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Is Harsh Parenting associated to Child Depression and Anxiety among War-Exposed Families?
Master thesis Preventive Youth Care and Upbringing Graduate School of Child Development and Education University of Amsterdam Student: KEK Thijssen Bsc. Student ID: 11804203 First reader: H. Eltanamly MSc. Second reader: Dr. P. Leijten Amsterdam, July 2018
2 Abstract
This study uncovers the association between parental harshness, depression and anxiety among war-exposed children by conducting a meta-analysis. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, we searched nine databases until November 2016, which provided 5,177 citations. Inclusion criteria for this study were: (1) study conducted with a war-affected population; (2) parents and children were exposed together; (3) children were maximum 18 years; (4) studies included assessment of parental harshness; and (5) children’s depression and anxiety. This meta-analysis includes twelve studies (N = 8507) with multiple effect sizes (ES = 16), children and adolescents (Mage = 13.2, SD = 2.7). Therefore, we conducted a multilevel-random effects model using R statistics. Our results reveal that harsh parenting is not associated with war-exposed children having symptoms of depression and anxiety. Our main limitation is the use of questionnaires in the individual studies, raising chances for giving socially desirable answers. Future research can rely on longitudinal designs, to identify developmental patterns between parental harshness, depression and anxiety. Moreover, qualitative studies can be added to elaborate on our findings more deeply. Practitioners should be aware of differences in parenting across cultures when treating war-affected families.
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Is Harsh Parenting related to Child Depression and Anxiety among War-Exposed Families? War experiences tend to change the way people perceive life and cope with daily life demands (Miller & Rasmussen, 2010). Some families stick together and can become closer; others fall apart because of trauma and daily stressors (Cairns, 1996). Experiencing a stressful environment like war is associated with harsh and rejecting parenting (Belsky, 2008). Parental harshness is defined as the use of punitive, hostile or physically aggressive disciplinary strategies (Holt & Black, 2007). Harsh parenting relates to an increased chance for depression and anxiety among adolescents and children (Weizman, Laor, Barber, & Selman, 1994; Conger, Conger, & Scaramella, 1997; Pettit, Laird, Dodge, Bates, & Criss, 2001; Wolfradt, Hempel, & Miles, 2003; Siequeland, Kendall, & Steinberg, 1996; Barber & Harmon, 2002). In addition there has been evidence for the direct relation between parental harshness, and child depression and anxiety in potential traumatic events like war (Valentino, Berkowitz, Stover, 2010).
Never in our history has there been so many families affected by the consequences of war, as there are now (UNCHR, 2017). In 2017, the Office of the United Nations High Commissioner for Refugees (UNHCR) estimated 22.5 million refugees worldwide. The majority of the refugees are under the age of 18 (UNCHR, 2017). It is a human right for refugees to receive proper social aid when needed (UNCHR, 2018). Therefore, effective interventions and an appropriate care system need to be developed to be able to treat the worldwide increasing population of refugees, with trauma and parental challenges. Some research has been done on parental practices during war; however, to our knowledge there is no review or meta-analysis present that was able to replicate the results.
Harsh Parenting, Depression and Anxiety
Harsh parenting can be subdivided into several parenting behaviors. First, shaming, is described asany social process that expresses disapproval of an accepted act such that there is
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the intent or effect of evoking moral regret in the person being shamed (Braithwaithe, 1989). Second, rejection involves the absence or significant withdrawal of parental warmth, affection, care, comfort, concern, nurturance, support or love and the presence of a variety of negative behaviors, both physically and psychologically (Rohner, 2004). Adolescents exposed to parental shaming and rejection are more likely to develop depression (Stuewig & McCloskey 2005). Third, guilt induction involves parents directing an inappropriate amount of blame and responsibility toward a child while frequently emphasizing declarations of disappointment over minor mistakes, and it is related to internalizing problems among children and adolescence like depression and anxiety disorders (Rakow et al, 2009). Fourth, psychological control refers to control attempts that inhibit or interfere with children’s development of independence and self-direction by keeping the child emotionally dependent on the parent (Barber and Harmon, 2002). Children of parents who use high levels of psychological control are more vulnerable to depression and anxiety symptoms (Pettit, Laird, Dodge, Bates, & Criss, 2001). Finally, yet importantly, yelling, hitting and spanking are also considered harsh parenting practices that are related to depression and anxiety among adolescents and children (McKee et al, 2007). Mechanisms of Harsh Parenting Related to Depression and Anxiety
Parental harshness can seriously disrupt the emotional development of children. When parents use physical, emotional or verbal harshness, their children are at risk for internalizing problem behavior such as depression and anxiety (Kim, Conger, Elder Jr, & Lorenz, 2003). In such situations, children can often become fearful, angry or avoiding towards their parents (Bugental & Goodnow, 1998; Grusec & Goodnow, 1994; Saarni, Mumme, & Campos, 1998). These reactions are typical symptoms of depression and anxiety and can lead to the development of depression and anxiety disorders (Peck, 2015). Moreover, often time’s children feel that physical discipline is beyond their control (Allen & Tarnowski, 1989). Hence, children
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can then adapt to learned helplessness, which may lead to symptoms of depression and anxiety (Rodriguez, 2003).
