561263
JEAXXX10.1177/0272431614561263Journal of Early AdolescenceDekel and Solomon
research-article2014
Article
The Contribution of
Maternal Care and
Control to Adolescents’
Adjustment Following
War
Journal of Early Adolescence
2016, Vol. 36(2) 198–221
© The Author(s) 2014
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DOI: 10.1177/0272431614561263
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Rachel Dekel1 and Dan Solomon2
Abstract
This study examined the contribution of maternal bonding to the adjustment
of Israeli adolescents following the 2006 Lebanon War. In all, 2,858 seventh
and eighth graders who lived in areas that were exposed to missile attacks
completed the Parental Bonding Instrument (assessing maternal care
and control) and questionnaires evaluating post-traumatic stress (PTS),
psychological distress, and life satisfaction. Beyond the contribution of war
exposure, maternal control was associated with adolescents’ greater distress,
more PTS symptoms, and lower life satisfaction. Maternal care contributed
to adolescents’ lower distress and greater life satisfaction. Furthermore,
maternal care moderated the association between adolescents’ war
exposure and their distress: Among adolescents who were highly exposed
to war, those who perceived their mothers as less caring exhibited greater
distress than equally traumatized adolescents who perceived their mothers
as more caring. The discussion deals with the findings in light of the literature
regarding parenting and trauma.
Keywords
maternal care and control, war, adolescents, PTSD, life satisfaction
1Bar
2Tel
Ilan University, Ramat Gan, Israel
Aviv University, Israel
Corresponding Author:
Rachel Dekel, Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat
Gan, 52900, Israel.
Email: rachel.dekel@biu.ac.il
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Introduction
In the last few decades, wars and terror attacks have become widespread
around the world. Consequently, a great deal of scientific effort has gone into
the examination of psychological harm caused to children and adolescents as
a result (e.g., Comer & Kendall, 2007; Joshi & O’Donnell, 2003; Masten &
Narayan, 2012; Pine, Costello, & Masten, 2005; Sagi-Schwartz, 2008). The
most common response reported has been post-traumatic stress disorder
(PTSD). In addition, the literature documents symptoms of distress such as
anxiety and depression (e.g., Barile, Grogan, Henrich, Brookmeyer, &
Shachar, 2012; Comer & Kendall, 2007; La Greca, 2007; Sagy & BraunLewensohn, 2009) and lack of life satisfaction (Besser & Neria, 2009; Shamai
& Kimhi, 2006) among adolescents in the aftermath of war.
In an attempt to understand the large variance in individuals’ mental health
outcomes following trauma, one must take into consideration the existence of
earlier traumatic experiences (T. Lavi, Green, & Dekel, 2013; Pfefferbaum,
1997) as well as characteristics of the current event and environmental factors such as familial resources (Brock, 2002; Harvey, 1996; Nader, 2008).
The nature of exposure characteristics to the traumatic event itself has been
thoroughly investigated (e.g., Ajdukovic & Ajdukovic, 1998; Barile et al.,
2012; Pat-Horenczyk et al., 2009; Punamaki, Qouta, & El Sarraj, 2001); variables such as the number of violent events to which the individual has been
exposed, their intensity or duration, and the individual’s proximity to them
have been reported to exert a heavy toll on an adolescent’s adjustment (Schiff,
2006). Much less is known, however, about the associations between familial
factors such as parenting characteristics and adolescents’ adaptation to traumatic situations. Thus, the current study aimed to broaden the discussion
regarding the contribution of maternal bonding to adolescents’ adaptation in
the aftermath of war. Our first goal was to examine the direct contribution of
maternal bonding, as manifested by aspects of care and control, to adolescents’ PTSD, psychological distress, and life satisfaction in the aftermath of
war. The second goal was to test the moderating role of maternal bonding:
that is, to see whether maternal bonding might buffer the impact of earlier
traumatic events and war exposure on adolescents’ adjustment.
Parenting During Adolescence
Parenting has long been acknowledged to be of great importance to children’s mental health (Freud, 1917). Bowlby (1969) regarded the quality of
the parent-infant bond as a main predictive factor of the child’s mental health
in the future. The influence of parenting during adolescence, however, has
always been a subject of scientific controversy.
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Piaget (1932/1965) and several classical psychoanalytic theorists (e.g.,
Blos, 1962; Erikson, 1959; Marcia, 1980) have emphasized the importance of
giving independence to adolescents in order to allow them to disengage emotionally from the family, as peer groups progressively become the predominant force in their lives. In contrast, family theorists have argued that
adolescents should not distance themselves from their families in order to successfully accomplish the transition from childhood to adolescence. Specifically,
they believe that parental support remains the principal component of healthy
development upon adolescence, as it enhances self-confidence, self-regulation,
and exploratory behavior (Baumrind, 1987, 1991; Hill, 1980). This latter view
is supported by research which points to parents’ direct and indirect influences
on the behavior and mental health of teenagers (Brown, Mounts, Lamborn, &
Steinberg, 1993; Steinberg, 2001). Contemporary literature has established the
important role that parents play in the enhancement of adolescents’ well-being
and the decrease of their likelihood of engaging in risk behaviors (Longmore,
Manning, & Giordano, 2013).
