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Maternal educational practices and mental health disorders of school-age children

Abstract

Objective:

To investigate the association between emotional and behavioral difficulties in schoolchildren and maternal educational practices.

Methods:

Participants and Setting: 631 mother-child pairs were evaluated in a poor urban district in Recife, northeastern Brazil. Cross-sectional study carried out between 2013 and 2014. It integrates a prospective cohort study designed to investigate the consequences of intimate partner violence that occurred during pregnancy, postpartum, and seven years after birth for the physical and mental health of women and their children. Maternal educational practices were assessed using the Parent-Child Conflict Tactics Scale (CTSPC – mother-child version) and the child’s behavioral and emotional disorders through the Strengths and Difficulties Questionnaire (SDQ) mother-version. The association was estimated through crude and adjusted prevalence ratios, using Poisson regression considering the 95% confidence interval.

Results:

The prevalence of violent maternal educational practices was 91.8% (572/631) being 89.7% (566/631) of psychological aggression and 75.6% of physical aggression, subdivided into corporal punishment (73.5%), physical maltreatment (35.8%) and severe physical maltreatment (1.7%). Corporal punishment (Adjusted PR 1.5; CI 95%: 1.1–2.1; p = 0.010) and severe physical maltreatment (Adjusted PR 1.9; CI 95%: 1.3–2.8; p = 0.002) were associated with emotional and behavioral difficulties in schoolchildren.

Conclusion:

The high prevalence of violent maternal educational practices, especially corporal punishment and severe physical maltreatment is associated with emotional and behavioral disorders in children. Therefore, it is necessary to interventions that promote parental support and effective use of non-violent discipline in conducting the educational process to establish healthier family relationships and to prevent/mitigate the impact of emotional and behavioral problems in children. © 2022 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

KEYWORDS
Child abuse; Child behavior; Mother-child relations; Parenting education

Introduction

The family is the first social environment in which the child will be exposed to educational practices whose quality will influence the behavioral, emotional, and social development of their children.11 Sanders MR. Development, evaluation, and multinational dissemination of the triple P-Positive Parenting Program. Annu Rev Clin Psychol. 2012;8:345–79.

Parental educational practices can act as protective factors (positive educational practices) or risk factors (negative educational practices) for children’s mental health, mainly behavioral and emotional problems.22 Altafim ER, Rodrigues OM. Maternal educational practices during the first year of life. J Hum Growth Dev. 2015;25:257–62.

Positive parenting practices are related to the development of secure attachment, good academic performance, and prosocial behavior, as well as negative parenting practices, which are related to the increase of psychopathology risk among children and adolescents.11 Sanders MR. Development, evaluation, and multinational dissemination of the triple P-Positive Parenting Program. Annu Rev Clin Psychol. 2012;8:345–79.

Among the negative educational practices, the use of violence to discipline children stands out. The practice of this “justified violence” is frequent in other countries33 Gershoff ET, Grogan-Kaylor A, Lansford JE, Chang L, Zelli A, Deater, et al. Parent discipline practices in an international sample: associations with child behaviors and moderation by perceived normativeness. Child Dev. 2010;81:487–502. and in Brazil.44 Baluta MC, Moreira D. A injunção social da maternagem e a violencia. Rev Estud Fem. 2019;27:e48990. Therefore, the family context that would have the function of protecting their members, especially children, fails to achieve this function, so that, domestic violence against children prevails as a serious social and human rights problem.44 Baluta MC, Moreira D. A injunção social da maternagem e a violencia. Rev Estud Fem. 2019;27:e48990.

In different countries, there is a high percentage of children who receive corporal punishment from their parents, with the mother being the main perpetrator.33 Gershoff ET, Grogan-Kaylor A, Lansford JE, Chang L, Zelli A, Deater, et al. Parent discipline practices in an international sample: associations with child behaviors and moderation by perceived normativeness. Child Dev. 2010;81:487–502.

In a study carried out in southern Brazil,55 Bolze SD, Schmidt B, Bossardi CN, Gomes LB, Bigras M, Vieira ML, et al. Marital and parental conflict resolution tactics in South-Brazilian families. Cienc. Psicol. 2019;13:67–81. despite mothers reporting high percentages of non-violent discipline, it was found that almost half of maternal conflict resolution tactics with their children involve verbal or physical aggression. Verbal aggression are representations of psychological aggression, which can cause fear and psychological suffering. Physical aggression represents corporal punishment that refers to the use of physical force to cause some level experience of pain and discomfort, with the intention of modifying the child’s behavior.66 Gershoff ET, Goodman GS, Miller-Perrin CL, Holden GW, Jackson Y, Kazdin AE. The strength of the causal evidence against physical punishment of children and its implications for parents, psychologists, and policymakers. Am Psychol. 2018;73:626–38.

