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Long-term consequences of childhood emotional abuse in mothers on

parental load and child mental health

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DOI: 10.1016/j.actpsy.2024.104169

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 Acta Psychologica 244 (2024) 104169

Contents lists available at ScienceDirect

Acta Psychologica
journal homepage: www.elsevier.com/locate/actpsy

Long-term consequences of childhood emotional abuse in mothers on

parental load and child mental health
Katharina Rost *, Emily Gossmann , Jörg M. Fegert , Ute Ziegenhain , Franziska Köhler-Dauner *
Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Childhood emotional maltreatment can be associated with long-term consequences on mental
Emotional abuse health. In addition, transgenerational transmission of adverse childhood experiences to the next generation can
Transgenerational transmission occur and thus have an impact on the mental health of one’s own children.
Parenting stress
Objective: The purpose of this study was to examine the role of stress on the association between childhood
Parenting load
Child mental health
emotional maltreatment and parental load what is referred to in this study as limitations in parental functioning
that affect the resources available to parents to cope with the demands of raising, caring for, and providing for
their child. Furthermore the effect of parental load on the mental health of one’s own children will be examined.
Participants and setting: N = 237 mother-child dyads (age mother M = 33.76, SD = 4.07 years; age child M =
11.91 months, SD = 0.89 months) from a longitudinal cohort study were examined at two different measuring
points.
Methods: Emotional abuse, perceived stress, parental load and child mental health were assessed using self and
external report questionnaires.
Results: The calculation of a mediation showed that the association of emotional abuse and parental load was
completely mediated by perceived stress (indirect effect ab = 0.44, 95 %-CI[0.17, 0.78]). In addition, effects of
parental load on the child’s mental health (β = 0.13, 95%CI [0.07;0.20]), mainly hyperactivity (β = 0.06, 95%CI
[0.03;0.11]) and prosocial behavior (β = − 0.04, 95%CI [− 0.07; − 0.01]), were evident.
Conclusions: The results of this study provide evidence that the mental health of children can be influenced in the
long term by increased parental load.

1. Introduction emotional abuse (Witt et al., 2017). Compared to the other forms of
abuse (e.g. physical or sexual), the prevalence of emotional abuse is the
Emotional abuse is defined as an intentional verbal or symbolic act highest, but lower than the prevalence of neglect (Witt et al., 2017).
by a parent or caregiver that results in or poses a high risk of significant Emotional abuse in childhood has repercussions for victims into
emotional harm to the child involved (Herrmann et al., 2022). It can be adulthood. Even when controlling for other types of childhood
differentiated between two sub-forms: First, there is an active form of maltreatment such as physical and sexual abuse, emotional abuse re­
emotional abuse, in which repeated hostile, dismissive, or ignorant mains a significant predictor of mental health problems (Korolevskaia &
behavior by a parent or caregiver towards a child occurs. On the other Yampolskaya, 2023). In particular, the odds of developing depression
hand, emotional abuse can also occur through withholding the experi­ are increased compared to other forms of abuse implying that depression
ence of relationships necessary for healthy emotional development, for may be the result of a specific sequela of emotional abuse (Gardner et al.,
example, by withdrawing attention, prohibiting relationships with peers 2019; Gerke et al., 2018; Nelson et al., 2017; Neumann, 2017). Addi­
or family members (Herrmann et al., 2022). The prevalence of tionally, mothers who experienced emotional abuse in childhood are at
emotional abuse in Germany is reported to be between 13 and 20 %, increased risk for developing postpartum depression (Choi et al., 2019).
making it one of the most common forms of adverse childhood experi­ The link between emotional abuse and depression is explained by the
ences (Buchheim et al., 2022; Witt et al., 2019). In Germany, 7 % adults fact that individuals with emotional abuse in childhood are more likely
report at least moderate emotional abuse and 19 % report at least mild to the formation of maladaptive schemas, unfavorable cognitive

* Corresponding author at: Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany.
E-mail addresses: [email protected] (K. Rost), [email protected] (F. Köhler-Dauner).

