100 Childhood Maltreatment and Parenting Sensitivity: Is Mental Health the Link?

Faculty Mentor: Lee Raby (Psychology, University of Utah)

Abstract

Childhood maltreatment has negative impacts on individuals that span much further than the moment the abuse or neglect occurs. During childhood, children learn their place in the world, and experiences of maltreatment can interrupt this process. These adverse experiences may continue to impact individuals as they grow and become parents. Maltreatment can lead to increased mental health problems and less sensitive parenting behaviors. We aimed to see if mental health during pregnancy mediated the association between maltreatment and parenting sensitivity as observed in mother-infant interactions at 7 and 18 months postpartum. We also explored whether mindfulness and resilience buffered the association between maltreatment and mental health, and if these constructs were correlated with maternal sensitivity. Linear regressions revealed maltreatment was associated with decreased maternal sensitivity and greater psychopathology. However, mental health did not mediate the association between childhood maltreatment and parenting sensitivity. Resilience and mindfulness were associated with fewer mental health problems, with only the latter acting as a buffer between childhood maltreatment and mental health.

Introduction

Parenting is a combination of trial and error, for there is no explicit lesson or instruction manual on effectively raising a child. Childrearing is complex and becomes more complicated when parents recognize each child is different, all with a unique temperament and personality. There is no one-size-fits-all approach to parenting, and caregivers must tailor their parenting approach to the needs of each child.

As children grow, they use their life experiences to develop a self-concept, or view of themselves in relation to the world around them (Butler & Gasson, 2005). Unfortunately, in some cases, children experience abuse or neglect. Maltreated children may grow up in environments that elicit feelings of insecurity and danger. If a child’s road map of themselves and the world around them is tainted with negative or adverse experiences, such as those of maltreatment, they may develop a more negative self-concept (Melamed et al., 2024). When these children become parents (specifically women), these adverse experiences might impact their mental health during pregnancy and how they navigate parenting.

Maltreatment and Parenting Behavior

Child maltreatment may impact how well parents can effectively support their children. Adults with histories of childhood physical abuse might be more likely to demonstrate inconsistent parenting behaviors, such as switching from sensitive child-led behaviors to becoming quickly intrusive or detached (Driscoll & Easterbrooks, 2007). Physical abuse could also be correlated with intrusive parenting behaviors, and sexual abuse with withdrawn behaviors (Lyons & Block, 1997). While a meta-analysis established parenting behaviors did not differ based on specific domains of maltreatment, all categories of maltreatment were associated with negative parenting behaviors, specifically intrusiveness (Greene et al., 2020). Similarly, Savage et al. (2019) conducted a meta-analysis on the relationship between childhood maltreatment and positive parenting behaviors. They found a small, but significant association (r = -.13, p < .05).

Maltreatment and Parental Mental Health

It is crucial to understand what factors explain the effects of childhood maltreatment on later parenting. One potential pathway is through mental health. Experiences of abuse and neglect can negatively impact one’s emotional well-being later in life (Driscoll & Easterbrooks, 2007; Galla et al., 2018; Kaliush et al., 2021; 2023; Lyons & Block, 1997; Savage et al., 2019; Speck et al., 2024). For example, childhood maltreatment is positively associated with emotional dysregulation during pregnancy (Kaliush et al., 2021; 2023). At post-natal timepoints, maltreatment is also correlated with increased psychopathology, such as internalizing, externalizing, and other mental health problems. When individuals become parents, their mental health may influence how they engage in caregiving tasks. This is because parents must be able to regulate their emotions to co-regulate with their children and, in turn, respond sensitively to the needs of their children (Savage et al., 2019).

Protective Factors

It is also important to identify what agents may shield parents against the potentially harmful effects of maltreatment and psychopathology.

Psychological resilience is one potential protective factor. Resilience is a construct that helps individuals adapt to challenges and cope with adversity (Hu et al., 2015). In their meta- analysis on the role of trait resilience and mental health, Hu et al. (2015) found poor mental health outcomes were associated with lower resilience. Moreover, individuals with higher resilience tended to have better overall well-being and fewer mental health problems. The association between resilience and positive mental health outcomes was significantly stronger for individuals who experienced adversity.