The recognition that parenting plays a major role in the adjustment of
children and adolescents has led to a wide-scale investigation of various
child-rearing behaviors. The effort to translate the concept of parenting into
operative structures has yielded two main dimensions of warmth and control
(Winefield, Goldney, Tiggemann, & Winefield, 1989), and different combinations of these dimensions are seen as forming distinct parenting styles. The
most common perspectives are those that were developed by Maccoby and
Martin (1983) and by Parker, Tupling, and Brown (1979). The first model
focuses on “responsiveness” and “demandingness,” while the second emphasizes “care” and “control/over-protectiveness” as the predominant aspects of
parenting. The current study is based on the latter model (Parental Bonding
or PB) as it has yielded the most widely used empirical measure of parental
behaviors in general (Enns, Cox, & Clara, 2002) and of parental behaviors
during times of trauma in particular (Bokszczanin, 2008).
The first dimension of PB, parental care, reflects an approach to parenting
that values the child’s emotions. This dimension includes elements such as
active listening, caring, appreciation, reinforcement of desirable behavior,
and parental involvement in the child’s life. Regarding the second dimension,
parental control, the positive aspects of it are reflected in setting clear boundaries, parental supervision, and encouragement of the child’s independence
(Steinberg, Lamborn, Dornbusch, & Darling, 1992). However, it is worth
noting that this second dimension—control—generally has a negative connotation under the PB model, more than it has under other models such as
Baumrind’s (Pedersen, 1994). The negative aspects of control are reflected in
excessive monitoring of the child’s daily routine and include coercive
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discipline, psychological control, the withholding of love, and expressions of
disappointment that cause the child to feel anxiety, isolation, and embarrassment (Barber, 1996; Peterson & Rollins, 1987).
Results from several studies that have been conducted among adolescents
over the years point to the associations between low levels of parental care,
high levels of parental control, and poor mental health. For example, low care
and high control were associated with adolescents’ psychological distress
(Shams & Williams, 1995), depression, anxiety and suicidal thoughts and
behavior (Diamond et al., 2005; Freudenstein et al., 2011; Pedersen, 1994),
oppositional and behavioral disorders (Rey & Plapp, 1990), homelessness
and runaway behavior (McGarvey et al., 2010; Schweitzer, Hier, & Terry,
1994), symptoms of eating disorders (Swanson et al., 2010), and low levels
of well-being (Canetti, Bachar, Galili-Weisstub, De Nour, & Shalev, 1997).
In the current study, we expected to find a similar pattern of findings
regarding adolescents’ adjustment following trauma. Specifically, we postulated that maternal care would contribute positively to adolescents’ post-war
adjustment and that maternal control would contribute negatively to adolescents’ post-war adjustment.
Parenting in the Shadow of Trauma
In the shadow of the destructive outcomes resulting from trauma, parenting
often becomes an especially challenging task. Parents, who are also exposed to
the traumatic event’s consequences, must be capable of regulating their personal
emotions in order to help their children reflect upon their own traumatic experiences; they must soothe and support their child on the one hand, while facilitating and accepting his/her separateness on the other (Cohen, 2009). It has been
shown that parents’ coping patterns, actual and perceived reactions, and practices and supervision following trauma are directly associated with children’s
and adolescents’ post-trauma mental health (Nader, 2008; Pfefferbaum, 1997).
As Masten and Narayan (2012) emphasize in their thorough review, parents can serve as protective or promotive factors in children’s and adolescents’ post-trauma adjustment. Therefore, an evolving field of research
involves the examination of diverse parental factors (such as parental coping
abilities and mental health) as moderators in the relationship between child
psychopathology and various stressors (Grant et al., 2006; Nader, 2008), particularly the stressor of disaster exposure (La Greca, Silverman, Vernberg, &
Roberts, 2003). Nevertheless, the moderating contribution of certain parenting styles and practices, which are thought to be salient components in the
process of children’s recovery after mass trauma (Gewirtz, Forgatch, &
Wieling, 2008), has been investigated in only a very few studies.
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To date, most of the existing studies regarding parental styles and practices as moderators of the association between trauma exposure and children’s adjustment have focused on samples of young children. These studies
pointed to the protective role played by warm and affectionate parenting (I.
Lavi & Slone, 2012; Punamaki, Qouta, & El Sarraj, 1997) as well as the risk
factor that over-protective parenting posed in children’s post-trauma adjustment (I. Lavi & Slone, 2012; McFarlane, 1987). Specifically, I. Lavi and
Slone (2012) found that maternal warmth was related to low levels of behavioral and social difficulties even for children reporting a high impact of exposure. Children with loving, affectionate, and caring parents were less likely to
be affected by political violence in comparison with children who had cold
and distant parents.