https://doi.org/10.1016/j.actpsy.2024.104169
Received 2 August 2023; Received in revised form 29 January 2024; Accepted 29 January 2024
Available online 10 February 2024
0001-6918/© 2024 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
K. Rost et al. Acta Psychologica 244 (2024) 104169

personality traits, problems with dysregulation, and/or unfavorable parental load, as well as the impact on children’s mental health. It is
interpersonal interaction styles (Li et al., 2020). Furthermore, emotional hypothesized that emotional abuse in the mother’s childhood will
abuse is a risk factor for suicidal behavior and non-suicidal self-harm impact later parental load, but this relationship will be mediated by the
(Angelakis et al., 2019; De Araújo & Lara, 2016; Liu et al., 2017; Liu mother’s perceived stress. Additionally, it is hypothesized that this
et al., 2018), dissociations, hallucinations, psychosis, substance abuse, parental load will impact children’s mental health (Fig. 1).
and sexual risk behaviors (Brassard et al., 2020; Houtepen et al., 2020).
In addition, adults who have experienced emotional abuse have a higher 2. Methods
risk for having high neuroticism, anxiety and stress scores (Dye, 2020)
and are more likely to use avoidant coping strategies (Nguyen-Feng 2.1. Study design and recruitment of participants
et al., 2017).
Childhood emotional abuse not only affects one’s own mental health, Within the project TRANS-GEN, mother-child dyads were examined
but also can have an impact on one’s own parenting skills and resources. longitudinally starting from birth of the child. The recruitment of
Mothers who experienced emotional abuse reported more stress in daily mother-child dyads (N = 533) took place in the women’s hospital of the
life and increased stress reactivity (Buchheim et al., 2022; Goodman University hospital of Ulm shortly after parturition (within 1 to 6 days
et al., 2017; Weltz et al., 2016), particularly including interpersonal after) in October 2013 (time point t0). Mothers provided written
stress (Hernandez et al., 2016). These findings suggest increased informed consent before participating in the study. After that, they took
vulnerability in interactions with others, which in turn may explain the part in an initial screening interview. Abuse and neglect in the mother’s
increased risk of depression among individuals with experiences of childhood were assessed using the Childhood Trauma Questionnaire
emotional childhood abuse. In addition, mothers with experiences of (CTQ; Bader et al., 2009). All mother–child dyads were invited at four
abuse reported having fewer coping strategies during stressful times of subsequential time points: 3 months (t1, N = 279), 12 months (t2, N =
the Covid-19 pandemic, suggesting that affected mothers are limited in 246), 24 to 36 months after birth (t3, N = 174) and at preschool age
their ability to cope with severe stress (Köhler-Dauner et al., 2021). between 4 and 7 years (t4, N = 116). With N = 246 mother-child dyads
Increased stress, in turn, impacts parental stress and parenting skills. parental stress load as well as mothers stress load were assessed using
High perceived stress is associated with deficits in parenting skills with the Eltern-Belastungs-Inventar (EBI; Tröster, 2011) and the Perceived Stress
lower empathy and greater psychological control, psychological Scale 14 (PSS-14; Cohen et al., 1983) at t2. At t4 N = 116 mothers were
aggression, and more negative reactions towards the child (Clowtis visited in their homes, where child mental health was assessed via the
et al., 2016; Liu & Wang, 2015; Mackler et al., 2015). In addition, par­ Strengths and Difficulties Questionnaire (SDQ; Klasen et al., 2003). There
ents who are exposed to more stress have lower parenting self-efficacy were different reasons for not participating at all measurement times
and less positive interactional behaviors with their child (Crnic & such as lack of time, current psychosocial circumstances, no willingness
Ross, 2017). Most importantly, perceived stress has been shown to be to take part in particular surveys or merely not reaching the families due
associated with a higher chance of neglecting or abusing one’s children to changed contact details.
(Beckerman et al., 2017; Brown et al., 2020; Warren & Font, 2015).
