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As many as one in three women in the United States experience intimate partner violence (IPV) in their lifetime (Breiding et al., 2015). Women of color experience especially high rates of partner violence, likely related to structural inequalities that disproportionately impact these women (Gillum, 2019). When women are exposed to IPV, they are more likely to have mental and physical health burdens, such as depression and HIV (Gustafsson & Cox, 2012; Muzik et al., 2017). 
Parents who face burdens or stressors may employ less effective parenting practices (Belsky, 1984). More specifically, parents who are exposed to IPV, who live with depression, or who live with HIV may use less positive parenting practices and more negative parenting practices (Chiesa et al., 2018; Muzik et al., 2017; Schulte et al., 2017). It is important to understand how experiencing multiple adversities relate to parenting practices. However, research to date has not explored how living with both depressive symptoms and HIV may relate to positive and negative parenting among women of color exposed to IPV. 
To address this gap in the literature, we used a case-control matched design to examine whether living with the additional health burden of HIV would influence the association between depressive symptoms and IPV. All participants were Black, Multiracial, or Hispanic/Latina mothers living in the MidSouth, United States. 
Findings showed that living with the additional health burden of HIV strengthened the association between depressive symptoms and negative parenting practices. Specifically, more depressive symptoms were associated with more negative parenting practices only for mothers who were exposed to IPV and HIV, but not for mothers exposed solely to IPV. In essence, as the adversity burden increased so did negative parenting practices. Interestingly, the impact of more adversities did not influence positive parenting practices. 
Study results highlight the importance of mother’s mental and physical health given the connection between IPV, HIV, depressive symptoms, and parenting. Findings make clear that the added burden of IPV plus HIV requires unique clinical attention in order to reduce the effect of these adversities on not only women’s health but also how they parent their children. Indeed, when mothers experience co-occurring adversities, treatment services should utilize a family systems approach that addresses the mental and physical health needs of mothers and their children. A clinical modality that focuses on the parent-child relationship and parenting strategies may be most impactful. 
Our study also underscores the importance of examining factors related to parenting among specific intersections of mothers of color as findings showcase nuanced and complex aspects of parenting practices among Black, Multiracial, and Hispanic/Latina mothers. Thus, interventions must target the physical and mental health burden of HIV and IPV while simultaneously addressing systemic factors (e.g., lack of access to healthcare, affordable and safe housing, childcare) that contribute to inequitable stress and depression. While such systemic changes may feel beyond the scope of services that one individual provider can offer, developing partnerships with organizations who generate and promote such health care policies will be critical to moving the needle on health equity. Psychologists can be on the front lines of such partnerships as our training sets us up with the necessary tools and resources to lead multidisciplinary teams and collaborate across professions.

Reference Article

Thurston, I. B., Howell, K. H., Kaufman, C. C., Mandell, J. E., & Decker, K. M. (2021).  Parenting in Matched-Pairs of Women of Color Experiencing Intimate Partner Violence living with and without HIV. Journal of Traumatic Stress. https://doi.org/10.1002/jts.22737

Discussion Questions

  1. Given study findings, how could clinicians best support mothers with high depressive symptoms in ways that reduce their use of negative parenting practices without increasing shame or putting blame onto these women?  
  2. How might future researchers build on these findings to move the needle on health inequities? What specific research questions need to be answered to drive tangible solutions in populations made vulnerable by adversity? What other factors might be important to consider in the lives of Black, Multiracial, and Latina mothers who have been exposed to IPV and are living with HIV?
  3. How might the training of public health professionals and mental health providers be enhanced to center cultural humility and competence? How might training be broadened to address all aspects of women’s lives that contribute to well-being?
  4. What funding models are needed to allow health care professionals to move toward treating entire family systems when interacting with parents or children in health care settings?

About the Authors

Idia B. Thurston, PhD (she/her) is a tenured Associate Professor with a joint appointment in the Department of Psychological and Brain Sciences, and the Department of Health Promotion and Community Health Sciences at Texas A&M University. She is an adolescent health psychologist who examines multilevel risk and protective factors contributing to health inequities. Her strengths-based work highlights how intersectional social identities of race, ethnicity, social class, gender, size, and sexuality influence health outcomes and well-being in youth and families. Dr. Thurston can be contacted at idiathurston@tamu.edu
Kathryn H. Howell, PhD (she/her) is a tenured Associate Professor in the Department of Psychology at the University of Memphis. Her program of research focuses on individual, relational, and community factors that enhance resilience or reduce psychopathology following exposure to traumatic events during childhood. A common theme underlying her studies is the promotion of resilience among youth and their families exposed to adversity.
Caroline C. Kaufman, PhD (she/her) is a postdoctoral fellow at McLean Psychiatric Hospital/Harvard Medical School in the Spirituality and Mental Health Program. Her research focuses on resilient and adaptive functioning in the context of adversity, as well as the intersection of spirituality/religion, mental health, and treatment outcomes. 
Jessica Eden Mandell, MS (she/her) is a doctoral candidate in the Clinical Psychology Program at the University of Memphis. Her research interests center around the intersection of mental, physical, and sexual health among and across partners, families, and communities. 
Kristina Decker, PhD (she/her) is an NIH-T32 postdoctoral fellow in Behavioral Medicine and Clinical Psychology at Cincinnati Children’s Hospital Medical Center. Her program of research focuses on understanding and fostering adolescent and young adult health and wellness, particularly related to core health behaviors (e.g., eating and sleeping) in the context of chronic stressors.

References Cited

Belsky, J. (1984). The determinants of parenting: A process model. Child Development, 55(1), 83–96. https://doi.org/10.1111/j.1467-8624.1984.tb00275.x

Breiding, M. J., Smith, S. G., Basile, K. C., Walters, M. L., Chen, J., & Merrick, M. T. (2015). Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization—National Intimate Partner and Sexual Violence Survey, United States, 2011. American Journal of Public Health, 105(4), e11–e12. 

Chiesa, A. E., Kallechey, L., Harlaar, N., Ford, C. R., Garrido, E. F., Betts, W. R., & Maguire, S. (2018). Intimate partner violence victimization and parenting: A systematic review. Child Abuse & Neglect, 80, 285–300. https://doi.org/10.1016/j.chiabu.2018.03.028

Gillum, T. L. (2019). The intersection of intimate partner violence and poverty in Black communities. Aggression and Violent Behavior, 46, 37–44. https://doi.org/10.1016/j.avb.2019.01.008

Gustafsson, H. C., & Cox, M. J. (2012). Relations among intimate partner violence, maternal depressive symptoms, and maternal parenting behaviors. Journal of Marriage and Family, 74(5), 1005–1020. 

Muzik, M., Morelen, D., Hruschak, J., Rosenblum, K. L., Bocknek, E., & Beeghly, M. (2017). Psychopathology and parenting: An examination of perceived and observed parenting in mothers with depression and PTSD. Journal of Affective Disorders, 207, 242–250. https://doi.org/10.1016/j.jad.2016.08.035

Schulte, M. T., Armistead, L., Marelich, W. D., Payne, D. L., Goodrum, N. M., & Murphy, D. A. (2017). Maternal parenting stress and child perception of family functioning among families affected by HIV. Journal of the Association of Nurses in AIDS Care, 28(5), 784–794. https://doi.org/10.1016/j.jana2017.05.004

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