Very few attempts have been made to address PB and adolescents’ adjustment to trauma, and those studies which do exist have only investigated
recovery from the specific kind of trauma experienced in the wake of natural
disasters. One study conducted in the aftermath of a deadly earthquake found
that higher parental care and lower parental control increased adolescents’
resilience and protected them against development of PTSD symptoms (Sun,
Fan, Zheng, & Zhu, 2012). Similarly, Bokszczanin (2008) revealed that parents could actually undermine adolescents’ resilience through too much
parental control, that is, over-protectiveness. She found a positive correlation
between levels of parental over-protectiveness and PTSD symptoms among
adolescents who had lived through a flood. She also showed that parental
control moderated the association between flood exposure and post-disaster
distress. Among adolescents who were highly exposed to the flood, those
with parents who were more protective exhibited higher levels of PTSD
symptoms than those with parents who were less protective.
Based on these findings, in the current study we expected maternal care to
protect against the negative contribution of war exposure and/or previous
trauma to adolescents’ adjustment. By contrast, we expected maternal control
to exacerbate the negative contribution of war exposure and/or previous
trauma to adolescents’ adjustment.
The Present Study
There is a dearth of data regarding the direct and moderating contribution of
parental styles and practices to adolescents’ adjustment in the aftermath of
trauma. To the best of our knowledge, there are no published works regarding
parental styles and adolescents’ adjustment to war; the current study thus
aimed to fill this gap. Specifically, we tested the contribution of maternal
bonding to Israeli adolescents’ adjustment 8 to 10 months after the end of the
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2006 Lebanon War, a 33-day military conflict between Hezbollah paramilitary forces in Lebanon and the Israeli Defense Forces. An additional contribution of the present study lies in its large sample and in the use of several
dependent measures for adolescents’ adjustment, both specifically in regard
to the trauma of the actual war itself (PTSD) and broader factors of adjustment (general psychological distress and life satisfaction).
The study’s first aim was to examine the direct contribution of maternal
bonding to adolescents’ adjustment to war, beyond the contribution of earlier
traumatic events and war exposure. The second aim was to test whether
maternal bonding moderated the associations between both earlier trauma
and war exposure to adolescents’ adjustment.
On the basis of literature suggesting that females tend to perceive their
parents as more caring than males do (Canetti et al., 1997; Pedersen, 1994),
we predicted that the female adolescents in our sample would report receiving higher maternal care than would the males. We also expected differences
between males’ and females’ perceived maternal control, but due to inconsistent former findings (Pedersen, 1994; Shams & Williams, 1995), we could
not predict the directionality of those differences. We further hypothesized
that earlier trauma and increased war exposure would be associated with participants’ adjustment difficulties, that is, higher levels of psychological distress (PTSD and general distress) and lower levels of life satisfaction.
With regard to maternal bonding, we postulated that maternal care would
make a significant contribution to adolescents’ adjustment to war, meaning
that higher maternal care would be associated with lower levels of psychological distress (PTSD and general distress) and higher levels of life satisfaction. We also expected that the associations between adolescents’ adjustment
difficulties and both earlier trauma and higher war exposure would be stronger for those who perceived their mothers as less caring. In addition, we
expected maternal control to make a significant contribution to adolescents’
adjustment to war: High control would be associated with higher levels of
psychological distress and lower levels of life satisfaction. Finally, we
hypothesized that the associations between adolescents’ adjustment difficulties and both earlier trauma and higher war exposure would be stronger for
those who perceived their mothers as more controlling.
Method
Participants and Procedures
The study participants were comprised of 2,858 seventh and eighth graders.
Their ages ranged from 12 to 15 ( X = 13.5, SD = 0.65), and 52.6% of the
sample were females. Most of the participants (90.5%) were Israeli-born and
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lived in urban environments (81.9%). In total, 96.7% of the sampled adolescents had at least one sibling. Most of the participants’ parents were married
(84.1%), and 94.3% of the fathers held partial or full-time jobs, and 86.7% of
the mothers were fully or partially employed.
After obtaining approval from the chief scientist at the Ministry of
Education, managers of the regional educational psychological services
were asked to invite high school principals to participate in the study.
Twenty regional high schools, located in both rural and urban parts of
northern Israel, were approached. Sixteen school principals originally
agreed to participate in the study. Ultimately, however, due to time constraints as the year came to an end, questionnaires were only distributed
throughout 14 of those schools. The participating schools had between 4
and 17 seventh-and eighth-grade classes, yielding a total of 125 high school
classes in all. The questionnaires were administered 8 to 10 months after
the war by trained social workers and social science students who had participated in a training session.
All in all, data were collected from 3,241 pupils. Three hundred eightythree respondents were excluded from the study’s sample due to the following criteria: pupils who did not fill out the questionnaires on their own, and
pupils who had been physically wounded during the war, and were thus especially vulnerable (Neria, DiGrande, & Adams, 2011; Whalley & Brewin,
2007). Therefore, the final sample included 2,858 participants.