The fact that a violent maternal educational practice is pointed out as the most frequent in several studies,33 Gershoff ET, Grogan-Kaylor A, Lansford JE, Chang L, Zelli A, Deater, et al. Parent discipline practices in an international sample: associations with child behaviors and moderation by perceived normativeness. Child Dev. 2010;81:487–502., 55 Bolze SD, Schmidt B, Bossardi CN, Gomes LB, Bigras M, Vieira ML, et al. Marital and parental conflict resolution tactics in South-Brazilian families. Cienc. Psicol. 2019;13:67–81. it may be a consequence of the mother spending more time with her children, being responsible for education and discipline, it is centralizing household chores, or even transferring to children her difficulties and internal conflicts.44 Baluta MC, Moreira D. A injunção social da maternagem e a violencia. Rev Estud Fem. 2019;27:e48990.

There are several other aspects that contribute to violent maternal educational practice and that can influence children’s mental health by altering both the environment and the maternal posture of child care, such as the mother mental health,77 Apter-Levi Y, Pratt M, Vakart A, Feldman M, Zagoory-Sharon O, Feldman R. Maternal depression across the first years of life compromises child psychosocial adjustment; relations to child HPA-axis functioning. Psychoneuroendocrinology. 2016;64:47–56. use of legal and illegal drugs,88 Ogbonnaya IN, Keeney AJ, Villodas MT. The role of co-occurring intimate partner violence, alcohol use, drug use, and depressive symptoms on disciplinary practices of mothers involved with child welfare. Child Abuse Negl. 2019;90:76–87. poverty,99 Boe T, Sivertsen B, Heiervang E, Goodman R, Lundervold AJ, Hysing M. Socioeconomic status and child mental health: the role of parental emotional well-being and parenting practices. J Abnorm Child Psychol. 2014;42:705–15. maternal history of recent intimate partner violence or in her family of origin or still abuse suffered as a child1010 Abdel-Fatah NA. Determinants of severe physical disciplinary practices against children in Egypt. Child Abuse Negl. 2021;111:104821. and lack of social support.1111 Pinto RJ, Correia-Santos P, LevendoskyA, Jongenelen I. psychological distress and posttraumatic stress symptoms: the role of maternal satisfaction, parenting stress, and social support among mothers and children exposed to intimate partner violence. J Interpers Violence. 2019;34:4114–36.

Children exposed to violent maternal educational practices, including psychological aggression and corporal punishment, can be associated with aggression, antisocial behavior, externalizing and internalizing problems, mental health problems, negative relationships with parents, lower cognitive ability, and low self-esteem.1212 Cuartas J, McCoy DC, Rey-Guerra C, Britto PR, Beatriz E, Salhi C. Early childhood exposure to non-violent discipline and physical and psychological aggression in low- and middle-income countries: national, regional, and global prevalence estimates. Child Abuse Negl. 2019;92:93–105., 1313 Heilmann A, Mehay A, Watt RG, Kelly Y, Durrant JE, van Turnhout J, et al. Physical punishment and child outcomes: a narrative review of prospective studies. Lancet. 2021;398:355–64.

The aim of the study is to investigate the association between maternal educational practices reported by the mothers and mental health disorders of school-age children.

Methods

Study design and population

Cross-sectional study inserted in a cohort conducted in the health district II in the city of Recife, Pernambuco, Brazil between July 2013 and December 2014, with women and children participating in the third stage of a prospective cohort study designed to investigate the consequences of violence committed by the intimate partner against women during pregnancy, in the postpartum period and in the last seven years for women’s mental health and the psychosocial development of children born between July 2005 and October 2006.

