Posttraumatic stress disorder in parents of children with newly diagnosed type 1 diabetes

OBJECTIVE: To determine rates of posttraumatic stress disorder (PTSD) and symptoms in mothers and fathers of children with newly diagnosed type 1 diabetes. METHODS: Parents of 38 children with newly diagnosed type 1 diabetes were assessed with the Posttraumatic Diagnostic Scale 6 weeks after diagnosis. RESULTS: Twenty-four percent of the mothers and 22% of the fathers met full diagnostic criteria for current PTSD. In addition, 51% of the mothers and 41% of the fathers met criteria for partial or subclinical PTSD. Co-occurence of PTSD in couples was very low. Posttraumatic stress symptomatology did not correlate with age and gender of the child, socioeconomic status, family structure, or length of hospital stay. CONCLUSIONS: The findings support applicability of a posttraumatic stress model for investigating the psychological impact of type 1 diabetes on parents.     

Brief report: quality of life is impaired in pediatric burn survivors with posttraumatic stress disorder

Objective This study assessed health-related quality of life(HRQOL) and posttraumatic stress disorder (PTSD) in pediatricburn survivors and examined associations between PTSD and HRQOL.Methods Forty-three burn survivors, ages 7–16 years, wereinterviewed at an average of 4.4 years after their accidentusing the Clinician-Administered PTSD Scale for Children andAdolescents and the TNO-AZL Child Quality of Life Questionnaire.Results Eight children (18.6%) met DSM-IV criteria for currentPTSD. While most dimensions of HRQOL were within normal limits,social functioning was impaired. Severity of PTSD was significantlyassociated with physical, cognitive, and emotional dimensionsof HRQOL. Children with PTSD reported an impaired overall HRQOLand limited physical (e.g., more bodily complaints) and emotionalfunctioning (e.g., more feelings of sadness). Conclusions Thisstudy provides tentative evidence for a considerably high prevalenceof PTSD in pediatric burn survivors and for a negative associationbetween PTSD and HRQOL.     

Brief report: pediatric cancer, parental coping style, and risk for depressive, posttraumatic stress, and anxiety symptoms

OBJECTIVE: According to the stress and coping goodness of fit model, parents' risk for psychological symptoms was hypothesized to decrease as a function of using emotional regulation and problem appraisal strategies more frequently, and to increase as a function of using problem-solving and avoidant behaviors more frequently to cope with an uncontrollable stressor--pediatric cancer diagnosis. METHODS: Parents (N = 150) completed measures of depression, PTSD, anxiety, and coping style. RESULTS: Regression analyses revealed that symptoms decreased as a function of using problem appraisal and an emotional regulation strategy (social support) more frequently; and increased as a function of using problem-solving strategies, avoidant coping (substance use), and another emotional regulation strategy (negative self-blame) more frequently. CONCLUSIONS: The findings provide some support for the model but suggest that the method of coping (e.g., social support) might be considered in addition to the focus of the coping strategy (e.g., emotional regulation).     

Psychological functioning of children with insulin-dependent diabetes mellitus: a longitudinal study

Assessed school-age youth repeatedly over the first 6 years of their insulin-dependent diabetes mellitus (IDDM) to determine self-perceived psychological adjustment. After the first year of IDDM, Ss exhibited a mild increase in depressive symptoms. Anxiety decreased for boys but increased for girls over the duration of IDDM. In contrast, self-esteem remained stable regardless of rehospitalizations or degree of metabolic control. Ss' adjustment shortly after IDDM onset, as reflected by levels of depression, anxiety, and self-esteem, were predictors of later adjustment. In general, Ss found the implications of IDDM more upsetting and the regimen more difficult with time, and girls were more upset by their illness than boys. The degree to which children were upset by the implications and management of IDDM varied as a function of their anxiety and depression.     