Mindfulness is another potential protective factor. Mindfulness is defined as being aware of one’s internal experiences and acting nonjudgmentally towards oneself (Keng et al., 2011). Mindfulness is associated with better psychological well-being, including lower levels of fear, anxiety, and worry.

Current Study

The first aim of this study was to evaluate whether childhood maltreatment was associated with less sensitive parenting behavior. We expected to find a correlation similar to the small association reported in the meta-analysis by Savage et al. (2019). We did not expect the type of maltreatment to significantly influence the strength of this relationship (Hypothesis 1).

The second aim of the study was to test whether maternal mental health was the bridge between childhood maltreatment and maternal sensitivity. We hypothesized maltreatment would be associated with increased mental health problems (Hypothesis 2a). Kaliush et al. (2021; 2023) reported that the associations between childhood maltreatment and mental health symptoms using different subsets of participants included in the current study were between r = .33 and r = .46.

We expected to find a similar correlation in the current project. We anticipated that negative mental health symptoms would be associated with less maternal sensitivity (Hypothesis 2b). Bernard et al. (2018) conducted a meta-analysis on the subject and discovered mothers with more severe depression tended to demonstrate fewer sensitive behaviors when interacting with their infants (r = -.16, p <.05). We expected to observe a similar weak association between parenting sensitivity and negative mental health symptoms.

Next, we expected mental health outcomes would at least partially mediate the association between childhood maltreatment and parenting behaviors. Specifically, we hypothesized the association between maltreatment and maternal sensitivity would be notably weaker after taking mental health problems into account (Hypothesis 2c).

The third aim of the study was to evaluate whether two psychological constructs, resilience and mindfulness, buffered the association between maltreatment and negative mental health outcomes. Resilience and mindfulness are negatively associated with poor mental health. Given that psychopathology may decrease parental sensitivity (Hu et al., 2015; Keng et al., 2011), we hypothesize that a higher level of either of these variables would be associated with more sensitive parenting behaviors.

Methods

Participants

The current project used data from the Baby Affect and Behavior Study (BABY), which is a NIH-funded project concerned with the intergenerational transmission of emotion dysregulation (Lin et al., 2019). The study achieved a semi-uniform distribution of emotion dysregulation and followed infant-mother dyads from pregnancy to 36 months postpartum. The study was conducted at two different time points with two separate cohorts, referred to as BABY 1.0 (n = 162) and BABY 2.0 (n = 223). Both cohorts were representative of Salt Lake County demographics.

We combined these two cohorts for the current study (n = 385). The mean age of participants was 29 years (SD = 4.9), with 58% identifying as White/non-Hispanic and 42% belonging to a minoritized racial group. The median household income ranged from $50,000 to $79,999, and 54% these mothers completed a bachelor’s degree or higher.

Measures

Childhood Maltreatment

Childhood maltreatment was measured prenatally for both cohorts, but with different measurements. For BABY 1.0, childhood maltreatment was measured using the Childhood Traumatic Questionnaire Short Form (CTQ-SF; Bernstein et al., 2003). This is a 28-item questionnaire capturing emotional, physical, and sexual abuse, along with emotional and physical neglect. Each subtype of maltreatment is measured using five items, and sits on a 5- point Likert scale, with responses ranging from “Never True” to “Very Often True.”

BABY 2.0 measured childhood maltreatment using the Traumatic Experiences of Betrayal Across the Lifespan (TEBL; Kaliush et al., 2023). This questionnaire captures a wide variety of attachment-related trauma from childhood to the third trimester of pregnancy, including experiences of childhood maltreatment. The TEBL asks participants if they have undergone certain distressing events, using a yes or no format (e.g., “At any time in your life, has someone with whom you were close or trusted called you names, said mean things, or humiliated you to make you feel badly about yourself?”). Participants who responded “yes” were then asked to report how often they experienced the event in each period of their life (e.g., ages 1-5, 6-11, 12- 18, etc.).

