goals) and (2) whether parenting beliefs mediate the impact of traumatic experiences and mental health on mother-infant interaction and infant development. Palestinian mothers (N = 510) participated during pregnancy and at four and 12 months postpartum. They reported current traumatic war events, emotional and physical abuse in their own childhood and mental health (posttraumatic stress disorder, depression, and anxiety symptoms), their ethnotheories and socialization goals and the quality of dyadic mother-infant interactions and infant developmental skills (language, fine-motor, and gross-motor). High maternal exposure to traumatic war events was associated with higher autonomy-enhancing-and lower relatedness-enhancing-socialization goals. Conversely, maternal childhood abuse was associated with higher relatedness-enhancing-and lower autonomy-enhancing-socialization goals. High maternal exposure to traumatic war events was associated with high levels of positive dyadic interaction, whereas high emotional and physical abuse and mental health problems were associated with low levels of positive dyadic interaction. Parenting beliefs did not mediate the impact of maternal traumatic experiences and mental health on dyadic interaction or infant development. The nature of maternal traumatic experiences was central for the socialization goals in unique and specific ways. The findings emphasize the meaningfulness of parenting values, goals, and practices among mothers caring for their infants in war conditions.Peer reviewe

How family relationships predict the effectiveness of a psychosocial group intervention among war-affected children

Family relationships habitually shape the way traumatic events affect children’s mental health in a context of war and violence, but research is scarce on the role these relationships play in the success of psychosocial interventions. This study is a secondary analysis of previously identified family system types that are based on attachment, parenting, and siblingship, and of the influence they have on the effectiveness of teaching recovery techniques (TRT). TRT is a psychosocial group intervention aimed at reducing children’s mental health problems and increasing their psychosocial resources. We tested three hypotheses. First was the compensation hypothesis, which holds that children from families with negative relationships benefit a great deal from the TRT intervention. The second was the accumulative hypothesis, which maintains that children from families with negative relationships do not benefit from the intervention. The third, the buffering hypothesis, states that children from families with positive relationships benefit a great deal from the intervention. The family sample consists of 325 Palestinian mothers and fathers and one of their children (age 10–13). Children participated either in the TRT intervention or waiting-list control groups. Their self-reported post-traumatic stress symptoms, emotional and conduct problems, positive resources, and prosocial behavior were assessed at baseline, three months post-intervention, and at a six-month follow-up. We found that family type was significantly associated with TRT effectiveness, which supports the compensation and buffering hypotheses. Children with insecure and negative family relationships and those from families with discrepant perceptions of relationship quality showed a decline in emotional problems across the three assessments, and an increase in positive resources. Children from families with highly secure, positive relationships and those with moderately secure, neutral relationships showed increased positive resources and prosocial behavior in the control group as well. We argue that a family system approach can deepen understanding of the mechanisms of successful psychosocial interventions and, therefore, that family relations should be taken into account when tailoring such interventions for traumatized children.publishedVersionPeer reviewe

Family systems approach to attachment relations, war trauma, and mental health among Palestinian children and parents

Background: Trauma affects the family unit as a whole; however, most existing research uses individual or, at most, dyadic approaches to analyse families with histories of trauma. Objective: This study aims to identify potentially distinct family types according to attachment, parenting, and sibling relations, to analyse how these family types differ with respect to war trauma, and to explore how children’s mental health and cognitive processing differ across these family types. Method: Participants included Palestinian mothers and fathers (N = 325) and their children (one per family; 49.4% girls; 10–13 years old; mean ± SD age = 11.35 ± 0.57 years) after the Gaza War of 2008–2009. Both parents reported their exposure to war trauma, secure attachment availability, and parenting practices, as well as the target child’s internalizing and externalizing symptoms [Strengths and Difficulties Questionnaire (SDQ)]. Children reported their symptoms of post-traumatic stress disorder (on the Children’s Revised Impact Event Scale), depression (Birleson), and SDQ, as well as their post-traumatic cognitions (Children’s Post Traumatic Cognitions Inventory). Results: A cluster analysis identified four family types. The largest type reflected secure attachment and optimal relationships (security and positive family relationships, 36.2%, n = 102), and the smallest exhibited insecurity and problematic relationships (insecurity and negative family relationships, 15.6%; n = 44). Further, families with discrepant experiences (23.0%; n = 65) and moderate security and neutral relationships (25.2%; n = 71) emerged. The insecurity and negative relationships family type showed higher levels of war trauma; internalizing, externalizing, and depressive symptoms among children; and dysfunctional post-traumatic cognitions than other family types. Conclusion: The family systems approach to mental health is warranted in war conditions, and therapeutic interventions for children should, thus, also involve parents and siblings. Knowledge of unique family attachment patterns is fruitful for tailoring therapeutic treatments and preventive interventions for war-affected children and families

How Family Relationships Predict the Effectiveness of a Psychosocial Group Intervention among War-Affected Children

Family relationships habitually shape the way traumatic events affect children’s mental health in a context of war and violence, but research is scarce on the role these relationships play in the success of psychosocial interventions. This study is a secondary analysis of previously identified family system types that are based on attachment, parenting, and siblingship, and of the influence they have on the effectiveness of teaching recovery techniques (TRT). TRT is a psychosocial group intervention aimed at reducing children’s mental health problems and increasing their psychosocial resources. We tested three hypotheses. First was the compensation hypothesis, which holds that children from families with negative relationships benefit a great deal from the TRT intervention. The second was the accumulative hypothesis, which maintains that children from families with negative relationships do not benefit from the intervention. The third, the buffering hypothesis, states that children from families with positive relationships benefit a great deal from the intervention. The family sample consists of 325 Palestinian mothers and fathers and one of their children (age 10–13). Children participated either in the TRT intervention or waiting-list control groups. Their self-reported post-traumatic stress symptoms, emotional and conduct problems, positive resources, and prosocial behavior were assessed at baseline, three months post-intervention, and at a six-month follow-up. We found that family type was significantly associated with TRT effectiveness, which supports the compensation and buffering hypotheses. Children with insecure and negative family relationships and those from families with discrepant perceptions of relationship quality showed a decline in emotional problems across the three assessments, and an increase in positive resources. Children from families with highly secure, positive relationships and those with moderately secure, neutral relationships showed increased positive resources and prosocial behavior in the control group as well. We argue that a family system approach can deepen understanding of the mechanisms of successful psychosocial interventions and, therefore, that family relations should be taken into account when tailoring such interventions for traumatized children