In the cohort study, three stages of data collection were conducted. The first two occurred in 2005 and 2006. In the first, all 1.120 pregnant women registered in the Family Health Strategy participated with ages between 18 and 49 years and with 31 weeks or more of gestation. In the second, interviews were carried out with 1.057 women until 01 years after delivery, from May to December 2006. Additional information about the study methods is reported in other publications with data from the first and second stages1414 Ludermir AB, Lewis G, Valongueiro SA, Araújo TV, Araya R. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet. 2010;376:903–10. and from the third one. Published studies with data from the third stage do not include information on the content of the present study.1515 Silva JM, Lima MC, Ludermir AB. Intimate partner violence and maternal educational practice. RevSaude Publica. 2015;51:34., 1616 Silva EP, Ludermir AB, Lima MC, Eickmann SH, Emond A. Mental health of children exposed to intimate partner violence against their mother: a longitudinal study from Brazil. Child Abuse Negl. 2019;92:1–11., 1717 Silva EP, Alan E, Ludermir AB. Depression in childhood: the role of children’s exposure to intimate partner violence and maternal mental disorders. Child Abuse Negl. 2021;122:105305.

From the first to the second stage there was a loss of only 5.7%. From the second to the third stage there was a loss of 39% of the 1057 women who were part of the 2nd stage of the cohort. A comparison of some characteristics of the women who left the study with those who stayed was carried out to assess the magnitude of the selection bias. However, there was no statistical difference between age, race/color, marital status, education, and reports of intimate partner violence between women who took part in this stage of the study and those who did not.1515 Silva JM, Lima MC, Ludermir AB. Intimate partner violence and maternal educational practice. RevSaude Publica. 2015;51:34.

For this study, 644 women were interviewed, representing 61% of those who participated in the second stage. Between the second and third stages, five women died, 391 were not found due to a change of address and 17 refused to remain in the study. Among the children, four died. Two children who were donated to other families, two who lived with other family members, and five pairs of twins were excluded from the study with their respective mothers. Thus, the study population consisted of 631 pairs of mothers and their children.

In the final sample for analysis, 73.2% of women were over 30 years old, 66.4% earned below the minimum wage, 50.6% had not completed fundamental education, and 82.2% declared non-white ethnicity. Non-white participants were predominately mixed race (brown/pardo/black). The children were between 6 and 9 years old, and 50.9% were female. The majority (64.1%) were attending the second year of elementary school.

All interviews were conducted by women researchers with experience in research on intimate partner violence and violence against children, without the presence of the partner or any child aged two years and older. The women interviewed received a guide with information about the support services available in the city of Recife for women and children in situations of violence.

Measures

Mental health difficulties of child

The Strengths and Difficulties Questionnaire (SDQ) is a brief questionnaire developed by Goodman (1997)1818 Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997;38:581–6. and validated for the Brazilian context.1919 Fleitlich B, Goodman R. Social factors associated with child mental health problems in Brazil: cross sectional survey. BMJ. 2001;323:599–600. It has been widely used to track behavioral and emotional difficulties. It is available free of charge in 85 languages, including Portuguese (http://www.sdqinfo.org/py/sdqinfo/b3.py?language=Portugueseqz(Brazil). It can be administered to parents and teachers of children and adolescents between 4 and 17 years old and self-administered to adolescents between 11 and 17 years old. It consists of 25 attributes, some positive and others negative, divided into five scales, each containing five items, which generate a total difficult score and scores for prosocial behavior, hyperactivity, emotional problems, behavioral problems, and relationship problems with peers. These child attributes are evaluated with reference to the last six months or the current school year.1818 Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997;38:581–6.

The authors used the total difficulties score of the SDQ. A child with a score of 17 or over was considered to have a high risk of mental health problems. The cut-off points used were: 0–13 to categorize normal children, 14–16 for borderline children, and 17–40 for abnormal children.1818 Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997;38:581–6. ’Borderline’ was categorized as ’normal’ and then compared to ’abnormal’ (positive for child mental health disorders).

Maternal educational practices

The Parent-Child Conflict Tactics Scale (CTSPC), adopted and validated in Brazil2020 Reichenheim ME, Moraes CL. Adaptação transcultural do instrumento Parent-Child Conflict Tactics Scales (CTSPC) utilizado para identificar a violência contra a criança. Cad Saude Publica. 2003;19:1701–12. is one of the most international instruments used for investigating domestic violence against children.2121 Alenko A, Girma S, Abera M, Workicho A. Children emotional and behavioural problems and its association with maternal depression in Jimma town, Southwest Ethiopia. Gen Psych. 2020;33:e100211. It consists of 22 items that investigate domestic violence based on parental educational practice. Three dimensions are evaluated: non-violent discipline (4 items), psychological aggression (5 items), and physical aggression (13 items) being this last one subdivided into three, each one contemplating different acts of severity: corporal punishment (6 items), physical maltreatment (3 items) and severe physical maltreatment (4 items).