A chi-square analysis revealed that in the excluded group (n = 383), a
significantly larger percentage of pupils were born outside of Israel (36.5%)
and a significantly smaller percentage of their parents were married (75.2%)
than in the included group: N = 2,858, 9.5%, χ2(2) = 227.51, p < .001; 84.1%,
χ2(3) = 39.54, p < .001, respectively. No other demographic differences were
found among the two groups.
Regarding missing data, 381 pupils had missing values. In order to
improve the accuracy and power of the analysis, missing data were handled
by the use of multiple imputation (Enders, 2010). We used Little’s missing
completely at random test (R. J. A. Little, 1998) which did not reach significance, suggesting that data were missing completely at random. In keeping
with T. D. Little (2013), we used only single imputation, as each of the variables had only around 5% of missing values.
Measures
Socio-demographic background. This questionnaire included questions regarding gender, class, age, number of siblings, parents’ marital status and occupation, current address, country of birth.
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Earlier traumatic life events. Participants were asked to indicate whether
they had experienced a traumatic event in the past (specific examples, such
as a car accident or a terrorist incident, were given for the purpose of
clarification).
Region of exposure. Participants were divided into four groups based on their
exposure to violent attacks, as manifested by the number of missiles that had
fallen in the school’s region during the entirety of the war. Data regarding the
number of missiles that had fallen was provided by the Israel Ministry of
Foreign Affairs (2006). The four groups thus created were (a) low exposure
region (n = 271, categorized by only a few missiles); (b) medium exposure
region (n = 1,288, categorized by 100-200 missiles); (c) high exposure region
(n = 497, categorized by 400-500 missiles); and (d) extreme exposure region
(n = 802, categorized by more than 800 missiles).
Personal direct exposure. Participants were asked to indicate the number of
times they saw and/or heard a missile fall in their surroundings. Based on
their reports, participants were divided into two exposure groups, thus creating a dichotomous variable with these two levels: (a) no direct exposure (n =
477) and (b) direct exposure, that is, exposure to one missile or more (n =
2,381).
Parental Bonding Instrument (PBI). The PBI was developed by Parker et al.
(1979) as a measure for assessing the quality of the parent-child relationship
(in this particular study, the mother-child relationship), as perceived by the
children. The questionnaire consisted of 25 items relating to two dimensions seen as central to the parent-child relationship. The first dimension
was “care,” which refers to the degree of warmth, empathy, and closeness
versus distance, indifference, and emotional neglect. The second dimension, “control,” referred to the degree of parental control and ranged from
over-protectiveness, intrusiveness, and impairment of autonomy to encouragement of independence, respect for personal space, and facilitation of autonomy.
Participants were asked to rate the extent to which each item reflected their
perceptions of their mother, on a 4-point Likert scale, ranging from 1 (very
appropriate) to 4 (very inappropriate). The scale was found to have high internal and test-retest validity (Parker, 1986, 1989; Torresani, Favaretto, & Zimmerman, 2000; Warner & Atkinson, 1988) and long-term stability over time
(Wilhelm, Niven, Parker, & Hadzi-Pavlovic, 2005). The PBI’s Hebrew version
has been used in several Israeli trauma studies (e.g., Dinshtein, Dekel, & Polliack, 2011). In the current study, the Cronbach’s alpha values were .88 for the
“care” dimension and .72 for the “control” dimension.
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PTSD. PTSD was measured using the Children’s Post-Traumatic Stress Reaction Index (CPTS-RI; Frederick, Pynoos, & Nader, 1992). This questionnaire
has 20 items and, as it is based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994)
PTSD symptoms, it allows for the examination of both the intensity and the
number of post-traumatic stress (PTS) symptoms. Subjects indicated their
responses on a 5-point Likert scale, with scores ranging from 0 (not at all) to
4 (all the time). The Global Symptom Score consists of the sum of the scores
with possible scores ranging from 0.00 to 80.00. The Hebrew translation of
the CPTS-RI has been widely used in trauma studies on Israeli youth and has
high reliability and validity (e.g., Schwarzwald, Weisenberg, Solomon, &
Waysman, 1997; Solomon & Lavi, 2005). Cronbach’s alpha in the current
study was .88.
Psychological distress. Distress was measured using the Brief Symptoms
Inventory (BSI; Derogatis & Melisaratos, 1983). The BSI is a self-report
symptom inventory designed to assess the psychological symptom status
among clinical and non-clinical samples. Its 53 items reflect nine primary
symptom dimensions: anxiety, somatization, social alienation, paranoid ideation, obsessive-compulsive symptoms, hostility, phobias, depression, and
interpersonal sensitivity. Each item is rated on a 5-point Likert scale ranging
from 0 (not at all) to 4 (extremely). The final score is summed up into a General Symptom Index (GSI) so that the GSI score represents the subjects’ level
of distress. The BSI has been used in several Israeli studies of trauma (e.g., T.
Lavi & Solomon, 2005). Cronbach’s alpha for the total score found in the
current study was .96.
