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. Author manuscript; available in PMC: 2022 Feb 1.
Published in final edited form as: Child Abuse Negl. 2020 Dec 22;112:104829. doi: 10.1016/j.chiabu.2020.104829

Child maltreatment: An intergenerational cascades model of risk processes potentiating child psychopathology

Justin Russotti 1, Jennifer M Warmingham 1, Elizabeth D Handley 1, Fred A Rogosch 1, Dante Cicchetti 1,2
PMCID: PMC7855935  NIHMSID: NIHMS1649209  PMID: 33359770

Abstract

Background:

Child maltreatment poses substantial risk for compromised mental health in children. Further, child abuse and neglect are potentiated within a cascade of intergenerational and current familial risk processes that require clarification to inform understanding of adverse outcomes and direct prevention and intervention efforts.

Objective:

Using a multi-informant design, the current study applied an intergenerational cascades approach to examine the interconnected pathways among several familial risk factors associated with child maltreatment and its consequences.

Participants:

Participants were 378 children (aged 10–12) and their mothers from economically disadvantaged, ethnically diverse backgrounds. The sample included maltreated children recruited via CPS records and demographically comparable non-maltreated children.

Methods:

Structural equation modeling (SEM) was conducted to test sequential mediation pathways examining the independent and cascading effects of maternal history of childhood maltreatment, maternal adolescent childbearing, current maternal depression, and the child’s lifetime history of maltreatment on the child's internalizing and externalizing symptoms.

Results:

Multigenerational developmental cascades were identified. Maternal history of maltreatment predicted chronic maltreatment for offspring, which in turn predicted greater internalizing (β = .167, p = .03) and externalizing symptoms (β = .236, p = .005) in late childhood. Similarly, children born to mothers who began childbearing in adolescence were more likely to experience chronic maltreatment during childhood and develop subsequent symptoms. Effects were found over and above a parallel cascade from maternal maltreatment to offspring psychopathology via a maternal depression pathway.

Conclusion:

Findings reveal targets to prevent or ameliorate progressions of intergenerational risk pathways.

Keywords: child maltreatment, developmental psychopathology, intergenerational cascades

Introduction

Child maltreatment is a prevalent and a severe issue that poses substantial risks for derailing development across multiple domains of functioning (Jaffee, 2017; Widom, 2014). Among its many pernicious effects, child maltreatment is a robust predictor of negative mental health outcomes. Evidence suggests that maltreatment sets in motion a path of vulnerability that broadly increases the likelihood of virtually all forms of psychopathology (McLaughlin, Colich, Rodman, & Weissman, 2020). Though child maltreatment is a potent predictor of adverse mental health outcomes, child psychopathology is rarely singularly determined (Cicchetti & Toth, 2016). Rather, child psychopathology is often an emergent outcome of multilevel, intergenerational processes. This concept is a hallmark of the developmental psychopathology perspective, which serves as the guiding framework for this study (Cicchetti & Toth, 2016; Hinshaw, 2017). As such, it is important to broaden the examination of child psychopathology to include risk processes occurring across generations and within multiple levels of the social ecology surrounding children during development (Cicchetti & Toth, 2016).

For instance, child maltreatment often exists within high-risk contexts characterized by several caregiving risk factors, some of which may influence both child maltreatment and psychopathology (Belsky, 1984). Examples include historical influences (e.g., parent’s own experience of maltreatment), psychological influences (e.g., parental psychopathology), sociological influences (e.g. poverty, unemployment), and familial influences (e.g., marital discord). Further, these various risky caregiver conditions may emerge over time through accumulating consequences that unfold over the course of development and ultimately spread across generations (i.e., developmental cascades; Masten & Cicchetti, 2010). Thus, applying an intergenerational cascades approach to child maltreatment and child psychopathology can unveil progressive effects beginning in the caregiver’s own childhood that may accumulate over time, via multiple processes and pathways, ultimately potentiating child maltreatment and influencing child psychopathology outcomes in the next generation (Masten & Cicchetti, 2010).

The following sections offer a brief review of a set of conceptually and empirically salient intergenerational risk factors associated with cascades to both child maltreatment and the development of psychopathology: maternal childhood maltreatment history, maternal adolescent childbearing, and current maternal depression. These risk factors were expressly selected because they: a) are associated with offspring child maltreatment; b) are empirically linked to increased internalizing and externalizing psychopathology for offspring; c) represent a sequential pattern of intergenerational risk (i.e., proximal risks are preceded by distal antecedent risks).

Child Maltreatment

Child maltreatment may contribute to child psychopathology via diverse mechanisms, such as hindered resolution of stage-salient developmental tasks, difficulties with emotion processing, neurobiological deficits, and interpersonal challenges (Jaffee, 2017; Widom, 2014). Further, evidence suggests that child maltreatment can be a result of vulnerabilities originating in the developmental history of the caregiver, such as the caregiver’s own abuse history (Assink et al., 2018; Madigan et al., 2019), the timing of parenthood (Valentino, Nuttal, Comas, Borkowski, & Akai, 2012), or the caregiver’s psychopathology (van IJzendoorn et al., 2020).

Maternal depression.

