Posttraumatic Stress Symptoms and Disorders in Parents of Children and Adolescents With Chronic Physical Illnesses: A Meta‐Analysis

The present meta‐analysis analyzed whether parents of young people with pediatric chronic physical illnesses experience higher levels of posttraumatic stress symptoms (PTSS) and higher rates of posttraumatic stress disorder (PTSD) than other adults and searched for correlates of PTSS in these parents. Based on a systematic search in electronic databases, 184 studies were included in the meta‐analysis. On average, 18.9% of the parents fulfilled the criteria for PTSD, and PTSS were more common among parents of young people with pediatric chronic physical illnesses than in other adults, with Hedges' g showing a 0.85 increase in standard deviation units. Parental PTSS were most prevalent among parents of children with epilepsy, g = 1.25, and diabetes, g = 1.16, and were positively associated with being the mother, r = .19; illness severity, r = .18; treatment duration/intensity, r = .21; and PTSS of the child, r = .34. In contrast, longer illness duration, r = ?.19; longer time since active treatment, r = ?.10; and better social resources, rs = ?.17 to ?.07, were associated with lower parental PTSS. The findings indicate that parents who have faced traumatic events in the context of their child's chronic illnesses should be screened for PTSS and PTSD and receive psychological interventions when needed.     

Predictors of Acute and Posttraumatic Stress Symptoms in Parents Following Their Child's Cancer Diagnosis

This longitudinal study aimed to examine acute and posttraumatic stress symptoms and predictors of traumatic stress symptoms in parents of children recently diagnosed with cancer. The sample comprised 220 parents of 143 children who completed questionnaires at diagnosis (T1) focused on acute stress disorder (ASD); of these, 145 parents of 97 children completed questionnaires 6–8 months later (T2) focused on posttraumatic stress disorder (PTSD). Demographic, psychosocial, and treatment and illness variables were predictors. Results were that 63% of mothers and 60% of fathers met criteria for ASD at T1. At T2, 21% of mothers and 16% of fathers met criteria for PTSD, with 40% of parents reporting significant subthreshold symptoms. Predictors of ASD symptoms were female gender, presence of psychosocial risk factors, trait anxiety, family functioning, and central nervous system tumor diagnosis. Risk factors for PTSD symptoms were younger maternal age, severity of ASD symptoms, and trait anxiety at T1, and parent‐reported quality of life of the child at T2. The results suggest that screening for ASD may help identify parents at increased risk of persistent traumatic stress symptoms who could benefit from preventative, evidence‐based psychosocial interventions.     

Association of Posttraumatic Growth and Illness‐Related Burden With Psychosocial Factors of Patient,Family, and Provider in Pediatric Cancer Survivors

Research has indicated that childhood cancer may lead to posttraumatic growth (PTG), given cancer's association with posttraumatic stress. PTG may be associated with family/home and health care dynamics, as well as parental resilience, distress, and coping. This cross‐sectional study investigated the associations of psychosocial factors of the patient, family, and health care team with PTG and illness‐related burden (IRB) in childhood cancer survivors. The sample comprised 61 children and adolescents (7–18 years of age), their parents, and their nurses. Respondents completed their assessment an average of 1.73 years after the end of treatment for the child's disease, which was either leukemia, a solid tumor, or lymphoma. Regression analyses showed that PTG was positively associated with the patients’ posttraumatic stress symptoms. It was also positively associated with the parents’ religious coping, and with measures of stronger family and oncologist relationships (R² = .32). IRB was positively associated with patient‐reported posttraumatic stress symptoms, negatively associated with the nurse's trust in the family, and positively associated with parent‐reported mental distress, lower family socioeconomic status, and female gender (R² = .53). There was no significant association with parenting style or parent‐reported posttraumatic stress symptoms in the child. The findings suggested that the young cancer patient's psychosocial and resource milieu (e.g., financial) may be instrumental in PTG and IRB. Psychosocial interventions with high‐risk families and their health care teams could increase growth and reduce burden.     

