Skip to main content

Advertisement

SpringerLink
Log in

Self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

The presence of posttraumatic stress disorder (PTSD) in male war veterans has been linked with family dysfunction and psychopathology in their children [1, 2]. This study aimed to evaluate self-reported emotional and behavioral symptoms, parent–adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans and determine the degree that parent–child bonding and family functioning contributed to adolescent behavior problems. Internalizing and externalizing behavior problems, parent–child bonding and family functioning were assessed in a sample of clinically referred Croatian PTSD veterans adolescent offspring (N = 122) and non-PTSD veteran adolescent offspring (N = 122) matched for age, sex, educational level, family income, parental employment status, ethnicity, and residential area. Youth Self-Report, Parental Bonding Instrument, Family Assessment Device were used. Adolescent offspring of PTSD veterans reported having significantly more internalizing and externalizing problems than non-PTSD veteran offspring, and also more difficulties in their family functioning, lower levels of maternal and paternal care, and more impaired mother–child and father–child bonding than control subjects. Internalizing symptoms were associated with family dysfunction, while externalizing symptoms were associated with paternal overcontrol/overprotection, and low maternal and paternal care. In conclusion, the increase in internalizing and externalizing symptoms as well as family and parental dysfunction among clinically referred adolescent offspring of PTSD veterans compared to their non-PTSD veteran counterparts indicates a need for early detection and interventions targeting both adolescent psychopathology and family relationships.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jordan BK, Marmar CB, Fairbank JA, Schlenger WE, Kulka RA, Hough RL et al (1992) Problems in families of male Vietnam veterans with posttraumatic stress disorder. J Consult Clin Psychol 60:916–926

    Article  CAS  PubMed  Google Scholar 

  2. Galovski T, Lyons JA (2004) Psychological sequelae of combat violence: a review of the impact of PTSD on the veteran’s family and possible interventions. Aggress Viol Behav 9:477–501

    Article  Google Scholar 

  3. Figley CR (1989) Treating stress in families. Brunner/Mazel, New York

    Google Scholar 

  4. Riggs DS, Byrne CA, Weathers FW, Litz BT (1998) The quality of the intimate relationships of male Vietnam veterans: problems associated with posttraumatic stress disorder. J Traum Stress 11:87–101

    Article  CAS  Google Scholar 

  5. Waysman M, Mikulincer M, Solomon Z, Weisenberg M (1993) Secondary traumatization among wives of PTSD combat veterans: a family typology. J Fam Psychol 7:104–118

    Article  Google Scholar 

  6. Franciskovic T, Stevanovic A, Jelusic I, Roganovic B, Klaric M, Grkovic J (2007) Secondary traumatization of wives of war veterans with posttraumatic stress disorder. Croat Med J 48:177–184

    PubMed Central  PubMed  Google Scholar 

  7. Solomon Z, Waysman M, Levy G, Fried B, Mikulincer M, Benbenishty R, Florian V, Bleich A (1992) From front line to home front: a study of secondary traumatization. Fam Process 31:289–302

    Article  CAS  PubMed  Google Scholar 

  8. Rosenheck R, Thomson J (1986) Detoxification of Vietnam war trauma: a combined family–individual approach. Fam Process 25:559–570

    Article  CAS  PubMed  Google Scholar 

  9. Miller TW, Veltkamp LJ (1993) Family violence: clinical indicators among military and post-military personnel. Mil Med 158:766–771

    CAS  PubMed  Google Scholar 

  10. Davidson AC, Mellor DJ (2001) The adjustment of children of Australian Vietnam veterans: is there evidence for the transgenerational transmission of war-related trauma? Aust N Z J Psychiatry 35:345–351

    Article  CAS  PubMed  Google Scholar 

  11. Caselli LT, Motta RW (1995) The effect of PTSD and combat level on Vietnam veterans’ perceptions of child behavior and marital adjustment. J Clin Psychol 51:4–12

    Article  CAS  PubMed  Google Scholar 

  12. Rosenheck R, Nathan P (1985) Secondary traumatization in children of Vietnam veterans. Hosp Community Psychiatry 36:538–539

    CAS  PubMed  Google Scholar 

  13. Ray SL, Vanstone M (2009) The impact of PTSD on veterans’ family relationships: an interpretative phenomenological inquiry. Int J Nurs Stud 46:838–847

    Article  PubMed  Google Scholar 

  14. Davidson J, Smith R, Kudler H (1989) Familial psychiatric illness in chronic posttraumatic stress disorder. Compr Psychiatry 30:339–345

    Article  CAS  PubMed  Google Scholar 

  15. Parsons J, Kehle TJ, Owen SV (1990) Incidence of behavior problems among children of Vietnam veterans. School Psychol Int 11:253–259