Maternal depression is common, and children exposed to maternal depression are at heightened risk to develop internalizing and externalizing symptoms (Goodman, 2020). There are several complex pathways that account for this association including genetic, neurobiological, and interpersonal pathways (Gotlib, Goodman, & Humphreys, 2020). Depression among mothers can disrupt healthy parent-child interactions (Humphreys et al., 2018) and depressed mothers are more likely to engage in hostile, detached, and inconsistent parenting styles (Goodman, 2014; Sellers et al., 2014), all of which contribute to child internalizing/externalizing symptoms. Further, maternal depression may contribute to child maltreatment, and the two frequently co-occur (Plant, Jones, Pariante, & Pawlby, 2017).

Maternal adolescent childbearing

Maternal adolescent childbearing (i.e., birth before age 20; CDC, 2020) is a salient risk factor for both subsequent maternal depression and offspring child maltreatment (Hodgkinson, Beers, Southammakosane, & Lewin, 2014; Putnam-Hornstein & Needell, 2011). Entering parenthood during adolescence can initiate a cascade of stress as the individual attempts to navigate the competing demands of adolescent development and the responsibilities and challenges of parenthood (Mollborn, 2017). In turn, these stressors increase the mother’s risk for depression and place their children at risk of experiencing both maltreatment and internalizing/externalizing symptoms (Pasalich et al., 2016; Yoon et al., 2019).

Maternal maltreatment history.

Importantly, the previously described conditions may all represent the deleterious sequelae of the maltreatment experienced by the mother in her own childhood. Indeed, maternal maltreatment history is a well-recognized risk for experiencing persistent and recurrent maternal depression (see Humphreys et al., 2020 for review). Likewise, those who become parents during adolescence are more likely to have experienced abuse in childhood (Noll et al., 2019). Finally, maltreatment often aggregates in families and may extend into future generations—otherwise known as intergenerational transmission or continuity. Results from two recent meta-analyses (Assink et al., 2018; Madigan et al., 2019) and one umbrella analysis (van IJzendoorn et al., 2019) report modest support for the intergenerational continuity of maltreatment. Still, discrepant findings across studies, ranging from weak to medium effects, may be attributable to design differences, such as methodological rigor or maltreatment informant, and additional studies are warranted (Assink et al., 2018; Buisman et al., 2020; Madigan et al., 2019; Thornberry, Knight, & Lovegrove, 2012). In sum, several risks unfolding in a mother’s own childhood and adolescence may perpetuate and transmit risk for negative experiences in the next generation, which place the child at higher risk for psychopathology (Bosquet-Enlow, Englund, & Egeland, 2018).

Economic adversity.

Although child maltreatment is not limited to economically disadvantaged contexts, children from the low-income sector represent a segment of the population that is severely at risk for child maltreatment (USDHHS, 2020). Conditions such as maternal depression and adolescent childbearing vary as a function of economic levels, with higher loads in disadvantaged contexts (Mollborn, 2017). Thus, child maltreatment, and associated concurrent/historical risk factors, tend to aggregate within disenfranchised, distressed families, and any attempt to disentangle the intergenerational cascades among said risks must be done within the larger context of socioeconomic adversity.

Intergenerational Pathways to Offspring Psychopathology

Recent studies have attempted to formally test the mediational pathways that intergenerationally link maltreatment with the development of offspring internalizing and externalizing psychopathology. For example, studies have demonstrated that offspring maltreatment mediated the association between maternal maltreatment and offspring psychopathology (Bosquet Enlow et al., 2018; Sierau et al., 2020). Others have demonstrated sequential mediational chains in which maternal history of maltreatment increases risk for maternal depression, which then increases the likelihood the child will experience maltreatment, which predicts greater child internalizing and externalizing symptoms (Choi et al., 2019; Plant et al., 2013; Plant et al., 2017).

Despite the emerging literature, multiple gaps remain. First, we are not aware of any study that has simultaneously considered the role of maternal adolescent childbearing in conjunction with the patterns of associations between the high-risk parenting conditions summarized above and offspring internalizing/externalizing psychopathology. This is a notable omission, as adolescent childbearing and child maltreatment are often products of the same disadvantaged contexts (Garwood, Gerassi, Jonson-Reid, Plax, & Drake, 2015). Also, as previously reviewed, the adverse mental health effects of economic disadvantage may be inextricably confounded with child maltreatment and adolescent childbearing. Thus, it is important to assess these intergenerational processes within low-income, high-risk samples that attend to the concentration of adversity. When previous studies have accounted for the influence of economic disadvantage, they have done so statistically, rather than methodologically.

Present Study

The aim of the present study was to advance our understanding of the mental health sequelae of child maltreatment by examining progressive intergenerational risk cascades that potentiate risk for maltreatment exposure and co-occurring caregiver risk processes that may also be associated with child psychopathology. Moreover, these processes were examined with a multi-informant design within a high-risk, economically disadvantaged, ethnically diverse sample allowing us to examine the unique unfolding of risks while also attending to concentration of adversities.

Specifically, we tested a model of multiple parallel and sequential mediation pathways to examine the independent and cascading effects of maternal history of childhood maltreatment, maternal adolescent childbearing, current maternal depression, and the child’s lifetime history of documented maltreatment on the child’s internalizing and externalizing symptoms at ages 10–12. We hypothesized that: 1) maternal history of maltreatment will predict greater child internalizing and externalizing symptoms at ages 10–12; 2) maternal adolescent childbearing, maternal depression, and child maltreatment will operate as independent mediators that help explain the relationship between maternal history of maltreatment and child internalizing and externalizing symptoms; 3) maternal adolescent childbearing will indirectly affect child outcomes including internalizing and externalizing symptoms through maternal depression and child maltreatment, demonstrating separate cumulative effects.

