Posttraumatic Stress in Parents of Hospitalized Children With Medical Complexity.

Post-traumatic stress disorder and post-traumatic stress symptoms in parents of children with cancer: A review

Previous studies consistently found remarkable prevalence rates of posttraumatic stress symptoms (PTSS) and posttraumatic stress disorders (PTSD) in pediatric patients and their parents. Findings suggest a significant association between child and parent PTSS. The present study examined, in a sample of pediatric patients with different conditions, incidence rates and determinants of PTSS and PTSD in the patients, and their mothers and fathers. Also, associations of maternal, paternal and child PTSS and PTSD were analyzed. Two hundred and nine children (aged 6.5-14.5 years) were interviewed 5-6 weeks after an accident or a new diagnosis of cancer or diabetes mellitus type 1 by means of the Child PTSD Reaction Index. Their mothers (n = 180) and fathers (n = 175) were assessed with the Posttraumatic Diagnostic Scale. Children reported PTSS levels in the mild range. Sixteen percent of the fathers and 23.9% of the mothers met full DSM-IV diagnostic criteria for current PTSD. Type of trauma impacted differently on parents and children. In children, accident-related injury was associated with higher PTSS scores. Conversely, in parents, diagnosis of cancer in their child was associated with more symptoms. Functional status of the child was also found to be an important predictor of PTSS in children and parents. PTSS scores of mothers and fathers were significantly correlated with each other. However, child PTSS were not significantly related to PTSS of mothers and fathers. This was true for total scores as well as for DSM-IV symptom clusters. There is a need for careful evaluation of PTSS and PTSD in pediatric patients with accidental injuries or sudden onset of severe chronic diseases and in their respective parents. Importantly, children, their mothers, and their fathers should be assessed separately, because a significant association between child and parental PTSS may not exist.

Adjustment after pediatric burn injury may be a challenge for children as well as their parents. This prospective study examined associations of internalizing and externalizing problems in children and adolescents 12 months postburn with preburn functioning, and parental acute and chronic posttraumatic stress symptoms (PTSS) from different perspectives. Child, mother, and father reports of 90 children (9–18 years), collected within the first month and 12 months postburn, were analyzed. Results indicated that overall, child and parental appraisals of pre- and postburn behavioral problems were not significantly different from reference data. Rates of (sub)clinical postburn behavioral problems ranged from 6 to 17 %, depending on the informant. Pre- and postburn behavioral problems were significantly related, but only from the parents’ perspective. Path models showed an association between parental PTSS 12 months postburn and parental reports of child internalizing problems, as well as a significant indirect relationship from parental acute stress symptoms via PTSS 12 months postburn. Notably, no associations between parental PTSS and child reports of postburn behavioral problems were found. In conclusion, parental observations of child externalizing problems appear to be influenced by their perspectives on the child’s preburn functioning, while parental observations of internalizing problems are also related to long-term parental PTSS. However, these factors seem of no great value in predicting behavioral problems from the child’s perspective, suggesting substantial informant deviations. To optimize adjustment, clinical burn practice is recommended to adopt a family perspective including parent perception of preburn functioning and parental PTSS in assessment and intervention.

Our systematic review aimed to investigate the prevalence of post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) among parents within 12 months of their child's burn injury. A literature search was conducted in PubMed, Embase, Web of Science, Psychinfo, and CINAHL on January 6, 2023, for quantitative studies reporting the prevalence of PTSD and/or PTSS in parents within 12 months following their child's burn injury. The risk of bias was assessed using the Mixed Methods Appraisal Tool version 2018. A narrative synthesis of prevalence was presented. We identified 15 articles that met our inclusion criteria. The prevalence of PTSS within 12 months following the burn injury ranged from 6% to 49%. Prevalence estimates of PTSD within the 12 months following a burn injury were limited, ranging from 4.4% to 22%. Our findings highlight the significant impact of burn injuries on parental mental health, with a considerable proportion of parents experiencing PTSS within 12 months following their child's burn injury. Prevalence estimates for PTSD were limited and warrant further investigation. Our review also underscores the need for standardization of PTSS/PTSD terminology. Timely and targeted psychological support is needed for parents in the aftermath of their child's burn injury.

