Maternal repressed anger and child behavioral problems in cerebral palsy: a Bayesian path analysis

Cerebral palsy (CP) is a neurodevelopmental disorder frequently accompanied by psychiatric comorbidities, and caring for children with CP imposes a significant psychological burden on mothers. However, studies examining the relationship between maternal repressed anger and children’s behavioral problems, particularly the underlying psychopathological transference mechanisms, remain limited. This cross-sectional, case-control study aimed to investigate the associations among repressed anger, depression, anxiety, and stress in mothers of children with CP and their relationship with children’s behavioral problems using Bayesian path analysis. The study included 28 children with CP and their mothers as the patient group and 60 healthy children and their mothers, matched sociodemographically, as the control group. Children were evaluated using the Child Behavior Checklist for Ages 4–18, and mothers were assessed with the Depression Anxiety Stress Scale-Short Form, the State-Trait Anger Scale, and the Parent Attitudes Scales for Parents of Children aged 4–12 years. Six Bayesian path models were developed exclusively for the CP group to examine the dynamics of mother–child psychological interactions across behavioral domains. Mothers of children with CP exhibited significantly higher anxiety ( p = 0.023), stress ( p = 0.035), trait anger ( p = 0.003), and expressed anger ( p = 0.001) levels than controls. Bayesian modeling revealed that repressed anger increased depression (β = 0.585–0.668) and stress (β = 0.591–0.668) in mothers, which subsequently influenced children’s internalizing (β = –0.388–0.618) and externalizing (β = 0.519–0.865) problems. The models explained 20.7%–40.4% of the variance in children’s behavioral problems. These findings indicate that maternal repressed anger indirectly contributes to child psychopathology and highlight the importance of integrating mother-focused interventions targeting anger and emotion regulation into CP rehabilitation programs.