War trauma and infant motor, cognitive, and socioemotional development : Maternal mental health and dyadic interaction as explanatory processes

Background: Taking care of infants in conditions of war is highly demanding and a few studies reveal the negative impact of war trauma on maternal and infant well-being. Yet, little is known regarding the influence of trauma on infant development and the potential explanatory mechanisms. First, the present study examines how mothers’ prenatal exposure to traumatic war events is associated with infant cognitive, motor, and socioemotional development. Second, it analyses the mediating roles of maternal postpartum mental health problems, quality of dyadic mother-infant interaction, and earlier infant development (at six months) in the association between prenatal traumatic war events and infants’ developmental skills at 18 months. Method: This prospective three-wave study involved 502 Palestinian pregnant females in their first trimester during the 2014 Gaza War and participated at delivery (T1) and when the child was six (T2;N = 392) and eighteen (T3; N = 386) months of age. Mothers reported their exposure to traumatic war events (human and material losses, horrors, and threat to life) at T1 and T2, and researchers photo-documented the extent of destruction at T1. Mothers reported infants’ language, fine- and gross-motor, and socioemotional skills at T2 and researchers tested infants’ motor, cognitive-language and socioemotional skills using the Bayley Scales of Infant development (BSID-II) at T3. Mothers reported their mental health problems (symptoms of post-traumatic stress disorder [PTSD], depression and somatization) at T2 and T3 as well as dyadic interaction quality (the emotional availability self-report, [EA-SR] brief) at T2. Results: First, the structural equation model (SEM) on direct effects indicated, in contrast to our hypotheses, that maternal prenatal exposure to traumatic war events did not associate with infants’ developmental skills at T2 and predicted higher level of developmental skills at T3. Second, as hypothesized, we found two negative underlying mechanisms (paths) between high exposure and low levels of motor, cognitive-language, and socioemotional skills at T3: (1) through increased maternal mental health problems at T2, which then were associated with problems at T3, and (2) through increased maternal mental health problems at T2, which then were associated with a low quality of mother-infant-interaction and low level of infant developmental skills at T2. Conclusion: Improving maternal mental health and encouraging close and positive dyadic interaction can be critical for infant sensorimotor, cognitive, and socioemotional development in war conditions.publishedVersionPeer reviewe

War trauma and maternal-fetal attachment predicting maternal mental health, infant development, and dyadic interaction in Palestinian families

Optimal maternal–fetal attachment (MFA) is believed to be beneficial for infant well-being and dyadic interaction, but research is scarce in general and among risk populations. Our study involved dyads living in war conditions and examined how traumatic war trauma associates with MFA and which factors mediate that association. It also modeled the role of MFA in predicting newborn health, infant development, mother–infant interaction, and maternal postpartum mental health. Palestinian women from the Gaza Strip (N = 511) participated during their second trimester (T1), and when their infants were 4 (T2) and 12 (T3) months. Mothers reported MFA (interaction with, attributions to, and fantasies about the fetus), social support, and prenatal mental health (post-traumatic stress disorder, depression, and anxiety) at T1, newborn health at T2, and the postpartum mental health, infant’s sensorimotor and language

Data from: A cross sectional study of the relationship between the exposure of pregnant women to military attacks in 2014 in Gaza and the load of heavy metal contaminants in the hair of mothers and newborns

OBJECTIVE: Metal contamination of humans in wars areas was rarely investigated. Weaponry’s heavy-metals become environmentally stable war-remnants and accumulate in livings. They pose health risks also by prenatal intake and potential long-term risks for reproductive and children’s health. We studied the contribution by military attacks to the load of 23 metals in the hair of Palestinian women in the Gaza Strip, pregnant at the time of military attacks in 2014, and their newborns. We compared the metal load in the mothers with values of adult hair from outside war area (RHS), as reference. We investigated heavy metals trans-passing in utero and assessed if risky heavy metals intake could come from not war-related sources. DESIGN: Cross-sectional study. PARTICIPANTS AND SETTING: Random cohort of 502 mothers delivering in the Gaza Strip and their newborns. MAIN OUTCOME MEASURED: Measure of the load of heavy-metals in mother and newborn hair by Inductively Coupled Plasma Mass Spectrometry (ICP/MS). Comparison of metal load with RHS, between groups with different exposures to attacks and house/agriculture chemicals, and between mothers and newborns. Data for birth registry and for exposures to war and other known risk factors were obtained at interviews with mothers. Photo documentation of damage from military attacks. RESULTS: The whole cohort had significantly higher load of heavy metals than RHS. Women exposed to military attacks had significantly higher load of heavy metals than those not exposed; the load in newborns correlated positively with mothers’; no significant difference was found between users/not users of house/agriculture chemicals; no other known confounder was identified. CONCLUSIONS: High heavy-metals loads in mothers, reflected in those of their newborns, are associated with exposure to military attacks posing risk of immediate and long-term negative outcomes for pregnancy and child health. Surveillance, biomonitoring and further research are recommended. Implications for general and public health are discussed