For the CTSPC, the items from different scales and different levels of severity are interspersed in a randomly determined order to make the subdivisions less evident to the interviewee.2222 Straus MA, Hamby SL, Finkelhor D, Moore DW, Runyan D. Identification of child maltreatment with the parent-child Conflict Tactics Scales: development and psychometric data for a national sample of American parents. Child Abuse Negl. 1998;22:249–70. Can be answered by the mother regarding her attitudes towards her child asks about the events of the last 12 months, evaluating the frequency of each of the 22 items in three dimensions: it did not happen, it happened once and it happened more than once.2222 Straus MA, Hamby SL, Finkelhor D, Moore DW, Runyan D. Identification of child maltreatment with the parent-child Conflict Tactics Scales: development and psychometric data for a national sample of American parents. Child Abuse Negl. 1998;22:249–70.

A positive case of violent maternal educational practice against the child was considered when the affirmative answer of the practice, in the last 12 months of at least one item of the subscales.

Covariates

The following covariates selected were related to the mother: age in years (≥ 30; < 30), race (white; nonwhite), education in years of schooling (> 9; ≤ 9), marital status (with a partner; without a partner), employment status (employed; unemployed), income in the minimum wage (≥ 1; < 1), head of household (yes; no), and common mental disorders (no; yes). Employment status was categorized according to the classification adopted by the Brazilian census (Instituto Brasileiro de Geografia e Estatística – IBGE, 2011): formal worker, informal worker, housewife, unemployed, student, or retired. In this report, the authors have grouped women as unemployed and employed.

The women’s mental health in the past four weeks was assessed by the Self Reporting Questionnaire (SRQ-20), an instrument developed by the World Health Organization to detect psychiatric problems in primary health care for developing countries. It consists of twenty yes-no questions, four on physical symptoms and sixteen on psycho-emotional disorders.2323 Harding TW, Climent CE, de Arango MV, Baltazar J, Ibrahim HH, Ladrido-Ignacio L, et al. Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychol Med. 1980;10:231–41. It was validated in Pernambuco.2424 Ludermir AB, Lewis G. Is there a gender difference on the association between informal work and common mental disorders? Soc Psychiatry Psychiatr Epidemiol. 2005;40:622–7. In data analysis, one point was assigned for each affirmative answer and zero for each negative answer. The cut-off score of the SRQ-20 for this study was defined as 7/8 and women were divided into two groups: non-suspected of common mental disorders (score ≤ 7) and suspected of common mental disorders (score ≥ 8).

Regarding children, the variables were: age (6–7 years; 8–9 years), sex (female; male), presence of siblings (no; yes), birth order (1st-2nd position; ≥ 3rd position), grade (≥ 2nd year; ≤ 1st year;), type of school (private; public).

The variables about the woman’s partner were: father of the child (yes; no), race (white; non-white), employment status (employed; unemployed), and use of alcohol (no; yes).

The profile of the couple’s relationship was measured by use of the variables: duration of the couple’s relationship in years (> 6; ≤ 6), communication between the couple (good; poor), couple’s fights in times per month (< 1; ≥ 1) and intimate partner violence (no; yes).

Statistical analysis

The statistical analysis was performed using the Stata program version 13.0 for Windows.

The sample was described by the variables studied. The prevalence and associations of maternal educational practice (non-violent discipline, physical aggression, and its subdivisions, and psychological aggression) and the child’s behavioral/emotional disorders were estimated through prevalence ratios, using Poisson regression considering the 95% confidence interval.

In the multivariate logistic regression analysis, it was included covariables that had p-value < 0.10 in the bivariate analysis with exposure and outcome.

This research was approved by the Research Ethics Committee of the Health Sciences Center of the Federal University of Pernambuco (ref 194.672 de 06/02/2013).

Results

Table 1 shows the association between the child’s behavioral and emotional disorders with the demographic and socioeconomic characteristics of the woman and her partner, the demographic characteristics of the child, the couple’s relationship, and the woman's mental health. The children who presented more behavioral and emotional problems, compared to those who had a normal score were those who had mothers under 30 years, were not white, with 9 years or less of study, were unemployed, with income < 1 minimum wage per month, and were suspected of common mental disorders.

Table 1
Bivariate analysis between demographic and socioeconomic characteristics of the woman and her partner, demographic characteristics of the child, the couple’s relationship, woman’s mental health, and child behavioral and emotional disorders.

