An investigation of parent posttraumatic cognitions and mental health outcomes after trauma exposure in children

Abstract

© 2017 Dr. Elizabeth Jane SchilpzandIntroduction: Parent posttraumatic cognitions have received little attention in the childhood posttraumatic stress literature, yet potentially play an important role in understanding how parents influence children’s recovery after trauma. The manner in which parents respond to their child’s experience is important in the development and treatment of childhood posttraumatic stress disorder (PTSD), and a range of parenting behaviours and parent psychological problems have been linked to childhood posttraumatic stress (Trickey, Siddaway, Meiser-Stedman, Serpell, & Field, 2012; Williamson et al., 2017). To date, limited empirical attention has been given to the nature of cognitions in parents of trauma-exposed children, and the research has been restricted to the use of small item pools, as a multidimensional measure of parent posttraumatic cognitions related to the child’s recovery had yet to be operationalised. The overall aim of this program of research was to develop a measure of parent posttraumatic cognitions for use after a child has experienced a traumatic event, and to examine whether these parent cognitions related to child and parent mental health outcomes. Method: This research had two parts. In Part A, a parent-report questionnaire, the Thinking About Recovery Scale (TARS), was developed to assess specific negative posttraumatic cognitions parents may have after their child is exposed to trauma. The theoretical-rational approach to scale development was used to generate items, which were then subjected to review by experts in the field of childhood trauma. In Part B, the TARS was used in a cross-sectional study, the Thinking About Recovery Project, to examine whether parent posttraumatic cognitions were related to mental health outcomes using a sample of parents and children after children’s experience of accidental injury. Participants were 116 parents and 88 children aged 8-16 years who had been physically injured (e.g., sporting injury, burns, motor vehicle accident) and subsequently admitted to hospital for at least 24 hours. Data collection involved questionnaires to assess parent and child posttraumatic cognitions and mental health outcomes (posttraumatic stress, depression, anxiety, externalising symptoms) between 3 and 6 months post injury. Results: The development and psychometric evaluation of the TARS is reported. The 33-item scale measuring three domains (My child has been permanently damaged; The world is dangerous for my child; Parents should always promote avoidance) demonstrated sound internal consistency and convergent validity when piloted in a sample of 116 parents of children who had been exposed to a serious accidental injury. Posttraumatic cognitions parents had about themselves, the world, and their child’s recovery were significantly associated with both parent and child posttraumatic stress symptoms (PTSS), and a range of other mental health outcomes. A range of parent posttraumatic cognitions were significantly associated with child posttraumatic cognitions. Parent cognitions related to the child mediated the relationship between parents and child PTSS. Discussion and Conclusion: This research was a necessary step in advancing knowledge about parental influences on children’s recovery from traumatic events. Findings provide an empirical basis for ongoing investigation into how parent posttraumatic cognitions may be contributing to the development and maintenance of PTSD symptomatology in parents and children, with particular consideration to cognitions parents have related to their child’s recovery