Resilient,recovering, distressed: A longitudinal qualitative study of parent psychosocial trajectories following child critical injury

IntroductionThe psychological distress and risk of mental health problems for parents of children with critical injury is well-established. There has been little exploration, however, of parent experiences and psychosocial trajectories over time following child critical injury. To address this knowledge gap, a longitudinal qualitative study was conducted to explore parent experiences and support needs and identify parent psychosocial trajectories in the 12 months following child critical injury.MethodsSemi- structured in-depth interviews were conducted with 27 parents at three time points over a 12 month period: the immediate hospital period post-child injury, and 6 and 12 months following injury, resulting in a total of 81 interviews. Data were analysed using a longitudinal within and across-case thematic analysis of patterns emerging over time.FindingsThree parent trajectory patterns were identified: resilient trajectory where parents were temporarily disrupted by the child’s injury and hospitalisation, but recovered their mental and emotional wellbeing quickly, which was maintained over time; recovering trajectory where parents were initially disrupted at the time of injury but their mental and emotional wellbeing fluctuated over time and had not been fully restored by 12 months; and distressed trajectory where parents experienced significant psychosocial disruption due to their child’s injury and struggled to adapt and regain their wellbeing over time, remaining emotionally distressed about the circumstances and impacts of the injury on their child and family. Illustrative narratives that represent each trajectory are presented.ConclusionsThis is the first qualitative study to report the psychosocial trajectories of parents of critically injured children. Clinical application of insights provided by these trajectories can assist clinicians to use targeted strategies to help strengthen parental adaptation and prevent adverse mental health outcomes, and address families’ psychosocial support needs following child injury. Screening for parent psychological distress and post-traumatic stress disorder is needed from the time of the child’s admission, and a dedicated trauma support role can facilitate an integrated care approach for children and families with complex needs across the care continuum.     

Resilience-promoting factors for parents of severely injured children during the acute hospitalisation period: A qualitative inquiry

BackgroundPaediatric injury impacts the entire family. Many parents experience stress and anxiety following paediatric injury, but little is known about factors that support parents’ wellbeing and how they successfully manage the adversity of child injury during acute hospitalisation.AimTo explore parent experiences and resilience-promoting factors that facilitate the wellbeing of parents with severely injured children during the acute hospitalisation period.MethodsA qualitative inquiry conducted across four major Australian paediatric trauma services. Semi-structured interviews were conducted with a purposive sample of 40 parents of 30 severely injured children aged 0–12 years during the acute post-injury hospitalisation period. Interviews explored parents’ experiences and how parents had managed the stress of their child’s injury during the acute hospitalisation period. Data were analysed using directed content analysis.ResultsParents identified a range of individual characteristics and resources, and those of their children and families, communities, and the hospital environment, which facilitated their wellbeing during the initial post-injury period. Three themes were derived from analysis: Drawing on inner strengths; Having positive and supportive relationships; Being in a safe place with the right help.ConclusionResilience-promoting factors for parents of injured children can be used to inform development of brief online intervention modules to enhance parent resilience. Routine screening and targeted psychological first aid for parental distress are recommended.     

Resilience in children and their parents enduring pediatric medical traumatic stress

Due to the general lack of familiarity with the concept in the medical field, resilience is rarely considered in pediatric medical traumas. Resilience is an ability that enables recovery after adversities such as traumas, surgeries, serious health problems, or social issues. Stress from medical traumas encompasses both the psychological and physical responses of children and their families. Lack of resilience in children with medical traumatic stress may contribute to poor adjustment, slow recovery, disruptive behaviors, and psychiatric disorders. Furthermore, persistent parental distress increases the child's risk of low resilience. Consequently, these patients and their parents require early identification. This is achievable using a common stress measure such as the Perceived Stress Scale. Moreover, health care providers can screen patients’ risks for low resilience, which include few social contacts, poor family functioning, and low cohesion among family members. Findings from the stress scale and screened risks could indicate the need for additional psychosocial support at the time of diagnosis of a serious illness, soon after injuries, and before and after operations. Such interventions can include decreasing distress, counseling children and their parents, and enabling strong connections to health care providers. Health care providers can help parents to minimize distress and adjust to their child's illness, thereby supporting the child's resilience, adjustment, and recovery.     