Harshness, Anxiety and Depression in Context of War
Due to the elevated daily stress resulting from living in a war context, parents can become exhausted and suffer from mental health problems, such as Post Traumatic Stress Disorder (PTSD). Parents with mental problems tend to apply harsher parenting (East, Gahagan & Al‐Delaimy, 2018). Consequently, it is common for these parents to express aggression, outburst of anger or disinterest in the family (Taft, Schumm, Panuzio, & Proctor, 2008), which can cause internalizing and externalizing behavioral problem among their children (Bat-Zion & Levy-Shiff, 1993). Another reason why parental harshness might be associated to depression and anxiety in families affected by war is, the parent-child relationship. As mentioned before, parental harshness can have a negative effect on the parent-child relationship (Bugental & Goodnow, 1998; Grusec & Goodnow, 1994; Saarni, Mumme, & Campos, 1998). Having a low quality parent-child relationship is seen as a risk factor to develop symptoms of depression, because children might not receive adequate parental support during emotional hardships (Branje, Hale, Frijns, & Meeus, 2010; Cobb, 1976). Especially, children affected by war face different kind of stressors that can lead to emotional hardships like loss of family members or threats.
Current study
Due to the alarming increase of global war activity, war-related topics are being investigated more and more. The positive relation between parental harshness, anxiety and depression in non-war context, is well established in the literature but less so in war affected families (Barber et al., 1994; Conger, Conger, & Scaramella, 1997; Pettit et al., 2001; Wolfradt, Hempel, & Miles, 2003; Siequeland et al., 1996; Barber & Harmon, 2002). Besides, the war affected families’ on harsh parenting, child depression and anxiety contradict each other’s
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findings. Therefore, the current study summarizes the empirical data on associations between parental harshness, and depression and anxiety among war-exposed children. Next, it tests the association to investigate if it is also evident in war context. Therefore, the present study meta-analyzed the quantitative literature to test the association between parental harshness, child depression and anxiety. We expect to find a positive association between war-exposed parental harshness parenting, depression and anxiety among children exposed to war.
Methods Literature Search
Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria, quantitative studies until November 2016, were identified by systematic searches in the following electronic databases: PsycINFO, MEDLINE, Web of Science, Scopus, Sociological Abstracts, Anthropology Plus, PILOTS, CINAHL and Cochrane Library. We used the following search terms in various combinations: war, terrorism, political revolution or unrest, genocide, refugees, asylum seekers, parenting, childrearing, parental harshness,, armed violence, political violence, war exposure, mental health, parent child interaction, families, refugee parenting, refugee parenting experiences, fear, depression, anxiety, PTSD, trauma and parental monitoring. Studies were also identified through citation tracking using reference lists from identified studies. Finally, experts in the field were emailed, inquiring about published or unpublished literature that was not identified using the first two search strategies.
Study selection
Our search process yielded a total of twelve studies [see Appendix A, Figure 1]. The searches of the electronic databases and other search techniques provided 5,177 citations, of which 3,652 unique publications were identified and screened by titles and abstracts. Next we checked the number of citations and the keywords: parenting, depression and anxiety. Of these,
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140 publications were examined in more detail. Three team members independently screened each of the abstracts and excluded studies not adhering to our inclusion criteria (86.5% agreement). We solved disagreements by discussion. All studies that were identified as being potentially suitable were examined to ensure that they met the inclusion criteria.
Study Inclusion and Exclusion Criteria
The inclusion criteria for this study were: (1) studies conducted with a war-affected population; (2) children under the age of 18 years; (3) children who also have been exposed to war along with their parents (co-exposed); (4) studies included an assessment of parental harshness; and (5) children’s depression and anxiety.
Exclusion criteria were: (1) studies that have only one family member exposed to war e.g., studies on child soldiers; holocaust parent survivors who were not co-exposed to war with their children; and studies on war veterans); (2) children with a medical condition; (3) studies that assess other traumatic exposures on top of war, and do not report the results separately; and (4) qualitative studies.
Data Extraction
Parental harshness.
As an index of parental harshness, we included measures of parenting behavior such as parental rejection, corporal punishment, harsh discipline, psychological control, guilt induction and shaming.
Depression and anxiety.
As an index of depression among children exposed to war, we included psychological distress, emotional problems, irritable mood, feelings such as loneliness, hopelessness, losing interest in things once pleasurable, worries and having suicidal thoughts. Anxiety symptoms of children exposed to war included, phobias, fearfulness, feeling nervous, feeling restless and experiencing panic attacks.
8 War exposure.
As an index for war exposure, we included traumatic events during war exposure that impacted participants in a negative way and made a distinction between low, medium and high levels of war exposure. Threats and fear for imprisonment were coded as low levels of war exposure. Traumatic experiences such as house raids and hearing shootings were coded as medium level of war exposure. Finally, traumatic experiences such as witnessing family member’s killings and seeing body parts were coded as high level of war experiences.