Methods

Participants and Procedures

The present study included 378 mothers and their biological school-aged children (49% male; Mage=11.24 SD=.98). Participants were racially and ethnically diverse (70.5% Black, 10.5% Hispanic, 14.6% white, 4.4% other race) and the families were primarily headed by a single parent (68.7%) and had histories of receiving public assistance (96.1%). The high-risk sample included maltreated children (n=214; 56.6%) and non-maltreated children (n=164; 43.4%), drawn from a larger study of 680 children (53% maltreated) who participated in a summer research camp from 2004–2007 (see Cicchetti & Manly, 1990 for a detailed description of the research camp setting). The present subsample of N=378 represents the families who completed both parent and child measures. Although both mothers and children were intended to participate in the study, mothers often were not available or declined interviews, despite diligent engagement efforts, particularly after children had attended the research camp. The current subsample does not differ from those not included in this sample on maternal adolescent childbearing, child gender, child age, or child internalizing/externalizing symptoms. The subsample included more maltreated children than the original sample (χ2 (1) = 4.6, p = .03).

Participants were initially recruited based on documented records of child abuse and neglect reports through the Department of Human Services (DHS). A DHS liaison reviewed Child Protective Services (CPS) records and identified children who had been maltreated. Children in foster care were not recruited. The DHS liaison then contacted a random sample of eligible families and explained the study to parents who were free to either agree to participate or to decline to have their information released to project staff. Interested parents provided project staff with informed consent for both their and their child’s participation in the summer camp research program and for full access to any DHS records pertaining to the family.

Maltreated children are disproportionately from low-income, single-parent families (USDHHS, 2020). Therefore, the DHS liaison identified demographically comparable families (i.e., families receiving Temporary Assistance for Needy Families) without histories of CPS or preventive services involvement for recruitment for the non-maltreated comparison group. As with the maltreated group, the DHS liaison contacted a random sample of eligible non-maltreated participants to discuss study details. If participants expressed interest, their information was passed to project staff who were provided consent to search family DHS records and further verify the absence of maltreatment for all children in the family. Further, trained research staff completed the Maternal Child Maltreatment Interview (Cicchetti et al., 2003) with all mothers to confirm the lack of maltreatment. If any conflicting information was provided that suggested the non-maltreated participants may have experienced maltreatment, they were excluded from the comparison group. Fourteen families were excluded based on this method.

Children enrolled in the study participated in a week-long research summer camp and provided assent for research activities. Trained camp counselors, blind to maltreatment status, worked with the same group of eight children (four maltreated and four non-maltreated) for the duration of the week (~35 hours of contact). Counselors were undergraduate and graduate students recruited through local universities. Once hired, they completed an extensive two-week training on completing behavioral assessments and were approved by an established trainer for validity and reliability via pilot sessions. Children completed study procedures, including ratings of their own experience. At the end of each week, counselors completed measures of emotional and behavioral functioning for each child based on their observation and interactions. Mothers completed self-report measures and interviews about their own experiences during two parent research sessions.

Measures of Parental Risk

Maternal history of childhood maltreatment.

The Childhood Trauma Questionnaire (CTQ; Bernstein et al., 2003) is a widely-used 28-item self-report measure that was completed by mothers to assess history of childhood maltreatment. Mothers rated the frequency (1- “never true” to 5- “very often true”) with which they had certain experiences pertaining to childhood maltreatment. Sample items include: “When I was growing up, people in my family hit me so hard it left me with bruises or marks,” “When I was growing up, someone molested me,” and “When I was growing up, people in my family said hurtful or insulting things to me.” The CTQ has evidence of acceptable psychometric properties, including the convergence with childhood trauma interviews (Bernstein et al., 1994). The CTQ scores five subtypes of maltreatment: physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect. Presence or absence of each subtype was determined using established cutoff scores (Walker et al., 1999). CTQ subtypes showed good internal consistency in the current sample (α range: .76–.97).

Maternal history of adolescent childbearing

The mother’s age at the birth of her oldest child was determined based on information obtained from DHS records and substantiated via maternal report. Specifically, the mother’s age at birth of her first child was calculated by subtracting the eldest child’s date of birth (DOB) from her DOB. Maternal adolescent childbearing was then coded into a dichotomous variable categorizing mothers who began childbearing when they were < 20-years-old as 1= adolescent childbearing and mothers who were = 20-years-old when they first gave birth as 0 = no adolescent childbearing. This criterion was elected to map onto the classification of adolescent childbearing (i.e., < 20yrs) defined by the Centers for Disease Control and Prevention (CDC, 2019).

Maternal current depressive symptoms.

Mothers completed the Beck Depression Inventory (BDI-II; Beck, Steer, Ball, & Ranieri, 1996), a well-validated and widely-used 21-item self-report measure of depressive symptoms. Participants selected statements related to symptom severity (e.g., 0 = “I do not feel sad”, 1 = “I feel sad much of the time”, 2 = “I am sad all the time”, 3 = “I am so sad or unhappy I can’t stand it”) that best represented their symptomatology over the past two weeks. The BDI-II has good psychometric properties, including test-retest reliability scores ranging from 0.73–0.96 and strong convergent validity with other depression measures (Wang & Gorenstein, 2013). The sum of symptoms score (0–63) was used to indicate the degree of maternal depressive symptoms (α = .92).

Child Measures

Offspring chronicity of maltreatment.

