Features of Difficulty in Child Raising and Resilience of Nurturing Mothers with Past Experience of Adversity

Reiko Okahisa1*, Saori Iwamoto2, Miyuki Tada1, Yasuko Matsushita1, Hiroko Hashimoto3 and Kenji Mori3 1Department of Community Health Nursing , Graduate School of Biomedical Sciences, Tokushima University, Tokushima, 770-8509, Japan 2Department of Public Health Nursing, Kobe City College of Nursing, Kobe, Hyogo 651-2103, Japan 3Department of Child Health & Nursing , Graduate School of Biomedical Sciences, Tokushima University, Tokushima, 770-8509, Japan


Introduction
The Healthy Parents and Children 21 (Second Phase), a national campaign led by the Ministry of Health, Labour and Welfare of Japan (MHLW) to improve health standards of mothers and children, includes the provision of support to parents having difficulty in raising children as one of the key issues of the campaign [1]. This difficulty in child raising [2][3][4] that parents face is regarded as attributable to such factors as those relating to children or parent s or the mutual parentchild relationship [5,6]. Parents own histories of growth for instance, any experience of being abused or bullied) are also one of such factors. The intergenerational transmission of child abuse has already been examined in many preceding studies [7] according to which children's family environment s have a profound impact on their child-raising when they become parents.
Meanwhile, although abuse is believed to potentially cause a chain of abuse, it is also possible to overcome the experience of abuse. Shoji [8] defines resilience as "good adaptation in the face of risks and adversity. " Furthermore, according to Endo [9], although children who were subjected to inappropriate child rearing such as abuse or neglect tend to grow up to lack fundamental trust in themselves or others, to despair of the future and to have predominantly negatively balanced emotions, they may also grow up not only to help themselves out of predicaments but also to defiantly expand their possibilities.
Resilience consists of innate and acquired factors [10], by exerting which mothers can regain composure and confidence in relation to child-raising and fulfill their role as a mother. Accordingly, childcare support that takes accounts of the features of "difficulty in child raising" and focuses on resilience is expected to prevent potential child abuse in the future, if it is provided to parents who did not have out of challenges and predicaments that nurturing mothers have and to adapt to their situations.
Experience of adversity: Experience of adversity means the experience of circumstances full of troubles or unfortunate circumstances. For this research, it is defined as the unstable family environment during childhood or "experience of having ever been bullied that the research subject went through in the past as a situation that the subject considers as undesirable.

Research subjects and method
During the period from February to March 2015, an anonymous self administered questionnaire survey was conducted targeting 4,013 mothers in Prefecture T who were raising young children aged 1.5 years or older. Questionnaire sheets were distributed at nursery centers, kindergartens and places of infant health checkup in Prefecture T. With regard to collection, the respondents were requested to send back their completed questionnaire sheets by using return envelopes. In conducting this survey, we explained the director of each aforementioned institution about the purpose and method of this research and obtained their cooperation.
The contents to be surveyed included the following: (i) the basic attributes of mothers which were age, occupation, marriage status, cohabiting family members, the age at the first childbirth, and the current medical history; (ii) the subject's history of growth (the family environment during childhood and any experience of being bullied); (iii) the child-raising environment including details concerning persons involved, places and the financial situation )); and (iv) the difficulty in child raising, for which subjective evaluation was to be carried out with a Likert scale of zero to 10 consisting of 11 levels in total) With regard to (v) resilience 21 items of the "Bidimensional Resilience Scale" [10] were answered with a five point scale consisting of Strongly agree "Agree, " "Neutral, " "Slightly agree, " and Disagree. " The "Bidimensional Resilience [10] is composed of "innate resilience factors" and "acquired resilience factors"; innate resilience factors are strongly associated with temperament and consist of four elements of optimism, control, sociability, and viability; and acquired resilience factors are likely to be acquired after birth and consist of three elements of attempting to solve problems, self understanding and understanding others. Each of these elements is composed of three items.