Effect Size
Pearson's correlation coefficient, r, was chosen as the effect size for the association between parental harshness, and depression and anxiety among children. In terms of practical importance, r gives a better understanding than Cohen’s of the strength of a relation between x and y variables (Mukaka, 2012; Field, 2001; Rosenthal, 1991; Rosenthal & DiMatteo, 2001). We extracted correlations out of the original publications and only converted betas to correlations. If betas were reported, we converted these to correlations based on the formula r = β + .05λ, where λ is 1 if β is non-negative and 0 if β is negative (Peterson & Brown, 2005). Some of the original publications included in this meta-analyses contained multiple effect sizes because of longitudinal study design [see Appendix B, Table 1]. Therefore, there is an increased chance for individual responses to correlate with each other within the same study. Next to this, there are studies included with multiple samples and multiple informants. Moreover, we are extracting the correlations on two variables, resulting in multiple effect sizes.
Data Analysis Strategy
To investigate whether harshness, and depression and anxiety is associated with child depression and anxiety among war-exposed families, we used a multi-level random effects model in R 3.2.2 (R Core team, 2015), which makes it possible to correctly estimate the relative variation in the correlations due to the effect of clustering in the same study (Borenstein,
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Hedges, Higgins, & Rothstein, 2009). A multilevel model provides estimates for parameters that vary at more than one level which means, multilevel analysis is a suitable approach to take into account the social contexts as well as the individual respondents or subject (Tom, Bosker, T. A. S. R. J., & Bosker, R.J.,1999).
We conducted a heterogeneity test using R to examine the variability of effect sizes across studies. A significant heterogeneity test indicates that the effect sizes are different between the individual studies. Therefore, in case the Q test is significant an additional moderation test by level of war exposure was conducted.
Publication Bias
We checked for publication bias by creating a funnel plot [see Appendix C, Figure 1]. The funnel plot with the effect sizes of the relation between parental harshness, depression and anxiety among children on the x-axis. The standard error of effects are displayed on the y-axis. By inspecting the funnel plot visually for symmetry we will check for publication bias. In case the plot is asymmetrical, we will run Egger’s regression test to explore publication bias. A regression line will indicate the presence of bias (Egger, Smith, Schneider, & Minder, 1997). Risk of Bias
To reduce risk of other biases, we appraised the quality of the included studies according to the following criteria: (1) recruitment strategies that reduced selection bias, (2) using instruments that have been validated, (3) whether statistical adjustments were applied, (4) using comparable outcome measures for longitudinal studies and across groups, (5) whether participants were comparable if assigned to different study groups, (6) the clarity of outcome measures and (7) for longitudinal studies, we assessed the retention rate of participants during follow-ups. Follow-ups with less than 60% were received a negative rating. Studies were given a score of 1 to 7.Studies with a score of 1 to 2 were rated as low quality. Studies with a score of 3 to 4 were rated as medium quality. Studies with a score of 5 to 7 were rated as high quality.
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The quality appraisal was conducted by the lead researcher and an under-graduate assistant. Disagreements were discussed together. After a training in quality appraisal, an interrater-reliability rate of 86 % was obtained.
Results Characteristics of Included Studies
Our final sample included twelve individual studies with data on 8507 participants [see Appendix B, Table 1]. Over a third (37.5%) of the participants were exposed to medium levels of war exposure and 62.5% to high levels of war exposure. The sample sizes ranged from 50 to 3,462 participants. Studies covered families from Palestine (50%), Sri Lanka (18.8%), Afghanistan (12.5%), Uganda (12.5%) and Northern Ireland (6.2%). The children’s mean age range was (Mage = 9.2 - 17.6 years). Six (37.5%) studies were longitudinal and ten (62.5%) studies were cross-sectional. Seven (43.8%) studies covered displaced refugees, four (25%) non-displaced families and five (31.2%) other studies did not report the status of their participants.
Multi-level Random-effects Model
The multi-level analysis showed that harsh parenting does not associate with depression and anxiety among war-exposed children (r = .017, 95% CI - .23 to .30, p = .787).
Heterogeneity
The heterogeneity test was not significant Q (df = 15) = 15.896, p = 0.389. Therefore, we can conclude that the individual studies do not differ significantly from each other. It is not likely that another variable, a moderator, might explain the association between parental harshness, and depression and anxiety among war-exposed children. For that reason no moderator analysis was conducted.
11 Publication Bias
Visual inspection of the funnel plot shows an absence of asymmetry [see Appendix C, Figure 1]. For this reason, we did not conduct any further test for publication bias.
Risk of Bias
The overall quality of the studies was medium. One study (6.2%) was low, eleven studies (68.8%) were medium and four studies (25%) were of high quality. Quality of studies was mainly compromised through contamination for example, by including and comparing traumas of different nature like sexual abuse and war-exposure in the same sample. Those studies were marked as contaminated and rated low quality but not excluded. Moreover, not all individual studies had a strategy to reduce selection bias, those studies also received a negative rating.