Additionally, previous findings suggest that emotional abuse in 2.2. Participants
childhood also increases the likelihood of abuse to one’s own children
(Madigan et al., 2019). For example, it has been demonstrated that there In total, N = 246 mother-child dyads participated at time point t0 and
may be an association between childhood emotional abuse with various t2. The average age of participating mothers at t2 was M = 33.70 years
facets of aversive parenting behavior such as unsupportive parenting (SD = 4.10), ranging from 24 to 44 years. Years spent in education were
behaviors, less emotional availability and maternal psychological and measured as an ordinal variable (1 =≤ 9 years of education, 2 = 10 years
physical aggression (Augsburger et al., 2019; Fuchs et al., 2015; of education and 3 = ≥12 years of education; classification based on the
McCullough et al., 2017), as well as with infant stress reactivity (Hipwell German education system and acquired educational school degree), 72
et al., 2019). These findings underscore the negative effects of emotional % of all mothers reported 12 years of education or more, whereas 22 %
abuse across multiple generations, which is also referred to as trans­ reported 10 years of education, and 5 % reported 9 years of education or
generational transmission. Risk factors for the transgenerational trans­ less. With regard to income, 9 % of mothers stated a monthly family
mission of emotional abuse include younger maternal age at birth, income below 2000 €, 24 % stated between 2000 and 3000 €, 27 %
parental mental illness, intimate partner violence, and lack of family stated between 3000 and 4000 € and 38 % stated above 4000 €. The
support (Langevin et al., 2021; McCullough et al., 2017; St-Laurent average age of all children at t2 was M = 11.91 months (SD = 0.89) with
et al., 2019). their ages ranging from 10 to 15 months. Nearly half of the participating
Children who grow up in the cycle of transgenerational transmission children (47 %) were females (Table 1).
are at an increased risk for developing mental illnesses both in childhood
and in adulthood (Islam et al., 2023). Children of parents with adverse 2.3. Measures
childhood experiences are at an increased risk for developing behavioral
problems, such as hyperactivity, emotional disturbance and maladap­ 2.3.1. Emotional abuse (EA)
tive socioemotional symptoms (Doi et al., 2021; McDonnell & Valentino, Maternal emotional abuse was retrospectively assessed at t0 using
2016; Schickedanz et al., 2018). Among these, emotional abuse of the the German short version of the Childhood Trauma Questionnaire (CTQ;
mother had a stronger impact than emotional abuse of the father Bader et al., 2009). The CTQ screening assesses child abuse and neglect
(Schickedanz et al., 2018). In addition, adverse childhood experiences in through a retrospective self-report. It contains five subscales each
the mother’s childhood also was related to the occurrence of biomedical assessed by 5 items on a 5-point Likert scale, screening emotional,
(e.g., diabetes during pregnancy, intensive care of the baby after birth) physical and sexual abuse as well as physical and emotional neglect.
or psychosocial risk factors (e.g., teenage mother, low family income). Additionally, three items assess whether participants tend to trivialize
These risk factors, in turn, affect the child and increase the risk for problematic experiences. In this study, only the scale “emotional abuse”
physical and emotional health problems (Madigan et al., 2017). In was used (“Members of my family called me “stupid”, “lazy”, “ugly” or the
addition, previous studies have shown that limited parenting skills also like”, “I thought my parents wished I had never been born”, “Family members
impact children’s mental health, especially the ability to regulate said hurtful or insulting things to me”, “I felt that someone in my family hates
emotions (Castro et al., 2015; Criss et al., 2016; Nanninga et al., 2015). me” and “I believe that I have been emotionally abused”). A sum score was
The purpose of this study is to examine the impact of maternal calculated from all five items. Internal consistency in a German sample
childhood emotional abuse and stress on later parenting ability and was measured at α = 0.87 (Klinitzke et al., 2012) and in our sample an α

