Examining Associations between Maternal Trauma, Child Attachment Security, and Child Behaviours in Refugee Families
DOI:
https://doi.org/10.25071/1920-7336.41085Keywords:
attachment, trauma, depression, refugee, mother-chiildAbstract
We examined post-traumatic stress disorder (PTSD) and depressive symptoms in refugee mothers and the relationships between maternal trauma, child attachment security, and child internalizing and externalizing behaviours. Results from 36 mothers of children 18–70 months old indicated that while 94.4% of mothers reported experiencing trauma, only 2.8% reported clinically elevated PTSD symptoms. Maternal PTSD symptoms were correlated with child internalizing and externalizing behaviours. Attachment security was negatively correlated with internalizing and externalizing behaviours. Attachment security moderated the relationship between PTSD symptoms and externalizing behaviours; PTSD symptoms predicted externalizing behaviours for children with low attachment security only. This suggests that child attachment security may protect against maternal trauma.
Metrics
References
Abbey, S., Charbonneau, M., Tranulis, C., Moss, P., Baici, W., Dabby, L., Gautam, M., & Paré, M. (2011). Stigma and discrimination. Canadian Journal of Psychiatry, 56(10), 1–9. https://pubmed.ncbi.nlm.nih.gov/22014688/
Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA preschool forms and profiles: An integrated system of multi-informant assessment. ASEBA.
Ahmed, A., Bowen, A., & Feng, C. X. (2017). Maternal depression in Syrian refugee women recently moved to Canada: A preliminary study. BMC Pregnancy and Childbirth, 17(1), 1–11. https://doi.org/10.1186/s12884-017-1433-2 DOI: https://doi.org/10.1186/s12884-017-1433-2
Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Lawrence Erlbaum. DOI: https://doi.org/10.1037/t28248-000
Alpak, G., Unal, A., Bulbul, F., Sagaltici, E., Bez, Y., Altindag, A., Dalkilic, A., & Savas, H. A. (2015). Post-traumatic stress disorder among Syrian refugees in Turkey: A cross-sectional study. International Journal of Psychiatry in Clinical Practice, 19(1), 45–50. https://doi.org/10.3109/13651501.2014.961930 DOI: https://doi.org/10.3109/13651501.2014.961930
Althubaiti, A. (2016). Information bias in health research: Definition, pitfalls, and adjustment methods. Journal of Multidisciplinary Healthcare, 9, 211–217. https://doi.org/10.2147/JMDH.S104807 DOI: https://doi.org/10.2147/JMDH.S104807
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 DOI: https://doi.org/10.1176/appi.books.9780890425596
Atkinson, L., Paglia, A., Coolbear, J., Niccols, A., Parker, K. C. H., & Guger, S. (2000). Attachment security: A meta-analysis of maternal mental health correlates. Clinical Psychology Review, 20(8), 1019–1040. https://doi.org/10.1016/S0272-7358(99)00023-9 DOI: https://doi.org/10.1016/S0272-7358(99)00023-9
Baker, E., Beech, A., & Tyson, M. (2006). Attachment disorganization and its relevance to sexual offending. Journal of Family Violence, 21(3), 221–231. https://doi.org/10.1007/s10896-006-9017-3 DOI: https://doi.org/10.1007/s10896-006-9017-3
Barnes, J., & Theule, J. (2019). Maternal depression and infant attachment security: A meta-analysis. Infant Mental Health Journal, 40(6), 817–834. https://doi.org/10.1002/imhj.21812 DOI: https://doi.org/10.1002/imhj.21812
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory-II: Manual. Psychological Corporation. DOI: https://doi.org/10.1037/t00742-000
Berthold, S. M., Mollica, R. F., Silove, D., Tay, A. K., Lavelle, J., & Lindert, J. (2019). The HTQ-5: Revision of the Harvard Trauma Questionnaire for measuring torture, trauma and DSM-5 PTSD symptoms in refugee populations. European Journal of Public Health, 29(3), 468–474. https://doi.org/10.1093/eurpub/cky256 DOI: https://doi.org/10.1093/eurpub/cky256
Bosquet-Enlow, M., Egeland, B., Carlson, E., Blood, E., & Wright, R. J. (2014). Mother–infant attachment and the intergenerational transmission of posttraumatic stress disorder. Developmental Psychopathology, 26(1), 41–65. https://doi.org/10.1017/S0954579413000515 DOI: https://doi.org/10.1017/S0954579413000515
Bowlby, J. (1982). Attachment and loss: Vol. 1. Attachment (2nd ed.). Basic Books.
