Emotional and behavioral problems in children of veterans suffering from Posttraumatic Stress Disorder

Uvod: Posljedice ratnih traumatskih događaja osjećaju i bližnji primarno traumatiziranih. Taj fenomen nazivamo sekundarna traumatizacija. Prema literaturi, transgeneracijski prijenos simptoma posttraumatskog stresnog poremećaja (PTSP) s veterana na potomke još uvijek je nedovoljno istraženo područje. Ciljevi: Ispitati imaju li djeca ratnih veterana oboljelih od posttraumatskog stresnog poremećaja (PTSP) više emocionalnih i ponašajnih smetnji u odnosu na djecu veterana bez PTSP-a. Drugi cilj istraživanja je utvrditi postoji li povezanost smetnji djece i očevih simptoma PTSP-a, majčinih simptoma sekundarne traumatizacije, majčine anksioznosti i depresivnosti, bračne prilagodbe roditelja i iskazane agresivnosti u obitelji. Cilj je utvrditi koje od procjenjivanih varijabli najbolje objašnjavaju pojavu smetnji djece veterana sa PTSP-om. Ispitanici i metode: U istraživanju je sudjelovalo 70 veterana oboljelih od PTSP-a, 70 veterana bez PTSP-a, te njihove supruge. Simptomi PTSP-a procijenjeni su PTSP ljestvicom koju primjenjuje kliničar (Clinician Administrated PTSD Scales, CAPS). Za procjenu smetnji djece korištena je Lista dječjeg ponašanja (Child Behavior Check List, CBCL) koju su ispunile majke. Majke su ispunile Upitnik posredne traumatizacije (PTSD Checklist Civilian Version, PCL) za procjenu simptoma sekundarne traumatizacije i Kratki inventar simptoma (Brief Symptom Inventory 53, BSI) za procjenu anksioznosti i depresivnosti. Oba roditelja ispunila su opći demografski upitnik, Spanierovu Ljestvicu prilagodbe partnera (Dyadic Adjustment Scale, DAS) za procjenu bračne prilagodbe i Ljestvicu načina rješavanja sukoba između roditelja i djeteta (Conflict Tactics Scale – Parent to Child Version, CTS-PC) za procjenu korištenja agresivnosti u odgojnim postupcima. IVRezultati: Djeca veterana sa PTSP-om imaju više rezultate na CBCL ljestvicama povlačenja, anksioznosti i depresivnosti i internalizirajućih smetnji u odnosu na djecu veterana bez PTSP-a. U djece veterana sa PTSP-om nije utvrđena povezanost smetnji djece i očevih simptoma PTSP-a, no postoji povezanost s majčinim simptomima sekundarne traumatizacije, anksioznosti i depresivnosti, bračnom prilagodbom roditelja. Ukupne emocionalne i ponašajne smetnje djece najbolje objašnjavaju majčini simptomi sekundarne traumatizacije, majčina bračna prilagodba i učestalost obiteljskih sukoba. Pri tomu više razine majčinih simptoma ponovnog proživljavanja, bolja majčina bračna prilagodba i češća nazočnost djeteta roditeljskim fizičkim sukobima znače manju razinu smetnji djece, dok više razine majčinih simptoma pretjerane pobuđenosti i češća nazočnost djeteta roditeljskim svađama i češća uključenost djeteta u fizički sukob roditelja znače više razine smetnji djece. Zaključak: Rezultati ovog istraživanja pokazuju da simptomi PTSP-a u oca veterana sami po sebi ne uzrokuju emocionalne i ponašajne smetnje djece. No, ako otac veteran ima PTSP, njegova djeca školske dobi imaju rizik za više razine anksioznosti, depresivnosti i povlačenja, u odnosu na djecu veterana bez PTSP-a. Majčini simptomi sekundarne traumatizacije, njena bračna prilagodba i učestalost agresivnih sukoba u obitelji najbolje objašnjavaju pojavu procjenjivanih smetnji djece.Introduction: Impact of traumatic war experiences is not limited to those engaged directly; as those who are in intimate relationship with the traumatized individual can also suffer from psychological consequences. This phenomenon is known as secondary traumatization. The literature about transgenerational transmission of Posttraumatic Stress Disorder (PTSD) symptoms from veterans to their offspring is still sparse. Objectives: The objective of this study was to examine if the children of veterans suffering from PTSD have more emotional and behavioral problems than those of veterans without PTSD; to explore the correlations between children’s problems and fathers’ PTSD symptoms, mothers’ symptoms of secondary traumatization, mothers’ anxiety and depression, parents marital adjustment and expressed aggressive behavior in family. The objective was to determine which of assessed variables best explain the problems in children. Patients and Methods: The research involved 70 veterans with PTSD and 70 without PTSD, including their wives. The PTSD symptoms in fathers were assessed using the Clinician- Administrated PTSD Scale (CAPS). Emotional and behavioral symptoms in children were indirectly assessed by the mothers using the Child Behavior Check List (CBCL). Symptoms of secondary traumatization in spouses were assessed using the PTSD Checklist - Civilian Version (PCL); and mothers’ anxiety and depression were assessed using the Brief Symptom Inventory 53 (BSI). Parents fulfilled demographic questionnaires, Dyadic Adjustment Scale (DAS) for assessment of marital adjustment and Conflict Tactics Scale – Parent to Child version (CTS-PC) for assessment of expressed aggression toward children. VIResults: The children of veterans with PTSD had significantly higher scores on CBCL scales of withdrawal, anxiety and depression, and internalizing problems compared to the children of veterans without PTSD. In children with PTSD father we found significant correlations between their problems and mother’s symptoms of secondary traumatization, her anxiety and depression. There were no correlations between father PTSD and problems in children. Using linear regression analyses we found that mother’s symptoms of secondary traumatization, her marital adjustment and frequency of family conflicts are the best contributor to the child’s symptoms in our model. Higher levels of mothers’ re-experiencing symptoms, better marital adjustment and more frequent exposure of child to the physical conflicts between parents were connected to the lower levels of problems in child. Higher levels of mothers’ hyperarousal symptoms and more frequent exposure of the child to the verbal fights between parents or involvement in their physical conflict were connected to the higher levels of problems in child. Conclusion: Our results show that veteran’s PTSD symptoms alone do not result in emotional and behavioral problems in children. Still, if a father veteran has PTSD his school-aged children are at risk to have higher levels of anxiety, depression and withdrawal, in relation to those of the veterans without PTSD. Mother’s symptoms of secondary traumatization, her marital adjustment and frequency of family conflicts are the best contributor to the child’s problems in our model