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K. Rost et al. Acta Psychologica 244 (2024) 104169

Fig. 1. Overview of the assumed relationships between all relevant variables.

“strongly agree.” Sum scores are calculated from raw scores. The sum
Table 1
values from the raw values were then transformed into T-values (M =
Descriptive statistics of all variables.
50, SD = 10). Scores above 60 indicate above-average parenting diffi­
t2 (n = 237) t4 (n = 103) culties. The internal consistency for the EBI total scale is α = 0.95 and for
M SD Range M SD Range the parent scale α = 0.93. The retest reliability for the parent scale after
Age mother 33.76 4.07 24–44 38.34 4.18 30–47
one year is rtt = 0.87 (Tröster, 2011). The internal consistency of the
Age child* 11.91 0.89 10–15 5.30 0.52 4–7 various subscales in our sample is between α = 0.68 (“attachment”) and
Emotional abuse 7.27 3.59 5–24 7.25 3.59 5–24 α = 0.78 (“personal limitation”) and for the parent scale at α = 0.83.
(CTQ)
Parental load (EBI) 55.28 10.29 30–100 56.12 11.89 34–100
2.3.3. Perceived daily stress (PSS-14)
Maternal stress (PSS- 19.11 8.94 1–49 22.19 9.32 3–49
14) Daily stress perceived by participating mothers was assessed via the
Child mental health “Perceived Stress Scale 14” (PSS-14; Cohen et al., 1983). The original
(SDQ) PSS-14 measures perceived stress in the previous four weeks, consisting
Emotional problems 1.45 1.45 0–5 of a 5-point scale from 0 to 4 with a total of 14 items of which 7 are
Conduct problems 2.09 1.48 0–7
Hyperactivity scale 2.91 2.16 0–8
positive and 7 are negative. After the positive items are reversed, a sum
Peer problems scale 1.00 1.46 0–7 score can be calculated from all 14 items (e.g. “How often in the last month
Prosocial scale 7.50 1.88 1–10 have you felt unable to control important things in your life?”, “How often
Global scale 7.45 4.06 0–20 have you felt nervous and stressed in the last month?”, “How often in the last
month have you had the feeling that you are successfully coping with
important changes in your life?”). The sum score can range from 0 to 54. In
N % N % general, high scores indicate a high degree of perceived stress, however,
Sex (male) 126 53 54 51 there are no cut-off values as the PSS is not a diagnostic tool. Previous
Maternal years of education studies have found high internal consistency between α = 0.82 to α =
≤9 years 13 5 7 7 0.86, as well as evidence for the convergent, concurrent and criterion
10 years 52 22 21 20
≥12 years 171 72 75 71
validity of the scale (Andreou et al., 2011; Cohen et al., 1983; Katsarou
Monthly family income (€) et al., 2012). The internal consistency in our sample is α = 0.91.
≤ 2000 21 9 1 1
2000–3000 57 24 6 6 2.3.4. Strengths and Difficulties Questionnaire (SDQ)
3000–4000 64 27 31 30
The German version of the Strengths and Difficulties Questionnaire
≥4000 90 38 62 59
(SDQ; Klasen et al., 2003) was used at t4 to survey the children’s mental
Note. Age child at t2 in months and at t4 in years. health and was completed by their parents. The questionnaire contains
five scales, each scale consisting of five items, which are rated on a 3-
