Parenting Stress Symptoms Research Articles

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

Increasing literature suggests the need to explore for post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in parents and caregivers of children with acute and chronic illnesses but scant data are available on epilepsy. The aim of the present study was to estimate full and partial PTSD rates among parents of children with epilepsy comparing DSM-5 and DSM-IV-TR criteria. Further, the aim of the present study was to examine possible gender differences between mothers and fathers. Results showed 9.1% and 12.1% PTSD rates in the total sample, according to DSM-5 or DSM-IV-TR criteria, respectively, with an overall consistency of 92.9% (Kohen's K=0.628, p=.453). Significant gender differences emerged for Avoidance/Numbing and Hyperarousal symptoms diagnosed by means of DSM-IV-TR criteria, as well as for Negative alterations in cognitions/mood and Hyperarousal symptoms, when adopting DSM-5 criteria. This study underscores the relevance of detecting PTSD in parents of children with a chronic illness such as epilepsy.

Prevalence and predictors of posttraumatic stress symptoms in parents of children with ongoing treatment for cancer in South China: a multi-centered cross-sectional study

Parents of children with ongoing cancer treatment are exposed to risks of developing posttraumatic stress symptoms (PTSS), but little is known about the prevalence and predictors of PTSS among Chinese parents of children with cancer. This study aimed to examine the predictors of PTSS, and explored the correlation of depression, resilience, and family functions with severe PTSS. This cross-sectional survey was conducted from May 2014 to September 2015 among the parents of cancer children treated in four general hospitals in South China. PTSS in the parents were measured using post-traumatic stress checklist-civilian version (PCL-C). Multiple regression analyses were performed to evaluate the predictive values of depression, resilience, family functioning, and the demographic variables for severe PTSS. A total of 279 parents (192 mothers and 87 fathers) participated in the survey. Severe PTSS, as defined by a PCL-C score ≥50, were reported in 32.97% (n=92) of the total participants, 26.44% (23/87) in the fathers and 35.94% (69/192) in the mothers. The level of PTSS was positively correlated with depression (r=0.782, P<0.01) and a poor general family function (r=0.325, P<0.01) and negatively correlated with resilience (r=-0.236, P<0.01). Multivariate analyses indicated that depression, general family function, gender, and education level were significant predictive factors of severe PTSS in the overall parents, accounting for 64.2% of the variance in the prediction of PTSS (R 2=0.642, F=122.602, P=0.000). For the mothers, depression and family function accounted for 66.5% of the variance in the prediction of PTSS (R 2=0.665, F=187.451, P=0.000); for the fathers, depression and educational level accounted for 58.8% of the variance in the prediction of PTSS (R 2=0.588, F=59.829, P=0.000). Parents, especially the mothers, of children with ongoing treatment for cancer are at risk of developing PTSS. Supportive psychological interventions to attenuate the negative emotions of the parents and improve their family functions are important means to promote their natural protective mechanisms to cope with the stressful events.

Early Traumatic Stress Responses in Parents Following a Serious Illness in Their Child: A Systematic Review.

A systematic review of the literature investigating the early traumatic stress responses in parents of children diagnosed with a serious illness/injury. A literature review was conducted (September 2013) using Medline, PsycINFO, and CINAHL databases. Twenty-four studies related to parents of children hospitalized due to diagnosis of cancer, type 1 diabetes, meningococcal disease, trauma or serious injury, preterm birth and other serious illnesses requiring admission to intensive care were included. Parents were assessed for early traumatic stress symptoms within 3 months of their child's diagnosis/hospitalization. Prevalence rates of acute stress disorder in parents ranged from 12 to 63%. Prevalence of posttraumatic stress disorder ranged from 8 to 68%. Variability was related to methodological factors including differences in study design, timing of assessments, measurement tools, and scoring protocols. Psychosocial factors rather than medical factors predicted parent distress. This review integrates and compares early traumatic reactions in parents with children suffering a range of serious illnesses. Findings suggest a high prevalence of acute and posttraumatic stress symptoms in parents. Methodological inconsistencies made comparison of early traumatic stress prevalence rates difficult. Risk factors associated with traumatic stress symptoms were identified.