Child participants’ history of maltreatment was determined by coding lifetime CPS records using the Maltreatment Classification System (MCS; Barnett, Manly, & Cicchetti, 1993). The MCS is a comprehensive system of coding dimensions of maltreatment, including subtype, severity, chronicity, and perpetrator, that does not depend on CPS designations. Coding of the CPS records was conducted by doctoral students and clinical psychologists who were required to meet acceptable reliability with criterion training standards before coding actual records; weighted ĸ with the criterion standard ranged from .86 to .98. MCS reliable coders scored presence of subtypes of maltreatment (i.e., sexual abuse, physical abuse, emotional maltreatment, and neglect) across developmental periods from birth to childhood. The average intraclass correlations (ICCs) between pairs of actual MCS coders ranged from .86–1.0 for presence/absence of maltreatment subtypes. In this study, chronicity of exposure to maltreatment, operationalized as number of developmental epochs in which maltreatment occurred, was used in the analyses. Developmental epochs included infancy, toddlerhood, preschool age, early school age, and later school age. This variable was coded on a scale of 0 (no maltreatment) to 5 (maltreatment in all five developmental periods). Among the maltreated children (N = 214), 54.7% experienced maltreatment in one developmental period, 25.7% in two developmental periods, 13.1% in three developmental periods, 4.7% in four developmental periods, and 1.9% in five periods. Finally, the mother was an indicated perpetrator in 93% of the maltreated cases.

Measures of Child Externalizing Symptoms

Pittsburgh Youth Survey

(PYS; Loeber, Farrington, Stouthamer-Loeber, & Van Kammen, 1998). Childhood conduct problems were assessed using the PYS, a self-report measure that examines a range of delinquent and substance use behaviors in childhood. Children indicated the lifetime prevalence of behaviors. This scale has strong evidence of convergent and predictive validity related to records of delinquency (Farrington et al., 1996). A total count of the 25 conduct disorder symptoms endorsed (e.g., stealing, cheating on school tests, damaging property) was used as an indicator of childhood externalizing symptomatology. Reliability was adequate for the 25 items (α = .81).

TRF Externalizing Subscale.

The Teacher Report Form (TRF) of the Childhood Behavior Checklist (Achenbach, 1991) is a well-validated, 113-item measure of multiple dimensions of child functioning rated by a non-related adult. In the current study, two camp counselors rated each child after ~35 hours of direct contact over the course of a five-day research camp. Counselors rated children on items (0=not true, 1=somewhat or sometimes true, 2 = very often true) and scores were averaged across the two raters. For the externalizing subscale, the average intraclass correlation between pairs of raters was .83, indicating high reliability. Standardized T-scores for the externalizing subscale (α = .76) were used as an indicator of childhood externalizing symptomatology.

Measures of Child Internalizing Symptoms

Children’s Depression Inventory

(CDI; Kovacs, 1982). The CDI is a reliable and validated 27-item self-report measure used to assess depressive symptoms (e.g., feelings of worthlessness) in school-aged children in the two weeks prior to administration (Saylor, Finch, Spirito, & Bennet, 1984). Each item on the CDI is scored from 0 to 2. The total symptom score (0–54) was used as an indicator of child internalizing symptoms in this study (α = .85).

Revised Children’s Manifest Anxiety Scale

(RCMAS; Reynolds & Richmond, 1985, 1997). The RCMAS is a 37-item self-report measure of anxiety. Child participants responded “yes” or “no” to items pertaining to anxiety symptoms (e.g., “I am nervous,” or “Often I feel sick to my stomach”). The RCMAS has extensive evidence of reliability and validity properties (Reynolds & Richmond, 1985). The measure produces a total anxiety score and three subscale scores (worry-oversensitivity, physiological arousal, and concentration). The present study used the total anxiety score as an indicator of childhood internalizing symptomatology (α = .84).

TRF Internalizing Subscale.

As described above, the Teacher Report Form (TRF) of the Childhood Behavior Checklist (Achenbach, 1991) was completed by two counselors who rated children on items related to behavioral and emotional functioning. The standardized T-score for the internalizing subscale (α = .70) was used as an indicator of childhood internalizing symptomatology. The average intraclass correlation between raters for this scale indicated high reliability (r = .79).

Data Analytic Plan

Descriptive data analyses were performed using SPSS 25 and structural equation models (SEMs) were conducted using Mplus Version 8.3 (Muthén & Muthén, 2019). First, measurement modeling was conducted to confirm the two factor structure of child symptomatology which included a childhood internalizing latent factor (indicators: 1) CDI sum score, 2) RCMAS total anxiety score, and 3) TRF internalizing subscale T-score) and a child externalizing latent factor (indicators: 1) PYS conduct problems and 2) TRF externalizing subscale T-score). The results of the confirmatory factor analysis (CFA) were used to inform SEM model specification.