Bronstein, I., & Montgomery, P. (2011). Psychological distress in refugee children: A systematic review. Clinical Child and Family Psychology Review, 14(1), 44–56. https://doi.org/10.1007/s10567-010-0081-0 DOI: https://doi.org/10.1007/s10567-010-0081-0
Buchmüller, T., Lembcke, H., Busch, J., Kumsta, R., & Leyendecker, B. (2018). Exploring mental health status and syndrome patterns among young refugee children in Germany. Frontiers in Psychiatry, 9, 1–12. https://doi.org/10.3389/fpsyt.2018.00212 DOI: https://doi.org/10.3389/fpsyt.2018.00212
Byrow, Y., Pajak, R., Specker, P., & Nickerson, A. (2020). Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees: A systematic review. Clinical Psychology Review, 75, Article 101812. https://doi.org/10.1016/j.cpr.2019.101812 DOI: https://doi.org/10.1016/j.cpr.2019.101812
Cadman, T., Diamond, P., & Fearon, P. (2018). Reassessing the validity of the attachment Q-sort: An updated meta-analysis. Infant and Child Development, 27(1), Article e2034. https://doi.org/10.1002/icd.2034 DOI: https://doi.org/10.1002/icd.2034
Cheung Chung, M., AlQarni, N., AlMazrouei, M., Al Muhairi, S., Shakra, M., Mitchell, B., Al Mazrouei, S., & Al Hashimi, S. (2018). The impact of trauma exposure characteristics on post-traumatic stress disorder and psychiatric co-morbidity among Syrian refugees. Psychiatry Research, 259, 310–315. https://doi.org/10.1016/j.psychres.2017.10.035 DOI: https://doi.org/10.1016/j.psychres.2017.10.035
Clayton, K. E. (2019). A meta-analysis on the rate of attachment classifications of infants in the Strange Situation paradigm: Distribution across cultures and demographic variables [Doctoral thesis, University of Manitoba]. FGS—Electronic Theses and Practica. http://hdl.handle.net/1993/34126
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates. https://doi.org/10.4324/9780203771587 DOI: https://doi.org/10.4324/9780203771587
Cook, N., Ayers, S., & Horsch, A. (2018). Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review. Journal of Affective Disorders, 225, 18–31. https://doi.org/10.1016/j.jad.2017.07.045 DOI: https://doi.org/10.1016/j.jad.2017.07.045
Dalgaard, N. T., Todd, B. K., Daniel, S. I. F., & Montgomery, E. (2016). The transmission of trauma in refugee families: Associations between intra-family trauma communication style, children’s attachment security and psychosocial adjustment. Attachment & Human Development, 18(1), 69–89. https://doi.org/10.1080/14616734.2015.1113305 DOI: https://doi.org/10.1080/14616734.2015.1113305
De Haene, L., Dalgaard, N. T., Montgomery, E., Grietens, H., & Verschueren, K. (2013). Attachment narrative in refugee children: Interrater reliability and qualitative analysis in pilot findings from a two-site study. Journal of Traumatic Stress, 26(3), 413–417. https://doi.org/10.1002/jts.21820 DOI: https://doi.org/10.1002/jts.21820
Fazel, M., Wheeler, M., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in Western countries: A systematic review. The Lancet, 365(9467), 1309–1314. https://doi.org/10.1016/S0140-6736(05)61027-6 DOI: https://doi.org/10.1016/S0140-6736(05)61027-6
Fearon, R. P., Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., Lapsley, A. M., & Roisman, G. I. (2010). The significance of insecure attachment and disorganization in the development of children’s externalizing behavior: A meta-analytic study. Child Development, 81(2), 435–456. https://doi.org/10.1111/j.1467-8624.2009.01405.x DOI: https://doi.org/10.1111/j.1467-8624.2009.01405.x
Garthus-Niegel, S., Ayers, S., Martini, J., von Soest, T., & Eberhard-Gran, M. (2017). The impact of postpartum post-traumatic stress disorder symptoms on child development: A population-based, 2-year follow-up study. Psychological Medicine, 47(1), 161–170. https://doi.org/10.1017/S003329171600235X DOI: https://doi.org/10.1017/S003329171600235X
Georgiadou, E., Zbidat, A., Schmitt, G. M., & Erim, Y. (2018). Prevalence of mental distress among Syrian refugees with residence permission in Germany: A registry-based study. Frontiers in Psychiatry, 9, 1–12. https://doi.org/10.3389/fpsyt.2018.00393 DOI: https://doi.org/10.3389/fpsyt.2018.00393
Gere, M. K., Hagen, K. A., Villabø, M. A., Arnberg, K., Neumer, S. P., & Torgersen, S. (2013). Fathers’ mental health as a protective factor in the relationship between maternal and child depressive symptoms. Depression and Anxiety, 30(1), 31–38. https://doi.org/10.1002/da.22010 DOI: https://doi.org/10.1002/da.22010
Greig, A., & Howe, D. (2001). Social understanding, attachment security of preschool children and maternal mental health. British Journal of Developmental Psychology, 19(3), 381–393. https://doi.org/10.1348/026151001166164 DOI: https://doi.org/10.1348/026151001166164
Groh, A. M., Fearon, R. P., Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., Steele, R. D., & Roisman, G. I. (2014). The significance of attachment security for children’s social competence with peers: a meta-analytic study. Attachment & Human Development, 16(2), 103–136. https://doi.org/10.1080/14616734.2014.883636 DOI: https://doi.org/10.1080/14616734.2014.883636
Guttmann-Steinmetz, S., & Crowell, J. A. (2006). Attachment and externalizing disorders: A developmental psychopathology perspective. Journal of the American Academy of Child & Adolescent Psychiatry, 45(4), 440–451. https://doi.org/10.1097/01.chi.0000196422.42599.63 DOI: https://doi.org/10.1097/01.chi.0000196422.42599.63
Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76, 408-420. https://doi.org/10.1080/03637750903310360 DOI: https://doi.org/10.1080/03637750903310360
Hayes, A. F.(2013). Introduction to mediation, moderation, and conditional process analyses: A regression-based approach (1st ed.). Guilford Press.
