The impact of healthy parenting as a protective factor for posttraumatic stress disorder in adulthood: a case-control study.
BACKGROUND
Early life social adversity can influence stress response mechanisms and is associated with anxious behaviour and reductions in callosal area later in life.


OBJECTIVE
To evaluate the association between perceptions of parental bonding in childhood/adolescence, hypothalamic-pituitary-adrenal (HPA) axis response, and callosal structural integrity in adult victims of severe urban violence with and without PTSD.


METHODS
Seventy-one individuals with PTSD and 62 without the disorder were assessed with the Parental Bonding Instrument (PBI). The prednisolone suppression test was administered to assess cortisol levels, and magnetic resonance imaging was used to assess the total area of the corpus callosum (CC), as well as the areas of callosal subregions.


RESULTS
The PBI items related to the perception of 'not having a controlling mother' (OR 4.84; 95%CI [2.26-10.3]; p=0.01), 'having a caring father' (OR 2.46; 95'%CI [1.18-5.12]; p=0.02), and 'not having controlling parents' (OR 2.70; 95%CI [1.10-6.63]; p=0.04) were associated with a lower risk of PTSD. The PTSD group showed a blunted response to the prednisolone suppression test, with lower salivary cortisol levels upon waking up (p=0.03). Individuals with PTSD had smaller total CC area than those without the disorder, but these differences were not statistically significant (e-value =0.34).


CONCLUSIONS
Healthy parental bonding, characterized by the perception of low parental control and high affection, were associated with a lower risk of PTSD in adulthood, suggesting that emotional enrichment and the encouragement of autonomy are protective against PTSD in adulthood.
Department of Psychiatry, São Paulo School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Adriano R
AR
Lima
Department of Psychiatry, São Paulo School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Marcelo F
MF
Mello
Department of Psychiatry, São Paulo School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Sérgio B
SB
Andreoli
Department of Mathematics and Statistics, University of São Paulo/USP, São Paulo, Brazil.
Victor
V
Fossaluza
Interdisciplinary Laboratory of Clinical Neuroscience (LiNC), Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Célia M
CM
de Araújo
Department of Psychiatry, São Paulo School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil ; Interdisciplinary Laboratory of Clinical Neuroscience (LiNC), Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Andrea P
AP
Jackowski
Department of Psychiatry, São Paulo School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil ; Interdisciplinary Laboratory of Clinical Neuroscience (LiNC), Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Rodrigo A
RA
Bressan
Department of Psychiatry, São Paulo School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
Jair J
JJ
Mari
D000328:Adult; D016022:Case-Control Studies; D005219:Father-Child Relations; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D009034:Mother-Child Relations / Q000523:psychology*; D016487:Parenting / Q000523:psychology*; D055500:Resilience, Psychological; D013313:Stress Disorders, Post-Traumatic / Q000097:blood / Q000523:psychology*
D006854:Hydrocortisone