We then attempted to harmonize the two childhood maltreatment questionnaires. First, we included all 25 items from the CTQ. Then, we selected items from the TEBL that mapped onto the CTQ (see Table 1) and categorized these items into the five measures of maltreatment. We only included the TEBL questions that pertained to childhood maltreatment experiences and removed items unrelated to the CTQ. We excluded question 4 from the TEBL in the measure of sexual abuse. The text of the item is: “At any time in your life, has someone with whom you were close or trusted exposed you to sexually explicit material (e.g., pornography) or forced you to do something scary or violent to someone else” (Kaliush et al., 2023)? Although the first part of this question assesses aspects of sexual abuse, the latter half measures constructs related to coercion and violence. We disregarded this item because it is double-barreled, and responses might have varied based on which half of the question participants attended to. We also omitted item 19 of the TEBL from the emotional abuse category. The text of the item is: “Have there been any other times in your life when you felt unprotected, like you had no one to turn to? This could include feeling emotionally alone or experiencing a stressful event and having no one to help you” (Kaliush et al., 2023). Participants who answered yes to this question had the opportunity to briefly describe the experience(s) that made them feel this way. Many of these short-answer responses captured normative life experiences and/or other domains of maltreatment.

As a second step to harmonize the two measures of childhood maltreatment, we converted the TEBL frequency data into a five-point scale. The TEBL provides guidance for reporting the regularity of maltreatment experiences during each 5-to-6-year time period: “Please enter the most exact number that you can. E.g., Once per month for 5 years = 60; Once per week for 5 years = 260; Once per day for 5 years = 1,825” (Kaliush et al., 2023). We converted the three relevant time-points (ages 1-5, 6-11, 12-18) to a five-point scale (see Table 2), so each question had three separate scores for childhood maltreatment. Then, we averaged these time points together to create one score of childhood maltreatment for each question. Next, we averaged the items together for each maltreatment subtype. Afterwards, we averaged the subtypes together to create a single measure of maltreatment. Lastly, we combined this TEBL measure with the CTQ to create a composite measurement of maltreatment. On a scale from 1 to 5 (0 = “no maltreatment,” 5 = “high levels of maltreatment”), values ranged from 1.00 to 4.16, with an average of 1.45.

Mental Health

Mental health was measured prenatally using the Achenbach System of Empirically Based Assessment Adults Self Report (Achenbach & Rescorla, 2003). This questionnaire assesses a variety of mental health problems (i.e., behavioral and clinical problems). For this study, we primarily utilized the total problems scale, which is a sum of the internalizing (e.g., anxiety, depression), externalizing (e.g., aggression), and other problems subscales (e.g., ADHD).

Parenting Behavior

Parenting behavior was observed through a mother-infant free-play interaction at 7 and 18 months postpartum. Mothers were instructed to play with their infants as they normally would for 10 minutes, using lab-provided toys. Maternal behavior during play was coded by trained research assistants, using an adapted version of the Observational Record of the Caregiving Environment (NICHD Early Child Care Research Network, 1996; Carreras et al., 2019). Coders evaluated maternal sensitivity, intrusiveness, detachment, and positive regard. Sensitivity was defined as actively engaging with the child, responding to their behavior and affect, and letting the child lead the interaction when possible. Intrusiveness was operationalized as adult-led interactions, usually those of rapid and overstimulating exchanges (such as tickling or manipulating the child’s body). Detachment was defined as acting aloof or disengaged from the child. Lastly, positive regard was the amount of positive affect mothers demonstrated in the interaction. These variables were coded separately on a 1 to 5 scale (1 = “not at all characteristic” to 5 = “very characteristic”). We averaged the four variables together (after reverse-scoring intrusiveness and detachment) to create a measure of overall maternal sensitivity at each time point. We then averaged the measures from the 7 month and 18 month time points together to create a composite score of parenting sensitivity. On a five-point scale, maternal sensitivity ranged from values of 1.75 to 4.81, with a mean value of 3.72. This indicates that, on average, mothers in the combined sample were more sensitive than insensitive.