Life satisfaction. This item was measured using a single 11- point Likert scale
ranging from 0 to 10. The respondents were asked the following question: “If
‘10’ is the best possible life for you and ‘0’ is the worst possible life for you,
how in general would you rate your life at the moment?” This measure was
adopted from the Health Behavior in School-Aged Children (HBSC) questionnaire, which was previously tested on a larger index in Israel (Harel-Fisch
et al., 2010).
Statistical Analysis
First, we compared boys and girls in the two measures of PBI: care and control. Second, we assessed the correlations between the study variables. Third,
in order to examine the contribution of maternal care and control to adolescents’ PTSD, GSI, and life satisfaction in the aftermath of war, we performed
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three hierarchical regressions, with four steps each. In each of the three
regressions, the first step included the background variables of age, gender,
and the experience of earlier traumatic events. In the second step, we entered
the exposure characteristics which were found in association with at least one
of the dependent variables, based on the pre-assessed correlations (i.e., only
the variable of personal direct exposure was entered). In the third step, the
variables of maternal care and maternal control were entered. In the fourth
step, the interactions between earlier traumatic events, direct personal exposure, and each of the two dimensions of PB were entered. The interactions
were analyzed according to procedures outlined by Preacher, Curran, and
Bauer (2006), developed specifically for two-way regression models.
Results
Comparing the Level of Maternal Bonding Between the Genders
Two simple t-tests revealed that the difference between the genders in relation
to maternal care was significant, t(2856) = 6.25, p < .001: Girls reported significantly higher levels of perceived care ( X = 3.56 SD = 0.51) than the boys
( X = 3.44, SD = 0.54). The difference in maternal control was not significant,
t(2856) = 0.54, girls: X =1.75, SD = 0.43; boys: X = 1.76, SD = 0.44.
Correlations
Table 1 presents the correlations between the study variables and the measures of adjustment. Participants’ age and gender were correlated with PTSD:
that is, girls and younger adolescents were at greater risk of developing posttraumatic symptoms. Girls also had higher GSI scores and reported less life
satisfaction. The existence of early trauma was correlated with higher levels
of PTSD and GSI and with lower levels of life satisfaction. The two measures
of exposure were found in correlation, while personal direct exposure was
found to be positively correlated with PTSD. Higher levels of perceived
maternal care were associated with lower GSI levels and with more life satisfaction. High maternal control was found to correlate with more symptoms
of PTSD and GSI and with less life satisfaction.
Multiple Variables Analysis: The Contribution of PB to
Adolescents’ Adjustment
Table 2 presents the b, SD b, and the beta coefficients of each of the four steps
for each one of the regressions.
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Table 1. Pearson Correlations Among the Study’s Variables (N = 2,858).
Variable
1.
2.
3.
4.
Age
Gender
Early trauma
Region of
exposure
5. Personal
direct
exposure
6. Maternal care
7. Maternal
control
8. PTSD
9. GSI
10. Life
satisfaction
1
2
1
−.02
1
−.02
.00
. 08*** −.04*
.02
−.01
3
4
1
−.05**
1
.00
5
.11***
1
−.03
−.02
.12*** −.02
.05*
−.01
.07*** −.09***
.03
.00
−.05**
.00
.00
.25*** .11*** .00
.19*** .10*** −.03
−.05** −.09*** .03
6
7
1
−.49***
1
8
9
.09*** −.04*
.17***
1
.03
−.22*** .30*** .66***
1
−.02
.33*** −.32*** −.31*** −.45***
10
1
Note. Gender (0 = male, 1 = female). PTSD = post-traumatic stress disorder; GSI = General Symptom
Index.
*p < .05. **p < .01. ***p < .001.
PTS. The total set of the independent variables explained 11.2% of the variance, F(6, 2857) = 59.713, p < .001. As can be seen in the first step, gender,
age, and earlier traumatic life events contributed significantly to PTS symptoms. Girls, younger adolescents, and those who experienced traumatic
events before the war reported higher levels of PTS. Level of exposure (Step
2) also contributed to PTS symptoms, so that adolescents who were directly
exposed to missiles reported higher levels of PTS. Regarding the maternal
dimensions, only maternal control was found to have made a significant contribution. Higher maternal control was found to be associated with higher
PTS. In the fourth step, none of the interactions reached significance.
GSI. The total set of the independent variables explained 14.9% of the variance, F(7, 2857) = 70.554, p < .001. As can be seen in Table 2, similar to the
earlier regression, gender and earlier traumatic life events contributed significantly to GSI symptoms. Girls and adolescents who experienced additional
traumatic events before the war reported higher levels of GSI. In contrast
with the earlier regression, participants’ direct exposure was not found to be
associated with GSI. Regarding the maternal dimensions, both maternal care
and control were found to have made significant contributions. Higher maternal care was found to be associated with lower GSI, whereas higher maternal
control was found to be associated with higher GSI. In the fourth step, only
the interaction between participants’ direct exposure and their perceived
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Dekel and Solomon
Table 2. Multiple Variables Analysis.