Statistical analysis
The method of descriptive statistics was performed on the basic attributes of mothers, the growing environment (experience of adversity), the child raising environment, concerns about children, the difficulty in child-raising and each item on resilience. A chisquared test was used in comparing, in terms of perception of the child raising environment, the group of subjects who had had stable family environments during childhood and the group of subjects who had not had stable family environments during childhood, and the group of subjects with past experience of being bullied and the group of subjects without such experience. The two-sample t-test was used in comparing, in terms of subjective difficulty in child raising and resilience evaluation scores, the group of subjects who had had stable family environments during childhood and the group of subjects who had not had stable family environments during childhood, and the group of subjects with past experience of being bullied and the group of subjects without such experience. SPSS 22.0 was used for statistical analysis.

Ethical consideration
This research was approved by the Ethics Committee of Tokushima University Hospital. (Approval No: 2184). An anonymous questionnaire sheet was used in the survey. Each research subject was provided with a research explanatory document setting out an explanation about the research, and informed that she would be deemed to consent to her participation in the research by completing her questionnaire sheet. The consent of each subject was obtained on the basis of our explanation that participation in the survey was voluntary, refusal to participate would cause no detrimental treatment, and data obtained were not to be used for any purpose other than this research.

Outline of the subjects
Responses to the questionnaire were obtained from 810 subjects among 4,013 subject mothers (collection rate of 20.2%). After excluding defective data concerning some of the items of the Bidimensional Resilience Scale, we analyzed the data of 706 subjects (valid response rate of 17.6%).

Basic attributes (Table 1)
The mean age of the subjects was 36.2 ± 4.8 years. With regard to their occupations and employment statuses, 264 subjects (37.4%) were working full-time; 201 subjects (28.5%) were part-timers; 46 subjects (6.5%) were self-employed; 176 subjects (24.9%) were homemakers; and 15 subjects (2.1%) fell under the category of "Other. " In relation to their family structures, approximately 80% of the subjects' families were nuclear families.

History of growth
With regard to the family environment during childhood, 587 subjects (83.1%) stated that they had had stable family environments, while 116 subjects (16.5%) answered negatively and three subjects

Child-raising environment
Among the subjects, 580 subjects (82.2%) had some persons to take care of their children, even for a short while, when they were away 682 subjects (96.6%) had some persons to turn to for advice concerning child-raising, such as family members or friends; and 336 subjects (47.6%) had specialists to consult with on child-raising. Furthermore, 462 subjects (65.4%) were living in areas where there were parks nearby to which they could walk with their children; 163 subjects (23.1%) had no opportunity for their children to play with other children at around the same age; and 120 subjects (17.0%) had no opportunity to talk to the mothers of other children at around the same age as their children. In addition, 496 subjects (70.3%) had moved to their current locations of residence after marriage.
Among the subjects, 176 subjects (24.9%) felt stressed about their relationships with their husbands; and 210 subjects (29.7%) felt stressed about their relationships with family members other than their husbands. With regard to the current financial situations of the subjects, 239 subjects (33 .9%) were experiencing financial difficulties. Also, 501 subjects (71.0%) felt that their communities were friendly in terms of child-raising.

Comparison of subjects' perception of their current child raising environments according to their family environments during childhood (Table 2)
In terms of perception of the current child raising environments of the subjects, the number of subjects who had no one to turn to for advice concerning child raising, had no opportunity to talk to the mothers of other children at around the same age as their children, or felt stressed about their relationships with their husbands, their relationships with others aside from their husbands, or their financial situations was significantly high (p < 0.001) in the group "without stable family environments" during childhood, compared with the group "with stable family environments" during childhood. The number of subjects who were not able to obtain information on group activities or social occasions was significantly high (p < 0.05) in the group "without stable family environments"; and the number of subjects who stated that their communities were friendly in terms of child-raising was significantly low in the same group (p < 0.001).

Comparison of subjects' perception of their current child raising environments according to their past experience of being bullied (Table 2)
In terms of perception of the current child raising environments of the subjects, the number of subjects who had no one to turn to for advice concerning child raising, had no opportunity to talk to the mothers of other children at around the same age a s their children, or felt stressed about their relationships with others aside from their husbands or about their financial situations was significantly high (p < 0.001) in the group with past experience of being bullied, " compared with the group " without past experience of being bullied.