To examine relationships amongst parental post-traumatic stress symptoms, parental post-traumatic growth, overprotective parenting, and child emotional/behavioural problems in families of children with critical CHD. Sixty parents (15 fathers) of children aged 1-6 completed online questionnaires assessing parental post-traumatic stress symptoms and post-traumatic growth, overprotective parenting, and child emotional/behavioural problems. Bivariate correlations and mediational analyses were conducted to evaluate overprotective parenting as a mediator of the association between parental post-traumatic stress symptoms and child emotional/behavioural problems. Parents reported significant post-traumatic stress symptoms, with over 18% meeting criteria for post-traumatic stress disorder and 70% meeting criteria in one or more clusters. Parental post-traumatic growth was positively correlated with intrusion (r = .32, p = .01) but it was not associated with other post-traumatic stress symptom clusters. Parental post-traumatic stress symptoms were positively associated with overprotective parenting (r = .37, p = .008) and total child emotional/behavioural problems (r = .29, p = .037). Overprotective parenting was positively associated with total child emotional/behavioural problems (r = .45, p = .001) and fully mediated the relationship between parental post-traumatic stress symptoms and child emotional/behavioural problems. Overprotective parenting mediates the relationship between parental post-traumatic stress symptoms and child emotional and behavioural problems in families of children with CHD. Both parental post-traumatic stress symptoms and overprotective parenting may be modifiable risk factors for poor child outcomes. This study highlights the need for interventions to prevent or reduce parental post-traumatic stress symptoms and to promote effective parenting following a diagnosis of CHD.

The objective of this study is to examine the relation between parental coping style and the risk of parental and child posttraumatic stress symptoms (PTSS) among pediatric cancer survivors. Child survivors of cancer ranging from 6 to 16 years of age (N = 111) completed standardized measures of depression and PTSS, while their parents completed standardized measures of PTSS and coping styles. Correlational analyses revealed that active and passive coping strategies were positively related to parental PTSS. Although child and parental PTSS were significantly related to each other, only one parental coping strategy-using substances-was significantly related to child PTSS. Regression analyses revealed support for a mediation and not for a moderation model for this relation, thereby suggesting that the relation between parental and child PTSS is mediated by parental substance use. Clinical implications including identifying risk factors for PTSS among pediatric cancer survivors are discussed.

DSM-5 criteria for PTSD in parents of pediatric patients with epilepsy: What are the changes with respect to DSM-IV-TR?

Previous research suggests that the birth of a preterm child with very low birth weight (VLBW; <1,500 g) can be traumatic for both parents and lead to short-term consequences like clinical levels of posttraumatic stress symptoms (PTSS) or even to the development of a Posttraumatic Stress Disorder (PTSD). However, little is known about possible mid- and long-term psychological consequences in affected parents. The purpose of this study were (a) to examine the prevalence of parental birth-related PTSS and PTSD in a group of parents with VLBW preterm infants compared to parents of full-term infants 5 years after birth and (b) to investigate potential associations with risk factors for parental PTSS at 5 years postpartum. Perinatal factors (VLBW preterm or term, perceived stress during birth), psychological factors (perceived social support and PTSS 4–6 weeks postpartum, psychiatric lifetime diagnosis) and sociodemographic characteristics (number of children, singleton or multiple birth, socio-economic status), were included in the analysis. The sample consisted of 144 families (77 VLBW, 67 term birth) who participated in the prospective longitudinal cohort study “Hamburg study of VLBW and full-term infant development” (HaFEn-study) and were initially recruited at three perinatal care centers in Hamburg, Germany. PTSD prevalence and PTSS of mothers and fathers were assessed with the Impact of Event Scale-Revised (IES-R), social support with the Questionnaire of Social Support (SOZU-K-22), and lifetime psychiatric diagnoses with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). Data were analyzed by hierarchic multiple regression analyses. Results showed that 5 years after birth none of the parents fulfilled the criteria for a birth-related PTSD diagnosis. For mothers, postnatal PTSS and a VLBW preterm birth significantly predicted PTSS 5 years postpartum. For fathers, psychiatric lifetime diagnosis and postnatal PTSS significantly predicted PTSS 5 years after birth. Early identification of parents with higher risk of PTSS, especially after VLBW preterm birth, and their clinical needs seems beneficial to reduce the risk of long-term consequences. More research is needed on the paternal perspective and on potential effects of preterm birth on both parents and their children's mental health outcomes.