Psychological Resilience

Resilience was measured using a 10-item version of the Conner-Davidson Resilience Scale (Connor & Davidson, 2003; Campbell-Sills & Stein, 2007). This questionnaire assesses individuals’ abilities to adapt and cope with stress (e.g., “I am able to handle unpleasant or painful feelings like sadness, fear, and anger”) and was developed to identify areas of one’s mental health that could benefit from treatment. Responses were on a 5-point Likert scale, ranging from “not true” to “true nearly all the time.” The ten items were summed together to create a total measure of resilience.

Mindfulness

Mindfulness was measured using the Mindful Attention and Awareness Scale (Brown & Ryan, 2023). The questionnaire consists of 15 items measuring mindfulness and psychological well-being (e.g., “I find it difficult to stay focused on what’s happening in the present.”) The measurement used a 6-point Likert scale, with responses ranging from “almost always” to “almost never.”

Family Socioeconomic Status.

We created a composite measure of family socioeconomic status by standardizing and averaging information regarding maternal educational attainment, household income, and household occupational prestige at the time of the prenatal visit.

Race

We converted participants’ self-reported race to a two-point scale (0 = “white,” 1 = “non-white”).

Results

Childhood Maltreatment and Parental Sensitivity

Our first hypothesis was that childhood maltreatment would predict lower parenting sensitivity. Older mothers, those who were white or of a high economic status, tended to report fewer childhood maltreatment experiences and demonstrate more sensitive parenting behaviors (See Table 3). Surprisingly, the association between maltreatment and sensitivity was statistically significant when utilizing the CTQ measure of maltreatment (r = -.20, p = .04) but not the TEBL (r = .11, p = .14) or composite measure (r = -.07, p = .21).

We used multiple linear regression models to test Hypothesis 1. The covariates and childhood maltreatment were included as the predictor variables, and the outcome variable was the composite measure of maternal sensitivity.

We decided to separately run regression models on each measure of maltreatment for all hypotheses because of the discrepancy between the two measures of child maltreatment.

CTQ Only

The overall regression model was statistically significant, F(4, 111) = 3.97, p = .005. Maternal race (β = -.17, p = .06), family SES (β = 12, p = .26), and maternal age (β = .13, p =.23) did not predict parenting sensitivity. However, childhood maltreatment was associated with less sensitive parenting behaviors (β = -.19, p = .039).

TEBL Only

When examining this hypothesis with the TEBL, the model was statistically significant, F(4, 180) = 4.77, p =.001. Neither maternal age nor race was a significant predictor of parenting sensitivity (β = .03, p =.71 and β = -.13, p =.08). Contrary to what we found with the CTQ, family SES was associated with maternal sensitivity (β = .24, p = .005). Additionally, the TEBL measure of maltreatment was a predictor of maternal sensitivity, but in the unexpected direction (β =.20, p = .009).

Composite Measure

The linear regression regarding the composite measure of maltreatment was statistically significant, F(4, 296) = 6.66, p < .01. Maternal race and family SES were significant predictors of maternal sensitivity (β = -.16, p = .005 and β = .16, p =.014), but maternal age was not (β = .07, p = .30). Lastly, maltreatment was not significantly associated with maternal sensitivity (β = -.02, p = .79).

Childhood Maltreatment and Prenatal Mental Health

Our second hypothesis was that childhood maltreatment would predict higher levels of psychopathology at the prenatal time point. We conducted similar linear regression models to test this hypothesis. The covariates and childhood maltreatment were included as the predictor variables, and the outcome variable was the measure of total mental health problems.

Total mental health problems were negatively associated with maternal age (r = -.14, p=.01), race (r = -.15, p =.006), and family SES (r = -.26, p <.001). Childhood maltreatment, as measured by the CTQ, was positively associated with emotion dysregulation (see Table 3). The strength of this association was nearly identical to the estimate previously reported by Kaliush et al. (2021) and Speck et al. (2024). Childhood maltreatment was also positively associated with pregnant mothers’ internalizing, externalizing, other, and total mental health problems (see Table 3).

