Introduction
Psychological problems have affected over 50% of the children and are one of the main reasons for their mortality and disability [1]. In Iran, 11-17% of children experience one or more psychological disorders, either internalizing or externalizing [2]. One important factor in the occurrence of internalizing and externalizing problems in children is the parental role. Parents not only provide care but also play a significant role in the social, emotional, cognitive, and physical development of children [3, 4]. The mental health of mothers has a main role in the emergence of externalizing or internalizing psychological problems in children [5]. One of the risk factors for the mental health problems of mothers during pregnancy [6] or after giving birth [7] is the Adverse childhood experiences (ACEs) of mothers, which can affect the susceptibility of the children to internalizing and externalizing behavioral problems [8]. long shadow of ACE in mothers can also affect their children through various mechanisms [9, 10], passing from one generation to the next, causing an intergenerational transmission [11]. The ACEs of mothers not only increase the risk of externalizing and internalizing problems in their children [12] but also affect the occurrence of these disorders through mothers’ emotional dysregulation. Mothers with emotion regulation difficulties due to having ACEs may adopt maladaptive strategies for the upbringing of their children or show excessive reactions, affecting their mental capacity [13]. Maternal mental capacity focused on the child’s mental state, and the children’s mental capacity focused on the mental state of themselves can predict internalizing problems in children [14].
Given the importance of internalizing and externalizing psychological problems in children and the significant role of maternal emotional dysregulation and maternal mental capacity in the intergenerational transmission of these disorders, this study aims to assess the relationship of ACEs in mothers with the internalizing and externalizing problems of their children, with the mediating role of emotional dysregulation and mental capacity in mothers.

Methods 
This is a correlational study using structural equation modeling (SEM). The study population consists of all mothers aged 30-40 years in Busher Province, south of Iran, with children aged 6-12 years, who had registered information in the electronic comprehensive health services system in 2022. Participants were selected using a random cluster sampling method. In this regard, Bushehr Province was divided into three regions: north, south, and central. Then, two cities of Bushehr and Borazjan were randomly selected from the central region; Khormoj city from the south, and Bandar Ganaveh from the north. Out of 700 selected participants, 632 completed the relevant questionnaires, including the child behavior checklist, the ACE questionnaire, the difficulties in emotion regulation scale, and the parental reflective functioning questionnaire. Data analysis was done using descriptive statistics, Pearson correlation test, and SEM. All analyses were performed in SPSS software, version 26 and AMOS version 24.

Results
This study examined 632 married mothers from the non-clinical population with children aged 6-12 in Bushehr, Iran. Regarding age, 425 mothers (67.2%) were in the 30-35 age group and 207 participants (32.8%) were in the 36-40 age group. The path coefficients for the relationship between the ACEs of mothers, children’s internalizing and externalizing problems, and emotional dysregulation and mental capacity of mothers are presented in Table 1. Mothers’ ACEs had a direct and significant relationship with internalizing problems (β=0.182, P<0.001) and externalizing problems (β=0.201, P<0.001) in children. Also, the ACEs of mothers had an indirect and significant relationship with their mental capacity (β=-0.125, P=0.006). The emotional dysregulation in mothers had a direct and significant relationship with internalizing problems (β=0.349, P<0.001) and externalizing problems (β=0.373, P<0.001) in children. The mental capacity of mothers demonstrated an indirect and significant relationship with externalizing problems (β=-0.092, P=0.019). 



Conclusion
The ACEs of mothers have a positive and significant effect on their children’s internalizing and externalizing problems. Additionally, the mothers’ ACEs can directly affect their emotion regulation and have a significant negative impact on their mental capacity. In other words, the mothers who experience adverse events in their childhood have lower mental capacity. The ACEs of mothers affect the behavioral problems of children through emotion dysregulation. However, maternal mental capacity only affects the externalizing problems of children; it has no effect on their internalizing problems. Based on the results of this study, it is recommended that mothers with a history of ACEs receive the necessary education on emotion regulation and mental capacity before becoming a parent to prevent intergenerational transmission of problems.

Ethical Considerations

Compliance with ethical guidelines
Participants voluntarily participated in the study, and their data were kept confidential. Ethical approval was obtained from the Ethics Committee of Royan Institute (Code: IR.ACECR.ROYAN.REC.1401.06).

Funding
This article was extracted from the PhD thesis of the first author in clinical psychology at the University of Science and Culture, Tehran, Iran. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Authors contributions
Investigation: Fatemeh Akbarizadeh; Supervision and editing: Ali Soleimani; Resource and editing: Mohsen Kachooei; Data Analysis: Hojjatollah Farahani.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all participants for their cooperation in this study sincerely.


 

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