Maternal PTSD Research Articles

41.1 JOINTLY APPROACHING AVOIDANCE: THE USE OF CLINICIAN-ASSISTED VIDEO FEEDBACK EXPOSURE SESSIONS WITH MOTHERS WHO HAVE VIOLENCE-RELATED POSTTRAUMATIC STRESS DISORDER AND THEIR TODDLERS

This presentation will review original research on the effects of maternal PTSD on the mother-toddler relationship and the effect of the toddler on maternal PTSD.

Association between theta power in 6-month old infants at rest and maternal PTSD severity: A pilot study

Compared to infants born to mothers without PTSD, infants born to mothers with active PTSD develop poorer behavioral reactivity and emotional regulation. However, the association between perinatal maternal PTSD and infant neural activation remains largely unknown. This pilot study (N=14) examined the association between perinatal PTSD severity and infant frontal neural activity, as measured by MEG theta power during rest. Results indicated that resting left anterior temporal/frontal theta power was correlated with perinatal PTSD severity (p=0.004). These findings suggest delayed cortical maturation in infants whose mothers had higher perinatal PTSD severity and generate questions regarding perinatal PTSD severity and infant neurophysiological consequences.

Elevated cortisol in healthy female adolescent offspring of mothers with posttraumatic stress disorder

Offspring with maternal PTSD are at increased risk of developing PTSD themselves. Alterations in the hypothalamic-pituitary-adrenal (HPA) axis may play a role and have been noted in offspring, although evidence is mostly from adult offspring with PTSD symptoms themselves. The present study of adolescent girls (N=472) and their mothers (n=18 with lifetime PTSD versus n=454 with no PTSD) sought to determine whether healthy, non-affected offspring of mothers with PTSD would exhibit altered HPA axis function. Saliva samples were collected from the adolescent girls at waking, 30min after waking, and 8 pm on 3 consecutive days. Offspring whose mothers were diagnosed with PTSD demonstrated higher cortisol awakening response (CAR; Cohen’s d=0.58) and greater total cortisol output (Cohen’s d=0.62). In this preliminary study, higher cortisol levels during adolescence among offspring of mothers with PTSD may index a vulnerability in these at-risk youth.

Methylation of NR3C1 is related to maternal PTSD, parenting stress and maternal medial prefrontal cortical activity in response to child separation among mothers with histories of violence exposure.

Prior research has shown that mothers with Interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) report greater difficulty in parenting their toddlers. Relative to their frequent early exposure to violence and maltreatment, these mothers display dysregulation of their hypothalamic pituitary adrenal axis (HPA-axis), characterized by hypocortisolism. Considering methylation of the promoter region of the glucocorticoid receptor gene NR3C1 as a marker for HPA-axis functioning, with less methylation likely being associated with less circulating cortisol, the present study tested the hypothesis that the degree of methylation of this gene would be negatively correlated with maternal IPV-PTSD severity and parenting stress, and positively correlated with medial prefrontal cortical (mPFC) activity in response to video-stimuli of stressful versus non-stressful mother–child interactions. Following a mental health assessment, 45 mothers and their children (ages 12–42 months) participated in a behavioral protocol involving free-play and laboratory stressors such as mother–child separation. Maternal DNA was extracted from saliva. Interactive behavior was rated on the CARE-Index. During subsequent fMRI scanning, mothers were shown films of free-play and separation drawn from this protocol. Maternal PTSD severity and parenting stress were negatively correlated with the mean percentage of methylation of NR3C1. Maternal mPFC activity in response to video-stimuli of mother–child separation versus play correlated positively to NR3C1 methylation, and negatively to maternal IPV-PTSD and parenting stress. Among interactive behavior variables, child cooperativeness in play was positively correlated with NR3C1 methylation. Thus, the present study is the first published report to our knowledge, suggesting convergence of behavioral, epigenetic, and neuroimaging data that form a psychobiological signature of parenting-risk in the context of early life stress and PTSD.

Journal Watch review of Influences of maternal and paternal PTSD on epigenetic regulation of the glucocorticoid receptor gene in Holocaust survivor offspring.

Journal Watch review of Influences of maternal and paternal PTSD on epigenetic regulation of the glucocorticoid receptor gene in Holocaust survivor offspring.