To test the effect of intergenerational child maltreatment on the development of child psychopathology, a SEM was specified as follows: maternal maltreatment history was entered as an exogenous variable; maternal adolescent childbearing was specified as the first mediating variable, predicted by maternal maltreatment history; chronicity of offspring child maltreatment and maternal depression were specified as additional mediating variables predicted by maternal adolescent childbearing and maternal maltreatment history; offspring internalizing and externalizing symptoms in childhood were modeled as endogenous latent factors predicted by maternal maltreatment history, maternal adolescent childbearing, maternal depression, and offspring child maltreatment. This model specification resulted in a model with 15 degrees of freedom (see Figure 1). The SEM was estimated using the weighted least squares mean and variance adjusted estimator (WLSMV). Mediation was tested using a resampling (i.e., bootstrapping) method with 1,000 sample replications and 95% confidence intervals (MacKinnon, Fairchild, & Fritz, 2007). Acceptable model fit for the CFA and SEM were determined using the following criteria: Comparative fit index (CFI) greater than .95, root mean square error of approximation (RMSEA) values less than 0.06, and standardized root mean square residual (SRMR) values less than 0.08 (Kline, 2011). Missing data on endogenous variables was estimated using WLSMV estimation (Muthén & Muthén, 2019) and no variable was missing more than 5% of data, with the majority missing less than 1%.

Figure 1. SEM results.

Figure 1.

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Notes. Standardized path coefficients are reported. Dashed lines indicated non-significant paths (p>.05). Maternal malx history is coded 0 = non-maltreated, 1 = maltreated. Maternal adolescent childbearing is coded 0 = no, 1 = yes. Maternal depx = Beck Depression Inventory-II sum score; Offspring malx = number of developmental periods where maltreatment occurred (i.e., chronicity). Conduct = number of conduct behaviors endorsed. Ext = Counselor report externalizing subscale T score. Depx= Child Depression Inventory sum score; Anx = Total anxiety symptom T score; Intx = Teacher Report Form internalizing subscale T score. *p < .05, **p < .01, ***p < .001.

Results

Descriptive

Table 1 presents the descriptive information and correlations among study variables. In this sample, 275 (72.8%) of the 378 mothers reported experiencing their own childhood maltreatment. There were significant differences in the observed patterns of maltreatment occurring across generations (χ2 (1) = 16.28, p < .001) with rates of maltreatment continuity exceeding those of discontinuity. Among maltreated mothers, 62.9% had children who experienced their own maltreatment by age 10–12, whereas 60.2% of nonmaltreated mothers had children who did not experience maltreatment.

Table 1.

Descriptive Statistics and Bivariate Correlations among study variables.

Range M(SD)/N(%) (1) (2) (3) (4) (5) (6) (7) (8)
(1) Maternal Maltreatment (CTQ;1=yes) 0–1 a275 (72.8%)
(2) Teen Parent (1=yes) 0–1 a236 (62.4%) .06 -
(3) Maternal Depressive Sx (BDI-II) 0–50 15.92 (11.30) .26** .01 -
(4) Child Maltreatment # dev. Prd 0–5 b1.73 (.98) .20** .19** .15** -
(5) Child Depressive Sx (CDI) 0–42 7.62 (7.00) .003 .04 .13* .15** -
(6) Child Internalizing Sx (TRF) 36–76 47.79 (8.47) .07 −.02 .05 .13* .21** -
(7) Child Anxiety (RCMAS) 18–78 46.53 (10.45) −.002 .06 .13* .11* 64** .13* -
(8) Child Externalizing Sx (TRF) 39–81 52.83 (8.93) .13* .14** .12* .20** .13* .18** .13* -
(9) Child Conduct Problems 0–23 4.82 (4.44) .18** 10† .07 .17** .28** .02 .26** .29**
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Notes:

†

p =.05–.08

*

p < .05

**

p <.01

a

Presented N(%) for presence of Maternal Maltreatment, Teen Parent

b

M(SD) Number developmental periods child maltreatment presented only for children with documented maltreatment (N=214)

Of the 378 mothers, 236 gave birth in adolescence (62.4%). The rates of adolescent childbearing did not significantly differ among mothers with a history of maltreatment and those without (χ2 (1) = 1.14, ns). Mothers who experienced adolescent childbearing were significantly more likely to have children who experienced maltreatment by the age of 10–12 (χ2 (1) = 25.81, p < .001). Among maltreated children, 73.7% had mothers who first gave birth in adolescence. However, 48.2% of comparison children had mothers who experienced adolescent childbearing.

There were 129 (34.1%) mothers who reported clinical level depressive symptoms on the BDI-II. Of the mothers who reported a history of maltreatment, 40.7% scored 20 or higher, as compared to 16.5% of the non-maltreated mothers (χ2 (1) = 19.56, p < .001).

Measurement Model

A measurement model with two CFAs was tested to determine the factor structure of latent variables measuring child internalizing and externalizing symptoms. Results suggested good model fit χ2 (3) = 2.82 p = .42, CFI = 1.00, RMSEA = .00 (90% CI: .00–.08), SRMR = .02 and standardized factor loadings were statistically significant for internalizing indicators: CDI (λ = .89), RCMAS (λ = .73), and TRF internalizing (λ = .22); and externalizing indicators: PSY conduct (λ = .63) and TRF externalizing (λ = .46).1

Structural Model

The SEM showed good model fit (χ2 (15) = 21.82 p = .11, CFI = .98, RMSEA = .04 (90% CI: .00–.06), SRMR = .03). Maternal maltreatment had a direct effect on offspring externalizing symptoms (β = .206, p = .007), but not internalizing symptoms. In addition, maternal maltreatment predicted greater chronicity of offspring child maltreatment (β = .184, p < .001) and greater maternal depressive symptoms (β = .257, p < .001), but not maternal adolescent childbearing. Chronicity of child maltreatment, in turn, predicted greater internalizing (β = .167, p = .03) and externalizing symptoms in childhood (β = .236, p = .005). Maternal depressive symptoms predicted greater child internalizing (β = .151, p = .004), but not externalizing symptoms. Maternal adolescent childbearing was related to higher child externalizing symptoms (β = .200, p = .04) and predicted greater offspring maltreatment chronicity (β = .235, p < .001); however, it did not significantly predict maternal depressive symptoms or child internalizing. There was a significant relationship between correlated residuals of maternal depression and offspring maltreatment (β = .110, p = .041), indicating that the unpredicted variance of maternal depression and offspring maltreatment was related. The correlated residuals of child internalizing and externalizing symptoms were also related (β = .140, p = .009). See Figure 1 for path model results and Table 2 for all path coefficients.