Health effects of passive smoking. 1. Parental smoking and lower respiratory illness in infancy and early childhood

BACKGROUND: A systematic quantitative review was conducted of evidence relating parental smoking to acute lower respiratory illness in the first three years of life. METHODS: Fifty relevant publications were identified after consideration of 692 articles selected by electronic search of the Embase and Medline databases using keywords relevant to passive smoking in children. The search, completed in April 1997, identified 24 studies ascertaining illnesses in a community setting, including five surveys of schoolchildren with retrospective ascertainment of early chest illness, and 17 studies of admissions to hospital for lower respiratory illness in early life. Thirty eight studies were included in a quantitative overview using random effects modelling to derive pooled odds ratios. RESULTS: The results of community and hospital studies are broadly consistent, with only one publication reporting a reduced risk among children of smokers. The pooled odds ratios were 1.57 (95% CI 1.42 to 1.74) for smoking by either parent and 1.72 (95% CI 1.55 to 1.91) for maternal smoking. There is a significantly increased risk of early chest illness associated with smoking by other household members in families where the mother does not smoke (1.29, 95% CI 1.16 to 1.44). The associations with parental smoking are robust to adjustment for confounding factors, and show evidence of a dose-response relationship in most studies in which this has been investigated. CONCLUSIONS: The relationship between parental smoking and acute lower respiratory illness in infancy is very likely to be causal. Although it is impossible to distinguish the independent contributions of prenatal and postnatal maternal smoking, the increased risk associated with smoking by other household members suggests that exposure to environmental tobacco smoke after birth is a cause of acute chest illness in young children.


     

Cortisol levels and psychosocial factors in preadolescent children

Regarding the relationship between psychosocial factors and health, one model of explanation states that psychosocial stress constitutes a principal mediator connecting psychosocial factors to health outcome, affecting the body through psychobiological mechanisms. This relationship has scarcely been studied in children. In the present study the relation between diurnal cortisol secretion and psychosocial factors [socio‐economic status (SES), immigrant status and impact of psychiatric symptoms] was investigated in a normal population of 6–12 year old children (n = 273). Salivary cortisol levels were measured in the early morning, late morning and in the evening during three consecutive days. Parents answered demographic questionnaires and teachers answered psychiatric questionnaires concerning the children. Children exposed to one or more of the factors of psychosocial load (n = 117) had significantly higher morning (p < 0.001) and evening (p = 0.029) cortisol levels as well as total daily cortisol secretion [measured by the area under the curve (AUC), p = 0.003] compared to the group of children with none of the factors (n = 156). Different psychosocial stressors seemed to influence different parts of the diurnal cortisol curve. In conclusion, this study indicates that even children exposed to a moderate degree of psychosocial load differ in their cortisol levels compared to non‐exposed children. Copyright © 2006 John Wiley & Sons, Ltd.     

Posttraumatic Stress Symptoms in Breast Cancer Patients: Temporal Evolution,Predictors, and Mediation

This study (N = 102 women) evaluated the time course of posttraumatic stress symptomatology (PTSS) at different stages of nonmetastastic cancer diagnosis and treatment: during treatment, at the end of treatment, and at a 6–12 months follow‐up. We also assessed the contribution of demographic, trait, and state predictors to PTSS, and coping processes as proximal mediators of the relation between Type C personality and PTSS. Results indicated that PTSS remained constant across all phases. There were significant correlations (range = .28 to .81) between PTSS and psychosocial variables and age, but not with other sociodemographic or medical factors. A linear growth curve model showed that hopelessness/helplessness (B = 1.45) and Type C personality (B = 1.40) were the best predictors of PTSD symptomatology, followed by trait dissociation (B = 0.55), and the coping strategies of anxious preoccupation (B = 1.20), cognitive avoidance (B = 0.91), and symptoms of acute stress disorder (B = 0.19). A mediation model showed that the coping strategies of anxious preoccupation, cognitive avoidance, and helplessness/hopelessness mediated the relationship between Type C personality and PTSS during treatment, posttreatment, and follow‐up. These results clarify the contribution of different predictors of PTSS and can help develop prevention programs.     