Henley, J., & Robinson, J. (2011). Mental health issues among refugee children and adolescents. Clinical Psychologist, 15(2), 51–62. https://doi.org/10.1111/j.1742-9552.2011.00024.x DOI: https://doi.org/10.1111/j.1742-9552.2011.00024.x
Hodes, M., Jagdev, D., Chandra, N., & Cunniff, A. (2008). Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. Journal of Child Psychology and Psychiatry and Allied Disciplines, 49(7), 723–732. https://doi.org/10.1111/j.1469-7610.2008.01912.x DOI: https://doi.org/10.1111/j.1469-7610.2008.01912.x
Hynie, M. (2018). The socal determinants of refugee mental health in the post-migration context: A critical review. The Canadian Journal of Psychiatry, 63(5), 297–303. https://doi.org/10.1177/0706743717746666 DOI: https://doi.org/10.1177/0706743717746666
Kobak, R., Zajac, K., & Madsen, S. D. (2016). Attachment disruptions, reparative processes, and psychopathology: Theoretical and clinical implications. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (3rd ed., pp. 25–39). Guilford Press.
Liu, J. (2004). Childhood externalizing behavior: Theory and implications. Journal of Child and Adolescent Psychiatric Nursing, 17(3), 93–103. https://doi.org/10.1111/j.1744-6171.2004.tb00003.x DOI: https://doi.org/10.1111/j.1744-6171.2004.tb00003.x
Lutz, W. J., Hock, E., & Kang, M. J. (2007). Children’s communication about distressing events: The role of emotional openness and psychological attributes of family members. American Journal of Orthopsychiatry, 77(1), 86–94. https://doi.org/10.1037/0002-9432.77.1.86 DOI: https://doi.org/10.1037/0002-9432.77.1.86
Madigan, S., Atkinson, L., Laurin, K., & Benoit, D. (2013). Attachment and internalizing behavior in early childhood: A meta-analysis. Developmental Psychology, 49(4), 672–689. https://doi.org/10.1037/a0028793 DOI: https://doi.org/10.1037/a0028793
Mahmood, H. N., Ibrahim, H., Goessmann, K., Ismail, A. A., & Neuner, F. (2019). Post-traumatic stress disorder and depression among Syrian refugees residing in the Kurdistan region of Iraq. Conflict and Health, 13(1), 1–11. https://doi.org/10.1186/s13031-019-0238-5 DOI: https://doi.org/10.1186/s13031-019-0238-5
Martins, C., & Gaffan, E. A. (2000). Effects of early maternal depression on patterns of infant–mother attachment: A meta-analytic investigation. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 41(6), 737–746. https://doi.org/10.1111/1469-7610.00661 DOI: https://doi.org/10.1111/1469-7610.00661
Mollica, R. F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard trauma questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. The Journal of Nervous and Mental Disease, 180(2), 111–116. https://doi.org/10.1097/00005053-199202000-00008 DOI: https://doi.org/10.1097/00005053-199202000-00008
Nakeyar, C., & Frewen, P. A. (2016). Evidence-based care for Iraqi, Kurdish, and Syrian asylum seekers and refugees of the Syrian civil war: A systematic review. Canadian Psychology / Psychologie Canadienne, 57(4), 233–245. https://doi.org/10.1037/cap0000067 DOI: https://doi.org/10.1037/cap0000067
Ogilvie, C. A., Newman, E., Todd, L., & Peck, D. (2014). Attachment & violent offending: A meta-analysis. Aggression and Violent Behavior, 19(4), 322–339. https://doi.org/10.1016/j.avb.2014.04.007 DOI: https://doi.org/10.1016/j.avb.2014.04.007
Palosaari, E., Punamäki, R. L., Qouta, S., & Diab, M. (2013). Intergenerational effects of war trauma among Palestinian families mediated via psychological maltreatment. Child Abuse and Neglect, 37(11), 955–968. https://doi.org/10.1016/j.chiabu.2013.04.006 DOI: https://doi.org/10.1016/j.chiabu.2013.04.006
Qouta, S., Punamäki, R. L., & El Sarraj, E. (2005). Mother–child expression of psychological distress in war trauma. Clinical Child Psychology and Psychiatry, 10(2), 135–156. https://doi.org/10.1177/1359104505051208 DOI: https://doi.org/10.1177/1359104505051208
Reker, D. (2003). Children’s emotional intelligence as a mediator between children’s attachment security and their internalizing and externalizing behaviours [Master’s thesis, Trent University].