    Article  Google Scholar 

  16. Harkness LL (1991) The effect of combat-related PTSD on children. Natl Cent PTSD Clin Newsl 2:12–13

    Google Scholar 

  17. Rosenheck R, Fontana A (1998) Warrior fathers and warrior sons: intergenerational aspects of trauma. In: Danieli Y (ed) International handbook of multigenerational legacies of trauma. Plenum Press, New York, pp 225–242

    Chapter  Google Scholar 

  18. Jacobsen LK, Sweeney CG, Racusin GR (1993) Group psychotherapy for children of fathers with PTSD: evidence of psychopathology emerging in the group process. J Child Adolesc Group Ther 3:103–120

    Article  Google Scholar 

  19. Zalihic A, Zalihic D, Pivic G (2008) Influence of posttraumatic stress disorder of the fathers on other family members. Bosn J Basic Med Sci 8:20–26

    PubMed  Google Scholar 

  20. Ahmadzadeh GH, Malekian A (2004) Aggression, anxiety, and social development in adolescent children of war veterans with PTSD versus those of non-veterans. J Research Med Sci 9:33–36

    Google Scholar 

  21. Beckham JC, Braxton LE, Kudler HS, Feldman ME, Lytle BL, Palmer S (1997) Minnesota Multiphasic Personality Inventory profiles of Vietnam combat veterans with posttraumatic stress disorder and their children. J Clin Psychol 53:847–852

    Article  CAS  PubMed  Google Scholar 

  22. Westerink J, Giarratano L (1999) The impact of posttraumatic stress disorder on partners and children of Australian Vietnam veterans. Aust N Z J Psychiatry 33(6):841–847

    Article  CAS  PubMed  Google Scholar 

  23. Rosenheck R, Fontana A (1998) Transgernerational effects of abusive violence on the children of Vietnam combat veterans. J Traum Stress 11:731–741

    Article  CAS  Google Scholar 

  24. Harkness LL (1993) Transgenerational transmission of war-related trauma. In: Wilson JP, Raphael B (eds) International handbook of traumatic stress syndromes. Plenum Press, New York, pp 635–643

    Chapter  Google Scholar 

  25. Ruscio AM, Weathers FW, King LA, King DW (2002) Male war-zone veterans’ perceived relationships with their children: the importance of emotional numbing. J Traum Stress 15:351–357

    Article  Google Scholar 

  26. Cummings EM, Davies P, Simpson K (1994) Marital conflict, gender, and children’s appraisals and coping efficacy as mediators of child adjustment. J Fam Psychol 8:141–149

    Article  Google Scholar 

  27. Demo DH, Small SA, Savin-Williams RC (1987) Family relations and the self-esteem of adolescents and their parents. J Marriage Fam 49:705–715

    Article  Google Scholar 

  28. Kagan J (1984) The nature of the child. Basic Books, Inc., New York

    Google Scholar 

  29. McHale JP, Khazan I, Erera P, Rotman T, DeCourcey W, McConnell M (2002) Coparenting in diverse family systems. In: Bornstein M (ed) Handbook of parenting: volume 3. Being and becoming a parent. Erlbaum, Mahwah

    Google Scholar 

  30. World Health Organization (1986) Young people’s health—a challenge for society. Report of a Study Group on Young People and Health for All by the Year 2000. Technical Report Series, No 731. World Health Organization, Geneva. http://whqlibdoc.who.int/trs/WHO_TRS_731.pdf. Accessed 11 Nov 2007

  31. Kozaric-Kovacic D, Bajs M, Vidosic S, Matic A, Alegic KA, Peraica T (2004) Change of diagnosis of posttraumatic stress disorder related to compensation-seeking. CMJ 45:427–433

    PubMed  Google Scholar 

  32. Achenbach TM (1991) Manual for the Youth Self Report and 1991 Profile. University of Vermont, Department of Psychiatry, Burlington

  33. Rudan V, Begovac I, Szirovicza L, Filipovic O, Skocic M (2005) The Child Behavior Checklist, Teacher Report Form and Youth Self Report problem scales in a normative sample of croatian children and adolescents aged 7–18. Coll Antropol 29:17–26

    PubMed  Google Scholar 

  34. Epstein NB, Baldwin LM, Bishop DS (1983) The McMaster Family Assessment Device. J Marital Fam Ther 9:171–180

    Article  Google Scholar 

  35. Miller IW, Ryan CE, Keitner GI, Bishop DS, Epstein NB (2000) The McMaster approach to families: theory, assessment, treatment and research. J Fam Ther 22:168–189