= 0.85. point Likert scale (0 = not applicable, 1 = partially applicable, 2 =
clearly applicable). The five scales are “Emotional problems” (e.g.
2.3.2. Parental load “Many worries or often seems worried” and “Many fears, easily scared”),
The foundation of the Eltern-Belastungs-Inventar (EBI; Tröster, “Conduct problems” (e.g. “Often loses temper” and “Often lies or cheats”),
2011) is Abidin’s (2012) Parenting Stress Model, according to which two “Hyperactivity scale” (e.g. “Restless, overactive, cannot stay still for long”
main sources of parental stress are distinguished: (1) child characteris­ and “Easily distracted, concentration wanders”) “Peer problem scale”
tics and behaviors that result in specific demands on parents and (2) (“Rather solitary, prefers to play alone” and “Gets along better with adults
limitations in parental functioning that affect the resources available to than with other children”) and “Prosocial scale” (e.g. “Considerate of other
parents to cope with the demands of raising, caring for, and providing people’s feelings” and “Often offers to help others (parents, teachers, other
for their child. In total, the EBI consists of a total of 48 items. In this children”). For each scale, the sum score of all 5 items was calculated.
study, only the parent scale has been used as a measure of parental load. Higher values indicate more severe problems. Husky et al. (2020) report
The EBI contains seven subscales that capture impairments in parental satisfactory internal consistencies (α Emotional Problems = 0.74, α Conduct
functioning domains. The items of the seven parental subscales regard problems = 0.74, α Hyperactivity scale = 0.82, α Peer problem scale = 0.67, α
topics such as “health” (e.g. “Since having children, I’ve been ill more Prosocial scale = 0.71) in a German sample. Internal consistencies in our
often.”), “depression” (e.g. “I sometimes have the feeling that it’s actually sample were measured at α Emotional Problems = 0.60, α Conduct problems =
my fault if my child has done something wrong.”), “social isolation” (e.g. 0.56, α Hyperactivity scale = 0.78, α Peer problem scale = 0.65 and α Prosocial scale
“Since becoming a mother, it’s been difficult for me to make new contacts.”), = 0.70.
“parenting skills” (e.g. “I sometimes have the impression that I don’t get on
particularly well with some things.”), “attachment” (e.g. “I sometimes find it
difficult to find out what my child needs.”), “partner relationship” (e.g. 2.4. Statistical analyses
“Since the child arrived, my partner and I haven’t spent as much time together
as I would like.”) and “personal limitation” (e.g. “I feel like I have to do The data was analyzed using R version 4.1.3 (R Core Team, 2019). p-
without a lot as a mother.”) with 4 items each. Each statement of the EBI values ≤ .05 were considered significant. N = 246 mothers and their
has to be answered on a five-point Likert scale ranging from “strongly children participated at measurement time point t2, but n = 9 mother-
disagree,” “somewhat disagree,” “not sure,” “somewhat agree,” to child dyads had to be excluded due to missing values. The mediation

