The Role of Impaired Caregiving in Polytrauma Exposure, Behavioral Problems, and Posttraumatic Stress Among Clinic-Referred Youth in the United States

Information on caregiver mental illness and drug/alcohol abuse, child trauma exposure, and child behavioral/emotional problems were obtained from 3,470 children and adolescents. Participants had at least one trauma exposure and were referred for mental health services at clinics in the National Child Traumatic Stress Network. Direct and indirect effects of caregiver mental illness and drug/alcohol abuse on child trauma exposure and behavioral/emotional problems were examined. Although there was not a significant interaction effect between caregiver impairment and child trauma exposure, children of caregivers with multiple forms of impairment had significantly higher rates of trauma exposure and PTSD compared to trauma-exposed children with only one form of impaired caregiving or no impaired caregiving. Additionally, children of caregivers with mental illness, either in isolation or in combination with drug/alcohol abuse, had significantly higher internalizing and externalizing problems compared to trauma-exposed children without impaired caregivers. These findings suggest that trauma-exposed children who also have an impaired caregiver may have higher levels of symptomatology compared to children with more stable home environments.