PTSD
Independent
variables
Step 1
Gender
Age
Earlier traumatic
events
Step 2
Gender
Age
Earlier traumatic
events
Personal direct
exposure
Step 3
Gender
Age
Earlier traumatic
events
Personal direct
exposure
Maternal care
Maternal control
Step 4
Gender
Age
Earlier traumatic
events
Personal direct
exposure
Maternal care
Maternal control
Personal direct
exposure ×
Maternal care
GSI
B
SD b
β
b
SD b
.28
−.04
.20
.02
.02
.03
.25***
−.04*
.11***
.24
.01
.22
.02
.02
.04
.28
−.04
.20
.02
.02
.03
.25***
−.05*
.11***
.24
.01
.22
.13
.03
.09***
.28
−.04
.18
.02
.02
.03
.13
Life satisfaction
β
SD b
β
.19*** −.18
.01
−.02
.10*** −.52
.07
.05
.11
−.05**
−.01
−.09***
.02
.02
.04
.19*** −.18
.01
−.02
.10*** −.52
.07
.05
.11
−.05**
−.01
−.09***
.05
.03
.03
−.10
.09
−.02
.25***
−.04*
.10***
.26
.01
.18
.02
.02
.04
.20*** −.29
.01
−.01
.08*** −.40
.06
.05
.11
−.08***
−.00
−.07***
.03
.09***
.06
.03
.04*
−.14
.08
−.03
.01
.21
.02
.03
.01
−.16
.17*** .34
.02
.03
−.13*** .82
.23*** −.82
.07
.08
.24***
−.20***
.27
−.04
.17
.02
.02
.03
.25***
−.04*
.09***
.26
.01
.18
.02
.02
.04
.20*** −.29
.01
−.01
.08*** −.40
.06
.05
.10
−.08***
−.00
−.07***
.13
.03
.09***
.06
.03
.03
−.15
.08
−.03
.03
.21
.02
.03
.03
.17***
.00
.33
−.10
.05
.03
.03
.00
.82
.23*** −.82
−.14***
.07
.08
.24***
−.20***
b
Note. For each one of the dependent variables, four interactions were tested: “Personal direct exposure ×
Maternal care,” “Personal direct exposure × Maternal control,” “Earlier traumatic events × Maternal care,”
“Earlier traumatic events × Maternal control.” All interactions besides the one presented in the table did
not reach statistical significance. PTSD = post-traumatic stress disorder; GSI = General Symptom Index.
*p < .05. **p < .01. ***p < .001.
maternal care was found significant. Probing this interaction revealed that
while the positive association between exposure and GSI among those with
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low maternal care was significant (b = .16), t(2850) = 4.02, p = .001, this
association among those with high maternal care was not significant (b =
.04), t(2850) = 1.10, n.s.
Life satisfaction. The total set of the independent variables explained 15.5% of
the variance, F(6, 2857) = 87.533, p < .001. As can be seen in Table 2, gender
and previous trauma contributed significantly to life satisfaction. Girls
reported lower levels of life satisfaction than the boys, and adolescents who
had experienced other traumatic events before the war also reported lower
levels. Personal direct exposure made no significant contribution to life satisfaction. Regarding the maternal dimensions, both care and control were
found to have made a significant contribution: Higher maternal care was
found to be associated with higher life satisfaction, whereas higher maternal
control was found to be associated with lower life satisfaction. None of the
interactions were significant.
Discussion
This study focused on the contribution of maternal bonding to Israeli adolescents’ adjustment following the 2006 Lebanon War as manifested in
their post-traumatic symptoms, levels of distress, and their general life
satisfaction.
First, we tested the contribution of war exposure and the existence of earlier trauma to adolescents’ adjustment. Two aspects of exposure were examined, namely, region of exposure and personal direct exposure. The only
significant correlation found was the expected positive association between
direct exposure and PTS symptoms. In this respect, our results add to the
well-established literature regarding the important role played by exposure
characteristics in the development of PTSD among adolescents (e.g.,
Ajdukovic & Ajdukovic, 1998; Herman, 1997; Punamaki et al., 2001, Schiff,
2006), and replicates the findings of a former study conducted on Israeli citizens following the 2006 Lebanon War, which pointed to a similar association
between direct exposure and adolescents’ PTSD (T. Lavi et al., 2013).
Previous trauma was also found to be a relevant variable in adolescents’
adjustment following war, as indicated by its significant associations with all
three dependent measures. Specifically, the existence of earlier traumatic
events was correlated with higher levels of PTSD, more psychological distress, and lower life satisfaction. These findings may support the “vulnerability hypothesis” in accordance with other studies which showed that
experiencing previous trauma enhanced adolescents’ risk of exhibiting
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distress and severe PTSD symptoms (Copeland, Keeler, Angold, & Costello,
2007; T. Lavi et al., 2013; Solomon & Laufer, 2004).