The measure of childhood maltreatment created using the items from the TEBL was also positively correlated with emotion dysregulation and internalizing, externalizing, other, and total mental health problems at the prenatal visit (see Table 3). The strength of the correlations was highly similar to the estimates reported by Kaliush et al. (2023) regarding the associations between the number of traumatic experiences during childhood and adolescence (not just experiences of childhood maltreatment) and symptoms of depression, anxiety, and BPD.

Regardless of whether maltreatment was measured using the CTQ or the TEBL, childhood maltreatment was significantly associated with emotion dysregulation and total mental health symptoms. Moreover, the strength of these associations was significant and comparable across internalizing and other mental health problems, but the connection between childhood maltreatment and externalizing symptoms was slightly weaker for the TEBL than the CTQ (see Table 3).

The composite measure of maltreatment was positively associated with emotion dysregulation and mental health symptoms (see Table 3). The strength of these associations was slightly stronger than that involving the TEBL alone. Although the correlations were slightly weaker than those involving the CTQ, this decrease in statistical power was more than offset by the increase in statistical power afforded by using a sample size that was over twice as large as BABY 1.0.

CTQ Only

The overall regression was significant when using the CTQ measure of maltreatment, F(4, 113) = 12.23, p < .001. Maternal age did not predict mental health outcomes (β = .008, p = .331), but race and family SES were significant predictors (β = -.27, p =.001 and β = -.23, p = < .001). Childhood maltreatment predicted total mental health problems (β = .43, p < .001).

TEBL Only

When examining the model with the TEBL measurement of maltreatment, the overall model was statistically significant, F(4, 210) = 12.66, p < .001. Maternal race and family SES were predictors of mental health outcomes (β = -.19, p = .004 and β = -.27, p <.001), but maternal age was not (β = -.09, p = .22). Childhood maltreatment predicted total mental health problems (β = .23, p < .001).

Composite Measure

The overall regression model using the composite measure of maltreatment was also significant, F(4, 328) = 18.19, p <.001. Maternal race and family SES were significant predictors of mental health problems (β = -.24, p < .001 and β = -.24, p < .001), but maternal age was not (β=-.01, p =.89). Childhood maltreatment predicted mental health outcomes (β = .27, p < .001).

Mental Health and Parenting Sensitivity

Our third hypothesis was that total mental health problems would predict lower maternal sensitivity. We again ran multiple linear regression models to test this hypothesis. The covariates and the measure of total mental health problems were included as the predictor variables, and the outcome variable was the composite measure of maternal sensitivity.

Pearson’s correlations revealed sensitivity was not significantly associated with total mental health outcomes (r = .02, p = .80). It is interesting to note that there was a small association between mental health problems and the positive regard domain of parenting behavior (r = -.24, p = < .001).

The linear regression model for this hypothesis was significant, F(4, 271) = 6.15, p < .001, but mental health outcomes did not predict maternal sensitivity (β = .05, p = .41).

Does Mental Health Mediate Maltreatment and Parenting Sensitivity?

Our next hypothesis was that the association between maltreatment and parenting sensitivity would be significantly weaker after considering mental health outcomes as a predictor. Because mental health did not predict maternal sensitivity, we did not run mediation analyses for this hypothesis.

Resilience

The next aim of the project was to examine how resilience and mindfulness impacted the association between mental health, maltreatment, and maternal sensitivity. We ran linear regression models to test the relationship between resilience, childhood, maltreatment, mental health, and parenting sensitivity. We later ran these same analyses using mindfulness.

Correlational analyses indicated that individuals of higher SES tended to self-report more resilience (r = .17, p < .001). Maternal age and race were not significantly associated with the construct (see Table 3). Participants with fewer mental health problems reported higher resilience (r = -.29, p < .001).