Does Child Sex Moderate Vulnerability to Postpartum Risk among Infants of Mothers at Risk for Psychopathology?

Early childhood behavior problems may indicate risk for subsequent psychopathology (Shaw, Gilliom, Ingoldsby, & Nagin, Developmental Psychology, 39, 2003, 189). There is some evidence to suggest that boys and girls may be differentially susceptible to postpartum risk factors that predict problem behaviors in early childhood (Kochanska, Coy, & Murray, Child Development, 72, 2001, 1091; Martel, Klump, Nigg, Breedlove, & Sisk, Hormones and Behavior , 55, 2009, 465). The main aim of this study is to examine whether child sex moderates the effect of infant and maternal predictors of toddler problem behaviors in a unique sample of high‐risk mother–child dyads. Analyses were based on data collected for 198 mother–child dyads (52% male offspring) followed longitudinally from birth to 18 months. Maternal and infant variables, including maternal PTSD and depression symptoms, maternal maltreatment history, observed maternal parenting quality, demographic risk, and infant negative emotionality and night waking, were used to predict toddler behavior problems. Although boys and girls displayed similar levels of total problem behaviors at 18 months overall, the specific set of infant and maternal variables that predicted toddler problems varied by child sex. The significant predictor for boys was maternal PTSD symptoms, whereas significant predictors for girls were infant negative emotionality and sleep problems. Results suggest that sex‐differentiated transmission of risk can be identified as early as 18 months postpartum. These differences suggest a gender‐specific biological sensitivity to maternal psychopathology, or alternatively, a gender‐specific reporting bias among mothers with childhood maltreatment histories.

Maternal reflective functioning among mothers with childhood maltreatment histories: links to sensitive parenting and infant attachment security

This study examined relationships among maternal reflective functioning, parenting, infant attachment, and demographic risk in a relatively large (N = 83) socioeconomically diverse sample of women with and without a history of childhood maltreatment and their infants. Most prior research on parental reflective functioning has utilized small homogenous samples. Reflective functioning was assessed with the Parent Development Interview, parenting was coded from videotaped mother–child interactions, and infant attachment was evaluated in Ainsworth’s Strange Situation by independent teams of reliable coders masked to maternal history. Reflective functioning was associated with parenting sensitivity and secure attachment, and inversely associated with demographic risk and parenting negativity; however, it was not associated with maternal maltreatment history or PTSD. Parenting sensitivity mediated the relationship between reflective functioning and infant attachment, controlling for demographic risk. Findings are discussed in the context of prior research on reflective functioning and the importance of targeting reflective functioning in interventions.

How do maternal PTSD and alexithymia interact to impact maternal behavior?

Maternal interpersonal violence-related post-traumatic stress disorder (IPV-PTSD) is known to be associated with impairment of a mother's capacity to participate in mutual emotion regulation during her child's first years of life. This study tested the hypothesis that maternal difficulty in identifying feelings in self and other, as an important dimension of the construct of alexithymia, together with maternal IPV-PTSD, would be negatively associated with maternal sensitivity. Maternal sensitivity to child emotional communication is a marker of maternal capacity to engage in mutual regulation of emotion and arousal. Following diagnostic interviews and administration of the Toronto Alexithymia Scale, 56 mothers and their toddlers (ages 12-42 months) were filmed during free-play and separation/novelty-exposure. Observed maternal sensitivity was coded via the CARE-Index. Maternal IPV-PTSD severity, difficulty in identifying emotions, and lower socio-economic status were all associated with less maternal sensitivity, and also with more maternal controlling and unresponsive behavior on the CARE-Index.

Elevation of 11β-hydroxysteroid dehydrogenase type 2 activity in Holocaust survivor offspring: evidence for an intergenerational effect of maternal trauma exposure.