Factors affecting parental satisfaction following pediatric procedural sedation

Study ObjectiveTo investigate factors affecting parental satisfaction with a pediatric sedation service in a university hospital setting.DesignProspective, observational study with interviews using a survey instrument.SettingAcademic university hospital.SubjectsParents (or legal guardians; hereafter “parents") of 220 children scheduled for sedation with the hospital's pediatric sedation service.Interventions and MeasurementsCaregivers of children scheduled for sedation were interviewed using a validated survey instrument. The instrument was designed to investigate the quality of communication, environment, care provided, and the overall experience. We followed patients by telephone the day after discharge. Chi-square or linear-by-linear association tests were used to evaluate associations between satisfaction scores and demographic variables; the Mann-Whitney test was used for mean levels of satisfaction in anxious versus non-anxious children.Main ResultsOf 222 parents approached, 220 agreed to participate (response rate = 99.1%). Significant associations between each area of satisfaction and parents' overall satisfaction existed (P < 0.001). Previous sedations, types of sedation, age of child, or any individual provider were not significantly associated with overall satisfaction. Caregivers of anxious children reported less satisfaction than caregivers of non-anxious children. Parents of children who underwent magnetic resonance imaging reported the lowest mean satisfaction scores.ConclusionsOverall satisfaction was high, and care provided by anesthesiologists was significantly associated with overall satisfaction. A site in our institution was associated with significantly lower satisfaction as a result of inadequate space and privacy.     

Pediatric Health‐Related Quality of Life: Feasibility,Reliability and Validity of the PedsQL™ Transplant Module

The measurement properties of the newly developed Pediatric Quality of Life Inventory? (PedsQL?) 3.0 Transplant Module in pediatric solid organ transplant recipients were evaluated. Participants included pediatric recipients of liver, kidney, heart and small bowel transplantation who were cared for at seven medical centers across the United States and their parents. Three hundred and thirty‐eight parents of children ages 2–18 and 274 children ages 5–18 completed both the PedsQL? 4.0 Generic Core Scales and the Transplant Module. Findings suggest that child self‐report and parent proxy‐report scales on the Transplant Module demonstrated excellent reliability (total scale score for child self‐report α= 0.93; total scale score for parent proxy‐report α= 0.94). Transplant‐specific symptoms or problems were significantly correlated with lower generic HRQOL, supporting construct validity. Children with solid organ transplants and their parents reported statistically significant lower generic HRQOL than healthy children. Parent and child reports showed moderate to good agreement across the scales. In conclusion, the PedsQL? Transplant Module demonstrated excellent initial feasibility, reliability and construct validity in pediatric patients with solid organ transplants.     

Health-related quality of life, psychosocial strains, and coping in parents of children with chronic renal failure

Health-related quality of life (HRQOL) in parents of children suffering from renal disease is often diminished by the illness burden experienced in daily life and by unfavorable ways of coping. Our aim was to examine the relationship between psychosocial strains perceived by parents, their ways of coping, and HRQOL. In an anonymous cross-sectional study, parents completed a questionnaire concerning psychosocial strains, coping strategies, and HRQOL, as well as sociodemographic and illness parameters. Study participants were recruited in two outpatient dialysis centers. Participating in the study were 195 parents (105 mothers, 90 fathers; age 43?±?8 years; representing 108 families) of children suffering from renal disease (age 12?±?5 years). Parents of children with chronic renal failure reported moderate HRQOL with parents of children undergoing dialysis experiencing more limitations in quality of life than parents of children living with a kidney graft and parents of children undergoing conservative treatment. Mothers experienced lower HRQOL and higher psychosocial strains than fathers. HRQOL was predicted by the coping strategies “focusing on child” (β?=?–0.25), “improving marital relationship” (β?=?0.24), “seeking social support” (β?=?–0.22) and “self-acceptation and growth” (β?=0?.19) as well as parents′ perceived limitation by illness in daily life (β?=?–0.15; explained variance 57%). In the comprehensive care for families with a child suffering from a renal disease, screening for psychosocial strains and ways of coping, along with applying interventions to strengthen adaptive coping strategies, may be a preventative means of improving parents′ quality of life.     