Difficulty in child-raising
The mean self evaluation score in relation to subjective difficulty in child-raising was 3.84 ±2.54. The number of subjects whose evaluation scores were 2 was the largest with 113 subjects, while nearly 30% of subjects stated that their evaluation scores were 6 or more. In the classification of self evaluation scores into a low score group (scores of 0 to 3), a middle score group (scores of 4 to 6 and a high score group (scores of 7 to 10), among the 696 subject mothers who gave their responses in relation to subjective difficulty in child raising , 349 subjects (50.1%) were in the low score group, 219 subjects (31.5%) in the middle score group, and 128 subjects (18.4%) in the high score group.
In comparison between the group of subjects "with stable family environments" during childhood and the group "without stable family environments" during child hood, the level of subjective difficulty in child raising was significantly higher (p < 001) in the latter group than the former group Also, in comparison between the group of subjects "with past experience of being bullied" and the group "without past experience of being bullied", the level of subjective difficulty in child raising was significantly higher (p < 0.001) in the former group than the latter group (Table 3).

Resilience
The contents of resilience of approximately 80% of subject nurturing mothers included items on their relationships with persons around them, such as "Having someone close to talk to at ease, " "Having someone to help me when needed, " and "Having someone who accept s me as I am, " and items on their manner of perceiving things and their attitude, such as "It is not like only bad things keep happening and "Dealing with what I can, one by one. " In relation to the item "There are individual differences in t he development and growth of children, " 97% of the mothers chose "Strongly agree" or "Slightly agree" as their responses.
In comparison between the group of subjects "with stable family environments" during childhood and the group "without stable family environments" during childhood in terms of resilience evaluation scores the score s of the latter group were significantly lower (p < 0.05) than those of the former group; in relation to each resilience element, the resilience evaluation scores for "control, " "sociability, " and "understanding others" were significantly lower (p < 0.05). In comparison between the group of subjects "with past experience of being bullied" and the group "without past experience of being bullied" in terms of resilience evaluation scores, the scores of the former group were significantly lower (p < 0.05) than those of the latter group; in relation to each resilience element, the resilience evaluation scores for "optimism, " "sociability, " and "attempting to solve problems" were significantly lower (for sociability, p < 0.01; for optimism and attempting to solve problems , p <0.05 (Table 4).

Discussion
The subjects of this survey were mothers raising young children aged 1.5 years or older, with a mean age of 36.2 years. Approximately 70% of the subjects were working, and approximately 80% of the subjects' families were nuclear families. Among the mothers with experience of adversity, those w hose family environments during childhood had not been stable accounted for 16.5% of the entirety, and those who had had past experience of being bullied accounted for 39.5%. These items on their histories of growth are also considered to have covered mothers with histories of being abused and those who are still traumatized by their experience of being subjected to serious bullying.  Table 4: Comparison of diffculty in raising and resilience according to experiance of being bullied. SD: Standard devation, The two sample t-test, *P<0.05, **P<0.01, **P<0.001

Perception and stress of mothers with experience of adversity with respect to their child raising environments
Among the nurturing mothers with experience of adversity, the percentage of those who felt stressed about their relationships with their husbands or family members other than the husbands or did not have opportunities to talk to the mothers of children at around the same age as their own children was high. For mothers who raise children and work at the same time, the provision of support by persons around them plays a particularly important role. Accordingly, stress associated with their relationships with persons close to them, such as their husbands or other family members, is considered to worsen the mental burden of such mothers. Urayama, Kanagawa, and Ooki [11] have also reported the relationship between stress associated with the mother's close relationships such a s her husband, parents, or neighbors, and her inappropriate approaches to child raising, stating that in particular the mother's stress related to her husband or child is strongly associated with such inappropriate approaches . For childcare support, it is considered necessary to understand not only the support provided by persons around mothers but also the perception of those mothers.
Furthermore, the mothers who had not had stable family environments during childhood felt stressed about their relationships with their husbands, regarding which a significant difference was observed. This feature is different from those of the mothers with past experience of being bullied. On this basis, it is considered that the perception of mothers differs depending on the contents of experience of adversity.