    Article  Google Scholar 

  36. Parker G, Tupling H, Brown LB (1979) A Parental Bonding Instrument. Br J Med Psychol 52:1–10

    Article  Google Scholar 

  37. Parker G (1990) The Parental Bonding Instrument: a decade of research. Soc Psychiatry Psychiatr Epidemiol 25:281–282

    Article  CAS  PubMed  Google Scholar 

  38. Akister J, Stevenson-Hinde J (1991) Identifying families at risk: exploring the potential of the McMaster Family Assessment Device. J Fam Ther 13:411–421

    Article  Google Scholar 

  39. Duke MR, Moore RS, Ames GM (2011) PTSD treatment-seeking among rural latino combat veterans: a review of the literature. J Rural Soc Sci 26:157–180

    PubMed Central  PubMed  Google Scholar 

  40. Jakupcak M, Luterek J, Hunt S, Conybeare D, McFall M (2008) Posttraumatic stress and its relationship to physical health functioning in a sample of Iraq and Afghanistan war veterans seeking postdeployment VA health care. J Nerv Ment Dis 196:425–428

    Article  PubMed  Google Scholar 

  41. Stecker T, Fortney JC, Hamilton F, Ajzen I (2007) An assessment of beliefs about mental health care among veterans who served in Iraq. Psychiatr Serv 58:1358–1361

    Article  PubMed  Google Scholar 

  42. Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL (2004) Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. NEJM 351:13–22

    Article  CAS  PubMed  Google Scholar 

  43. Dohrenwend BP, Turner JB, Turse NA, Lewis-Fernandez R, Yager TJ (2008) War-related posttraumatic stress disorder in black, hispanic, and majority White Vietnam veterans: the roles of exposure and vulnerability. J Traum Stress 21:133–141

    Article  Google Scholar 

  44. Hynes DM, Koelling K, Stroupe K, Arnold N, Mallin K, Sohn MW, Weaver FM, Manheim L, Kok L (2007) Veterans’ access to and use of medicare and veterans affairs health care. Med Care 45:214–223

    Article  PubMed  Google Scholar 

  45. Wallace AE, MacKenzie TA, Wright SM, Weeks WB (2010) A cross-sectional, multi-year examination of rural and urban veterans administration users: 2002–2006. Mil Med 175:252–258

    Article  PubMed  Google Scholar 

  46. Zahn-Waxler C, Klimes-Dougan B, Slattery MJ (2000) Internalizing problems of childhood and adolescence: Prospects, pitfalls, and progress in understanding the development of anxiety and depression. Dev Psychopathol 12:443–466

    Article  CAS  PubMed  Google Scholar 

  47. Ancharoff MR, Munroe JF, Fisher LM (1998) The legacy of combat trauma: clinical implications of intergenerational transmission. In: Danieli Y (ed) International handbook of multigenerational legacies of trauma. Plenum, New York, pp 257–276

    Chapter  Google Scholar 

  48. Biederman J, Monuteaux MC, Doyle AE, Seidman LJ, Wilens TE, Ferrero F, Morgan CL, Faraone SV (2004) Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. J Consult Clin Psychol 72:757–766

    Article  PubMed  Google Scholar 

  49. Scott J, Martin G, Bor W, Sawyer M, Clark J, McGrath J (2009) The prevalence and correlates of hallucinations in Australian adolescents: results from a national survey. Schizophr Res 107:179–185

    Article  PubMed  Google Scholar 

  50. McGorry PD, McFarlane C, Patton GC, Bell R, Hibbert ME, Jackson HJ, Bowes G (1995) The prevalence of prodromal features of schizophrenia in adolescence: a preliminary survey. Acta Psychiatr Scand 92:241–249

    Article  CAS  PubMed  Google Scholar 

  51. Tangney JP, Wagner P, Gramzow R (1992) Proneness to shame, proneness to guilt, and psychopathology. J Abnorm Psychol 101:469–478

    Article  CAS  PubMed  Google Scholar 

  52. Ferguson TJ, Stegge H, Miller ER, Olsen ME (1999) Guilt, shame, and symptoms in children. Dev Psychol 35:347–357

    Article  CAS  PubMed  Google Scholar 

  53. Adleman NE, Menon V, Blasey C, White CD, Warsofsky IS, Glover GH, Reiss AL (2002) A developmental fMRI study of the Stroop Color-Word Task. NeuroImage 16:61–75

    Article  PubMed  Google Scholar 

  54. van Rossum I, Dominguez M, Lieb R, Wittchen HU, van Os J (2011) Affective dysregulation and reality distortion: a 10-year prospective study of their association and clinical relevance. Schizophr Bull 37:561–571

