Breaking the chain together: Understanding and supporting parents with PTSD

Abstract

This dissertation examines how parental post-traumatic stress disorder (PTSD) affects parenting, and whether a parenting intervention in addition to trauma-focused therapy (TFT) can prevent potential negative effects of parental PTSD on parenting and the mental health of children. Using a combination of quantitative, qualitative, meta-analytic and intervention research, it aims to deepen understanding of the mechanisms linking parental PTSD to parenting challenges and to evaluate possibilities for prevention. First, the impact of parental childhood interpersonal trauma and PTSD symptoms on parenting stress was investigated using a one-stage individual participant data meta-analysis (IPDMA) of 12 studies including trauma-exposed parents of children aged 0–18. Results showed that both childhood interpersonal trauma and greater PTSD symptom severity were associated with higher parenting stress. However, childhood interpersonal trauma did not moderate the relationship between PTSD severity and parenting stress. This study was the first to apply IPDMA to this topic, demonstrating the value of pooling individual-level data to assess associations between trauma, PTSD, and parenting outcomes. Second, parents’ lived experiences of parenting with PTSD were explored through qualitative interviews with 14 parents seeking TFT in a tertiary mental healthcare setting. Parents described significant challenges related to emotional dysregulation and attempts to maintain control through overprotectiveness or strictness, often accompanied by strong self-criticism and feelings of parental incompetence. Limited social support further exacerbated these difficulties. At the same time, parents had important strengths, including prioritizing their children’s needs, carefully considering how to communicate about PTSD, and potential post-traumatic growth through parenting. Despite the often severe and complex consequences of their traumatic experiences, parenting remained a central source of motivation and meaning. These findings suggest that preventive parenting support should address both dysregulation and overcontrolling strategies, and help parents reduce their feelings of incompetence. Furthermore, the parenting role should be more explicitly integrated into TFT. Third, the development of a blended care parenting intervention for parents with PTSD was described: KopOpOuders for PTSD (KOO-PTSD). KOO-PTSD was then tested in a randomized controlled trial comparing TFT alone with TFT plus KOO-PTSD. Contrary to expectations, no additional benefits of KOO-PTSD were found. Instead, both conditions showed comparable improvements in several parenting behaviors and child mental health outcomes, suggesting that TFT itself may positively influence parenting and child wellbeing. This was the first randomized controlled trial specifically evaluating a parenting intervention for parents with PTSD in addition to TFT. Finally, the dissertation reflected on broader conceptual and methodological challenges in PTSD and parenting research, including the tendency of PTSD research to be secluded to ‘trauma-islands’, limited methodologies and populations, and insufficient attention to cultural context, resilience and growth. Recommendations were made to advance the field through open science, shared theoretical frameworks, longitudinal and diverse methods, centering lived experience, and addressing systemic inequalities.