There was also a small but noteworthy association between resilience and the composite measure of overall maternal sensitivity (r = .20, p < .001). The maternal detachment parenting domain at 7 and 18 months was negatively correlated with resilience (r = .15, p = .019 and r = .23, p < .001). Resilience was also related to intrusive behaviors at the 18-month timepoint (r = – .20, p = .002). Mothers who demonstrated higher levels of positive regard at 7 months reported more resilience (r = .20, p =.001).

Resilience was negatively associated with the composite measure of child maltreatment (r = -.22, p < .001), but not the CTQ and TEBL (see Table 3).

Does Resilience Predict Fewer Mental Health Problems?

When examining the relationship between total mental health outcomes and resilience, the ANOVA model was significant, F (4, 325) = 16.63, p < .001. SES and Race were predictors of mental health problems (β = -.29, p <.001 and β = -.197, p = <.001), along with resilience (β = -.226, p < .001).

Does Mental Health Mediate Childhood Maltreatment and Mental Health?

CTQ. The strength of the association between the CTQ measure of childhood maltreatment and total mental health problems decreased by .06 when including resilience into the model (β = .36, p < .001). The relationship between resilience and mental health continued to be significant (β = -.41, p < .001).

Mediation analyses using Process indicated maltreatment had a direct effect on mental health, b = 16.21, se = 3.20, t = 5.07, p < .01, 95% CI [9.87, 22.51], but the indirect effect was insignificant, b = 1.97, 95 % CI [-1.97, 4.93].

TEBL. After accounting for resilience, the strength of the association between the TEBL measurement of childhood maltreatment and mental health weakened by .04 (β = .19, p < .001). Resilience continued to be associated with mental health (β = -.45, p < .001).

Child maltreatment had a significant indirect effect on mental health via resilience, b = 1.67, 95% CI, [.46, 3.25]. The direct effect was also robust, b = 11.82, se = 2.66, t = 4.45, p = 0.00, 95% CI [6.59, 17.05].

Composite Measure of Maltreatment. When utilizing the combined childhood maltreatment measure, the association between maltreatment and mental health decreased by .04 (β = .23, p <.001), and the association between resilience and mental health continued to be significant (β = -.19, p <.001).

Bootstrapped mediation analyses showed the direct path of childhood maltreatment on mental health was significant, b = 10.68, se = 3.23, p = 0.00, 95% CI [4.31, 17.06], but the indirect path was not, b = 1.94, 95% CI [-1.99, 5.96].

Is Resilience Associated with Sensitive Parenting?

The overall model between resilience and sensitivity was significant, F(4, 328) = 18.19, p < .001. However, there was not a significant relationship between these two variables (β = .11, p =.066).

Mindfulness

Individuals of higher family SES tended to demonstrate more mindfulness (r = .17, p <.001). Maternal age, race, and sensitivity were not significantly associated with mindfulness (see Table 3). Participants with greater mental health challenges and difficulties in emotional regulation exhibited less mindfulness (r = -.41, p < .001, and r = -.22, p < .001). There was a small association between intrusive maternal behaviors and mindfulness at 18 months postpartum (r = -.15, p = .019).

Does Mindfulness Predict Lower Levels of Mental Health Symptoms?

The ANOVA model showed mindfulness was associated with total mental health problems, F(4, 323) = 46.7, p < .001. Race and family SES continued to predict mental health (β = -.12, p < .005 and β = -.33, p < .001), along with mindfulness (β = -.52, p < .001).

Does Mindfulness Mediate Childhood Maltreatment and Mental Health?

CTQ. When examining the association between mindfulness, the CTQ measure of childhood maltreatment, and mental health, the overall model was significant, F(5, 109) = 24.01, p < .001. Maltreatment became a weaker predictor of total mental health problems when accounting for mindfulness, decreasing by .17 (β = .26, p < .001). The relationship between mental health and resilience also slightly weakened, by .005 (β = -.51, p < .001).