Discussion
We meta-analyzed whether children exposed to harsh parenting also show signs of elevated depression and anxiety symptoms among war-exposed children. We found that more parental harshness was not associated with more depression and anxiety symptoms for their war exposed children. Thus, the results do not support our hypothesis.
In favor of the wellbeing of children, our findings contradict some previous research, where the harsher the parent, the more depression and anxiety symptoms the children exposed to war showed. One recent study found that maternal PTSD and depressive symptoms meditates the association between parental harshness and depression among children affected by war (East, Gahagan & Al‐Delaimy, 2018). Some studies suggest that a positive association is valid only for mothers (Lavi & Slone, 2012). Others only find evidence for a positive association for fathers (Palosaari, Punamäki, Qouta, & Diab, 2013). The current study was not able to run a moderator such as maternal PTSD and parent gender due to the lack of heterogeneity.
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Harsh parenting characterizes the less sensitive, authoritarian, parenting style (Baumrind, 1991). However, there has been disagreement and critics on Baumrind’s parenting styles not being universal in definition and effects on children (Kagitcibasi, 2005; Chao & Sue, 1996). Moreover, there is support for authoritarian parenting practices being associated with positive psychosocial adjustment among low-income African-American youth, and not to maladaptive adjustment as expected from Baumrind’s early research on the effects of parenting styles on Caucasian youth (Greening, Stoppelbein, & Luebbe, 2010). Perhaps the positive attributes of being harsh, such as clear communication, might provide protection against developing symptoms of depression and anxiety among children (Greening & Stoppelbein, 2002). African-American children may perceive strict, but clear communication as guidance and concern and thus could be willing to adjust their behavior to the expectations of their harsh parent (Reitman, Rhode, Hupp, & Altobello, 2002).
In some countries, harsh discipline is the norm. Like in Arab countries, harsh punishment is a justified reaction in general to disobedience of higher authorities like teachers and parents (Dwairy et al., 2006). More importantly, both populations, low-income African American and Arab societies, often times face dangerous living environments due to community violence or political unrest. Parents being harsh towards their children in these environments seems to be a protective factor rather than a risk factor for depression and anxiety for their children (Ungar, 2009). For example, by restricting adolescents to participate in political activities during war, parents protect their child from being involved in riots that can result in violent death (Punamaki, Quota, & Sarraj, 1997). Since half of the participants included in our meta-analysis originate from the State of Palestine it may be the reason why we did not find an association between parental harshness, depression and anxiety. “Culture constitutes a strong factor in structuring parental practices because it can transmit guidelines about parenting” (Dwairy, 2004, p.231).
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During and after trauma exposure, caregivers play an important role in affecting children’s development; for that reason, children traumatized by war who had harsh parents had an increased chance of developing depression and anxiety (Valentino, Berkowitz & Stover, 2010). However, according to the life history theory (Hill & Kaplan, 1999), parents become harsher to increase the chance of survival of their children in a dangerous extra-familial environment by increasing symptoms of depression and anxiety. Thus, parents parent this way to protect their children. Children with anxiety disorders will be more alert to avoid danger (Dalgleish, Moradi, Taghavi, Neshat-Doost, & Yule, 2001) and children with symptoms of depression can be submissive and therefore inhibit enemy’s hostility (Irons & Gilbert, 2005). Hence, children can develop more depression and anxiety symptoms to be able to protect themselves from living in a dangerous environment.
Our meta-analysis included individual studies with big sample sizes and smaller sample sizes [Appendix B, Table 1]. It is possible that the individual studies had low power to detect an effect and for that reason, no main effect could be detected in this meta-analysis (Walker, Herhandez, &Kattan, 2008). Next to that, we had a low number of included studies (k= 12), this also compromises the power of the current study.
Our findings are not without limitation. First, primary studies mainly used
questionnaires to assess harshness, depression and anxiety. Questionnaires raise the chances of giving socially desirable answers and can cause distorted results. Second, since we have a small number of studies, the test for heterogeneity can be seriously underpowered (Walker, Hernandez, & Kattan, 2008). Third, most studies included in the meta-analyses are cross-sectional, making it impossible to monitor trends and find causal relations. Additionally, there is a higher chance for results not to be representative when using cross-sectional study design. Hence, if participants who consent to take part in the study differ from those who do not, it can cause a non-response bias.
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Our study also has some strengths. This was the first study, to our knowledge, to meta-analyze findings according to the PRSIMA guidelines on parenting behavior in a war context and depression and anxiety among children and using a multi-level random effects model. By including exclusively co-exposed families in the meta-analysis, our study makes it possible to get insight of the effects of war on the nuclear family living in a warzone. The meta-analysis gives a summary of mostly medium to high quality studies to this date on these defined variables through the selection criteria and quality appraisal that we used. Furthermore, there was a high level of interrater-reliability and no publication bias has been detected in the meta-analysis.