Rizkalla, N., & Segal, S. (2018). Well-being and posttraumatic growth among Syrian refugees in Jordan. International Society for Traumatic Stress Studies, 31, 213–222. https://doi.org/10.1002/jts.22281 DOI: https://doi.org/10.1002/jts.22281
Sim, A., Bowes, L., & Gardner, F. (2018). Modeling the effects of war exposure and daily stressors on maternal mental health, parenting, and child psychosocial adjustment: A cross-sectional study with Syrian refugees in Lebanon. Global Mental Health, 5, Article E40. https://doi.org/10.1017/gmh.2018.33 DOI: https://doi.org/10.1017/gmh.2018.33
Slone, M., & Mann, S. (2016). Effects of war, terrorism and armed conflict on young children: A systematic review. Child Psychiatry and Human Development, 47(6), 950–965. https://doi.org/10.1007/s10578-016-0626-7 DOI: https://doi.org/10.1007/s10578-016-0626-7
Solomon, J., & George, C. (2016). The measurement of attachment security and related constructs in infancy and early childhood. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (3rd ed., pp. 366–396). Guilford Press.
Trapolini, T., McMahon, C. A., & Ungerer, J. A. (2007). The effect of maternal depression and marital adjustment on young children’s internalizing and externalizing behaviour problems. Child: Care, Health and Development, 33(6), 794–803. https://doi.org/10.1111/j.1365-2214.2007.00739.x DOI: https://doi.org/10.1111/j.1365-2214.2007.00739.x
van Ee, E., Kleber, R. J., Jongmans, M. J., Mooren, T. T., & Out, D. (2016). Parental PTSD, adverse parenting and child attachment in a refugee sample. Attachment & Human Development, 18(3), 273–291. https://doi.org/10.1080/14616734.2016.1148748 DOI: https://doi.org/10.1080/14616734.2016.1148748
van IJzendoorn, M. H., Vereijken, C. M., Bakermans-Kranenburg, M. J., & Riksen-Walraven, J. M. (2004). Assessing attachment security with the attachment Q sort: Meta-analytic evidence for the vaidity of the observer AQS. Child Development, 75(4), 1188–1213. https://www.jstor.org/stable/3696534 DOI: https://doi.org/10.1111/j.1467-8624.2004.00733.x
Viljoen, J. L., Iverson, G. L., Griffiths, S., & Woodward, T. S. (2003). Factor structure of the Beck Depression Inventory-II in a medical outpatient sample. Journal of Clinical Psychology in Medical Settings, 10, 289–291. https://doi.org/10.1023/A:1026353404839 DOI: https://doi.org/10.1023/A:1026353404839
Waters, E. (n.d.). Assessing secure base behavior and attachment security using the Q-sort method. Attachment Theory & Research @ Stony Brook. http://www.psychology.sunysb.edu/attachment/measures/content/aqs_method.html
Waters, E. (1995). Appendix A: The Attachment Q-Set (Version 3.0). Monographs of the society for research in child development, 60(2/3), 234–246. https://doi.org/10.2307/1166181 DOI: https://doi.org/10.1111/j.1540-5834.1995.tb00214.x
West, J. (1985). An Arabic validation of a depression inventory. International Journal of Social Psychiatry, 31(4), 282–289. https://doi.org/10.1177/00207640850310040 DOI: https://doi.org/10.1177/002076408503100406
Yunis, F., Eapen, V., Zoubeidi, T., & Youself, S. (2007). Psychometric properties of the Child Behavior Checklist 2/3 in an Arab population. Psychological Reports, 100(3), 771–776. https://doi.org/10.2466/pr0.100.3.771-776 DOI: https://doi.org/10.2466/pr0.100.3.771-776
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Jennifer Barnes, Jennifer Theule
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Refuge authors retain the copyright over their work, and license it to the general public under the Creative Commons Attribution-Non Commercial License International (CC BY-NC 4.0). This license allows for non-commercial use, reproduction and adaption of the material in any medium or format, with proper attribution. For general information on Creative Commons licences, visit the Creative Commons site. For the CC BY-NC 4.0 license, review the human readable summary.