Features of the difficulty in child-raising and resilience of mothers with experience of adversity
The level of difficulty in child raising felt by the mothers who had not had stable family environments during child hood and those with past experience of being bullied was high. This clarifies that past experience of adversity has an influence over the difficulty in child raising that nurturing mothers experience Moreover, the group without stable family environments during childhood had lower resilience scores than those of the group with stable family environments, and the group with past experience of being bullied" had lower resilience scores than those of the group "without past experience of being bullied. " Thus, mothers' experience of adversity clearly has an impact on their current resilience and sense of difficulty in child-raising.
In particular, the resilience elements characteristic only of the mothers without stable family environments during childhood were "control" and "understanding others"; the resilience elements characteristic only of the mothers with past experience of being bullied were "optimism" and "attempting to solve problems"; and the common resilience element between these two groups was "sociability. " Accordingly, these results clarify that the contents of mothers' current resilience differ according to the contents of their past experience of adversity. In a preceding study, "a low ability to understand others' feelings and perspectives" during childhood to adolescence is regarded as a developmental issue that young children who were abused by their parents during their periods of infancy face later in their lives [12]. In terms of childcare support, it is important to support mothers in a manner that enables this ability to "understand others" of theirs to be improved. Moreover, low "sociability" means that the mother's communication with the husband, family members, and other persons would be difficult, and consequently, she would often feel stressed. Additionally, the vicious cycle that the mother's mutual relationships with people around her would not work and her low understanding of her child's mental state would together result in her difficulty in child-raising being worsened. In order to sever such a vicious cycle, childcare support based on mothers' resilience is required.

The modality of child care support for mothers with experience of advesity
Having a high level of "difficulty in child-raising, " feeling " stressed about the husband, family members, or other persons, " and having a low "sociability" among resilience elements were the observed traits of mothers with experience of adversity. These traits indicate that, in many cases, such mothers lack the ability to seek advice from others and dealing with childcare-related concerns and problems when there is any. This situation suggests that it is important to ensure there are reliable persons to turn to for advice and such mothers are motivated to actually seek advice, in order for them to overcome their difficulties concerning child-raising [13,14]. Kubota [7] states that support from the non-married or married partner from during the period of pregnancy functions as a protective factor in suppressing the intergenerational transmission of child abuse. With regard to childcare support with an eye on resilience for mothers with experience of adversity, such support should not be solely based on environmental factors, but it is essential that such support should draw attention to the interaction between environmental and intraindividual factors of such mothers. No matter how accessible a support system is, it is hard to reduce mothers' sense of difficulty in child-raising without a fundamental trust-based relationship with persons associated with that support system. Therefore, it is necessary for their support system to understand their perception, work closely with them, and consider various matters together with them.
Humans have an intrinsic capability to deal with difficulties [15][16][17], but some mothers have not exerted such a capability. The role that childcare support based on the concept of resilience plays is to create scenes and situations in which those mothers can independently realize the existence of opportunities for them to exert the capability. Through this type of support, mothers are expected to be able to realize the existence of important persons around them and change the manner in which they perceive and understand their children and themselves (cognitive correction), there by building up their confidence in child-raising. In turn, supporters should develop their ability to encourage mothers to realize opportunities for them to exert their capability to overcome challenges. The way to achieve this end is to consider, together with mothers, matters that those mothers perceive as difficulties. This requires supporters to be a good environmental factor for mothers and enhance their resilience on the basis of a sense of basic trust. Moreover, it is necessary to create an arena for this purpose, and this arena is also where supporters learn how their actions for parents should be.

Limitation
This research clarifies the features of the difficulty in child-raising and resilience of nurturing mothers with past experience of adversity. However, it does not cover the severity of mothers' experience of adversity. For the future provision of childcare support that incorporates resilience-related perspectives, it is necessary to continue quantitative and qualitative studies on the contents and processes of the resilience of mothers who have overcome serious adversities.

Conclusion
A questionnaire survey was conducted targeting mothers who were raising young children aged 1.5 years or older to analyze the features of the "difficulty in child-raising" and "resilience" of mothers with past experience of adversity. Mothers with past experience of adversity were characterized by facing intense difficulty in child-raising, feeling stressed about their relationships with their husbands, family members, or other persons, lacking confidence in child-raising, being self-denying, and paying mind to others. Furthermore, the resilience of mothers with past experience of adversity was characterized by being low, especially in terms of sociability.