One of the study’s aims was to examine the direct contribution of maternal
bonding to adolescents’ adjustment to war. As can be concluded from the
results of the hierarchical regression, maternal bonding was found to be
meaningful for adolescents’ adjustment beyond the mere contribution of the
traumatic event’s exposure characteristics. As hypothesized, maternal control
was significantly correlated with all three dependent variables, meaning that
higher maternal control was associated with higher PTSD symptoms, higher
general distress, and lower life satisfaction. Our findings are consistent with
studies that were conducted among adolescents after they had been exposed
to a flood (Bokszczanin, 2008) and after they had been exposed to an earthquake (Sun et al., 2012). In relation to the positive association between
maternal control and general distress, our findings are in line with non-trauma
studies which established the association between over-control and poor
mental health (e.g., Diamond et al., 2005; Freudenstein et al., 2011; Pedersen,
1994; Shams & Williams, 1995). Our results also reveal a negative correlation between maternal control and life satisfaction and support a non-trauma
study which showed a similar negative association between parental overcontrol and reports of well-being in a sample of healthy adolescents (Canetti
et al., 1997).
The association between maternal over-control and adolescents’ poor
post-war adjustment should be cautiously interpreted. On the one hand, it is
possible to infer that the mothers’ tendency to develop too-strict and overprotective relations with their children in the aftermath of war is experienced
by adolescents as invasive and harmful, and therefore leads to greater distress
among them. This notion is supported by a study which found that traumatic
exposure predicted negative parenting practices, which, in turn, predicted
increased adolescent psychopathology (Kelley et al., 2010). On the other
hand, it is important to remember that parents’ behavior is often a reaction to
their children’s behavior rather than its cause (e.g., Kerr & Stattin, 2003). The
mothers’ increased control in our study may therefore have been an appropriate response to their adolescent children’s post-war elevated distress.
Adolescents who were strongly emotionally affected by the war may also
have tended to perceive their mothers as more over-protective than they were
in actuality. Future causational designs must elaborate on these issues.
Contrary to our hypothesis, maternal control did not moderate the relationship between adolescents’ adjustment and war exposure, nor did it moderate the relationship between adolescents’ adjustment and earlier trauma. We
were unable to replicate findings regarding the negative moderating effect of
parental control which had emerged previously from a sample of young
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children (McFarlane, 1987) and also from a sample of adolescents
(Bokszczanin, 2008). While those two studies focused on the trauma of natural disasters, however, our study focused on the trauma of war, and it may be
that the specific type of event—for example, man-made vs. natural—
(Herman, 1997), plays an important role in terms of its effects. Moreover,
while in our study we measured only maternal control, both McFarlane
(1987) and Bokszczanin (2008) measured maternal and paternal control. The
presence of an over-protective father may have a different meaning for the
adolescent’s experience of trauma than the presence of an over-protective
mother.
As hypothesized, maternal care was negatively correlated with general
distress and positively correlated with life satisfaction. The fact that low
levels of maternal care were associated in our sample with enhanced psychological distress supports non-trauma studies which established the association between low parental care and poor mental health (e.g., Diamond
et al., 2005; Freudenstein et al., 2011; Pedersen, 1994; Shams & Williams,
1995). Also in accordance with non-trauma studies which demonstrated an
association between parental care and adolescents’ well-being (Canetti et al.,
1997), low levels of parental care were associated in our sample with less
life satisfaction.
This finding regarding maternal care is of theoretical significance. It supports family theorists such as Baumrind (1987, 1991) and Hill (1980) who
believe that emotional bonding and parental involvement in the child’s life
remain principal components of healthy development upon adolescence. It
seems that parental support remains crucial in the emotional life of the burgeoning adolescent, and its lack can be a strong indicator of emotional difficulties to come (Helsen, Vollebergh, & Meeus, 2000). This notion is supported
by the partial confirmation of the moderation hypothesis with regard to
maternal care. The interaction between participants’ exposure to trauma and
their perceived maternal care was found to be significant in the measurement
of psychological distress. The pattern of this interaction showed that among
individuals who were highly exposed to war, adolescents with less caring
mothers exhibited higher levels of distress than equally traumatized adolescents who had more caring mothers.
This finding may be of clinical interest as it echoes previous studies which
found mothers to have a protective role in their young children’s adjustment.
Maternal warmth protected Israeli children from developing behavioral and
social difficulties as a result of political violence (I. Lavi & Slone, 2012), and
affectionate parenting protected Palestinian children’s psychological adjustment by making them less vulnerable to traumatic exposure (Punamaki et al.,
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1997). Our results raise the possibility that maternal care also serves as a
protective factor for adolescents coping with trauma.
As opposed to our initial expectations, high maternal care was not associated in the current sample with lower levels of PTSD symptoms. This result
is also inconsistent with research conducted upon earthquake adolescent survivors (Sun et al., 2012). This inconsistency again raises the question of
whether different types of traumatic events (e.g., man-made vs. natural) bring
about different types of ramifications. This finding is somewhat bothersome
as it implies that maternal warmth and care may not be strong enough
resources to overcome adolescents’ post-traumatic responses to war.
