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VA researchers are studying how PTSD impacts the parenting experience, and children’s outcomes. (Photo ©iStock/shapecharge)
April 4, 2018
By Mike Richman
VA Research Communications
In recent years, there has been a huge growth in research examining the influence of post-deployment mental health disorders on family functioning, namely spousal interaction. But fewer studies have explored the impact of psychiatric conditions, such as combat-related PTSD, on parent-child relationships.
Dr. Suzannah Creech is a clinical psychologist at the Central Texas Veterans Health Care System.
Dr. Suzannah Creech, a clinical psychologist at the Central Texas Veterans Health Care System in Waco, is seeking to better understand this relatively untapped area of research. A researcher at the VISN (Veterans Integrated Service Network) 17 Center of Excellence for Research on Returning War Veterans, she led a study that examined post-9-11 research on the common effects of military PTSD on parenting, child outcomes, and parent-child functioning. She and her team also shed light on the ways PTSD may impact parent-child relationships and proposed an adaptation to the cognitive-behavioral interpersonal theory of PTSD, a theoretical model, as a way of improving parent-child interaction.
Her review study appeared in Frontiers in Psychology in June 2017. VA Research Currents spoke with her about the work.
Why do you think the impact of PTSD on parent-child functioning has been understudied?
One reason this area has lagged is that studying parenting is a bit harder than studying family relationships. To do this work well, you may want to do assessments with parents and children together. That is much more complex. Some other systemic and societal barriers have slowed this work. The first is that research on parent-child functioning has typically focused on mothers, not fathers. The number of women in the military is growing. But given that most of our military and Veteran population still consists of men, I think that societal barrier has led to a lack of focus. Secondly, here at VA, we are charged with care for the Veteran. It’s only recently that family-centered care has become a priority. In that sense, the fact that many Veterans are parenting just hasn’t been at the forefront of our thinking.
"We do know that, in general, parental PTSD symptoms appear to be linked to lower parenting satisfaction, increased parenting stress, and lower levels of positive engagement with children."
What are some PTSD symptoms that parents are more likely to exhibit with their children? What are the short- and long-term effects of those symptoms on kids?
Data from decades of work on mental health disorders and parent-child functioning in civilian families tell us that parenting behaviors and the family environment are powerful determinants of physical and mental health outcomes over the life span. That is, when children have positive relationships with caring adults, they have better health outcomes over time even when bad things happen. With regard to military families, we need much more research to answer these questions. We do know that, in general, parental PTSD symptoms appear to be linked to lower parenting satisfaction, increased parenting stress, and lower levels of positive engagement with children. Then, there are studies showing that parental PTSD is associated with child mental health symptoms. We do not have good data yet that give us definitive ideas about other risk factors and length of risk period in military children.
Your study identifies the strengths and limitations of existing research on PTSD and its impact on parent-child interaction. What are those strengths and limitations?
The biggest strength is that the volume of studies is increasing and that new data from some important intervention studies are coming out more frequently. The biggest limitation is that studies of parent-child functioning in military samples have focused so much on deployment separation. That time is very important to consider, of course. But I’d argue that even more important is the physical and mental health problems that may come after deployment and how those problems influence parenting and child outcomes. Within this, we need more data involving men and women Veterans, child assessments, and interventional work.
For my study, we reviewed 83 studies and were hoping to gather some sense of whether the pattern of findings we see in the United States is the same as what we see in other countries. That’s a key way to start to look for new risk and resilience factors that may be helpful in designing interventions for military and Veteran families. Risk and resilience factors are family characteristics that may predict better or worse outcomes. Unfortunately, we didn’t find any studies from other countries that met our inclusion criteria. But that could be related to the type of search engines we used.
In the study, you extend the cognitive-behavioral interpersonal theory of PTSD, or C-BIT, to parent-child functioning. What is C-BIT and how does it affect parent-child relationships?
C-BIT is a theoretical model that seeks to explain why PTSD symptoms may influence relationships from a cognitive-behavioral framework. This model is so special because it helps explain how PTSD may influence relationships, as well as how relationships may influence PTSD. For example, avoidance symptoms of PTSD may cause a parent to avoid parent-child activities that involve large crowds because they may bring up trauma reminders. This can take a toll on parent-child functioning and exacerbate those avoidance symptoms at the same time. These types of theoretical models help us design better studies and interventions. I extended the model to parenting in a theoretical way, but studies are needed to validate that approach.
Do you hope your study will bring more attention in the research community to the impact of war-related trauma and PTSD on parent-child relationships?
That’s what I work for every day. Our military and Veteran families are a great asset to the nation, and children in military families are likely to join the armed forces in the future. If we can understand how to reduce the risk of negative health outcomes in children by supporting a health family environment now, that could reduce mental health disorders down the road in their adult lives.
The best way to truly understand this issue will be through very large studies that include male and female Veterans and their children. Those studies must use gold-standard measurements of mental health symptoms, parenting behaviors, and child functioning. This will enable us to understand the problem with greater specificity so we can better determine how and when it’s best to intervene.
Our group at the VISN 17 Center of Excellence for Research on Returning War Veterans is excited that we recently received three years of funding from VA’s Rehab R&D office to develop and test a trauma-based parental support program. We hope this will reduce parental stress and improve parenting behaviors in Veterans with PTSD symptoms who are concerned about parent-child functioning!
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