About the children, most were aged between 8 and 9 years (51.5%), female (50.9%), had siblings (79.1%), with the 1st or 2nd position in birth order (70.8%), ≥ 2nd-year grade (64.1%), in a public school (52.9%).

Regarding the characteristics of the partner of the women, most of the partners were the parents of the children (64%), non-white (68.3%), unemployed (32.2%), and used alcohol (75.3%).

In the relationship profile, most of the couples had a relationship time > 6 years (66.6%), did not have good communication (20,6%) frequency of fights ≥ 1 time per month (32.2%), and reported intimate partner violence (32,8%).

The prevalence of child behavioral and emotional difficulties was 31.54% (199/631).

Bivariate analysis shows that the sociodemographic variables were strongly associated with children’s abnormal total difficulties, except for age and marital status among women and use of alcohol among men. Children with high total difficulties scores were more likely to have siblings and to have attended a public than a private school. Couple’s fights ≥ one time per month and intimate partner violence were also associated with children’s abnormal total difficulties.

The violent maternal educational practice had high frequency. When describing the three dimensions of the instrument separately, 89.7% of the women reported acts of psychological aggression and 75.6% of physical aggression, which was subdivided into corporal punishment (73.5%), physical maltreatment (35.8%), and severe physical maltreatment (1.7%).

Non-violent discipline had a prevalence of 96.8% coexisting with violent discipline strategies.

In the bivariate analysis (Table 2), corporal punishment was associated with lower maternal education, grade ≤ 1st year, public school, and intimate partner violence reported.

Table 2
Bivariate analysis between demographic and socioeconomic characteristics of the woman and her partner, demographic characteristics of the child, couple’s relationship, woman's mental health and maternal educational practice.

As for physical maltreatment, several covariates were associated with this type of violence, such as age < 30 years, lower education, and common mental disorders (related to women); presence of siblings, birth order ≥ 3rd position, public school (related to the child); poor communication, frequency of couple’s fights ≥ 1 per month and intimate partner violence (related to the profile couple’s relationship).

Severe physical maltreatment was associated with: age < 30 years, without a partner, not the head of household, and common mental disorder of the woman, child’s grade ≤ 1st year, and couple’s relationship time ≤ 6 years.

Table 3 shows the association of maternal educational practice, in the last 12 months, with the child’s behavioral and emotional disorders even after adjusting for confounders. Mental health difficulties of child were associated with corporal punishment (adjustedPR=1.5; 95% CI: 1.1–2.1; p = 0.010) and with severe physical maltreatment (adjustedPR=1.9; 95% CI: 1.3–2.8; p = 0.002) compared to children not exposed.

Table 3
Association between maternal educational practice and the child behavioral and emotional disorders at school age reported by mothers using the Strengths and Difficulties Questionnaire.

Discussion

This study evaluated the frequency of mental health disorders in schoolchildren from a low-income community in Northeast Brazil, exposed or not to violent maternal educational practice. Corporal punishment and severe physical aggression, used by the mother as disciplinary educational practices, remained associated with mental health disorders even after controlling for confounding variables.

Non-violent discipline was a frequent practice in conflict resolution that mothers used with their children as well as other studies show.55 Bolze SD, Schmidt B, Bossardi CN, Gomes LB, Bigras M, Vieira ML, et al. Marital and parental conflict resolution tactics in South-Brazilian families. Cienc. Psicol. 2019;13:67–81., 2525 DuRivage N, Keyes K, Leray E, Pez O, Bitfoi A, Koç C, et al. Parental use of corporal punishment in Europe: intersection between public health and policy. PLoS One. 2015;10:1–11. This maternal attitude is positive because it is a discipline that leads the child to reflect and understand inappropriate behaviors, consequently stimulating the management of emotions and the regulation of behaviors.55 Bolze SD, Schmidt B, Bossardi CN, Gomes LB, Bigras M, Vieira ML, et al. Marital and parental conflict resolution tactics in South-Brazilian families. Cienc. Psicol. 2019;13:67–81., 2525 DuRivage N, Keyes K, Leray E, Pez O, Bitfoi A, Koç C, et al. Parental use of corporal punishment in Europe: intersection between public health and policy. PLoS One. 2015;10:1–11.