Table 2.

Standardized SEM coefficients and Indirect Effects.

Standardized Regression Coefficients
Independent Variable Dependent Variable β P
Maternal Malx History→ Maternal Adolescent Pregnancy .070 .28
Maternal Malx History→ Maternal Depx .260 <.001
Maternal Malx History→ Offspring Malx .180 <.001
Maternal Malx History→ Offspring Internalizing −.062 .30
Maternal Malx History→ Offspring Externalizing .210 .007
Maternal Adolescent Pregnancy→ Maternal Depx −.004 .95
Maternal Adolescent Pregnancy→ Offspring Malx .240 .001
Maternal Adolescent Pregnancy→ Offspring Internalizing .027 .75
Maternal Adolescent Pregnancy→ Offspring Externalizing .200 .04
Maternal Depx→ Offspring Internalizing .150 .004
Maternal Depx→ Offspring Externalizing .065 .44
Offspring Malx→ Offspring Internalizing .170 .03
Offspring Malx→ Offspring Externalizing .240 .005
Indirect Effects μ 95%CI
Maternal Malx→ Offspring Malx→ Internalizing .031 .002 – .067
Maternal Malx→ Offspring Malx→ Externalizing .043 .008 – .081
Maternal Malx→ Adolescent Preg→ Internalizing .002 −.015 – .022
Maternal Malx→ Adolescent Preg→ Externalizing .014 −.012 – .05
Maternal Malx→ Maternal Depx→ Internalizing .039 .013 – .074
Maternal Malx→ Maternal Depx→ Externalizing .017 −.022 – .064
Adolescent Preg→ Offspring Malx→ Internalizing .039 .003 – .091
Adolescent Preg→ Offspring Malx→ Externalizing .056 .014 – .11
Adolescent Preg→ Maternal Depx→ Internalizing −.001 −.021 – .021
Adolescent Preg→ Maternal Depx→ Externalizing .000 −.017 – .014
Maternal Malx→ Adolescent Preg→ Offspring Malx → Internalizing .003 −.002 – .011
Maternal Malx→ Adolescent Preg→ Offspring Malx → Externalizing .004 −.002 – .014
Maternal Malx→ Adolescent Preg→ Maternal Depx → Internalizing .000 −.002 – .002
Maternal Malx→ Adolescent Preg→ Maternal Depx → Externalizing .000 −.002 – .002
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Note: Bolded values indicate statistical significance,α = .05.

Indirect effects

Table 2 presents the estimates for the specific indirect effects for both child internalizing and externalizing symptoms. Multiple mediated pathways to internalizing symptoms were observed. There were two specific indirect effects from maternal maltreatment history to offspring internalizing symptoms. Maternal maltreatment indirectly affected child internalizing through chronic offspring maltreatment [LCL = .002, UCL = .067] and maternal depressive symptoms [LCL = .013, UCL = .074], but not via maternal adolescent childbearing. However, there was a significant indirect pathway from maternal adolescent childbearing→ offspring maltreatment→offspring internalizing symptoms [LCL = .003, UCL = .091]. Mediated pathways to externalizing symptoms were also found. Maternal history of child maltreatment had an indirect effect on offspring child externalizing symptoms through offspring child maltreatment [LCL = .008, UCL = .081], but not through adolescent childbearing or maternal depression. Finally, maternal adolescent childbearing had an indirect effect on offspring externalizing symptoms through offspring maltreatment [LCL = .014, UCL = .110].

Discussion

This study applied an intergenerational cascades approach to a high-risk sample of families and examined the independent and cascading contributions of maternal history of childhood maltreatment, maternal adolescent childbearing, current maternal depression, and the child’s chronicity of maltreatment exposure on the development of childhood internalizing and externalizing symptoms. The results provide support for multiple intergenerational cascades of risk processes whereby familial factors occurring before the child’s birth are directly and indirectly associated with child maltreatment and subsequent mental health problems. Specifically, maternal child maltreatment increased the likelihood of offspring exposure to both child maltreatment and maternal depression—which differentially related to childhood internalizing and externalizing symptoms. Chronic exposure to child maltreatment predicted greater internalizing and externalizing symptoms in childhood. Contemporaneous maternal depression was related to greater offspring internalizing symptoms in childhood, but not externalizing symptoms. Finally, adolescent childbearing directly influenced offspring child externalizing symptoms and indirectly influenced offspring child internalizing and externalizing symptoms via offspring maltreatment exposure.

