Psychosocial pathways of intergenerational transmission of parental trauma and mental health problems in Rwanda

• In Event: Intergenerational impacts of war and instability: Caregiver trauma exposure, mental health, parenting, and offspring development

Abstract

Background: Millions of people worldwide experience trauma. Trauma has long-lasting effects on the mental well-being of those exposed. Beyond the immediate devastating consequences to the individual, trauma may affect the wider family system thereby potentially impacting the development and emotional wellbeing of subsequent generations. Studies of war-affected populations have found that the mental health of parents exposed to war and armed conflict correlates with mental health outcomes of offspring that was not directly exposed to trauma. In particular, children are vulnerable to the mental health of caregivers, who may struggle to effectively engage in warm, responsive interactions, and to attend to children’s emotional and physical needs. In this paper we use longitudinal data from a study of caregivers who live in severe poverty in rural Rwanda to test the hypothesis that trauma and hardship affect caregivers’ mental health, which in turn affects parenting behaviors. We further hypothesize that some of the effect of caregivers’ mental health on parenting behaviors are accounted for by emotion dysregulation. Emotion dysregulation is an important unifying symptom that cuts across diagnose and can be addressed using common elements of evidence-based intervention models tested with traumatized populations.
Methods: We use data from 732 caregivers of children aged 6–36 months, and who live in poor rural households in Rwanda. Trauma and daily hardships are assessed using questionnaires from previous studies of war affected populations. Caregivers’ internalizing symptoms (depression and anxiety) are assessed using Hopkin’s Symptoms Checklist (HSCL-25). Caregiver posttraumatic stress disorder symptoms are assessed using the PTSD Checklist-Civilian Version (PCL-C). Parenting behaviors are assessed using the Parent Acceptance-Rejection Questionnaire (PARQ) to assess rejection and acceptance. Finally, caregiver emotion regulation is assessed using the Difficulties in Emotion Regulation Scale (DERS). Analyses are conducted using structural equation modelling in Mplus. Indirect effects of trauma and hardship on parenting behaviours are modeled as indirect effects.
Results: Results are shown in Figure 1 and 2. Cumulative trauma exposure is associated with higher levels of internalizing (anxiety and depression) and post-traumatic stress disorder (PTSD) symptoms which, in turn, predict less accepting and more rejecting parenting behaviors. Caregiver internalizing is associated with more rejection only, while caregiver PTSD is associated with both low acceptance and high rejection. Caregiver internalizing and PTSD symptoms are associated with emotion dysregulation, which accounts for large portions of the effect of mental health symptoms on parenting behaviors. Indirect effects suggest that while caregiver trauma and hardships have no direct effects on parenting, both affect parenting indirectly via poor caregiver mental health and emotion dysregulation.
Conclusions: Caregiver internalizing and PTSD symptoms are important mechanisms through which caregiver trauma and hardship affect parenting behaviors. Emotion dysregulation is a shared mechanism linking caregiver mental health problems with low acceptance and high rejection in parenting. Emotion regulation is indicated as a key target for prevention of adverse effects of caregiver trauma on mental health and child wellbeing.

Authors

• Sarah Jensen, Boston College
  Presenting Author

• Vincent Sezibera, University of Rwanda
  Non-Presenting Author

• Shauna M. Murray, Boston College
  Non-Presenting Author

• Robert T Brennan, Research Program for Children and Adversity at Boston College
  Non-Presenting Author

• Theresa Stichick Betancourt, Boston College
  Non-Presenting Author