Parents of children with severe inborn errors of metabolism frequently face stressful events related to the disease of their child and are consequently at high risk for developing parental posttraumatic stress disorder (PTSD). Assessment and subsequent treatment of PTSD in these parents is however not common in clinical practice. PTSD can be effectively treated by Eye Movement Desensitization and Reprocessing (EMDR), however no studies have been conducted yet regarding the effect of EMDR for parental PTSD. EMDR is generally offered in multiple weekly sessions which may preclude participation of parents as they are generally overburdened by the ongoing and often intensive care for their child. Therefore, we offered time-limited EMDR with a maximum of four sessions over two subsequent days to two parents of mucopolysaccharidosis type III (MPS III) patients to explore its potential effects. Both qualitative and quantitative outcomes were used to evaluate treatment effects. Both parents felt more resilient and competent to face future difficulties related to the disease of their child, and no adverse effects were reported. Quantitative outcomes showed a clinically significant decrease in post traumatic stress symptoms and comorbid psychological distress from pre- to post treatment, and these beneficial effects were maintained at follow-up. In conclusion, time-limited EMDR may be a highly relevant treatment for traumatized parents of children with MPS III, and probably also for parents of children with other rare progressive disorders. Further research is needed to validate the efficacy of EMDR in this specific population.

This study examined the association between parent and child reported posttraumatic stress symptoms (PTSS) and parenting stress as well as parent posttraumatic stress disorder (PTSD), parent depression and child PTSS as predictors of parenting stress. Forty-three children ages 8–12 years and their parents/guardians participated. Semi-structured interviews occurred independently with parents and children about child PTSS. Parents completed a self-report parenting stress measure and participated in interviews about their PTSD and depression. There was a moderate association between parent and child reported PTSS, and there was a stronger association between parent-reported PTSS and parenting stress than child-reported PTSS. Parent depression and parent-reported PTSS predicted parenting distress; whereas parent-reported PTSS predicted parenting stress related to parent–child dysfunctional interaction and difficult child behavior. Results suggest clinicians working with children exposed to trauma need to assess both parent and child reports of child PTSS, as well as parent symptomology and parenting stress.

Various studies have highlighted the increased incidence and symptoms of depression and anxiety in paediatric cancer survivors (PCS). Yet no meta-analysis has focused on post-traumatic stress disorder (PTSD) or post-traumatic stress symptoms (PTSS) in PCS and their family nucleus. To evaluate the overall risk of PTSD and severity of PTSS in PCS and their family nucleus. Secondary objectives include identifying potential risk factors of PTSD and high PTSS. We systematically searched PubMed, Embase and PsycINFO for studies comparing the risk of PTSD and PTSS severity among PCS, their family nucleus and non-cancer controls. PRISMA reporting guidelines were followed. Random effects meta-analyses and meta-regressions were conducted. From 1089 records, we included 21 studies. PCS have an increased risk of PTSD (risk ratio 2.36, 95% CI 1.37-4.06) and decreased PTSS severity (standardised mean difference -0.29, 95% CI -0.50 to -0.08). Subgroup analyses of other categorical study-level characteristics revealed that female PCS who were older at diagnosis and data collection had a significantly higher risk of PTSD. Meta-regression were insignificant. Family nucleus did not show a significantly increased risk of PTSD (risk ratio 1.13, 95% CI 0.59-5.00) and PTSS severity (standardised mean difference 0.53, 95% CI -0.00 to 1.06). Systematically reviewing studies on the family nucleus found that the majority reported a significantly increased risk of psychological trauma compared with the comparator. Lower education, income and social status were also risk factors. Timely identification and interventions are imperative for policy makers and healthcare providers to prevent trauma from worsening in this population group.