Stress, Psychosocial Mediators, and Cognitive Mediators in Parents of Child Cancer Patients and Cancer Survivors: Attention and Working Memory Pathway Perspectives

Objective: This review examines stress and its consequences on attention and working memory, stress symptoms in parents of child cancer patients and survivors and long-term consequences of stress on cognitive processing in parents of child cancer survivors. Method: Eligible studies were experimental, meta-analyses, and qualitative (2000–2013) from Pubmed, Medline, the Cochrane Library, PsycArticles, and Google Scholar. Results: We identified 92 eligible papers. They showed that elevated stress can impede performances on tasks requiring attention and memory patterns. In pediatric oncology, parental stress increased shortly after diagnosis involving depression and anxiety. Consequences of stress on cognitive performances were observed mainly among depressed individuals. As regards parents of child cancer survivors, female gender, low Socioeconomic Status (SES), and innate traits of anxiety/anger predicted the development of PTSS. Conclusion: Evidence of stress on attention and working memory processes in parents of child cancer survivors is insufficiently developed.

Parent distress reactions following a serious illness or injury in their child: a protocol paper for the take a Breath Cohort Study.

BackgroundDiagnosis of life threatening childhood illness or injury can lead to significant distress reactions in parents, with many experiencing clinically significant levels of post-traumatic stress symptoms. These symptoms can have long-term adverse impacts on parent mental health, family functioning, and the adjustment of the ill child. Independent studies have found such reactions in several different illness groups. However, very little research has systematically compared the prevalence, impact and trajectories over time of post-traumatic stress symptoms in parents across different childhood illness groups with an acute life threat. The current study seeks to map the course of post-traumatic stress reactions in parents of children with various life threatening illnesses over an 18 month period, and identify factors that predict successful adaptation in families.Method/DesignThe current study described is of a prospective, longitudinal design. The sample included parents of children admitted to four major hospital departments at the Royal Children’s Hospital, Melbourne, Australia, for a life threatening illness or injury. Eligible parents were those who were caregivers of children aged 0-to 18-years admitted to the Oncology, Cardiology, Neurology and Pediatric Intensive Care Unit. Parents were recruited acutely, and completed self-report questionnaires at four time-points: within the first 4 weeks (T1:); then at 4 months (T2); 7 months (T3); and 19 months (T4) after admission. Questionnaires assessed parent and child mental health and wellbeing, and a number of risk and reliance factors such child illness factors, parent demographic factors, and psychosocial factors.DiscussionThis study is one of the first to document the trajectory of post-traumatic stress responses in parents of very ill children, across illness groups. Given that it will also identify risk and resilience factors, and map the course of parent outcomes over an 18 monthperiod, it has the potential to inform novel strategies for intervention.

Tėvų, auginančių onkologine liga sergančius vaikus, potrauminio streso simptomai: sisteminė literatūros apžvalga

Diagnosis of childhood cancer is one of the strongest, most devastating and affecting experiences taken into consideration by parents. It is commonly accepted that a message about a child’s life-threatening disease might develop a post-traumatic stress disorder (PTSD) or post-traumatic stress symptoms (PTSS). The aim of the research: to select and review publications related with post-traumatic stress symptoms, which affect parents, who have children with oncological diseases. Methodology: a systematic review. Results: the systematic review revealed the variety of valuation techniques used in scientific researches. The articles included in the systematic analysis show that post-traumatic stress symptoms are mostly evaluated according to the impact of event scale (IES-R) and PTSD checklist – civil version (PCL-C). Despite the benefits of longitudinal researches mentioned in many articles, many models are still based on the instantaneous tracking study. As per results of the systematic review, there is a wide range of factors that can affect the development of post-traumatic stress symptoms in parents who have children with oncological diseases. These are socio-demographic factors associated with the specifics of treatment, emotional state of children, traumatic experience and the coping strategies of parents, relationship between parents and children, etc. The cultural context is also important when analysing factors that might affect the development of PTSS. In order to help the parents who have children with oncological diseases function better, it is crucial to study the post-traumatic stress symptoms that occur as well as predisposed and protecting factors.

Does time heal all wounds? A longitudinal study of the development of posttraumatic stress symptoms in parents of survivors of childhood cancer and bereaved parents.