The indirect path from maltreatment to mental health showed a meaningful association, b = 6.73, CI 95% [2.63, 12.55], indicating that resilience is a mediator. The direct effect was also robust, b = 11.68, se = 3.14, t =3.72, p = 0.0003, CI 95% [2.63, 12.55].

TEBL. The overall model using TEBL measure of childhood maltreatment showed a significant association between mindfulness and mental health, F (5, 206) = 36.26, p <.001. The connection between these variables decreased by .07 (β = .15, p = .006) when including resilience in the model. The association between mindfulness and mental health slightly increased, by .03 (β = -.55, p < .001).

Bootstrapped analyses indicated mindfulness was a mediator in the relationship between maltreatment and mental health, b = 5.75, CI 95% [2.67, 9.34]. The direct effect remained significant, b = 7.73, se = 2.37, t = 3.26, p = 0.00, 95% CI [3.06, 12.40].

Composite Measure. The overall model was significant when using the combined measure of maltreatment, F(5, 321) = 40.48, p < .001. When accounting for mindfulness, maltreatment became a weaker predictor of total mental health problems, decreasing by .12 (β = .15, p < .001). The association between mindfulness and mental health was also weakened by .03 (β = -.484, p <.001).

Process analyses indicated mindfulness served as a mediator between maltreatment and mental health, b = 5.75, 95% CI [2.67, 9.37]. The direct effect remained significant, b = 7.73, se = 2.34, t = 3.26, p<.01, CI 95% [3.06, 12.34].

Is Mindfulness Related to Sensitive Parenting?

The ANOVA model between mindfulness and sensitivity was significant, F(4, 291) = 7.20, p < .001. Nevertheless, there was not a significant association between these variables (β = .06, p = .29).

Discussion

The first aim of the study was to examine whether mothers’ histories of childhood maltreatment are associated with less maternal sensitivity. Consistent with our hypothesis, child maltreatment, as measured with the CTQ, predicted less maternal sensitivity. We found the strength between maltreatment and maternal sensitivity to be slightly stronger than what was found in the meta-analysis by Savage et al. (2019). The bivariate correlations indicated child maltreatment, as measured with the TEBL, was not significantly correlated with maternal sensitivity. However, the TEBL had an unexpected positive association with parenting sensitivity in the regression models that included maternal race, age, and family SES as covariates.

One potential explanation for the discrepancy between the measures is that the TEBL might not capture maltreatment in the same way as the CTQ. Another explanation is that the format of the TEBL differs from that of the CTQ. The TEBL asks individuals to report how many times they have undergone adverse experiences, for multiple 5-year spans. If participants consistently experienced maltreatment, it would take a great deal of cognitive labor to identify an accurate numerical response for each question. Additionally, it may be distressing to thoroughly explore one’s maltreatment history to respond to each question.

The CTQ, on the other hand, uses a 5-point Likert scale, which is more straightforward in asking for responses. As individuals do not have to be as conscious of their past experiences to calculate how often they experienced maltreatment, their self-reports may be more accurate and less influenced by distress. To evaluate whether this is the case, future research can administer both the TEBL and the CTQ to participants. Because the BABY cohorts completed separate measures of maltreatment, it is hard to explain why the TEBL results differed from the CTQ. If individuals complete both measures of maltreatment, it may be easier to ascertain the discrepancy between the TEBL and CTQ in their relation to parenting sensitivity.

The second aim of the project was to see if mental health problems mediated the association between childhood maltreatment and parenting sensitivity. Firstly, we predicted childhood maltreatment would be correlated with increased mental health problems. Our findings aligned with previous research, indicating that both the TEBL, CTQ, and composite measure of childhood maltreatment predicted mental health problems. The TEBL, however, showed slightly weaker associations with mental health than the CTQ did. Secondly, we hypothesized mental health would predict less sensitive parenting behaviors. Contrary to existing literature, we did not find this to be the case. It is plausible that certain protective factors, such as resilience, mindfulness, social support, or a combination of them all, may prevent mental health from impacting parenting behavior. That said, our measure of maternal sensitivity is purely observational. Mothers may behave differently when they know they are under the eye of a trained researcher (i.e., the Hawthorne effect).