Adult offspring of Holocaust survivors comprise an informative cohort in which to study intergenerational transmission of the effects of trauma exposure. Lower cortisol and enhanced glucocorticoid sensitivity have been previously demonstrated in Holocaust survivors with PTSD, and in offspring of Holocaust survivors in association with maternal PTSD. In other work, reduction in the activity of the enzyme 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD-2), which inactivates cortisol, was identified in Holocaust survivors in comparison to age-matched, unexposed Jewish controls. Therefore, we investigated glucocorticoid metabolism in offspring of Holocaust survivors to evaluate if similar enzymatic decrements would be observed that might help to explain glucocorticoid alterations previously shown for Holocaust offspring. Holocaust offspring (n=85) and comparison subjects (n=27) were evaluated with clinical diagnostic interview and self-rating scales, and asked to collect a 24-h urine sample from which concentrations of cortisol and glucocorticoid metabolites were assayed by GCMS. 11β-HSD-2 activity was determined as the ratio of urinary cortisone to cortisol. Significantly reduced cortisol excretion was observed in Holocaust offspring compared to controls (p=.046), as had been shown for Holocaust survivors. However, 11β-HSD-2 activity was elevated for offspring compared to controls (p=.008), particularly among those whose mothers had been children, rather than adolescents or adults, during World War II (p=.032). The effect of paternal Holocaust exposure could not be reliably investigated in the current sample. The inverse association of offspring 11β-HSD-2 activity with maternal age at Holocaust exposure is consistent with the influence of glucocorticoid programming. Whereas a long standing reduction in 11β-HSD-2 activity among survivors is readily interpreted in the context of Holocaust related deprivation, understanding the directional effect on offspring will require replication and further exploration.

Maternal PTSD associates with greater glucocorticoid sensitivity in offspring of Holocaust survivors

Intergenerational effects of trauma have been observed clinically in a wide range of populations, and parental PTSD has been associated with an increased risk for psychopathology in offspring. In studies of Holocaust survivor offspring, parental PTSD, and particularly maternal PTSD, has been associated with increased risk for PTSD, low basal urinary cortisol excretion and enhanced cortisol suppression in response to dexamethasone. Such findings implicate maternally derived glucocorticoid programming in the intergenerational transmission of trauma-related consequences, potentially resulting from in utero influences or early life experiences. This study investigated the relative influence of Holocaust exposure and PTSD in mothers and fathers on glucocorticoid sensitivity in offspring. Eighty Holocaust offspring and 15 offspring of non-exposed Jewish parents completed evaluations and provided blood and urine samples. Glucocorticoid sensitivity was evaluated using the lysozyme suppression test (LST), an in vitro measure of glucocorticoid receptor sensitivity in a peripheral tissue, the dexamethasone suppression test (DST), and 24-h urinary cortisol excretion. Maternal PTSD was associated with greater glucocorticoid sensitivity in offspring across all three measures of glucocorticoid function. An interaction of maternal and paternal PTSD on the DST and 24-h urinary cortisol showed an effect of decreased glucocorticoid sensitivity in offspring with paternal, but not maternal, PTSD. Although indirect, these findings are consistent with the hypothesis that epigenetic programming may be involved in the intergenerational transmission of trauma-related effects on glucocorticoid regulation.

Mother–infant bonding impairment across the first 6 months postpartum: the primacy of psychopathology in women with childhood abuse and neglect histories

Our goal was to examine the trajectory of bonding impairment across the first 6months postpartum in the context of maternal risk, including maternal history of childhood abuse and neglect and postpartum psychopathology, and to test the association between self-reported bonding impairment and observed positive parenting behaviors. In a sample of women with childhood abuse and neglect histories (CA+, n = 97) and a healthy control comparison group (CA-, n = 53), participants completed questionnaires related to bonding with their infants at 6weeks, 4months, and 6months postpartum and psychopathology at 6months postpartum. In addition, during a 6-month postpartum home visit, mothers and infants participated in a dyadic play interaction subsequently coded for positive parenting behaviors by blinded coders. We found that all women, independent of risk status, increased in bonding with their infant over the first 6months postpartum; however, women with postpartum psychopathology (depression and posttraumatic stress disorder [PTSD]) showed consistently greater bonding impairment scores at all timepoints. Moreover, we found that, at the 6-month assessment, bonding impairment and observed parenting behaviors were significantly associated. These results highlight the adverse effects of maternal postpartum depression and PTSD on mother-infant bonding in early postpartum in women with child abuse and neglect histories. These findings also shed light on the critical need for early detection and effective treatment of postpartum mental illness in order to prevent problematic parenting and the development of disturbed mother-infant relationships. Results support the use of the Postpartum Bonding Questionnaire as a tool to assess parenting quality by its demonstrated association with observed parenting behaviors.

