The protective role of maternal post-traumatic growth and cognitive trauma processing in Palestinian mothers and infants: a longitudinal study

Abstract

BackgroundWomen at pre partum and post partum are especially susceptible to war trauma because they struggle to protect their infants from danger. Trauma research suggests increased problems in maternal mental health and infant development. Yet many cognitive-emotional processes affect the trauma survivors' mental health, such as post-traumatic growth and post-traumatic cognition. The aim of this study was to examine whether a mother's high post-traumatic growth and optimal post-traumatic cognition could protect their own mental health and their infant's stress regulation from the effects of traumatic war experiences. MethodsThis three-wave prospective study involved Palestinian women living in the Gaza Strip who were at the second trimester of pregnancy (T1), women with infants aged 4 months (T2), and women with children aged 12 months (T3) months. The participants reported their war experiences in a 30-item checklist of losses, destruction, and atrocities in the 2008–09, 2012, and 2014 military offensives. Post-traumatic growth was assessed by a 21-item scale and post-traumatic cognition by a 36-item scale. Maternal mental health was assessed by post-traumatic stress disorder (PTSD), depressive, anxiety, and dissociation symptoms at T1 and T3, and infants' stress regulation was assessed with the Infant Behaviour Questionnaire at T2 and T3. FindingsWe included 511 women at T1, 481 women at T2, and 454 women at T3. High maternal post-traumatic growth and post-traumatic cognition had protective roles. Post-traumatic growth had a protective effect on maternal mental health since severe exposure to traumatic war experiences was not associated with maternal PTSD, depression, and dissociation if women showed high post-traumatic growth, as indicated by the significant interaction effect between post-traumatic growth and war trauma on each of the three symptoms. Post-traumatic cognition had a protective effect on infant development since severe exposure was not associated with dysfunctional infant emotion regulation when mothers reported optimal post-traumatic cognition, as indicated by the significant interaction effect between post-traumatic cognition and war trauma on each of negative affectivity and surgency or extraversion. InterpretationThe nature of cognitive emotional processing of war trauma could explain the distinct roles of post-traumatic growth and post-traumatic cognition. High post-traumatic growth involves increased social affiliation, spiritual awareness, and psychological strengths resulting from painful and traumatic experiences. In the national struggle for independence, post-traumatic growth is often associated with heroism and even hardiness, which might benefit a mother's mental health but not their infant's wellbeing. Optimal post-traumatic cognition indicates successful and harmonious trauma processing, which enables mothers to be more reflective and sensitive to their infant's needs. Interventions to promote healthy infant development in war settings should encourage and support mothers' effective cognitive-emotional processing of traumatic experiences. FundingThe Academy of Finland and University of Tampere, Finland.