Future research can expand on our findings by also reviewing qualitative studies, in addition to quantitative studies. This way we can gain more insight in how and why parental harshness is related to depression and anxiety among war exposed families. Future studies can also use more longitudinal designs to be able to identify developmental patterns of the possible association between parental harshness and depression and anxiety. The elevated rates of depression and anxiety (Kim, Conger, Elder Jr, & Lorenz, 2003) could not be explained by harshness, yet maybe due to child trauma, length of war exposure and child gender; an association can be found in future research. Finally, to diminish recruitment bias, future studies might need to apply random assignment of participants to study groups for example and avoid contamination by strictly focusing on war effects on parenting. Yet, we understand that these recommendations are not always feasible in a war context.
Conclusion
The current study summarizes the scientific body of literature on harsh parenting, depression and anxiety among war exposed children. Our results suggest that harsher parenting is not associated with children having more symptoms of depression and anxiety. This is good news for families and practitioners. Instead of focusing on parental harshness and how it can affect depression and anxiety symptoms among war exposed children, practitioners can focus
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on other child outcomes such as for example, parent-child communication or attachment behavior. However, practitioners should be aware of the differences in parenting across different cultures and take this into consideration when working with war-exposed families or developing interventions for war affected families.
16 References
References marked with an asterisk indicate studies included in the meta-analysis.
*Al‐Krenawi, A., Graham, J. R., & Sehwail, M. A. (2007). Tomorrow's players under occupation: An analysis of the association of political violence with psychological functioning and domestic violence, among Palestinian youth. American Journal of Orthopsychiatry, 77(3), 427-433. doi: 10.1037/0002-9432.77.3.427
*Barber, B. K. (1999). Political violence, family relations, and Palestinian youth functioning. Journal of Adolescent Research, 14(2), 206-230. doi:10.1177/0743558499142004
Barber, B., & Harmon, E. (2002). Violating the self: Parental psychological control of children and adolescents. (pp. 15-52). American Psychological Association. doi:
10.1037/10422-002
Bat-Zion, N., Levy-Shiff, Rachel, & יול-ףיש, לחר. (1993). Children in war. In Children in war: Stress and coping reactions under the threat of Scud missile attacks and the effect of proximity (pp. The Psychological Effects of War and Violence on Children (1993) 143-161). Retrieved on 2018/07/11 from: http://psycnet.apa.org/record/1993-98910-008
Baumrind, D. (1991). The influence of parenting style on adolescent competence and substance use. The Journal of Early Adolescence, 11(1), 56-95. doi:10.1177/0272431691111004
Belsky, J. (2008). War, trauma and children's development: Observations from a modern evolutionary perspective. International Journal of Behavioral Development, 32(4), 260-271. doi:10.1177/016502540
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Introduction to meta-analysis. Chichester: John Wiley & Sons.
Braithwaite, J. (1989). Crime, Shame and Reintegration: Cambridge University Press. Branje, S. J., Hale, W. W., Frijns, T., & Meeus, W. H. (2010). Longitudinal associations
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between perceived parent-child relationship quality and depressive symptoms in adolescence. Journal of Abnormal Child Psychology, 38(6), 751-763.
doi:10.1007/s10802-010-9401-6
Bugental, D. B., & Goodnow, J.J. (1998). Socialization processes. In W. Damon (Series Ed.) & N. Eisenberg (Vol. Ed.), Handbook of child psychol ogy: Vol. 3. Social, emotional and personality development (5th ed.). New York: Wiley
*Catani, C., Schauer, E., & Neuner, F. (2008). Beyond individual war trauma: domestic violence against children in Afghanistan and Sri Lanka. Journal of Marital and Family Therapy, 34(2), 165-176. doi:10.1111/j.1752-0606.2008.00062.x
*Catani, C., Schauer, E., Elbert, T., Missmahl, I., Bette, J., & Neuner, F. (2009). War trauma, child labor, and family violence: Life adversities and PTSD in a sample of school children in Kabul. Journal of Traumatic Stress, 22(3), 163-171. doi:10.1002/jts.20415
*Catani, C. (2010). War in the home: A review of the relationship between family violence and war trauma. Verhaltenstherapie, 20(1), 19-27. doi:10.1159/000261994
Chao, R. K., & Sue, S. (1996). Chinese parental influence and their children’s school success: A paradox in literature on parenting styles. In S. Lau (Ed.), Growing up the Chinese way (pp. 93-120). Hong Kong: Chinese University Press.
Conger, K. J., Conger, R. D., & Scaramella, L. V. (1997). Parents, siblings, psychological control, and adolescent adjustment. Journal of Adolescent Research, 12(1), 113-138. doi:10.1177/0743554897121007
*Cummings, E. M., Merrilees, C. E., Schermerhorn, A. C., Goeke‐Morey, M. C., Shirlow, P., & Cairns, E. (2012). Political violence and child adjustment: Longitudinal tests of sectarian antisocial behavior, family conflict, and insecurity as explanatory
pathways. Child Development, 83(2), 461-468. doi:10.1111/j.1467-8624.2011.01720.x.