Intergenerational Continuity of Maltreatment and the Development of Psychopathology

Results indicated that maternal history of maltreatment was associated with greater chronicity of offspring child maltreatment. Although this relationship is not inevitable, and discrepant findings exist within the literature, there is modest support for the intergenerational continuity of maltreatment (see Assink et al., 2018; Madigan et al., 2019; van IJzendoorn et al., 2019 for meta-analytic reviews of the diverse literature). However, the strength of this association varies across individual studies, ranging from medium to weak effects, and results may differ based on informant, methodological rigor, and/or maltreatment type or severity (Buisman et al., 2020; Madigan et al., 2019; Thornberry et al., 2012). For example, the use of official records of offspring maltreatment and a focus on maltreatment chronicity, as done in this study, may both increase the detection of intergenerational maltreatment patterns. As such, generalizability of this finding will be improved with future replication.

Further, chronic child maltreatment was associated with greater internalizing and externalizing symptoms in childhood. Research suggests that children who experience maltreatment are twice as likely to experience multiple forms of psychopathology, compared to nonmaltreated children (McLaughlin et al., 2020), and children who experience chronic maltreatment are at even greater risk (Jonson-Reid, Kohl, & Drake, 2012). We also found a cascading effect, whereby maternal maltreatment predicted offspring child maltreatment, which in turn predicted more offspring internalizing and externalizing symptoms. This finding is consistent with previous research demonstrating the effect of intergenerational maltreatment continuity on child mental health outcomes (Bosquet et al., 2018; Choi et al., 2019; Plant et al., 2017; Sierau et al., 2020).

In line with previous research (Bosquet et al., 2018), we found a direct effect from maternal maltreatment history to offspring externalizing symptoms, but not internalizing symptoms. This suggests that the chronicity of offspring exposure to child maltreatment only partially explains the relationships between maternal maltreatment history and offspring externalizing problems. It is possible that other unmeasured parental risk factors related to both maternal maltreatment history and offspring externalizing symptoms, such as maternal antisociality, may explain this relationship.

We also found evidence for the intergenerational continuity of internalizing symptoms. Our results suggest that maternal history of child maltreatment may partially initiate this multigenerational cascade by increasing risk for maternal depression, which is then associated with concurrent offspring internalizing symptoms. These results corroborate existent findings that reveal maternal depression as a key additional mechanism of intergenerational risk transmission that co-occurs independent of offspring child maltreatment (Choi et al., 2019; Plant et al., 2017; Sierau et al., 2020). The pathway through maternal depression did not predict offspring externalizing symptoms, which is consistent with other studies identifying distinct prediction from maternal depression to offspring internalizing symptoms (Hentges, Graham, Plamondon, Tough, & Madigan, 2019; Sierau et al., 2020).

The Role of Maternal Age of Childbearing

The current study further extended the literature on intergenerational cascades to offspring psychopathology with the inclusion of maternal adolescent childbearing as another risk process operating among maternal maltreatment history, maternal depression, and offspring child maltreatment. This is an important contribution, as less is known about the intergenerational effects of maternal adolescent childbearing and offspring psychopathology, especially within the context of the intergenerational transmission of maltreatment. Results indicated that maternal adolescent childbearing was not a mechanism underlying the effect of maternal maltreatment history on offspring mental health difficulties. Specifically, there was not evidence of an association between maternal maltreatment history and maternal adolescent childbearing. This is noteworthy, as child maltreatment is a putative risk for adolescent pregnancy (Noll et al., 2019). This may be due to several factors: 1) the current study examined adolescent childbearing, not adolescent pregnancy; 2) studies have found unique predictive effects of sexual abuse on adolescent motherhood (Noll et al., 2019) and this study did not examine specific subtypes of maternal maltreatment; 3) the rate of adolescent childbearing in this particular low-income sample is quite high and it is possible that it represents a more common experience that is not dependent on a prior risk factor.

Consistent with prior studies, our results indicated that maternal adolescent childbearing directly and indirectly influenced offspring outcomes. Specifically, maternal adolescent childbearing predicted offspring child maltreatment exposure, which in turn predicted greater offspring internalizing and externalizing symptoms in late childhood. This finding is consistent with previous studies showing a link between hostile parenting behaviors and offspring psychopathology symptoms among samples of adolescent parents (Pasalich et al., 2016; Yoon et al., 2019). The current study extends these findings by demonstrating the effect on both offspring internalizing and externalizing symptoms within the context of several other risk processes. Thus, maternal adolescent childbearing may represent a distinct risk factor for offspring maltreatment and subsequent mental health outcomes that operates independently of the risks associated with maternal maltreatment history.

Contrary to our expectations, maternal adolescent childbearing did not predict subsequent maternal depression. Although research has demonstrated a relationship between adolescent childbearing and maternal depression (Easterbrooks, Kotake, Raskin, & Bumgarner, 2016), this association is most robust in the postnatal period and has been found to weaken over time (Madigan et al., 2014). Because this study measured current maternal depression (i.e., when the child was aged 10–12), it possible that any preexisting association diminished after a decade removed from the postnatal period.

Strengths and Limitations

The multi-informant design of this study is a particular strength. Reporter bias is a common challenge that plagues studies examining several complex, intergenerational cascades that include both parental risk conditions and offspring outcomes. Uniquely, of the 13 paths simultaneously estimated within this intergenerational cascade, all but one (the effect of maternal maltreatment history on maternal depression) were rater-independent associations. In addition, by drawing on an economically disadvantaged sample that includes maltreated and non-maltreated comparison groups, we were able to examine these intergenerational risk processes within high-risk families, where these processes are especially salient and prevalent.

