Maternal Chronic Pain Associated with Child Psychological Symptoms Through Pain-Specific Parenting and Child Distress Tolerance

• In Event: Parenting Practices as Mechanisms for Transmission of Maternal Risk Factors and Child Psychological Outcomes

Abstract

Parental chronic pain is associated with negative child psychological symptoms (Higgins et al., 2015), and prevalence rates of chronic pain are increasing at an alarming rate (Institute of Medicine, 2011). General parenting (e.g., inconsistent responding) and pain-specific parenting behaviors (e.g., those that model or reinforce children’s pain responses) are theorized as important mechanisms underlying the intergenerational transmission of risk in families with chronic pain (Stone & Wilson, 2016), but empirical evidence testing these pathways is limited. The present study served to empirically test mechanistic pathways between maternal pain and child psychological symptoms one year later through parenting behaviors and child distress tolerance, and characterize general and pain-specific parenting behaviors in a longitudinal sample of 400 mothers with chronic pain and their children (Mage=9.82 years, SD=1.36).
To test the mechanistic model of how maternal pain may impact child psychological symptoms, we used structural equation modeling. Specifically, we tested the direct association between maternal pain and child psychological symptoms one year later, as well as the indirect associations through parenting behaviors and child distress tolerance. Latent variables for maternal pain (pain intensity at best, worst, and on average; interference experienced due to pain) and child psychological symptoms (depression, anxiety, anger) were created. Composite variables were created for pain-specific parenting (catastrophizing and protectiveness in response to child’s pain) and negative parenting (inconsistent discipline, poor supervision). An exploratory latent profile analysis was then used to identify parenting profiles unique to mothers with chronic pain in which we included general parenting (inconsistent discipline, poor supervision, positive parenting) and pain-specific parenting practices (catastrophizing, protectiveness).
In the structural equation model (see Figure 1), higher maternal pain was significantly associated with higher levels of positive parenting and pain-specific parenting behaviors. In turn, higher pain-specific parenting behaviors were significantly associated with lower levels of child distress tolerance one year later. Lower levels of child distress tolerance were significantly associated with higher levels of child psychological symptoms. In the exploratory analyses, four profiles of parenting emerged (see Figure 2). Profiles were characterized by (1)“Average Parenting” (76.2%, n=304), as well as elevated levels of (2)“Poor Supervision” (10.3%, n=41), (3)“Pain-Specific Parenting” (14.5%, n=44), and (4)“Very Poor Supervision” (2.5%, n=10). Multinomial logistic regressions showed that both maternal pain intensity and interference was associated with increased odds of being in the profile characterized by elevated pain-specific parenting.
Findings suggest some mothers experiencing chronic pain engage in parenting characterized by poor supervision, as well as catastrophizing and protectiveness in response to their child’s pain. Mothers experiencing more pain and pain interference are more likely to engage in parenting characterized by high levels of pain-specific parenting. Importantly, pain-specific parenting was significantly associated with lower child distress tolerance one year later, which was directly associated with negative child psychological outcomes. The direct effects between parenting behaviors and child psychological outcomes were not significant, suggesting child distress tolerance may be an important mediator of this relationship. Results highlight pain-specific parenting and child distress tolerance as potential intervention points to disrupt the intergenerational transmission of risk in this context.

Authors

• Jacqueline O'Brien, University of Oregon
  Presenting Author

• Angela H. Lee, University of Oregon
  Non-Presenting Author

• Amanda L. Stone, Vanderbilt University Medical Center
  Non-Presenting Author

• Maureen Zalewski, University of Oregon
  Non-Presenting Author

• Anna C. Wilson, Oregon Health & Science University
  Non-Presenting Author