Early childhood is a high-risk time for exposure to potentially traumatic medical events. We have previously reported that 10% of young children continue to have posttraumatic stress disorder (PTSD) 6 months after burn injury. This study aimed to 1) document the prevalence and prospective change in parental psychological distress over 6 months following their child's burn injury and 2) identify risk factors for posttraumatic stress symptoms (PTSS) in young children and their parents. Participants were 120 parents of 1-6-year-old children with unintentional burn injuries. Data were collected within 2 weeks, 1 month, and 6 months of burn injury using developmentally sensitive diagnostic interviews and questionnaires. Within the first month, ∼ 25% of parents had a probable PTSD diagnosis, and moderate to extremely severe levels of depression, anxiety, and stress. Distress levels decreased significantly over time; however, 5% of parents still had probable PTSD at 6 months. Hierarchical multiple regression and path analyses indicated that parent posttraumatic stress reactions contributed significantly to the development and maintenance of child PTSS. Other risk factors for child PTSS included premorbid emotional and behavioral difficulties and larger burn size. Risk factors identified for parent PTSS included prior trauma history, acute distress, greater number of child invasive procedures, guilt, and child PTSS. The findings from this study suggest that parents' responses to a traumatic event may play a particularly important role in a young child's psychological recovery. However, further research is needed to confirm the direction of the relationship between child and parent distress. This study identified variables that could be incorporated into screening tools or targeted by early intervention protocols to prevent the development of persistent child and parent PTSS following medical trauma.

BackgroundPreterm birth and subsequent NICU admission can be a traumatic experience for parents who may subsequently develop post-traumatic stress (PTS) disorder (PTSD). Given that developmental issues are common among children of parents with PTSD, interventions for prevention and treatment are essential.ObjectiveTo assess the most effective non-pharmacological interventions to prevent and/or treat PTS symptoms in parents of preterm newborns.MethodsSystematic review performed in accordance with the PRISMA statements. Eligible articles in English language were searched in MEDLINE, Scopus, and ISI Web of Science databases using the following medical subject headings and terms: “stress disorder, post-traumatic,” “parents,” “mothers,” “fathers,” “infant, newborn,” “intensive care units, neonatal,” and “premature birth.” The terms “preterm birth” and “preterm delivery” were also used. Unpublished data were searched in ClinicalTrials.gov website. All intervention studies published until September 9th, 2022 and including parents of newborns with gestational age at birth (GAb) <37 weeks which underwent ≥1 non-pharmaceutical interventions for prevention and/or treatment of PTS symptoms related to preterm birth were included. Subgroup analyses were conducted by type of intervention. The quality assessment was performed according to the criteria from the RoB-2 and the “NIH Quality Assessment Tool for Before-After studies.”ResultsSixteen thousand six hundred twenty-eight records were identified; finally, 15 articles (1,009 mothers, 44 fathers of infants with GAb ≤ 366/7 weeks) were included for review. A good standard of NICU care (effective as sole intervention: 2/3 studies) and education about PTSD (effective in association with other interventions: 7/8 studies) could be offered to all parents of preterm newborns. The 6-session Treatment Manual is a complex intervention which revealed itself to be effective in one study with low risk of bias. However, the effectiveness of interventions still remains to be definitively established. Interventions could start within 4 weeks after birth and last 2–4 weeks.ConclusionThere is a wide range of interventions targeting PTS symptoms after preterm birth. However, further studies of good quality are needed to better define the effectiveness of each intervention.

The purpose of the study was to describe relationships between uncertainty, anxiety, and symptoms of posttraumatic stress (PTS) in parents of children recently diagnosed with cancer. The study was guided by the Uncertainty in Illness Theory. The setting was a children's hospital. Participants were 15 parents of 12 children recently diagnosed with cancer. Anxiety was measured by the State-Trait Anxiety Inventory. Uncertainty was measured by the Parent Perception of Uncertainty Scale. Symptoms of PTS were measured by the Reaction Index. Total scale scores were calculated and psychometrics estimated. Differences in uncertainty, anxiety, and symptoms of PTS by parent race were assessed using analysis of variance. The correlation matrix was estimated to assess relationships between variables. The level of uncertainty was lower than expected, but was significantly higher for black parents (p < .001). The level of anxiety was comparable to that for hospitalized persons with anxiety disorders. The level of symptoms of PTS was higher than reported for parents of childhood cancer survivors. The relationship between anxiety and symptoms of PTS was significant (r =.56, p < .02). Pediatric oncology nurses should offer parents interventions to relieve high levels of anxiety and symptoms of PTS; some parents could also benefit from interventions that target uncertainty.

Uncertainty, anxiety, and symptoms of posttraumatic stress in parents of children recently diagnosed with cancer