Pediatric medical traumatic stress (PMTS) in parents of newborns with a congenital anomaly requiring surgery at birth

BackgroundPediatric medical traumatic stress (PMTS) is a psychological and physiological response of children and their families to pain, serious illness, and invasive medical procedures. We aimed to apply the PMTS model to parents of newborns operated at birth for a congenital malformation and to identify clinical and sociodemographic risk factors associated with PMTS symptoms at 6 months.MethodsWe designed a cross-sectional study to assess PMTS symptoms (avoidance, arousal, reexperiencing) in parents of six months children operated on for a congenital anomaly, with the Italian version of the Impact of Event Scale – Revised (IES-R).ResultsOne-hundred-seventy parents form the object of the study. Eighty-two parents (48.2%) fell over the clinical cut-off. Ventilatory time (p = 0.0001), length of hospital stay (p = 0.0001), associated anomalies (p = 0.0002), medical devices at discharge (p = 0.0001) and Bayley motor scale (p = 0.0002) were significantly correlated with IES-R Total and Subscale Scores.Multivariate linear regression showed length of hospital stay and number of associated anomalies as significant predictors of IES-R Scores.ConclusionsRegardless the type of anomaly and sociodemographic factors, it is the clinical history of the child which seems to predict the severity of PMTS symptoms in this population of parents. PMTS represents a useful model to describe the psychological reactions of parents of newborns operated at birth for a congenital malformation. NICU and outpatient pediatric staff should be aware of risk factors to identify families who may request early multidisciplinary interventions since the first admission.Level of evidencePrognosis study, level II.     

Sleep disturbance and sleep insufficiency in primary caregivers and their children with cystic fibrosis

BackgroundChronically ill children and their parents are at risk for sleep disorders and associated morbidity. Sleep disturbance prevalence and the relationships between parent and child sleep among children with CF are not well defined. Clarifying the presence and impact of sleep disturbances among pediatric CF patients and their parents could lead to improved health in this population.MethodsCross-sectional study assessing parent-reported sleep in ninety-one CF patients (mean age 8.8 years; 53.8% female) and their primary caregivers. Sleep sufficiency determined using American Academy of Sleep Medicine guidelines; correlation coefficients computed for sleep problem domains; stepwise multiple linear regression determined predictive models for sleep duration.ResultsParents reported concerns about their own sleep and that of their children. Night waking and daytime sleepiness were most common in parents; prolonged sleep latency was most common for children. Most parents and children had inadequate sleep duration. School-age children had the highest frequencies of overall sleep concerns and inadequate sleep. Most parent and child sleep problem domains were significantly associated, with large effects for similar parent and child problems. Stepwise multiple linear regression demonstrated that CF caregiver/patient sleep duration was significantly predicted by insomnia symptoms.ConclusionsMany CF children and their parents experience sleep difficulties including inadequate sleep duration, with presence of sleep problems in many families whose children with CF had normal lung function. These data suggest that sleep health should be a CF Care Model component and should be a health care focus for families of children with other chronic illness.     

Demographic risk factors of self-immolation: A case–control study

ObjectiveTo investigate demographic risk factors for self-immolation patients.MethodsIn a case–control study, 30 consecutive cases of deliberate self-inflicted burns admitted to the regional Burn centre (Imam Khomeini hospital in Kermanshah province, Iran) were compared with 30 controls who were selected from the community and matched by gender, age, and living area. All cases and controls were reviewed for demographic variables, including: age, gender, living area, family size, marital status, bearing and number of children, Body Mass Index (BMI), birth order, employment state, educational status, early school drop-out, and parent/guardian employment status.ResultsTwo variables emerged as related to risk of self-immolation. Being the first or last child in family birth order was associated with increased risk of self-immolation. Moreover, among the married participants, having children was associated with decreased risk of self-immolation. The comparisons of other variables were not statistically significant. In multivariate analyses, none of the variables predicted risk for self-immolation.ConclusionThis study suggests that being the first or last child of a family might be a risk factor for self-immolation. For married persons, having children might serve as a protective factor from self-immolation. Other variables such as family size, marital status, number of children, BMI, employment state, educational status, early school drop-out, and parent/guardian employment status did not play a role as individually protective or risk factors for self-immolation.     

Neurobehavioral recovery after pediatric head trauma: injury, pre-injury, and post-injury issues

This article reviews the most significant demographic, neurological, and psychosocial factors affecting the occurrence of and recovery from traumatic head injury (THI) in children and adolescents. Review of the available literature suggests that, as with adults, there is no compelling evidence for persistent neurobehavioral deficits after mild THI in children. In contrast, neurobehavioral deficits are common in children who have sustained moderate to severe THI. This article emphasizes that a long-term developmental perspective that considers in concert injury, pre-injury, and post-injury variables is needed for a proper appreciation of possible sequelae of pediatric THI. Specific pitfalls in forensic assessments of these children are reviewed. Empirical findings are presented to support the position that neuropsychological evaluations of children with THI that do not consider pre-injury status are likely to lead to misattribution errors. Clinical implications are illustrated with a case example.     