3
K. Rost et al. Acta Psychologica 244 (2024) 104169

analysis was calculated with N = 237 using the PROCESS macro soft­ predicted parental load, (β = 0.71, p < .001). When perceived maternal
ware by Hayes (2018) in R, which uses ordinary least squares regression, stress was included in the model, parental load was no longer signifi­
yielding unstandardized path coefficients for total, direct, and indirect cantly predicted by childhood emotional abuse (β = 0.07, p = .625). The
effects. Bootstrapping with 5000 samples together with hetero­ relationship between childhood emotional abuse and parental load was
scedasticity consistent standard errors (Davidson & MacKinnon, 1993) fully mediated by perceived maternal stress (indirect effect ab = 0.44,
were employed to compute the confidence intervals and inferential 95 %-CI[0.17, 0.78] (see Fig. 2).
statistics. Effects were deemed significant when the confidence interval
did not include zero. A-priori Power-Analysis was conducted using the
3.3. Effects on child mental health
simulation calculations by Fritz and MacKinnon (2007). Small to me­
dium effects were expected in the a-path and b-path in our sample. To
The results of the regression analyses are presented in Table 2 and
reach a power of p = .8 a sample size of min. N = 148 was required (Fritz
Fig. 2. Except for the peer problems scale (F(4, 98) = 1.55, p = .194, R2
& MacKinnon, 2007).
= 0.02), the overall model fit was significant in all other models.
At t4, N = 116 mother-child-dyads participated in the study. In total,
Parental load around the child’s first birthday was identified as a sig­
N = 103 complete data sets until measurement time point t4 could be
nificant predictor for the child mental health scales hyperactivity (β =
used for the analysis of the second hypothesis. A total of 6 regression
0.06, 95%CI [0.03;0.11]), prosocial behavior (β = − 0.04, 95%CI
models were calculated. For all multiple regression models, assumptions
[− 0.07;-0.01]) and the global scale (β = 0.13, 95%CI [0.07;0.20]),
of linear regression were checked visually and analytically. Boot­
indicating that higher parental load is associated with higher levels of
strapping with n = 5000 was applied (Davison & Hinkley, 1997) due to
hyperactivity, less prosocial behavior and a higher overall score for
violations of the normal distribution assumption of the residuals. All
mental health problems in preschool age. Parental load could neither
variables were added simultaneously to the corresponding models. We
significantly predict emotional problems (β = 0.02, 95%CI
included emotional abuse and maternal stress as control variables in all
[− 0.00;0.04]) nor conduct problems (β = 0.02, 95%CI [− 0.00;0.06]).
models. Age of the mother, mother’s education years, monthly family
income, sex of the child and the mothers stress level at t4 were tested as
4. Discussion
additional control variables. Due to significant negative associations
with child mental health, implying that older age is associated with
The results of this study imply that there is a relationship between
lower SDQ scores and therefore better mental health, maternal age was
the expression of childhood emotional abuse of mothers and later
included as a control variable. Children’s sex only showed associations
parental load when the child was 12 months old. The results showed a
with the emotional problems and prosocial behavior scales and was
positive association between emotional abuse in the mother’s childhood
therefore only included as a control variable in the corresponding
and parental load at the time when their children were about one-year
models. Mother’s education and monthly family income showed no
old. However, this relationship is completely mediated by the
significant associations with any scale of child mental health and were
mother’s perceived stress at this time. Mothers who were more
therefore not included in the models. A a-priori power analysis was
emotionally abused in childhood report more perceived stress, which in
conducted using the program G*Power (Version 3.1.9.4). A medium
turn increases parenting stress. In addition, parental stress has an impact
effect of parental load on child mental health was expected. To reach a
on children’s mental health in primary school age. Specifically, an effect
power of p = .9 a sample size of min. N = 116 was required for models
on higher levels of hyperactivity and less prosocial behavior, as well as
with 5 predictors and N = 108 for models with 4 predictors.
on the global score from several problem areas was identified. No as­
sociations with emotional or conduct problems could be found.
3. Results
Although the focus of this study was not to assess the prevalence of
emotional abuse, it can nevertheless be reported in this cohort. The
3.1. Descriptive analyses
mean score for the emotional abuse scale is in the unremarkable range
and represents nonexistent to minimal expression of emotional abuse
Descriptive statistics of demographic variables, all variables included
(Häuser et al., 2011). 81 % (n = 191) of the surveyed women reported
in the mediation analysis as well as in the linear regression models are
nonexistent to minimal emotional abuse in their childhood. On the other
presented in Table 1.
hand, 11 % (n = 27) of the surveyed women reported low to moderate
emotional abuse, 3 % (n = 6) of women reported moderate to severe
3.2. Mediation analysis emotional abuse and 5 % (n = 13) of women reported severe to extreme
emotional abuse. The prevalence suggests that nearly 1 in 5 women have
A simple mediation was performed to analyze whether emotional been affected by childhood emotional abuse. These prevalences are
abuse in childhood predicts parental load around the child’s first comparable to other German studies with larger samples (Witt et al.,
birthday and whether the direct path would be mediated by the 2017) and prevalences from other studies with the same cohort as
perceived maternal stress at the same time. An effect of emotional abuse studied here (Buchheim et al., 2022).
on parental load was observed (β = 0.51, p = .005). Emotional abuse The results imply a connection between the extent of emotional
predicted the mediator significantly (β = 0.62, p < .001) which in turn abuse in the mothers’ childhood with parental load at the time of their