However, it is of great clinical significance, as it supports the idea that PTSD
is a psychological condition that requires specific interventions and mental
health programs in a post-war setting. Natural variables such as parental
warmth and support are insufficient to protect war survivors from developing
PTSD in the long term. Further studies examining the association between
maternal care and PTSD development are needed.
In accordance with other studies, female adolescents in our sample
reported more PTSD symptoms, higher levels of distress, and less life satisfaction than did males (e.g., Canetti et al., 1997; Galea et al., 2002; T.
Lavi et al., 2013; Roussos et al., 2005; Yablon, Itzhaky, & Pagorek-Eshel,
2011). Also in keeping with earlier findings (Canetti et al., 1997; Pedersen,
1994), females in our sample perceived their mothers as more caring than
the males. This result might be partially explained by the fact that during
adolescence, females find parental support to be more important than do
males (Helsen et al., 2000) and exhibit greater emotional self-disclosure to
parents than do males (Papini, Farmer, Clark, Micka, & Barnett, 1990).
Moreover, as it was only maternal (and not paternal) bonding that was measured in our sample, this result may be the outcome of the strong motherdaughter relationship. Mother-adolescent daughter dyads were found to
have lower levels of conflict and to engage in more mutually open conversations than mother-adolescent son dyads (Domene, Socholotiuk, & Young,
2011). Our study has failed to shed light on the inconsistent findings regarding the association between gender and parental control (Pedersen, 1994;
Shams & Williams, 1995), as no significant correlation between these constructs was found. Future studies should focus attention on this potential
association.
The current study suffers from several limitations. First, it is a retrospective cross-sectional study conducted with a specific population at a specific
time; therefore, it is impossible to infer directionality of results. Second, the
way in which the questionnaires were distributed—that is, in classrooms,
where there was little privacy—may have influenced both the willingness of
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the participants to answer the questions and also the type of answers they
gave. Research assistants were, however, present in the classrooms in order
to help alleviate these problems. Third, pupils who were ultimately excluded
from the study’s sample differed from participants who were included in
terms of country of birth and parents’ marital status. In comparison with the
excluded group, the final sample had higher rates of Israeli-born participants,
and more of them had married parents. Therefore, results should be interpreted cautiously and generalized primarily to Israeli-born adolescents and
adolescents whose parents are married. As immigration (Mirsky, 2009) and
having divorced or single parents (Farbstein et al., 2010) are known to be risk
factors for Israeli adolescents’ mental health disorders, it may be interesting
to search further for a potential unique influence of war on immigrant youth
and on children of non-married parents. Fourth, although fathers play an
important role in the psychological outcomes of their children and paternal
support is known to have a crucial impact on adolescents’ well-being
(Flannery, Montemayor, & Eberly, 1994; Gecas & Schwalbe, 1986; GilRivas, Holman, & Silver, 2004), only maternal bonding was assessed in our
study. As primary caregivers, the role of the mother-child relationship has an
immense influence on the child’s psychological development (Rothbaum &
Weisz, 1994), but adolescents’ adjustment in the aftermath of war could
potentially be associated with the father-child relationship as well, or with the
perceived bonding with both parents as a unit. Future studies should examine
these possibilities. It should also be mentioned, however, that positive and
satisfying relations with the mother have been shown to reduce the damage
caused to children by their fathers’ negative behavior (Moore et al., 1990) and
that the infant-father attachment is to some degree dependent upon the quality of the infant-mother attachment (Fox, Kimmerly, & Schafer, 1991; Steele,
Steele, & Fonagy, 1996).
Despite its limitations, the study has numerous clinical implications for
coping with war. It illuminates the importance that should be attributed to the
family unit when trying to help adolescents who have survived a war.
Treatment programs should consider the inclusion of several family members
in addition to the adolescent. Moreover, providing educational programs and
psycho-educational information for parents about their parenting style and its
implications may contribute to their adolescent children’s resilience when
coping with trauma.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
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Dekel and Solomon
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
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Author Biographies
Rachel Dekel, PhD, is the director and professor in the School of Social -Work at
Bar-Ilan University, Ramat-Gan, Israel. In the last decade she has been involved in
various research projects that examined different facets of human coping with traumatic events such as, war, terror and family violence. Prof. Dekel’s research focuses
on individuals who have experienced secondary exposure to traumatic events. She has
conducted studies among spouses of veterans, children of fathers with PTSD, and
therapists who work in areas under terrorism. Prof. Dekel has published 100 articles
and book chapters and supervised around 50 students.
Dan Solomon finished his Masters in clinical psychology, Tel-Aviv University. His
masters’ thesis is based on the “Vigilant Care” model and includes a development of
a drug and alcohol prevention program for parents of children in their early adolescence. After a year of CBT practicum at the Anxiety Clinique at Schneider Children’s
Medical Center, he currently practices psychodynamic treatment for adults at RamatHen Mental Health Clinic. For the last 2 years he has been working as a research
assistant in various studies in the fields of family and trauma.
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