Group interventions for mental health and parenting in parents with adverse childhood experiences: A systematic review and meta‐analysis

• Published date: 01 October 2023
• Author: Renhui Lyu,Shuang Lu,Xinyao Ma
• Date: 01 October 2023
• DOI: http://doi.org/10.1111/fare.12768

RESEARCH

Group interventions for mental health and parenting

in parents with adverse childhood experiences: A

systematic review and meta-analysis

Renhui Lyu

1

|Shuang Lu

1

|Xinyao Ma

2

1

Department of Social Work and Social

Administration, The University of Hong

Kong, Hong Kong

2

Department of Psychology, University at

Buffalo, Buffalo, NY

Correspondence

Shuang Lu, Jockey Club Tower, 5/F,

Centennial Campus, The University of Hong

Kong, Pokfulam Road, Hong Kong.

Email: shuanglu@hku.hk

Abstract

Objective: This meta-analysis synthesizes the effects of

group parenting interventions (GPIs) on mental health

and parenting-related outcomes among parents with

adverse childhood experiences (ACEs).

Background: Parents’history of ACEs can jeopardize

parental mental health and impede their children’s devel-

opment through dysfunctional parenting. GPIs are

increasingly applied to parents with ACEs, but their effec-

tiveness remains to be synthesized.

Method: We identified 12 relevant studies that involve

709 families from PsycINFO, Medline, CINAHL Plus,

and Embase. The overall intervention effect size was esti-

mated by adjusted pooled standardized mean difference

using random-effects models, and moderator analyses

were performed to explore the variability in intervention

effects. Risks of bias and publication bias were also

assessed.

Results: Most of the parents in the included studies were

mothers from ethnic minority groups who had limited

family support and a low socioeconomic status. The aver-

age age of parents ranged from 18 to 32years. GPIs

showed small positive effects on parenting (Hedge’s

g=0.36, 95% confidence interval [CI] [0.22, 0.49]) and

parent mental health (g=0.34, CI [0.16, 0.53]), with some

variability across the studies.

Conclusion: GPIs show promising effects in improving par-

enting and mental health among parents who have experi-

enced early-childhood trauma.

Implications: Addressing the needs of parents with ACEs

warrants a comprehensive intervention framework.

Received: 19 October 2021Revised: 19 April 2022Accepted: 14 July 2022

DOI: 10.1111/fare.12768

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits

use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or

adaptations are made.

© 2022 The Authors. Family Relations published by Wiley Periodicals LLC on behalf of National Council on Family Relations.

1806 Family Relations. 2023;72:1806–1826.

wileyonlinelibrary.com/journal/fare

Interventions for parents with ACEs should balance the

focus on building healthy parent–child attachment and

addressing parents’personal emotional needs.

KEYWORDS

adverse childhood experience, group intervention, mental health,

meta-analysis, parenting, systematic review

Adverse Childhood Experiences (ACEs) are events during which children and adolescents under

18 years of age are exposed to various kinds of maltreatment and household dysfunction (Anda

et al., 2006). About 61% of adults surveyed across 25 states in the United States reported having

experienced at least one type of ACE, and nearly 1 in 6 reported experiences of four or more

types of ACEs (Centers for Disease Control and Prevention, 2021). People who have experi-

enced ACEs may encounter various mental health related challenges when transitioning topar-

enthood. ACEs are reported to increase the risks of perinatal and postpartum depression,

posttraumatic stress disorder (PTSD), anxiety, substance abuse, and suicidal ideation. Parents

who have experienced ACEs also showed increased negative physical changes and they held

more negative views of their child (Christie et al., 2017). The presence of three or more ACEs

was associated with postpartum smoking, binge drinking, depressive and anxiety symptoms,

lower optimism, higher neuroticism, and lower parenting morale in pregnant women

(McDonald et al., 2019).

Moreover, parents who have experienced ACEs are more likelyto engage in parenting styles

that negatively impact parent–child interaction. Adverse parenting outcomes related to experience

of ACEs included increased parentingstress, child neglect and abuse, harsh/physical/punitive dis-

cipline, inconsistent discipline, intrusive parenting, poor monitoring and supervision, lower empa-

thy, and greater psychological control (Harel & Finzi-Dottan, 2018; Hughes & Cossar, 2016;

Lotto et al., 2021). Furthermore, individuals reporting four or more ACEs were most vulnerable

to forming insecure parent–child relationships (Lange et al., 2019; Murphy et al., 2014).

Additionally, ACEs can impact families across generations. Children of ACE-exposed par-

ents are at a heightened risk for negative psychological and behavioral outcomes. For instance,

a systematic review showed that parental ACEs were significantly associated with child exter-

nalizing problems (i.e., inattention, hyperactivity, impulsivity, and aggression) and internalizing

problems (i.e., anxiety and depression; Cooke et al., 2021). Additionally, ACEs may transmit

intergenerationally. Maltreatment-related ACEs (such as neglect; physical, emotional, or sexual

abuse) demonstrated heterotypic and homotypic patterns of continuity across parent and child

through various paths of intergenerational transmission: from parental physical and sexual

abuse to all other types of child-generation abuse; from parental emotional abuse to child-gen-

eration emotional, physical, and sexual abuse; and from parental neglect to child-generation

sexual and psychological abuse (Madigan et al., 2019).

Given the detrimental impact of ACEs on parent and child mental health, addressing the

effects of toxic stress and early childhood trauma is a public health imperative (Waters

et al., 2018). Parenting interventions can effectively improve parent mental health and parent-

ing, two important mediators of parental ACEs and child outcomes (Treat et al., 2020; Wolford

et al., 2019). Structured group parenting interventions (GPIs) are increasingly applied for par-

ents with histories of trauma. In GPIs, parents may gain peer support from other group mem-

bers with similar experiences. GPIs may particularly benefit marginalized families because

parents may form secure, stable, and nurturing relationships in the group environment, which

they may have been unable to find in their harsh childhood environments and the potentially

difficult living environments in which they actively raise their children (Steele et al., 2010).

GROUP INTERVENTIONS FOR PARENTS WITH ACES:

A META-ANALYSIS

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