Fig. 2. Overview of the calculated mediation model and regression models including all variables and operationalizations.

4
K. Rost et al. Acta Psychologica 244 (2024) 104169

Table 2 Table 2 (continued )

Results of multiple regression models (N = 116). β 95 % CI* SE* t p
β 95 % CI* SE* t p
Maternal − 0.05 [− 0.09;− 0.01] 0.02 − 2.27 0.025
Emotional F(5, stress
problems 97) = Mother’s 0.03 [− 0.04;0.11] 0.04 0.81 0.419
4.64, age
p< Child’s sexb 0.96 [0.28;1.66] 0.35 2.70 0.008
.001, Global scale F(4,
R2 = 98) =
0.15 10.16,
Emotional − 0.06 [1.52;0.01] 0.04 − 1.65 0.103 p<
abuse .001,
Parental 0.02 [− 0.00; 0.04] 0.01 1.64 0.104 R2 =
load 0.26
Maternal 0.04 [0.00;0.07] 0.02 2.20 0.030 Emotional − 0.05 [− 0.23;0.16] 0.10 − 0.52 0.603
stress abuse
Mother’s − 0.08 [− 0.15; 0.04 − 2.57 0.012 Parental 0.13 [0.07;0.20] 0.04 4.16 <0.001
age − 0.01] load
Child’s 0.51 [− 0.02;1.04] 0.28 1.88 0.063 Maternal 0.08 [− 0.01;0.18] 0.05 2.00 0.048
sex** stress
Conduct F(4, Mother’s − 0.32 [− 0.48;− 0.17] 0.08 − 3.79 <0.001
problems 98) = age
5.90, *
Confidence interval and standard error with n = 5000 bootstrapping
p<
.001, samples.
**
R2 = Covariates; reference category male sex.
0.16
Emotional 0.02 [− 0.05;0.12] 0.04 0.44 0.662
child’s first birthday. Findings of other studies show associations of
abuse
Parental 0.02 [− 0.00;0.06] 0.02 1.84 0.070
maternal emotional abuse with later parenting skills and parenting
load behavior (Augsburger et al., 2019; Fuchs et al., 2015; McCullough et al.,
Maternal 0.05 [0.02;0.08] 0.02 3.07 0.003 2017). Therefore, it is assumed that parental load can be regarded as a
stress risk factor for aversive parenting behavior, including emotional, verbal
Mother’s − 0.06 [− 0.11;0.01] 0.03 − 1.79 0.077
and physical violence. Through these findings, evidence for long term
age
Hyperactivity F(4, consequences of childhood emotional abuse on later parental load could
98) = be found in the study. However, in our study, the association was fully
4.35, mediated by current perceived stress suggesting that it is not emotional
p= abuse per se that leads to fewer parenting skills, but the increased stress
.003,
R2 =
experienced by abused mothers. Findings from previous studies indi­
0.12 cated that emotional abuse affects perceived stress (Buchheim et al.,
Emotional − 0.01 [− 0.14;0.13] 0.07 − 0.25 0.801 2022; Goodman et al., 2017; Köhler-Dauner et al., 2021; Weltz et al.,
abuse 2016), which in turn leads to impaired parenting skills (Clowtis et al.,
Parental 0.06 [0.03;0.11] 0.02 3.44 0.001
2016; Hughes & Cossar, 2016; Liu & Wang, 2015; Mackler et al., 2015).
load
Maternal − 0.01 [− 0.06;0.04] 0.02 − 0.56 0.580 Parental load also had a significant association with the mental
stress health of elementary school-aged children. This finding is consistent
Mother’s − 0.13 [− 0.22;− 0.04] 0.05 − 2.70 0.008 with studies that have shown that limited parenting skills impact child
age mental health (Castro et al., 2015; Criss et al., 2016; Nanninga et al.,
Peer F(4,
problems 98) =
2015). The results of this study were able to show associations with
1.55, higher levels of hyperactivity and less prosocial behavior in particular.
p= Previous studies have shown that emotional abuse is a major risk factor
.194, for the development of depression in adulthood. In this study, no asso­
R2 =
ciation of parental load in abused mothers with emotional problems was
0.02
Emotional 0.01 [− 0.06;0.07] 0.03 0.25 0.804 found. However, two differences need to be highlighted: first, in this
abuse study this relationship refers to the children of abused mothers and not
Parental 0.03 [0.00;0.05] 0.01 1.96 0.053 abused individuals themselves. Even though we found evidence of
load transgenerational transmission of emotional abuse, as evidenced by
Maternal 0.00 [− 0.03;0.04] 0.02 0.21 0.834
stress
parental load and parenting skills, explicit emotional abuse was not
Mother’s − 0.04 [− 0.10;− 0.02] 0.03 − 1.24 0.218 investigated in the children. Second, the age seems to play a role. At
age younger ages, the prevalence of externalizing disorders is generally
Prosocial F(5, higher than for internalizing disorders (Georgiades et al., 2019; Li et al.,
behavior 97) =
2022), which corresponds to the age of the population studied here. The
4.47,
p= literature suggests that psychopathology at younger ages is more likely
.001, to manifest itself via externalizing symptoms and later develops into
R2 = internalizing disorders (Loth et al., 2014). This could explain why as­
0.15 sociations with externalizing behaviors were more likely to be found in
Emotional 0.11 [0.01;0.21] 0.05 2.17 0.033
abuse
the cohort of elementary school children studied. Additionally, limited
Parental − 0.04 [− 0.07;− 0.01] 0.01 − 2.56 0.012 parenting skills and parenting stress as well as parental depression as a
load possible result of emotional abuse are risk factors for the development of
ADHD, which could also explain the link between parental load and
hyperactivity as one of the main symptoms of ADHD (Claussen et al.,