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Dalgleish, T., Moradi, A., Taghavi, M., Neshat-Doost, H., & Yule, W. (2001). An
experimental investigation of hypervigilance for threat in children and adolescents with post-traumatic stress disorder. Psychological Medicine, 31(3), 541-547. doi:10.1017/S0033291701003567
Dwairy, M. (2004). Parenting styles and mental health of Palestinian–Arab adolescents in Israel. Transcultural Psychiatry, 41(2), 233-252. doi: 10.1177/1363461504043566
Dwairy, M., Achoui, M., Abouserie, R., Farah, A., Sakhleh, A. A., Fayad, M., & Khan, H. K. (2006). Parenting styles in Arab societies: A first cross-regional research study. Journal of Cross-Cultural Psychology, 37(3), 230-247. doi: 10.1177/0022022106
East, P. L., Gahagan, S., & Al-Delaimy, W. K. (2018). The impact of refugee mothers’ trauma, posttraumatic stress, and depression on their children’s adjustment. Journal of Immigrant and Minority Health, 20(2), 271-282. doi: 10.1007/s10903-017-0624-2 Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected
by a simple, graphical test. Bmj, 315(7109), 629-634. doi: 10.1136/bmj.315.7109.629
Greening, L., & Stoppelbein, L. (2002). Religiosity, attributional style, and social support as psychosocial buffers for African American and white adolescents’ perceived risk for suicide. Suicide and Life Threatening Behavior, 32, 404–417. doi: 10.1521/suli.32.4.404.22333. Retrieved on 2018/07/09 from
https://guilfordjournals-com.proxy.uba.uva.nl:2443/doi/pdf/10.1521/suli.32.4.404.22333 Greening, L., Stoppelbein, L., & Luebbe, A. (2010). The moderating effects of parenting styles
on African-American and Caucasian children’s suicidal behaviors. Journal of Youth and Adolescence, 39(4), 357-369. doi:10.1007/s10964-009-9459-z
Grusec, Joan E., & Goodnow, Jacqueline J. (1994). Impact of Parental Discipline Methods on the Child's Internalization of Values: A Reconceptualization of Current Points of View. Developmental Psychology, 30(1), 4-19. doi:10.1037/0012-1649.30.1.4
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Hill, K., & Kaplan, H. (1999). Life history traits in humans: Theory and empirical studies. Annual Review of Anthropology, 28(1), 397-430. doi:10.1146/annurev.anthro.28.1.397
Holt, N. L., & Black, D. E. (2007). Parenting styles and specific parenting strategies in youth sport. Journal of Sport & Exercise Psychology, 29. Retrieved on 2018/07/11
https://web.a.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtyp e=crawler&jrnl=08952779&AN=25216413&h=UzcQ42p0JFu6lGg1rAy4hnaSBswX XKWJH9akL9WHHDTBkYlShgNDKYmhoL7GFkYk1WV9VDA5F6vyMueratA00 A%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashu rl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype% 3dcrawler%26jrnl%3d08952779%26AN%3d25216413
Irons, C., & Gilbert, P. (2005). Evolved mechanisms in adolescent anxiety and depression symptoms: The role of the attachment and social rank systems. Journal of Adolescence, 28(3), 325-341. doi: https://doi.org/10.1016/j.adolescence.2004.07.004
Kagitcibasi, C. (2005). Autonomy and relatedness in cultural context: Implications for self and family. Journal of Cross-Cultural Psychology, 36, 1-20. doi:10.1177/00220221
Kim, K. J., Conger, R. D., Elder Jr, G. H., & Lorenz, F. O. (2003). Reciprocal influences between stressful life events and adolescent internalizing and externalizing problems. Child Development, 74(1), 127-143.
Retrieved from http://www.jstor.org.proxy.uba.uva.nl:2048/stable/3696346
Lavi, I., & Slone, M. (2012). Parental Practices and political violence: the protective role of parental warmth and authority‐control in Jewish and Arab Israeli Children. American Journal of Orthopsychiatry, 82(4), 550-561. doi: 10.1111/j.1939-0025.2012.01183.x McKee, L., Roland, E., Coffelt, N., Olson, A. L., Forehand, R., Massari, C., ... & Zens, M. S.
(2007). Harsh discipline and child problem behaviors: The roles of positive parenting and gender. Journal of Family Violence, 22(4), 187-196. doi:
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https://doi-org.proxy.uba.uva.nl:2443/10.1007/s10896-007-9070-6
Miller, K. E., & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Social Science & Medicine, 70(1), 7-16.
doi: :10.1016/j.socscimed.2009.09.029
*Olema, D. K., Catani, C., Ertl, V., Saile, R., & Neuner, F. (2014). The hidden effects of child maltreatment in a war region: correlates of psychopathology in two generations living in Northern Uganda. Journal of Traumatic Stress, 27(1), 35-41.
doi: https://doi-org.proxy.uba.uva.nl:2443/10.1002/jts.21892
*Palosaari, E., Punamӓki, R. L., Diab, M., & Quota, S. (2013). Posttraumatic cognitions and posttraumatic stress symptoms among war-affected children: A cross-lagged analysis. Journal of Abnormal Psychology, 122(3), 656. doi: 10.1037/a0033875
Peck, E. M. (2015). Tiiger Parents Rear Anxious Cubs [webtext]. Retrieved on 2018/07/03.from https://www.scientificamerican.com/article/harsh-critical-parenting-may-lead-to-anxiety-disorder-symptoms/
Pettit, G. S., Laird, R. D., Dodge, K. A., Bates, J. E., & Criss, M. M. (2001). Antecedents and behavior‐problem outcomes of parental monitoring and psychological control in early adolescence. Child Development, 72(2), 583-598.