Risk of posttraumatic stress symptoms: a comparison of child survivors of pediatric cancer and parental bereavement

OBJECTIVE: To compare the risk of posttraumatic stress (PTS) symptoms and the mediating effect of perceived future threat on the risk of PTS symptoms among survivors of pediatric cancer and children who had a parent die. METHODS: Seventy-eight children (39 survivors of cancer, 39 bereaved) completed self-report measures of PTS symptoms, depression, anxiety, and perceived risk of future threat for the event they experienced. RESULTS: The children who lost a parent reported significantly more PTS symptoms than the survivors of cancer. The effect of group status (survivor of cancer vs. bereaved) on PTS symptomatology was partly mediated by the children's perceived risk of future threat. CONCLUSIONS: The rate of PTS symptoms was found to be higher among children who had lost a parent than among survivors of pediatric cancer. This difference may partly be explained by their perceived risk of a future threat. Clinical implications are discussed.     

Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis

Research has demonstrated that women develop postpartum PTSD. Prevalence of postpartum PTSD has ranged from 1% to 30%, and many risk factors have been identified as predictors of postpartum PTSD. While qualitative reviews have identified patterns of risk, the lack of quantitative reviews prevents the field from identifying specific risk factors and making a single estimate of the prevalence of postpartum PTSD. The current meta-analysis investigated prevalence and risk factors of postpartum PTSD, both due to childbirth and other events, among community and targeted samples. Prevalence of postpartum PTSD in community samples was estimated to be 3.1% and in at-risk samples at 15.7%. Important risk factors in community samples included current depression, labor experiences such as interactions with medical staff, as well as a history of psychopathology. In at-risk samples, impactful risk factors included current depression and infant complications. Further research should investigate how attitudes towards pregnancy and childbirth may interact with women's experiences during delivery. Additionally, studies need to begin to evaluate possible long-term effects that these symptoms may have on women and their families.     

Brief report: self-care behaviors of children with type 1 diabetes living in Puerto Rico

OBJECTIVE: To examine self-care behaviors among children and adolescents with type 1 diabetes living in Puerto Rico, to determine the relationship between self-care and demographic variables, and to investigate the utility of the 24-hour recall interview within a Hispanic population. METHOD: Forty-one children (M age = 12.6 years) with type 1 diabetes, and their mothers, were administered the 24-hour recall interview on three separate occasions to assess diabetes-related self-care behaviors. RESULTS: Children reported self-care behaviors that included daily administration of an average of two insulin injections and two blood glucose tests, and consumption of 5.5 meals a day comprised of 52% carbohydrates and 29% fat. Younger age, female gender, longer illness duration, and better metabolic control were associated with higher rates of several self-care behaviors. CONCLUSIONS: Data provide a first look at self-care behaviors of children with type 1 diabetes living in Puerto Rico and suggest the utility of the 24-hour recall interview within this population.     

Brief report: a cognitive behavioral intervention for distressed adolescents with type I diabetes

OBJECTIVE: To examine the impact of a cognitive behavioral intervention for distressed adolescents with Type I diabetes. METHODS: Six youths with elevated levels of anxiety, anger, or diabetes stress received training in cognitive restructuring and problem solving in individual sessions. A multiple baseline design across participants was used. Treatment effectiveness was assessed through measures of anxiety, anger expression, and diabetes stress. RESULTS: Four youths displayed some improvement on one or more variables for which they had elevated levels during baseline, while others showed no impact. CONCLUSIONS: Cognitive behavioral interventions show some promise for distressed youths with Type I diabetes. Individual youths responded to treatment differently. Further research is needed in developing procedures to better meet the needs of youths, improve youth participation, and enhance treatment effectiveness.     

Brief report: the impact of maternal posttraumatic stress disorder symptoms and child gender on risk for persistent posttraumatic stress disorder symptoms in child trauma victims

OBJECTIVE: To longitudinally examine the impact of maternal posttraumatic stress disorder symptoms (PTSS) on child adjustment following a child's traumatic injury, focusing on child gender differences. METHODS: Forty-one child traumatic injury victims aged 8-18 years and their biological mothers were interviewed over two follow-ups (6 weeks and 7 months). Children were administered the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale for Children and Adolescents (CAPS-CA), whereas mothers completed the CAPS. RESULTS: Six weeks post trauma, maternal PTSS were significantly related to PTSS in boys but not in girls. However, at 7 months, maternal PTSS were strongly related to child PTSS in both boys and girls. Significant 6-week maternal distress-child gender interactions suggested that maternal PTSS, especially avoidance, predicted greater 7-month PTSS but that this was primarily because of a significant relationship in females. CONCLUSIONS: Maternal distress was found to negatively impact subsequent child adjustment, particularly in females. These results underscore the importance of considering family-centered interventions for child PTSD, especially in girls.     