BackgroundA lack of longitudinal studies has hampered the understanding of the development of posttraumatic stress symptoms (PTSS) in parents of children diagnosed with cancer. This study examines level of PTSS and prevalence of posttraumatic stress disorder (PTSD) from shortly after diagnosis up to 5 years after end of treatment or child's death, in mothers and fathers.MethodsA design with seven assessments (T1–T7) was used. T1–T3 were administered during treatment and T4–T7 after end of treatment or child's death. Parents (N = 259 at T1; n = 169 at T7) completed the PTSD Checklist Civilian Version. Latent growth curve modeling was used to analyze the development of PTSS.ResultsA consistent decline in PTSS occurred during the first months after diagnosis; thereafter the decline abated, and from 3 months after end of treatment only minimal decline occurred. Five years after end of treatment, 19% of mothers and 8% of fathers of survivors reported partial PTSD. Among bereaved parents, corresponding figures were 20% for mothers and 35% for fathers, 5 years after the child's death.ConclusionsFrom 3 months after end of treatment the level of PTSS is stable. Mothers and bereaved parents are at particular risk for PTSD. The results are the first to describe the development of PTSS in parents of children diagnosed with cancer, illustrate that end of treatment is a period of vulnerability, and that a subgroup reports PTSD 5 years after end of treatment or child's death. © 2015 The Authors. Psycho‐Oncology published by John Wiley & Sons Ltd.

Family Adjustment and Parenting Stress When an Infant Has Serious Liver Disease

Parenting stress, problems in family functioning, and lack of fathers' engagement in treatment are associated with poor quality of life in children with chronic illnesses. The aim of the present study was to examine these characteristics in families of infants with serious liver disease in Australia, to inform the provision of mental health care for these families. From September 2009 to May 2013, 42 parents of infants recently diagnosed as having serious liver disease (defined as liver disease that may require transplantation in the future) completed questionnaires about family function, impact of the infant's illness on the family, parent stress symptoms, and fathers' engagement in the care of the child. Participants were recruited from 4 metropolitan children's hospitals in Australia. Parents reported psychological symptoms at similar rates to normative populations. Their reports of family functioning were significantly below mean scores in previously published populations with a medically ill family member (population mean 1.89; mothers mean 1.59; fathers mean 1.61, P < 0.001). Disruption to family roles was significantly correlated with psychological symptoms for mothers (r = 0.48, P < 0.01) and fathers (r = 0.31, P < 0.05). Greater helpfulness of fathers was correlated with lower depression in mothers (r = -0.35, P < 0.05), and fathers' anxiety was correlated with their increased engagement (r = 0.40, P < 0.01). When parents report the presence of psychological symptoms, symptoms are likely to be present in both parents and are associated with difficulties adjusting to disrupted family roles. Father engagement may be protective of mothers' mental health.

Coping and Well-Being in Parents of Children with Autism Spectrum Disorders (ASD).

This study examined psychological well-being and coping in parents of children with ASD and parents of typically developing children. 73 parents of children with ASD and 63 parents of typically developing children completed a survey. Parents of children with ASD reported significantly more parenting stress symptoms (i.e., negative parental self-views, lower satisfaction with parent-child bond, and experiences of difficult child behaviors), more depression symptoms, and more frequent use of Active Avoidance coping, than parents of typically developing children. Parents of children with ASD did not differ significantly in psychological well-being and coping when compared as according to child's diagnosis. Study results reinforced the importance of addressing well-being and coping needs of parents of children with ASD.

Parental Symptoms of Posttraumatic Stress After Pediatric Extracorporeal Membrane Oxygenation*

To investigate the prevalence of posttraumatic stress symptoms in parents of children who have been supported on extracorporeal membrane oxygenation and to explore associated factors. Descriptive cross-sectional study. A specialist pediatric tertiary center in the United Kingdom. Parents (n = 52) of children who had been supported with extracorporeal membrane oxygenation at least 6 months previously. None. Self-reported questionnaires were completed measuring posttraumatic stress symptom, family functioning, depression, anxiety, and demographic variables. Approximately 20% of parents experienced posttraumatic stress symptoms at levels suggestive of a diagnosis of posttraumatic stress disorder, irrespective of the time that had elapsed since extracorporeal membrane oxygenation. Although having a child who had ongoing illness before extracorporeal membrane oxygenation was associated with avoidance posttraumatic stress symptoms, results suggest that other previously identified risk factors, such as gender and family functioning, may not be risk factors for posttraumatic stress symptom in this population. A substantial number of parents in this population experience posttraumatic stress symptom. Psychological interventions may be targeted toward those whose child has had ongoing illness before extracorporeal membrane oxygenation.

