Prospective Evaluation of Parent Distress Following Pediatric Burns and Identification of Risk Factors for Young Child and Parent Posttraumatic Stress Disorder

Abstract

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.