Brief report: Cross-cultural replication of an anomalous psychometric pattern in children with type 1 diabetes

OBJECTIVE: To replicate an anomalous psychometric profile previously documented in children with Type 1 diabetes living in the mainland United States with a cross-cultural sample selected from Puerto Rico. METHODS: Ninety-three Spanish-speaking children (M age = 12.8 years) with Type 1 diabetes living in Puerto Rico were administered the Puerto Rican version of the Wechsler Intelligence Scale for Children-Revised (WISC-R). The factor structure of the Puerto Rican sample's WISC-R was then compared to that of a United States sample (n = 95) in which an anomalous factor structure in children with diabetes was first documented. RESULTS: As in the United States sample, a four-factor IQ structure was obtained. Instead of the traditional three-factor structure of the WISC-R, the Perceptual Organization factor split into a Spatial Conceptual factor and an anomalous Visual Discrimination factor. CONCLUSIONS: Results support previous findings and suggest anomalies in the psychometric profiles of children with Type 1 diabetes. Cross-cultural replication of the anomalous IQ factor structure, and atypical visual discrimination, suggests that differences are illness-related, and consideration may therefore be warranted when administering some subtests of the Wechsler scales to children with Type 1 diabetes.     

Family resources and stress: a comparison of families of children with cystic fibrosis, diabetes, and mental retardation.

Assessed patterns of stress in families of children with pediatric conditions that varied on 2 dimensions: (a) fatal vs. nonfatal outcome and (b) presence vs. absence of cognitive impairment. Families of children with cystic fibrosis (n = 23), diabetes (n = 24), and moderate mental retardation (n = 24) were compared to families of well children (n = 24) in 3 age groups. Maternal responses to a multidimensional measure of family stress, the Questionnaire on Resources and Stress--Short Form (QRS-S), indicated that families of children with chronic conditions did not differ from families of well children on scales assessing generic aspects of family stress, such as family conflict. However, diagnostic groups differed on QRS-S scales assessing stressors specific to the child's disability (e.g., families of children with mental retardation were characterized by concerns about caring for the child as an adult). There was no evidence of higher levels of stress for families of older children. Data on the internal consistency of QRS-S scales and their relation to measures of maternal and child adjustment are presented.     

Posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in families of adolescent childhood cancer survivors

OBJECTIVE: To describe rates and concordance of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in adolescent childhood cancer survivors and their mothers and fathers. METHOD: Participants were 150 adolescent survivors of childhood cancer, 146 mothers, and 103 fathers who completed the Impact of Events Scale-Revised, the Posttraumatic Stress Disorder Reaction Index, and the PTSD module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. RESULTS: PTSS are common in families of childhood cancer survivors. Parents reported more symptomatology than former patients. Mothers and fathers had relatively equal rates of current PTSD and levels of PTSS. Nearly 30% of mothers met diagnostic criteria since their child's diagnosis, with 13.7% currently experiencing PTSD. Nearly 20% of families had at least one parent with current PTSD. Ninety-nine percent of the sample had at least one family member reexperiencing symptoms. CONCLUSIONS: Both PTSD and PTSS help in understanding the experience of adolescent cancer survivors and their families. Within families of childhood cancer survivors, it is likely that some member may be experiencing treatable bothersome memories, arousal, or avoidance specific to the cancer experience.     