Posttraumatic Stress Symptoms in Parents of Pediatric Cancer Patients: A Mediational Analysis.

Prior research finds that anxiety and depression among parents of pediatric cancer patients are associated with posttraumatic stress symptoms in response to children's cancer. This study examined whether this relationship is mediated by parents' negative affective reactions in response to their children's cancer-related treatment procedures. Participants were parents of 101 patients within six months of diagnosis who had completed at least two treatment-related procedures. Parents completed measures of trait anxiety and depression at baseline and posttraumatic stress symptoms at 3-month follow-up assessment. On the day of each treatment procedure, parents completed measures of state anxiety immediately before and negative mood and distress immediately after the procedure. Trait anxiety was positively associated with state anxiety immediately before procedures and negative mood after procedures. Depression was positively associated with state anxiety immediately before procedures and negative mood and distress after procedures. Both trait anxiety and depression were positively associated with posttraumatic stress symptoms at 3-months follow-up. Parent state anxiety, negative mood, and distress partially mediated the effects of trait anxiety and/or depression on posttraumatic stress symptoms. Controlling for child age and social desirability did not affect these relationships. Parents' trait anxiety and depression may influence cancer-related posttraumatic stress partially through their effect on parents' negative affective reactions at the time of their child's treatment procedures. These findings provide a more nuanced understanding of how parents' affect in response to procedures contributes to parent posttraumatic stress and suggest that interventions targeting treatment-related affective reactions of parents with high trait anxiety and/or depression may reduce the risk for longer-term distress and posttraumatic stress symptoms.

"Posttraumatic stress symptoms in parents of children with cancer within six months of diagnosis": Correction to Dunn et al. (2012).

"Posttraumatic stress symptoms in parents of children with cancer within six months of diagnosis": Correction to Dunn et al. (2012).

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.

Objective and subjective factors as predictors of post-traumatic stress symptoms in parents of children with cancer--a longitudinal study.

BackgroundParents of children with cancer report post-traumatic stress symptoms (PTSS) years after the child's successful treatment is completed. The aim of the present study was to analyze a number of objective and subjective childhood cancer-related factors as predictors of parental PTSS.MethodsData were collected from 224 parents during and after their child's cancer treatment. Data sources include self-report questionnaires and medical records.ResultsIn a multivariate hierarchical model death of the child, parent's perception of child psychological distress and total symptom burden predicted higher levels of PTSS. In addition, immigrants and unemployed parents reported higher levels of PTSS. The following factors did not predict PTSS: parent gender, family income, previous trauma, child's prognosis, treatment intensity, non-fatal relapse, and parent's satisfaction with the child's care.ConclusionsAlthough medical complications can be temporarily stressful, a parent's perception of the child's distress is a more powerful predictor of parental PTSS. The vulnerability of unemployed parents and immigrants should be acknowledged. In addition, findings highlight that the death of a child is as traumatic as could be expected.

Posttraumatic stress symptoms in parents of children with cancer within six months of diagnosis.

To investigate levels and correlates of posttraumatic stress symptoms (PTSS) in mothers and fathers of children and youth with cancer. Mothers (n = 191) and fathers (n = 95), representing 195 families of children and youth with cancer, completed measures of PTSS (Impact of Event Scale-Revised), depression (Beck Depression Inventory-II), and anxiety (Beck Anxiety Inventory) between 2 and 22 weeks after their child's cancer diagnosis or recurrence of initial diagnosis. Substantial subgroups of mothers (41%) and fathers (30%) reported levels of PTSS that exceeded cut-offs for elevated symptoms, and these subgroups of parents were characterized by heightened symptoms of depression and anxiety. Fathers of children and youth treated for relapse reported higher rates of elevated PTSS than fathers of children and youth treated for first-time diagnosis, but mothers' rates were similar. Mothers and fathers reported comparable mean levels of PTSS that were strongly positively correlated with symptoms of anxiety and depression. PTSS and other symptoms of distress were negatively related to education level for fathers. These findings provide additional evidence that mothers and fathers experience substantial PTSS near the time of their child or adolescent's cancer diagnosis during the first 6 months of treatment. Results suggest that PTSS may be part of a broader pattern of emotional distress and that a substantial portion of both mothers and fathers of children and youth with cancer may be in need of supportive mental health services within the first 6 months of their child's diagnosis.