Distinct influence of maternal and paternal PTSD on Holocaust offspring

Distinct influence of maternal and paternal PTSD on Holocaust offspring

Posttraumatic Stress Disorder in Infants and Young Children Exposed to War-Related Trauma

Although millions of the world's children are growing up amidst armed conflict, little research has described the specific symptom manifestations and relational behavior in young children exposed to wartime trauma or assessed factors that chart pathways of risk and resilience. Participants included 232 Israeli children 1.5 to 5 years of age, 148 living near the Gaza Strip and exposed to daily war-related trauma and 84 controls. Children's symptoms were diagnosed, maternal and child attachment-related behaviors observed during the evocation of traumatic memories, and maternal psychological symptoms and social support were self-reported. PTSD was diagnosed in 37.8% of war-exposed children (n = 56). Children with PTSD exhibited multiple posttraumatic symptoms and substantial developmental regression. Symptoms observed in more than 60% of diagnosed children included nonverbal representation of trauma in play; frequent crying, night waking, and mood shifts; and social withdrawal and object focus. Mothers of children with PTSD reported the highest depression, anxiety, and posttraumatic symptoms and the lowest social support, and displayed the least sensitivity during trauma evocation. Attachment behavior of children in the Exposed-No-PTSD group was characterized by use of secure-base behavior, whereas children with PTSD showed increased behavioral avoidance. Mother's, but not child's, degree of trauma exposure and maternal PTSD correlated with child avoidance. Large proportions of young children exposed to repeated wartime trauma exhibit a severe posttraumatic profile that places their future adaptation at significant risk. Although more resilient children actively seek maternal support, avoidance signals high risk. Maternal well-being, sensitive behavior, and support networks serve as resilience factors and should be the focus of interventions for families of war-exposed infants and children.

The impact of maternal childhood abuse on maternal and infant HPA axis function in the postpartum period

Early life trauma, particularly child abuse, has been associated with aberrations in hypothalamic-pituitary-adrenal (HPA) axis functioning in adulthood. However, the relationship of early abuse and later adult neuroendocrine changes may be moderated by additional factors such as comorbid psychopathology and recent life stress. Parental exposure to child abuse may have transgenerational effects, with offspring of abuse victims showing similar neuroendocrine profiles as their mothers. The majority of previous studies in this area focus on adult offspring, and the degree to which the effects of parental child abuse can be detected earlier in the development of the offspring remains obscure. The current study utilized a clinical sample of women with a history of MDD (N=126), to examine the effects of maternal early life sexual and physical abuse (Childhood Trauma Questionnaire (CTQ)) on both maternal and infant salivary cortisol levels during a laboratory stress paradigm at 6 months postpartum. Maternal child abuse was associated with steeper declines in cortisol in the mothers and lower baseline cortisol in their infants. Comorbid maternal PTSD, current maternal depressive symptoms, and recent life stressors were significant moderators of maternal cortisol change. Maternal abuse history was associated with increases in cortisol levels in those mothers who experienced these additional stressors. Similarly, a history of early maternal abuse and comorbid PTSD was associated with greater increases in infant cortisol levels. Maternal childhood abuse was associated with HPA axis function in both the mother and the infant during the postpartum period.

Assessing the Effects of Maternal Symptoms and Homelessness on the Mental Health Problems in their Children

Objective: This study examines the longitudinal association between measures of child well being and maternal posttraumatic stress disorder symptoms, homelessness, substance abuse, and other psychiatric conditions.Method: A sample of 142 mothers who were veterans of the US armed forces were assessed at program entry and every three months thereafter for one year. A repeated‐measures with mixed‐effects analytic strategy was used to assess the association of children’s mental health, school enrolment and attendance with measures of maternal psychiatric symptoms and homelessness.Results: Significant associations between mothers’ psychiatric symptoms and child well‐being were identified. However, the multivariable mixed‐models suggest that increased depression and anxiety symptoms among children were associated primarily with mothers’ PTSD, and not depression, symptoms.Conclusions: These findings provide evidence of an association between maternal and child mental health and may suggest that treating maternal PTSD symptoms may also benefit children, regardless of whether the child was also exposed to the traumatic experience.