Addressing Disaster Exposure Measurement Issues With Latent Class Analysis

Disaster exposure can put survivors at greater risk for subsequent mental health (MH) problems. Within the field of disaster MH research, it is important to understand how the choice of analytic approaches and their implicit assumptions may affect results when using a disaster exposure measure. We compared different analytic strategies for quantifying disaster exposure and included a new analytic approach, latent class analysis (LCA), in a sample of parents and youth. Following exposure to multiple floods in Texas, a sample of 555 parents and 486 youth were recruited. Parents were predominantly female (70.9%) and White (60.8%). Parents were asked to have their oldest child between the ages of 10 and 19 years old participate (M = 13.74 years, SD = 2.57; 52.9% male). Participants completed measures on disaster exposure, posttraumatic stress, depression, and anxiety. The LCA revealed four patterns of exposure in both parents and youth: high exposure (15.5% parent, 9.5% child), moderate exposure (19.8% parent, 28.2% child), community exposure (45.9% parent, 34.4% child), and low exposure (18.8% parent, 27.8% child). In terms of MH, there were similarities across analytic approaches, but the LCA highlighted a threshold effect, with the high exposure class doing worse than all others, d = 1.12. These results have important implications in understanding the different exposure experiences of survivors and the linkage to MH outcomes. The findings are also informative in the development and use of screening tools used in postdisaster contexts in determining who may or may not need MH services.     

Parent experiences and psychosocial support needs 6 months following paediatric critical injury: A qualitative study

IntroductionParents of critically injured children can experience high levels of psychological distress post-injury, however little is known about their experiences and needs following injury. This study aimed to explore parent experiences and psychosocial support needs in the six months following child critical injury.MethodsAn interpretive qualitative design was used. Semi-structured interviews were conducted with 30 parents of 23 critically injured children. Interviews explored parent experiences and psychosocial support needs. Qualitative data were managed using NVIVO 10 and analysed thematically.ResultsFour themes were identified: integrating back into home life; adjusting mentally and emotionally to injury; coping with injury as a family; and navigating resources to meet family needs. Parents and families experienced substantial ongoing emotional impacts at 6 months following child injury. Parents were unprepared for the negative changes in their child’s psychological wellbeing and behaviour post injury, and parents’ mental health was negatively impacted, with mothers more likely to seek emotional support than fathers. Parents reported receiving no psychosocial follow-up from the hospital and limited information about community services and accessing local community resources on returning home.ConclusionsThere is a need to include all family members in discharge planning, and to use a family-centred continuity-of-care approach from the time of child injury through to post-discharge recovery. To strengthen parent and family wellbeing, a biopsychosocial holistic approach is recommended, including cognitive-behavioural and other psychological strategies to help reduce distress for parents and all family members and strengthen their coping capacity. A dedicated family support coordinator role to facilitate care over the child recovery trajectory, and development of accessible online and e-psychosocial support resources for parents and families are recommended.     

Psychological characteristics and physiological reactivity to acute stress in mothers of children with autism spectrum disorder

Stress related to parenting a child with autism spectrum disorder can differently affect caregiver's physiological reactivity to acute stress. Here, parental stress levels, psychological characteristics, and coping strategies were assessed alongside measures of heart rate, heart rate variability, and cortisol during a psychosocial stress test in mothers of children with ASD (M‐ASD, n = 15) and mothers of typically developing children (n = 15). M‐ASD reported significantly higher levels of parental stress, anxiety, negative affectivity, social inhibition, and a larger preference for avoidance strategies. M‐ASD showed larger heart rate and cortisol responses to the psychosocial stress test. A positive relationship was found between parental stress levels and the magnitude of the cortisol stress response in both groups. The present findings indicate exaggerated physiological reactivity to acute psychosocial stress in M‐ASD and prompt further research to explore the role of individual differences in mediating the effects of parental stress on physiological stress responses.