Retrieved from http://www.jstor.org.proxy.uba.uva.nl:2048/stable/1132415
*Punamäki, R. L., Qouta, S., & El Sarraj, E. (1997). Relationships between traumatic events, children’s gender, and political activity, and perceptions of parenting styles. International Journal of Behavioral Development, 21(1), 91-109. doi:10.1080/016502597385009
21
*Punamäki, R. L., Qouta, S., & El-Sarraj, E. (2001). Resiliency factors predicting psychological adjustment after political violence among Palestinian children. International Journal of Behavioral Development, 25(3), 256-267. doi:10.1080/01650250042000294
*Qouta, S., Punamäki, R.-L., Montgomery, E., & El Sarraj, E. (2007). Predictors of psychological distress and positive resources among Palestinian adolescents: Trauma, child, and mothering characteristics. Child Abuse & Neglect, 31(7), 699-717.
doi: https://doi.org/10.1016/j.chiabu.2005.07.007
R Core Team. (2015). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing. Retrieved on 2018/07/03 from https://www.R-project.org/
Rakow, A., Forehand, R., McKee, L., Coffelt, N., Champion, J., Fear, J., & Compas, B. (2009). The relation of parental guilt induction to child internalizing problems when a caregiver has a history of depression. Journal of Child and Family Studies, 18(4), 367-377. doi:10.1007/s10826-008-9239-5
Reitman, D., Rhode, P. C., Hupp, S. D., & Altobello, C. (2002). Development and validation of the parental authority questionnaire–revised. Journal of Psychopathology and Behavioral Assessment, 24(2), 119-127. doi:10.1023/A:1015344909518
Rodriguez, C. M. (2003). Parental discipline and abuse potential affects on child depression, anxiety, and attributions. Journal of Marriage and Family, 65(4), 809-817. Retrieved on 2018/07/11 from http://www.jstor.org.proxy.uba.uva.nl:2048/stable/3599892 Rohner, R. P. (2004). The parental" acceptance-rejection syndrome": universal correlates of
perceived rejection. American Psychologist, 59(8), 830. Retrieved on 2018/07/03 from
https://ovidsptxovidcom.proxy.uba.uva.nl:2443/sp3.30.0b/ovidweb.cgi?WebLinkFrameset=1 &S=HFIEFPCFJGDDNLHLNCEKOAMCCHBGAA00&returnUrl=ovidweb.cgi%3f %26Full%2bText%3dL%257cS.sh.32.33%257c0%257c0000048720041100000046%
22 26S%3dHFIEFPCFJGDDNLHLNCEKOAMCCHBGAA00&directlink=https%3a%2f %2fovidsp.tx.ovid.com%2fovftpdfs%2fFPDDNCMCOAHLJG00%2ffs046%2fovft% 2flive%2fgv023%2f00000487%2f0000048720041100000046.pdf&filename=The+Par ental+%22AcceptanceRejection+Syndrome%22%3a+Universal+Correlates+of+Percei ved+Rejection.&pdf_key=FPDDNCMCOAHLJG00&pdf_index=/fs046/ovft/live/gv0 23/00000487/00000487-200411000-00046
Saarni, C., Mumme, D. L., & Campos, J. J. (1998). Emotional development: Action, communication and understanding. In W. Damon (Ed.), Handbook of child psychology (5th ed., pp. 237-309). New York: Wiley.
Siqueland, L., Kendall, P. C., & Steinberg, L. (1996). Anxiety in children: Perceived family environments and observed family interaction. Journal of Clinical Child Psychology, 25(2), 225-237. doi:10.1207/s15374424jccp2502_12
*Sriskandarajah, V., Neuner, F., & Catani, C. (2015). Predictors of violence against children in Tamil families in northern Sri Lanka. Social Science & Medicine, 146, 257-265. doi: https://doi.org/10.1016/j.socscimed.2015.10.010
Stuewig, J., & McCloskey, L. A. (2005). The relation of child maltreatment to shame and guilt among adolescents: Psychological routes to depression and delinquency. Child Maltreatment, 10(4), 324-336.
doi: https://doi-org.proxy.uba.uva.nl:2443/10.1177/10775595
Taft, C. T., Schumm, J. A., Panuzio, J., & Proctor, S. P. (2008). An examination of family adjustment among Operation Desert Storm veterans. Journal of Consulting and Clinical Psychology, 76(4), 648. doi: 10.1037/a0012576
Tom, A. B., Bosker, T. A. S. R. J., & Bosker, R. J. (1999). Multilevel analysis: an introduction to basic and advanced multilevel modeling. London. Sage.