Effect of Maternal Psychopathology on Behavioral Problems in Preschool Children Exposed to Terrorism

To examine whether the number of maternal psychopathologies is associated with increased clinically significant behavioral problems in preschool children exposed to disaster, using child behavior ratings from multiple informants. Cross-sectional study. Lower Manhattan, New York, New York. One hundred two preschool child-mother dyads directly exposed to the World Trade Center attacks. Maternal disorders: 2 (posttraumatic stress disorder [PTSD] and depression), 1 (depression or PTSD), or none. Maternal depression and PTSD were self-reported. Child behavioral problems were rated by mothers and teachers using a standardized behavioral checklist. For each informant, we created separate dichotomous variables that indicated whether the child's behavioral problems were severe enough to be clinically significant. We then used an analytic technique (generalized estimating equations) that integrates the child behavioral problem ratings by the mother and teachers to derive a more reliable indicator of clinically significant child behavioral problems. The rate of clinically significant child behavioral problems increased linearly relative to the number of maternal psychopathologies. The number of maternal psychopathologies was associated with a linear increase in functional impairment. Compared with children of mothers without psychopathologies, children of mothers with depression and PTSD were at greater risk for several clinically significant problems, notably, aggressive behavior (relative risk, 13.0), emotionally reactive behavior (11.2), and somatic complaints (10.5). Boys were more likely to have clinically significant behavior problems than were girls. Concurrent maternal depression and PTSD was associated with dramatic increases in the rate of clinically significant behavioral problems in preschool children, particularly boys, 3 years after the World Trade Center attacks.

Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors

Background A significant association between parental PTSD and the occurrence of PTSD in offspring has been noted, consistent with the idea that risk for the development of PTSD is transmitted from parent to child. Two recent reports linking maternal PTSD and low offspring cortisol prompted us to examine the relative contributions of maternal vs. paternal PTSD in the prediction of PTSD and other psychiatric diagnoses in offspring. Methods One hundred seventeen men and 167 women, recruited from the community, were evaluated using a comprehensive psychiatric battery designed to identify traumatic life experiences and lifetime psychiatric diagnoses. 211 of these subjects were the adult offspring of Holocaust survivors and 73 were demographically comparable Jewish controls. Participants were further subdivided based on whether their mother, father, neither, or both parents met diagnostic criteria for lifetime PTSD. Results A higher prevalence of lifetime PTSD, mood, anxiety disorders, and to a lesser extent, substance abuse disorders, was observed in offspring of Holocaust survivors than controls. The presence of maternal PTSD was specifically associated with PTSD in adult offspring of Holocaust survivors. However, other psychiatric diagnoses did not show specific effects associated with maternal PTSD. Conclusion The tendency for maternal PTSD to make a greater contribution than paternal PTSD to PTSD risk suggests that classic genetic mechanisms are not the sole model of transmission, and paves way for the speculation that epigenetic factors may be involved. In contrast, PTSD in any parent contributes to risk for depression, and parental traumatization is associated with increased anxiety disorders in offspring.

Maternal PTSD Tied to Vulnerability in Offspring

Maternal PTSD Tied to Vulnerability in Offspring

An investigation into the possible overlap between PTSD and unresolved responses following stillbirth: An absence of linkage with only unresolved status predicting infant disorganization

It has been suggested that the characteristic lapses in thinking and reasoning of the unresolved/disorganized (U) state of mind following traumatic loss involve psychological mechanisms similar to those found in PTSD and that a fuller understanding of these mechanisms may help explain the disruptions in parental caretaking behaviour that lead to disorganized infant attachment. This paper investigates whether PTSD, assessed in 60 mothers in the pregnancy after stillbirth, predicts infant disorganized (D) attachment in next-born children, and whether there was any association between U and PTSD. We report that in this population there was no significant correspondence between U and PTSD scores or caseness and no association between maternal PTSD and infant D. We discuss possible interpretations of these findings.

Commentary: Maternal PTSD over the course of the evaluation: Decompensation or clinical progress?

Commentary: Maternal PTSD over the course of the evaluation: Decompensation or clinical progress?