However, negative educational practices, such as psychological aggression, corporal punishment, physical aggression, and severe physical punishment, presented high percentages, which reveals the co-occurrence of negative and positive maternal educational practices. This fact suggests the possibility that when non-violent practices do not result in the desired effect on children’s behavior, mothers use violent strategies.55 Bolze SD, Schmidt B, Bossardi CN, Gomes LB, Bigras M, Vieira ML, et al. Marital and parental conflict resolution tactics in South-Brazilian families. Cienc. Psicol. 2019;13:67–81.

The hypothesis for mothers to use violent educational practices is to teach appropriate behaviors, according to their rules, but studies66 Gershoff ET, Goodman GS, Miller-Perrin CL, Holden GW, Jackson Y, Kazdin AE. The strength of the causal evidence against physical punishment of children and its implications for parents, psychologists, and policymakers. Am Psychol. 2018;73:626–38. show the ineffectiveness and negative impacts of these practices on socio-emotional development and a greater chance of problems in the mental health of children, as also demonstrated by the present results.

Corporal punishment, as well as psychological aggression, appears as a frequent practice of disciplining children in different countries and cultures,2626 Greene CA, Haisley L, Wallace C, Ford JD. Intergenerational effects of childhood maltreatment: a systematic review of the parenting practices of adult survivors of childhood abuse, neglect, and violence. Clin Psychol Rev. 2020;80:101891. both in high-income countries2727 Ryan R, Kalil A, Ziol-Guest K, Padilla C. Socioeconomic gaps in parent’s discipline strategies from 1998 to 2011. Pediatrics. 2016;138:e20160720. and in low- and middle-income countries,2828 United Nations Children’s Fund. A familiar face: violence in the lives of children and adolescents. New York: UNICEF; 2017, [Cited 30 Dec 2019]. Available from: https://data.unicef.org/resources/a-familiar-face/#.
https://data.unicef.org/resources/a-fami...
which supports the results of the present study, carried out in a low-income community. However, corporal punishment, of any severity level, only controls inappropriate behavior due to fear of the aggressor and promotes the resolution of conflicts through violence, favoring the transgenerational transmission of violence, as demonstrated in studies that report that parents with a history of childhood violence use more negative educational practices.2929 Altafim ER, McCoy DC, Linhares MB. Relations between parenting practices, socioeconomic status, and child behavior in Brazil. Child Youth Serv Rev. 2018;89:93–102.

The prevalence of child behavioral and emotional disorders is higher than in international studies.2121 Alenko A, Girma S, Abera M, Workicho A. Children emotional and behavioural problems and its association with maternal depression in Jimma town, Southwest Ethiopia. Gen Psych. 2020;33:e100211. However, it is very similar to other Brazilian studies in which the samples of children evaluated have similar socioeconomic status,1919 Fleitlich B, Goodman R. Social factors associated with child mental health problems in Brazil: cross sectional survey. BMJ. 2001;323:599–600., 2525 DuRivage N, Keyes K, Leray E, Pez O, Bitfoi A, Koç C, et al. Parental use of corporal punishment in Europe: intersection between public health and policy. PLoS One. 2015;10:1–11. and factors associated with violent parenting practices such as maternal common mental disorders and intimate partner violence.3030 Reyes AN, de Lima Bach S, do Amaral PL, Jansen K, Molina MR, Spessato B, et al. Emotional and behavioral problems in children of depressed mothers: a school-based study in Southern Brazil. Psychol Health Med. 2019;24:14–20.

The study has some limitations. The prevalence of violent maternal educational practices was high, but it is still possible to have an information bias because the CTSPC scale was reported only by the child’s mother, which may underestimate the prevalence of violent practices, especially physical abuse. Therefore, to minimize this limitation, the strategy of interspersing randomly the questions is used to make the objectives of the questions less evident and to reduce the possibility of negative answers regarding the occurrence of violence. This information bias may also have occurred in the prevalence of the child’s behavioral and emotional disorders, as it is assessed only from the perspective of the mother who tends to overestimate behavioral changes in her children. Although the study is aligned with a cohort, the cross-sectional study does not allow for the establishment of causality. However, based on the literature, including longitudinal studies,1313 Heilmann A, Mehay A, Watt RG, Kelly Y, Durrant JE, van Turnhout J, et al. Physical punishment and child outcomes: a narrative review of prospective studies. Lancet. 2021;398:355–64. there seems to be a strong association between violent parental practices and behavioral and emotional disorders in the child. In addition, cross-sectional studies are faster to be applied and all variables are collected in a single moment so that they can be used to describe the population studied.

