Maternal posttraumatic stress symptoms, parenting stress, and child psychological and cognitive outcomes among Syrian refugee mother–child dyads in Türkiye: a mixed-methods study

Abstract

Refugee children exposed to war and forced displacement are at elevated risk for emotional, behavioral, and cognitive difficulties. However, child outcomes may be shaped not only by direct trauma exposure but also by the psychological functioning of caregivers and stress within the parent–child relationship. The present mixed-methods study examined whether parenting stress was associated with the relationship between maternal posttraumatic stress symptoms and child psychological and cognitive outcomes among Syrian refugee families living in Mardin, Türkiye. Participants were 200 Syrian refugee mother–child dyads with children aged 6–11 years. Mothers completed measures of posttraumatic stress symptoms (PCL-5), parenting stress (PSI-SF), depressive symptoms (BDI-II), anxiety symptoms (GAD-7), and child emotional and behavioral problems (CBCL/6–18). Children completed the Stroop Color–Word Test assessing inhibitory control and selective attention. Mediation analyses were conducted using bootstrapped indirect effects while controlling for maternal depression, maternal anxiety, child age, and child gender. A purposeful subsample of 30 dyads participated in semi-structured qualitative interviews exploring trauma experiences, parenting stress, attachment-related behaviors, and child emotional and cognitive functioning. Maternal posttraumatic stress symptoms were positively associated with parenting stress, child emotional and behavioral problems, and poorer child executive functioning. Parenting stress significantly mediated the association between maternal PTSD symptoms and CBCL Total Problems, indirect effect = 0.12, 95% CI [0.058, 0.196], and also mediated the association between maternal PTSD symptoms and Stroop interference, indirect effect = 0.052, 95% CI [0.012, 0.103]. Secondary analyses demonstrated significant indirect effects for both internalizing and externalizing symptoms. Qualitative findings converged with the quantitative results and showed that maternal trauma-related distress, emotional exhaustion, irritability, and inconsistent responsiveness were reflected in children’s fear, withdrawal, dysregulation, separation distress, and attentional difficulties. Protective factors included maternal warmth, school support, supportive relationships, religious coping, and future-oriented hope. The findings suggest that parenting stress may represent an important relational pathway linking maternal trauma-related distress with children’s emotional, behavioral, and cognitive functioning in refugee families. Interventions targeting refugee child mental health may benefit from simultaneously addressing caregiver trauma symptoms, parenting stress, and the broader relational environment in which children develop and recover.