Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Health

First Advisor

Shannon Self-Brown, PhD

Second Advisor

Laura Carruth, PhD

Third Advisor

Betty Sao-Hou Lai, PhD


Introduction: Parental stress is an important risk factor for child maltreatment (CM) that can increase the likelihood of perpetration of abuse. Evidence-based, parent-training programs have shown a positive impact on preventing CM, and reducing self-reported parental stress. However, limited research among high-risk parents for CM perpetration has examined physiological correlates of stress, such as impaired cortisol, alpha-amylase, and dihydroepiandrosterone (DHEA). Because there are many challenges with validity of self-report measures, it is imperative to explore biomarkers as novel benchmarks of parental stress. Thus, the goal of this research was to conduct a quasi-experimental, mixed-methods and multidisciplinary study examining behavioral and physiological stress in response to a six-week, evidence-based program, SafeCare®, with a sample of at-risk mothers.

Methods: High-risk parents (n=18) were recruited from a children’s hospital pediatric clinic in Atlanta, Georgia. Participants completed repeated within subject assessments of behavioral (self-report) and physiological (cortisol, alpha-amylase, DHEA) stress measures pre-and post-intervention. Acute cortisol and alpha-amylase were collected through Salivette® methods. Chronic cortisol was assessed using hair samples. DHEA was collected through passive drool samples. Participants also completed a qualitative interview at baseline. Correlational analyses were conducted to examine associations between self-reported parental stress and biomarkers. Paired t-test analyses were conducted to examine changes in self-reported stress and physiological markers pre-to post- intervention, as well as to examine participants’ acute stress responses during a SafeCare® session in the presence of a home visitor. Qualitative analyses were conducted using line-by-line coding to examine feasibility of collecting biospecimens. In addition, themes on parental and general stress perceptions were examined.

Results: Participants were African American (M age=27.0 years, SD=6.7), and of low socioeconomic status (60% r= -.70, p=.005), as well as with alpha-amylase (r=.74, p=.005) among all participants at baseline. Correlations were also found between self-reported stress and alpha-amylase at follow-up (r=.87, p<.05) (n=7). Trends, although non-significant, were noted among completers towards decreased average self-report stress and improved salivary cortisol (p=.08) and alpha-amylase (p=.08). Participants with impaired salivary cortisol levels at baseline showed normalization post-intervention. No significant changes in participant acute stress levels were noted in the presence of the home visitor mid-intervention. Findings from qualitative interviews indicated that parents were generally willing to provide hair and salivary samples, but showed clear preference for Salivette methods over passive drool. While parents described many parental stresses addressed by SafeCare®, parents also described contextual factors such as socioeconomic status and other chronic stressors that contribute to parenting stress.

Conclusions: Study findings suggest that salivary cortisol and alpha-amylase are compelling neurobiological correlates of parental stress among high-risk parents for CM. Further, results support the short-term, positive effects of SafeCare® in potentially regulating physiological stress systems among at-risk parents. Given the feasibility noted in biomarker collection among participants, larger, and more rigorous studies should be conducted in the future to validate these results.

Available for download on Thursday, April 26, 2018