    Article  PubMed Central  PubMed  Google Scholar 

  55. Cournard A, Mercelis M, Myin-Germeys I, De Graaf R, Vollebergh W, Krabbendam L, Lieb R, Wittchen HU, Henquet C, Spauwen J, Van Os J (2007) Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness-persistence model. Psychol Med 37:513–527

    Article  Google Scholar 

  56. Dominguez M, Wichers M, Lieb R, Wittchen H, van Os J (2011) Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study. Schizophr Bull 37:84–93

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  57. Stein D, Williamson DE, Birmaher B et al (2000) Parent–child bonding and family functioning in depressed children and children at high risk and low risk for future depression. J Am Acad Child Adolesc Psychiatry 39:1387–1395

    Article  CAS  PubMed  Google Scholar 

  58. Tamplin A, Goodyear IM, Herbert J (1998) Family functioning and parent general health in families of adolescents with major depressive disorder. J Affect Disord 48:1–13

    Article  CAS  PubMed  Google Scholar 

  59. Gowers S, North C (1999) Difficulties in family functioning and adolescent anorexia nervosa. Br J Psychiatry 174:63–66

    Article  CAS  PubMed  Google Scholar 

  60. Dekel R, Goldblatt H, Keidar M, Solomon Z, Polliack M (2005) Being a spouse of a PTSD veteran. Fam Relations 54:24–36

    Article  Google Scholar 

  61. Hill JP, Holmbeck GN (1986) Attachment and autonomy during adolescence. Ann Child Dev 3:145–189

    Google Scholar 

  62. Thomasgard M, Metz WP (1993) Parental overprotection revisited. Child Psychiatry Hum Dev 24:67–80

    Article  CAS  PubMed  Google Scholar 

  63. Barber BK (1996) Parental psychological control: revisiting a neglected construct. Child Dev 67:3296–3319

    Article  CAS  PubMed  Google Scholar 

  64. Stice E, Barrera M, Chassin L (1993) Relation of parental support and control to adolescents’ externalizing symptomatology and substance use: a longitudinal examination of curvilinear effects. J Abnorm Child Psychol 21:609–629

    Article  CAS  PubMed  Google Scholar 

  65. Hoffman ML (2000) Empathy and moral development: Implications for caring and justice. Cambridge University Press, Cambridge

    Book  Google Scholar 

  66. Blair C (2002) School readiness: integrating cognition and emotion in a neurobiological conception of children’s functioning at school entry. Am Psychologist 57:111–127

    Article  Google Scholar 

  67. Keitner GI, Ryan CE, Miller IW, Kohn R, Bishop DS, Epstein NB (1995) Role of the family in recovery and major depression. Am J Psychiatry 152:1002–1008

    CAS  PubMed  Google Scholar 

  68. Lewinsohn P, Rosenbaum M (1987) Recall of parental behaviour by acute depressives, remitted depressives, and non-depressives. J Pers Soc Psychol 52:611–619

    Article  CAS  PubMed  Google Scholar 

  69. Gotlib IH, Mount JH, Cordy NI, Whiffen VE (1988) Depression and perceptions of early parenting: a longitudinal investigation. Br J Psychiatry 152:24–27

    Article  CAS  PubMed  Google Scholar 

  70. Parker G (1981) Parental reports of depressives. An investigation of several explanations. J Affect Disord 3:131–140

    Article  CAS  PubMed  Google Scholar 

  71. Duggan C, Sham P, Minne C, Lee A, Murray R (1998) Quality of parenting and vulnerability to depression: results from a family study. Psychol Med 28:185–191

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Psychiatric Hospital for Children and Youth, Zagreb, Croatia

    Vlatka Boričević Maršanić & Vlasta Matko

  2. Department of Psychiatry, University Hospital Zagreb, Zagreb, Croatia

    Branka Aukst Margetić

  3. Psychiatric Hospital Vrapče, Zagreb, Croatia

    Vlado Jukić

  4. Department of Psychological Medicine, University Hospital Zagreb, Zagreb, Croatia

    Vesna Grgić

Authors
  1. Vlatka Boričević Maršanić
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Branka Aukst Margetić
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vlado Jukić
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vlasta Matko
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vesna Grgić
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vlatka Boričević Maršanić.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Boričević Maršanić, V., Aukst Margetić, B., Jukić, V. et al. Self-reported emotional and behavioral symptoms, parent-adolescent bonding and family functioning in clinically referred adolescent offspring of Croatian PTSD war veterans. Eur Child Adolesc Psychiatry 23, 295–306 (2014). https://doi.org/10.1007/s00787-013-0462-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-013-0462-2

Keywords

Search

Navigation