5
K. Rost et al. Acta Psychologica 244 (2024) 104169

2022; Robinson et al., 2022). In particular, sensitivity and warmth in due to changed contact details. It must be critically noted that the results
parenting could predict the symptoms of hyperactivity. It can be of this study could be influenced by the high drop-out rate over time. As
assumed that mothers with increased parental load act less sensitively the final and important point, maternal stress and parental load were
towards their child, which is related to hyperactive symptoms. This assessed at the same measurement point. Therefore, inferences about the
could also explain the positive association of parental load with causality and direction of the associations are limited and are important
hyperactivity. to keep in mind when interpreting the results. However, it is additionally
However, there was also a significant relationship the global score of noted that this study builds on the findings of previous studies that
the SDQ. This could mean that stress in the child can not only show up in identified relationships of stress and parental stress with behavior across
one specific problem area, but that psychological problems can show up different time points (e.g. Mackler et al., 2015). Therefore, a causal
on several levels. Both internalizing and externalizing disorders are relationship is also assumed in the present study. Future studies should
related to emotion regulation (Brenning et al., 2022). Additionally, it consider the points noted.
can be assumed that the ability to regulate emotions adequately is not
learned properly when growing up with stressed and less competent 5. Conclusions
parents (Castro et al., 2015; Criss et al., 2016). Dysfunctional emotion
regulation in childhood and adolescence is associated with a variety of This study is based on data from a longitudinal cohort study with
mental health conditions including eating disorders (Favieri et al., 2021; recruitment of mothers and children at the time of birth and several
Sivasankar, 2020), externalizing disorder symptoms (Wills et al., 2016), subsequent measurement time points. In summary, the findings of the
anxiety, depression (Golombek et al., 2020; Gonçalves et al., 2019; study demonstrated an association between maternal emotional abuse
Young et al., 2019), and suicidality (Hatkevich et al., 2019). The het­ in childhood and later parental stress around the child’s one-year
erogeneity of the associated clinical pictures could explain why the birthday, which was completely moderated by perceived stress. In
children in this study showed a heterogeneous symptomatology as a addition, there were associations with the mental health of elementary
result of parental load. school-aged children, particularly hyperactivity and less prosocial
behavior. The results of this study provide evidence of transgenerational
4.1. Limitations of the study transmission of emotional abuse, manifested in increased stress and
parental distress in a nonclinical sample. In the long term, these factors
Considering the present study, several limitations need to be dis­ could increase the risk for emotional abuse of one’s own children. The
cussed. First, it has to be mentioned that a great number of our partic­ results of this study refer to time points before the global pandemic and
ipants had a high level of education, which has not been reported in it can be assumed that negative effects on children are further amplified
other German cohort studies (Kantorczyk et al., 2020; Kohlhuber et al., by the pandemic (Dalhof et al., 2023). This illustrates the relevance of
2008). Therefore, the present cohort does not represent the general providing early and low-threshold support to affected families and
population, indicating that generalizability of the results might be children. Particularly in light of the fact that long-term psychological
limited. Second, the collected data is based on self-report question­ effects on the next generation can be expected and that children with
naires, which were filled out independently by the mothers. Also, mental behavioral problem experience less support and social participation in
problems of the children were filled out by the mothers as an external everyday life (Wang, 2022), which can further intensify the symptoms
assessment. Therefore, it must be considered that the mothers completed already shown.
the questionnaires according to social desirability, which may have
biased the results of this study. In addition, data on the children’s mental Funding
health could be influenced by the mothers’ stress, which could have
further strengthened the measured correlation. Third, this study did not The study was funded by the Federal Ministry of Education and
closely examine the psychological mechanisms through which an impact Research (Grant No. 01KR1304A) (BMBF 2013–2016 additional interim
on children’s mental health occurs. It was discussed above that children funding 2017).
from affected families have a higher risk of not learning adequate
emotion regulation and thus may develop psychopathology. However, CRediT authorship contribution statement
this assumption needs to be investigated by future studies. Fourth, this
study did not consider actual parental behavior or interaction with Katharina Rost: Conceptualization, Data curation, Formal analysis,
children. The variable parental load was used to summarize various Funding acquisition, Investigation, Methodology, Project administra­
aspects, including mental health, parenting skills, and partnership. tion, Resources, Software, Writing – original draft, Writing – review &
Through these variables, actual parental behavior or actual emotional editing. Emily Gossmann: Conceptualization, Project administration,
abuse cannot be inferred, which must be considered when interpreting Supervision, Validation, Formal analysis, Methodology. Jörg M. Fegert:
the findings and should be investigated by future studies. Fifth, it must Conceptualization, Supervision, Validation, Funding acquisition. Ute
be noted that the SDQ is primarily a screening instrument to determine Ziegenhain: Conceptualization, Supervision, Validation, Funding
whether mental abnormalities or disorders are present at all, but not a acquisition. Franziska Köhler-Dauner: Conceptualization, Data cura­
diagnostic instrument for psychiatric disorders. Furthermore, the indi­ tion, Funding acquisition, Supervision, Validation.
vidual scales do not have a sufficiently high internal consistency, espe­
cially the scales “emotional problems”, “conduct problems” and “peer
problems scale”, to allow reliable statements to be made about indi­ Declaration of competing interest
vidual mental disorders. It must be accepted that children and adoles­
cents are more often wrongly classified as healthy although mental KR states that she has no conflict of interests.
disorders are present (Bettge et al., 2002; Brøndbo et al., 2011). Sixth, EG states that she has no conflict of interests.
despite good sample maintenance, the cohort used became smaller over JMF states that she has no conflict of interests.
the various measurement points, particularly after the first measure­ UZ states that she has no conflict of interests.
ment point in the clinic. At t0, all measurements were conducted directly FKD states that she has no conflict of interests.
in the clinic after birth and did not involve increased time spent on
laboratory visits and home visits. Various reasons for further drop-out Data availability
were given, including current psychosocial circumstances, no willing­
ness to take part in particular surveys or merely not reaching the families The authors do not have permission to share data.

6
K. Rost et al. Acta Psychologica 244 (2024) 104169

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