Thus, the high prevalence of the violent maternal educational practice, especially corporal punishment and severe physical abuse, and the association with children’s mental health problems, as well as the involvement of factors from the family context show the complexity of the theme. Therefore, the results reinforce the need for interventions that promote support and encouragement for parents to effectively use non-violent discipline in conducting the educational process, making it possible to establish healthier relationships between mothers and children to prevent and mitigate the impact of emotional and behavioral problems in childhood. Future studies should involve both parents in the assessment of parenting practices and variables related to the cultural background as this might better represent the child’s behavior in the family context.

  • Funding
    This study was supported by the Brazilian Federal Government, through the Conselho Nacional de Desenvolvimento Científico e Tecnologico (CNPq) do Ministerio da Educac ao e Cultura, Brazil – Grant numbers: 403060/2004-4 and 475240/2011-1, and the Departamento de Ciencia e Tecnologia da Secretaria de Ciencia, Tecnologia e Insumos Estrategicos do Ministerio da Saude (DECIT), Brazil – Grant number: 473545/2004-7.

References

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    Sanders MR. Development, evaluation, and multinational dissemination of the triple P-Positive Parenting Program. Annu Rev Clin Psychol. 2012;8:345–79.
  • 2
    Altafim ER, Rodrigues OM. Maternal educational practices during the first year of life. J Hum Growth Dev. 2015;25:257–62.
  • 3
    Gershoff ET, Grogan-Kaylor A, Lansford JE, Chang L, Zelli A, Deater, et al. Parent discipline practices in an international sample: associations with child behaviors and moderation by perceived normativeness. Child Dev. 2010;81:487–502.
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    Baluta MC, Moreira D. A injunção social da maternagem e a violencia. Rev Estud Fem. 2019;27:e48990.
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    Bolze SD, Schmidt B, Bossardi CN, Gomes LB, Bigras M, Vieira ML, et al. Marital and parental conflict resolution tactics in South-Brazilian families. Cienc. Psicol. 2019;13:67–81.
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    Gershoff ET, Goodman GS, Miller-Perrin CL, Holden GW, Jackson Y, Kazdin AE. The strength of the causal evidence against physical punishment of children and its implications for parents, psychologists, and policymakers. Am Psychol. 2018;73:626–38.
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    Apter-Levi Y, Pratt M, Vakart A, Feldman M, Zagoory-Sharon O, Feldman R. Maternal depression across the first years of life compromises child psychosocial adjustment; relations to child HPA-axis functioning. Psychoneuroendocrinology. 2016;64:47–56.
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    Ogbonnaya IN, Keeney AJ, Villodas MT. The role of co-occurring intimate partner violence, alcohol use, drug use, and depressive symptoms on disciplinary practices of mothers involved with child welfare. Child Abuse Negl. 2019;90:76–87.
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    Boe T, Sivertsen B, Heiervang E, Goodman R, Lundervold AJ, Hysing M. Socioeconomic status and child mental health: the role of parental emotional well-being and parenting practices. J Abnorm Child Psychol. 2014;42:705–15.
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    Abdel-Fatah NA. Determinants of severe physical disciplinary practices against children in Egypt. Child Abuse Negl. 2021;111:104821.
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    Pinto RJ, Correia-Santos P, LevendoskyA, Jongenelen I. psychological distress and posttraumatic stress symptoms: the role of maternal satisfaction, parenting stress, and social support among mothers and children exposed to intimate partner violence. J Interpers Violence. 2019;34:4114–36.
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    Cuartas J, McCoy DC, Rey-Guerra C, Britto PR, Beatriz E, Salhi C. Early childhood exposure to non-violent discipline and physical and psychological aggression in low- and middle-income countries: national, regional, and global prevalence estimates. Child Abuse Negl. 2019;92:93–105.
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    Heilmann A, Mehay A, Watt RG, Kelly Y, Durrant JE, van Turnhout J, et al. Physical punishment and child outcomes: a narrative review of prospective studies. Lancet. 2021;398:355–64.
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    Ludermir AB, Lewis G, Valongueiro SA, Araújo TV, Araya R. Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet. 2010;376:903–10.
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Publication Dates

  • Publication in this collection
    17 Apr 2023
  • Date of issue
    Mar-Apr 2023

History

  • Received
    06 Apr 2022
  • Accepted
    27 Sept 2022
  • Published
    28 Oct 2022
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