The notable strengths of the study should be contextualized by the methodological limitations that warrant discussion. First, interviews to assess maternal history of maltreatment, maternal depression, and child psychopathology symptoms were conducted contemporaneously. Although temporal and theoretical precedence can be established for the current model, shared method variance (e.g., reporting biases on the CTQ, BDI-II; McCrory, Gerin, & Viding, 2017) and/or bidirectional effects between maternal and child psychopathology may be present and not accounted for by the current model. Though we cannot be definitive, it is likely that the observed maternal depression in this study represents pre-existing symptoms, as the vast majority of depression has onset before age 30, with peak onset prior to age 21 (Klein et al., 2013). Some of these issues could be addressed with prospective, prenatal cohorts followed longitudinally.

Additionally, the use of a retrospective adult self-reporting of childhood maltreatment is not without flaws and the assessment of maternal maltreatment history in this study may be inflated or underestimated (Colman et al., 2016). Relatedly, although we screened for maternal report of child maltreatment prior to classifying the non-maltreated families, it is possible that this sample contained unreported maltreatment (Shenk, Noll, Peugh, Griffin, & Bensman, 2016). Although our set of observed caregiver risk factors is consistent with prior literature, distinct sources of caregiver risks, such as parental substance use, that were not measured may influence child outcomes and should be explored in future research. Also, the data examined herein is archival, which may limit the generalizability of the findings and limit the ability to contextualize these findings within contemporary child welfare policies. Finally, we did not measure compensatory factors that may buffer against the distal and proximal risk factors examined in this study. The patterns of association presented herein are probabilistic, not deterministic, and there were mothers and children in this study who experienced risks but were able to interrupt risk trajectories and avoid negative outcomes, demonstrating discontinuity in risk transmission. Future research should aim to elucidate resilient cascades despite the presence of intergenerational caregiving adversities.

Implications

Child maltreatment and psychopathology within high-risk populations are prevalent, but preventable. Social and economic resources are often directed to intervention efforts that begin late in the child’s risk trajectory (McCloskey, 2017). Identifying pathways of risk that eventuate in child mental health symptoms is key to optimize timely early prevention efforts. Child maltreatment represents a modifiable and transdiagnostic risk factor for psychopathology. However, child maltreatment and its mental health sequalae occur within a cascade of intergenerational and current contextual risk processes that require study to inform prevention, intervention, and social policy.

First, universal programs and policies designed to address the strain of poverty and disadvantage and increase equitable access to preventive services are crucial to addressing the cascades identified in this study (Herrenkohl, 2020). Further, our findings highlight the criticality of universal screening for expectant and new mothers. The perinatal period represents an opportune time to identify vulnerable families and implement preventive interventions with intergenerational implications.

When indicated, delivering parenting interventions that address maternal trauma histories and psychopathology can effectively prevent offspring child maltreatment (Chen & Chan, 2016; Valentino, 2017) and reduce the impact of maternal depression on offspring development (Goodman, 2020), interrupting the detrimental cascades presented herein. Insight-oriented relational interventions are particularly effective in dually addressing maternal abuse history and psychopathology to promote emotionally sensitive parenting, foster secure attachment relationships, and contribute to sustained resilience for offspring (Steele & Steele, 2018). Additionally, and importantly, interventions deliverable in the home setting may reduce treatment barriers in low-income contexts and increase treatment effects (Toth & Manly, 2011).

Similarly, comprehensive intervention programs for adolescent mothers that utilize home-visiting to seamlessly integrate tiered service pyramids addressing the basic socioeconomic (e.g., employment and educational support), psychological (e.g., maternal mental health), and parenting needs of adolescent mothers may alleviate parenting stress, amplify caregiver strengths, and attenuate risk for offspring maltreatment and psychopathology (Toth & Manly, 2011). Finally, if the opportunity for prevention has passed, interventions that target child psychopathology directly should consider the current caregiving environment as well as the remnants of distal adversities occurring in the caregivers’ past that may contextualize the clinical needs of the family unit.

Conclusion

In sum, the results suggest that risk for child maltreatment and its mental health sequelae is not limited to what is directly detectable within the child’s proximal experience. Rather, historical risks that mothers may transmit from their own developmental adversities, recreating environments of risk, are essential to evaluate (Noll, Reader, & Bensman, 2017). Moreover, as others have articulated (Hentges et al., 2020), an intergenerational cascades approach can elegantly and simultaneously showcase the developmental psychopathology concepts of multifinality and equifinality (Cicchetti & Rogosch, 1996). For example, the results of this study demonstrate that an array of intergenerational pathways are associated with child externalizing symptoms (i.e., equifinality). Indeed, some risk processes may be initiated in a mother’s childhood (i.e., her own abuse history) and be sustained through the continuity of maltreatment, while other risk processes may originate in the mother’s adolescence (i.e., adolescent childbearing). Alternatively, our results exemplify how the same starting point can have multiple ends (i.e., multifinality). For instance, maternal maltreatment history may unfold into distinct risk processes, such as offspring maltreatment or maternal depression, that may operate across generations and contribute to diverse child psychopathology outcomes. Thus, the findings demonstrate that the contributions to the prediction of child maltreatment and its mental health sequelae may derive from a complex interplay of intergenerational and current contextual risk processes. Well-timed interventions may promote positive cascades that result in progressive, transgenerational patterns of resilience.

Acknowledgments

Funding: This research was supported by grants received from the National Institute on Drug Abuse (R01DA17741), National Institute of Child Health and Human Development (P50-HD096698), and the Spunk Fund, Inc.

Footnotes

1

Note that lower loadings are related to counselor report indicators and are expected with the multi-informant factor.

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