Brief report: speed of information processing in children with insulin-dependent diabetes mellitus

OBJECTIVE: To determine whether children with insulin-dependent diabetes mellitus (IDDM) process information more slowly than children who do not have diabetes. METHODS: We tested 31 children with early onset and longer duration of IDDM, 35 with later onset and briefer duration of IDDM, and 36 comparison children without diabetes. They were administered five tasks requiring rapid responding that assessed a range of cognitive processes. RESULTS: On most tasks, children in the three groups were quite similar in the accuracy and speed of performance. Furthermore, for children in the diabetic groups, disease-related variables were unrelated to accuracy and speed of performance. CONCLUSIONS: The results suggest that children with IDDM do not have a pervasive deficit in speed of information processing, although more circumscribed deficits in processing speed are possible.     

Brief report: psychometric evaluation of the severity of illness scale in a pediatric oncology sample

OBJECTIVE: To examine the psychometric properties of the Severity of Illness Scale (SOIS), a measure that focuses on the medical severity of illness of children with cancer, from the point of view of medical personnel. METHODS: Following pretesting, the SOIS was administered to nurses and physicians of 55 pediatric cancer patients at three time periods: entry into study, 2-week follow-up, and 3-month follow-up. Validity determination included analyses of relapse status and bone marrow transplant. Test utility was determined via a respondent questionnaire. RESULTS: Test-retest reliability coefficients were .96 and .92 for 2-week and 3-month time periods. Interrater reliability, assessed by comparing physician ratings to nurse ratings, was .89. Evidence for criterion-related validity revealed that the SOIS discriminates both bone marrow transplant and relapse status. Physicians and nurses rated the SOIS positively for brevity, ease of completion, and usefulness in depicting medical severity of disease. CONCLUSIONS: There is preliminary evidence for the psychometric utility of the Severity of Illness Scale for a pediatric cancer population. The inclusion of illness parameters in current models of risk and resiliency dictate the need for such a measure.     

Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: a critical review

There is a great deal of research on the prevalence, correlates, and treatment of PTSD in the general population. However, we know very little about the manifestation and consequences of PTSD in more complicated patient populations. The purpose of the current paper is to provide a comprehensive review of PTSD within the context of severe mental illness (SMI; i.e., schizophrenia spectrum disorders, mood disorders). Extant data suggest that trauma and PTSD are highly prevalent among individuals with SMI relative to the general population, and both are associated with adverse clinical functioning and increased healthcare burden. However, trauma and PTSD remain overlooked in this population, with low recognition rates in public-sector settings. Additionally, there are few data on the clinical course and treatment of PTSD among individuals with SMI. Particularly lacking are longitudinal studies, randomized controlled treatment trials, and studies using ethno-racially diverse samples. Furthermore, there is a need to better understand the interplay between trauma, PTSD, and severe forms of mental illness and to further develop and disseminate evidence-based PTSD treatments in this population. The current state of the literature and future directions for practice are discussed.     

Trajectories of adjustment in mothers of children with newly diagnosed cancer: a natural history investigation

OBJECTIVES: The objectives of this study were (a) to assess negative affectivity and posttraumatic symptomatology in mothers following the diagnosis of cancer in their children; (b) to examine sociodemographic and psychosocial variables associated with change in distress over time; and (c) to identify distinct subgroups of mothers whose patterns and trajectories of adjustment can be distinguished according to available predictor data. METHODS: Two hundred and twelve mothers at seven sites were assessed just following their child's diagnosis, and again 3 months and 6 months later. Primary outcomes included measures of mood disturbance, depressive symptoms, and symptoms of posttraumatic stress. RESULTS: Overall, mothers demonstrated a pattern of mildly elevated negative affectivity and posttraumatic symptomatology initially, with steady improvements evident at 3- and 6-month follow-up. Distinct adjustment trajectories were evident within the sample as a whole, indicating subgroups of mothers with high-declining, moderate-stable, and low-stable distress levels. CONCLUSIONS: These findings highlight considerable resilience among mothers facing the stress of childhood cancer. Intervention efforts aimed at reducing maternal distress might best be targeted towards the subgroup of mothers who may be predicted to exhibit the highest level of distress.     