Furthermore, not all parenting behaviors are created equally. Prenatal mental health may impact some domains of parenting and not others. For instance, we found a small correlation between total mental health problems and positive regard (see above). Future research can examine the association between mental health and specific domains of parenting, rather than overall sensitivity.

The third aim of the study was to see if resilience and mindfulness buffered the association between maltreatment and mental health, and if these variables were associated with maternal sensitivity. Contrary to our hypothesis, on the whole, resilience was not a mediator between maltreatment and mental health, nor was it correlated with increased maternal sensitivity. It appears that resilience helps individuals cope with mental health challenges, potentially reducing mental health problems, but does not reduce the effect of maltreatment on mental health. Because psychopathology is not associated with maternal sensitivity, it makes sense that resilience (which is correlated with lower mental health) does not impact parenting behavior.

Mindfulness was a buffer between childhood maltreatment and mental health. As found in our study, psychopathology is associated with increased emotional dysregulation. When individuals practice mindfulness, they accept the uncomfortable feelings dysregulation can cause and try not to judge themselves for experiencing mental health difficulties or intense emotional reactions (Keng et al., 2011).

Surprisingly, mindfulness was not correlated with sensitive parenting. Mindfulness may have a more direct effect on the individual using the practice, rather than those in their inner circle (e.g., their children). Furthermore, because mental health is not associated with maternal sensitivity, it is logical that mindfulness, which impacts mental health, shows an insignificant association with parenting behavior.

Strengths and Limitations

This research was unique in that it followed pregnant women from the third trimester of pregnancy to 18 months postpartum. Because the study was longitudinal, we were able to examine whether specific constructs, such as maternal sensitivity, were consistent over time (i.e., test-retest, reliability). The study also used a wide variety of measurement tools, ranging from self-reports to behavioral observations, which may paint a more complete picture of mothers’ behaviors and internal experiences.

One major limitation of this research was that the two cohorts of the study measured maltreatment differently. Even after harmonization, it is hard to know if maltreatment across the CTQ and TEBL is similar. Had BABY 1.0 and BABY 2.0 administered both the TEBL and the CTQ, it would have been easier to determine why the TEBL is positively associated with sensitive parenting behavior.

Another limitation of this research was that environmental factors could have also impacted the participants. For instance, the pandemic interrupted data collection for BABY 2.0. This required switching visits to a virtual format to follow health guidelines. Additionally, COVID-19 could have created unforeseen stressors that uniquely impacted this cohort. The BABY 1.0 and BABY 2.0 cohorts may differ from one another due to contextual factors.

Future Directions

Both the TEBL and CTQ may capture maltreatment, but in dissimilar ways. Future research can further examine the differences between these measurements. It would also be worthwhile to modify the TEBL questions to better reflect the CTQ format. For example, one could change the TEBL to a 5-point scale or solely administer the questions that map onto the CTQ. Slightly altering the TEBL to reflect a shorter format could also limit potential responder fatigue.

Lastly, it would be beneficial to research the potential mediators or moderators that buffer the association between childhood maltreatment and parenting sensitivity. If we can identify these protective factors, we can develop and tailor interventions to help support mothers who experienced childhood maltreatment. Even though mental health does not directly impact parenting, it is also important to prioritize this aspect of mothers’ well-being. Specifically, the general community can work on raising awareness of maternal mental health problems and providing better access to care.

Conclusions

Experiencing abuse and neglect in childhood has ongoing effects on one’s mental health. Mothers with histories of childhood maltreatment were more likely to report more mental health problems than those without these adverse experiences. Protective factors, such as mindfulness, buffer the association between maltreatment and mental health. Childhood maltreatment was also associated with lower levels of parenting sensitivity. It is important to understand that experiences of abuse and neglect can influence how one views and navigates life. To create the best possible outcomes for mothers and their children, we must provide support for individuals who have experienced childhood maltreatment.

Tables

Bibliography

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