Medically Related Post-traumatic Stress in Children and Adolescents with Congenital Heart Defects.

Maya G Meentken,Ingrid M Van Beynum,Willem A Helbing,Elisabeth M W J Utens,Jeroen S Legerstee

doi:10.3389/fped.2017.00020

Abstract

Children and adolescents with a congenital heart defect (ConHD) frequently undergo painful or frightening medical procedures and hospitalizations. They often need multiple invasive procedures at a very young age and require regular checkups during their entire life. From other pediatric populations, it is known that these kinds of experiences can result in acute stress reactions and even in post-traumatic stress disorder (PTSD) in the long-term. PTSD and also subthreshold PTSD can lead to serious (psychosocial) impairment. However, limited information is available about PTSD in children with ConHD. Therefore, the aim of this review is to provide a summary of the current literature on post-traumatic stress (PTS) in children and adolescents with ConHD describing the prevalence of PTSD and its predictors/correlates. This review indicates that a range of 12–31% of children undergoing cardiac surgery develop PTSD. A range of 12–14% shows elevated post-traumatic stress symptoms (PTSS). These findings are comparable to those of hospitalized children without ConHD. Noteworthy, most studies used varying self-report questionnaires to measure PTSD and only one study used a semistructured interview. Although all studies point in the same direction of elevated PTSD and PTSS, systematic research is necessary to be able to draw firm conclusions. At present, as far as we know, in most clinics treating patients with ConHD, there is no regular screening for PTS in children with ConHD. In the reviewed literature, there is strong consensus that screening for PTSS and (preventive) psychological care for children and adolescents with ConHD is urgently needed.

Highlights

Medical events are often experienced as stressful and frightening
This review aims to give an overview of what is known in the field of medically related post-traumatic stress (PTS) in children and adolescents with congenital heart disease and suggests future directions
We suggest to use the term subthreshold post-traumatic stress disorder (PTSD) as it refers best to patients who do not meet full PTSD criteria, and this term is preferred by the World Health

Summary

INTRODUCTION

Medical events are often experienced as stressful and frightening. Especially in young patients, this can be overwhelming. To meet the diagnostic threshold for PTSD of the DSM-IV, individuals must experience at least one symptom of cluster B, three symptoms of cluster C, and two symptoms of cluster D in reaction to a traumatic event for more than a month. [2] The University of California at Los Angeles post-traumatic Stress Disorder Reaction Index (UCLA PTSD-RI) has a child, adolescent, and parent version. It can be administered verbally (questions are read out loud) or as a self-report (completed on paper). [3] The Impact of Event Scale-Revised (IES-R) [30] is a selfreport instrument to measure subjective distress after a traumatic event This questionnaire has not been developed to diagnose PTSD. PTSS seemed to be present in adolescents with ConHD long after surgery

Design

CONCLUSION AND CLINICAL IMPLICATIONS