Brief report: Parental perceptions of child vulnerability in children with chronic illness

OBJECTIVE: To determine the extent to which parental perceptions of child vulnerability predict school and social adjustment in children with chronic illness. METHODS: Sixty-nine child-parent dyads were recruited from pediatric rheumatology and pulmonary clinics. Parents completed a self-report measure of parental perceptions of child vulnerability. Children completed measures of social adjustment. Parents also provided written permission to obtain school attendance records. Physicians provided a global assessment of children's disease severity. RESULTS: Increased parental perceptions of child vulnerability were related to increased social anxiety in children, even after controlling for child age and disease severity. Lower levels of parental education related to both increased perceptions of child vulnerability and increased school absences. CONCLUSIONS: Health providers should assess parental beliefs and parenting practices in assessing the adjustment of children with chronic illness. Moreover, interventions aimed at enhancing child adjustment to chronic illness might best target parents as well as children.     

Maternal parenting style and adjustment in adolescents with type I diabetes

OBJECTIVE: To investigate the cross-sectional relationship between maternal parenting style and indicators of well-being among adolescents with diabetes. METHODS: Seventy-eight adolescents (ages 11.58-17.42 years, M = 14.21) with type 1 diabetes and their mothers separately reported perceptions of maternal parenting style. Adolescents reported their own depressed mood, self-efficacy for managing diabetes, and diabetes regimen adherence. RESULTS: Adolescents' perceptions of maternal psychological control were associated with greater depressed mood regardless of age and gender. Firm control was strongly associated with greater depressed mood and poorer self-efficacy among older adolescents, less strongly among younger adolescents. Adolescents' perceptions of maternal acceptance were associated with less depressed mood, particularly for girls and with better self-efficacy for diabetes management, particularly for older adolescents and girls. Maternal reports of acceptance were associated only with adherence. CONCLUSIONS: Maternal parenting style is associated with well-being in adolescents with diabetes, but this association is complex and moderated by age and gender.     

Brief report: family-based group intervention for young siblings of children with chronic illness and developmental disability

OBJECTIVE: To evaluate the impact of a family-based group intervention for young siblings of children with chronic illness and developmental disability (CI/DD). METHODS: Forty-three healthy siblings (ages 4-7 years) of children with CI/DD and their parents participated in an intervention designed to address sibling challenges that cut across types of diagnostic conditions. The intervention consisted of six sessions of collateral and integrated sibling-parent groups. Measures of sibling knowledge, sibling sense of connectedness with other children in similar family circumstances, and sibling global functioning were collected before and after intervention. A subsample of 17 families completed a 3-month follow-up. RESULTS: Siblings' knowledge of the child's disorder and sibling connectedness increased significantly from pre- to posttreatment for both boys and girls, regardless of the nature of the brother or sister's condition. Sibling perceptions of self-competence increased from pre- to posttreatment, whereas parent reports of sibling behavioral functioning remained within the normal range. Improvements in sibling knowledge and connectedness maintained at follow-up. Parent satisfaction with the program was high. CONCLUSIONS: Results support more controlled evaluations of family-based intervention to improve young sibling adaptation to CI/DD.     

Brief report: the relationship between chronic illness and identification and management of psychosocial problems in pediatric primary care

OBJECTIVE: To compare identification, management, and barriers to treatment for psychosocial concerns in children with and without a chronic illness. METHODS: Using data from the Child Behavior Study (CBS), provider rates of identification, treatment, and reports of barriers to treatment were compared in children with and without a chronic illness. Of the 21,065 children ranging in age from 4 to 15 years, 808 children were identified with a chronic illness and were matched on eight demographic variables with 763 healthy children. RESULTS: Providers identified psychosocial concerns in significantly more children with a chronic illness (36.8%) than healthy children (20.2%). Among children with psychosocial concerns, rates of identification, treatment, and barriers to treatment did not differ across the two groups. CONCLUSIONS: Chronic illness did not present more barriers to the management of psychosocial concerns. Increased rates of identification and treatment of psychosocial concerns require attention to general barriers to treatment and screening.