23
Ungar, M. (2009). Overprotective parenting: Helping parents provide children the right amount of risk and responsibility. The American Journal of Family Therapy, 37(3), 258-271. doi:10.1080/01926180802534247
United Nations High Commisioner of Refugees. (2018). Cijfers [factsheet]. Retrieved on 2018/07/03from http://www.unhcr.org/nl/wie-we-zijn/cijfers/
Valentino, K., Berkowitz, S., & Stover, C. S. (2010). Parenting behaviors and posttraumatic symptoms in relation to children's symptomatology following a traumatic event. Journal of Traumatic Stress, 23(3), 403-407.
doi: https://doi-org.proxy.uba.uva.nl:2443/10.1002/jts.20525
Walker, E., Hernandez, A. V., & Kattan, M. W. (2008). Meta-analysis: Its strengths and limitations. Cleveland Clinic Journal of Medicine, 75(6), 431.
doi: https://doi-org.proxy.uba.uva.nl:2443/10.1176/ajp.151.1.71
Weizman, R., Laor, N., Barber, Y., & Selman, A. (1994). Impact of the Gulf War on the anxiety, cortisol, and growth hormone levels of Israeli civilians. The American Journal of Psychiatry, 151(1), 71.
doi: https://doi-org.proxy.uba.uva.nl:2443/10.1176/ajp.151.1.71
Wolfradt, U., Hempel, S., & Miles, J. N. (2003). Perceived parenting styles,
depersonalisation, anxiety and coping behaviour in adolescents. Personality and Individual Differences, 34(3), 521-532. doi:10.1016/S0191-8869(02)00092-2
24 Appendices
Appendix A
Figure 1: PRISMA flowchart included studies
Figure 1. PRISMA flowchart of Study Inclusion. K = number of individual studies
Records excluded Child age > 18
Multiple publications on the same study
Follow-up publications on intervention studies No co-exposure
Instrument validation articles No measures of parenting Trauma measure confounded
with other natural disasters/ interpersonal trauma (k = 102)
Records identified through database searching (k = 5,177) Id en tif icat ion Records screened (k = 3,652)
Full-text articles assessed for eligibility
(k = 140)
Full-text articles excluded Non-usable data
(k = 126)
Studies included in meta-analysis (k = 12) S cr ee n in g E li gib il ity In clu d ed
25 Appendix B
Table 1: Included studies
Publication Study Type N Exposur e Exposure Level Displace d P_cOrg C_Age_M Hrsh_D A Al-Krenawi_2007 Longitudinal 23
28 War High 999 Palestine 15,40 0,43
Barber_1999
Cross-sectional
34
62 War High No Palestine 999 0,18
Barber_1999
Cross-sectional
34
61 War High No Palestine 999 0,19
Catani_2010
Cross-sectional
10
49 War Medium 999 Sri Lanka 13,00 -0,33
Catani_2008
Cross-sectional
29
6 War Medium 999 Sri Lanka 12,20 -0,27
Sriskandarajah_2015 Cross-sectional
35
9 War Medium Yes Sri Lanka 9,20 0,55
Catani_2009 Cross-sectional 12 2 War High 999 Afghanista n 11,80 0,51 Catani_2009 Cross-sectional 16 5 War High 999 Afghanista n 10,90 -0,03 Cummings_2012 Longitudinal 29 9 CV Medium No N Ireland 12,33 0,82 Olema_2014
Cross-sectional 50 War Medium Yes Uganda 14,00 0,537
Olema_2014
Cross-sectional 50 War Medium Yes Uganda 14,00 0,487
Palosaari_2013
Longitudinal 24
0 War High No Palestine 11,40 0,37
Punamaki_1997
Cross-sectional
10
8 War High Yes Palestine 999 0,29
Punamaki_2001 Longitudinal 86 War High Yes Palestine 14,04 0
Punamaki_2001 Longitudinal 86 War High Yes Palestine 14,04 0,02
Quota_2007 Longitudinal 65 War High Yes Palestine 17,60 0,07
Note. N = number of participants; Exposure = event participants are exposed to; Exposure Level = based on type
of trauma participants experienced; Displacement = status of participants P_cOrg = Parentes country of origin; C_Age_M = child mean age; Hrsh_DA = correlation between parental harshness, and depression and anxiety among children exposed to war.
26 Appendix C
Figure 1: Funnel plot
Figure1. Funnel plot with on the X-axis parental harshness – depression and anxiety adolescent’s effect sizes and
on the Y-axis the standard errors (a higher standard error reflects a lower sample size).
Correlation coefficient S ta n d a rd E rr o r 1 .8 3 1 1 .3 7 3 0 .9 1 6 0 .4 5 8 0 -4 -2 0 2 4