A Pilot Study of Acute Stress Symptoms in Parents and Youth Following Diagnosis of Type I Diabetes

The primary aims of this exploratory study were to determine the rate of occurrence of acute stress disorder (ASD) in children newly diagnosed with Type 1 diabetes and their parents, to examine relationships with demographic and psychosocial factors, and to examine the relationships between ASD symptom clusters and early adherence behavior (clinic attendance). The sample consisted of 102 parents of children ages 0-17 years and 40 youth ages 11-17 who were evaluated within three days of diabetes diagnosis. Eighteen percent of parents and 17% of youth reported subthreshold symptoms of ASD. Acute stress symptoms and demographic variables predicted clinic attendance, with a differential pattern evident in the responses of youth and their parents. These findings reinforce the importance of screening symptoms of ASD in youth with newly diagnosed diabetes and their parents to assist in identifying families who may be in need of additional support.

Parental Response to Child Injury: Examination of Parental Posttraumatic Stress Symptom Trajectories Following Child Accidental Injury

Trajectory analyses were used to empirically differentiate patterns of posttraumatic stress symptoms in parents following child accidental injury and explore the relationship between parent and child recovery patterns. Parent (n = 189) self-reported symptoms from acute to 2 years post accident were examined to (1) identify distinct parent symptom trajectories; (2) identify risk factors; and (3) explore the patterns of children and parents together. Analysis revealed three distinct symptom trajectory groups for parents: resilient (78%); clinical level acute symptoms that declined to below clinical level by 6 months (recovery 8%); and chronic subclinical (14%). Children of resilient parents were most likely to be resilient. Half of the children of parents with chronic subclinical trajectories were likely to have chronic trajectories. Clinicians cannot rely only on clinical level symptoms in parents to identify high risk families but include families where the parent has subclinical level symptoms.

Parenting Stress in Pediatric Oncology Populations

The experience of childhood cancer can be one of the most severe stressors that parents endure. Studies using illness-specific measures of parental stress indicate that moderate-to-severe parenting stress is quite common in the first year of childhood cancer treatment, and as many as 5% to 10% of these parents go on to develop posttraumatic stress disorder. This review of the literature suggested that although parenting stress symptoms may be relatively transitory for most parents dealing with childhood cancer, the impact of these stress symptoms on parent and child functioning is substantive and worthy of therapeutic attention. The stresses entailed in childhood cancer should be viewed as complex and varied across stages of diagnosis and treatment. Factors associated with increased risk of parental posttraumatic stress symptoms include poor social support, adverse experience with invasive procedures, negative parental beliefs about the child's illness and/or associated treatment, and trait anxiety. For those parents with risk factors that might forebode more severe and enduring stress reactions to their children's cancer, therapeutic strategies are proposed to ameliorate their stress and reduce the development and/or maintenance of posttraumatic stress symptoms.

Posttraumatic Stress Symptoms in Parents of Children with Acute Burns

To develop a model of risk factors for posttraumatic stress disorder (PTSD) symptoms in parents of children with burns. Immediately following the burn and 3 months later, parents reported on their children's and their own psychological functioning and traumatic stress responses. Approximately 47% of the parents reported experiencing significant posttraumatic stress symptoms 3 months after the burn. Our model indicates three independent pathways to PTSD symptoms (i.e., parent-child conflict, parents' dissociation, and children's PTSD symptoms). Additionally, parents' anxiety predicted increased parent-child conflict, conflict with extended family and size of the burn predicted parents' dissociation, and size of the burn and children's dissociation predicted children's PTSD symptoms. This study suggests that many parents of children with burns suffer from posttraumatic stress symptoms. Interventions that target factors such as family conflict, children's symptoms, and parents' acute anxiety and dissociation may diminish the risk for PTSD.

Patterns of Posttraumatic Stress Symptoms in Parents of Childhood Cancer Survivors.

Posttraumatic stress (PTS) symptoms have been reported in mothers and fathers of childhood cancer survivors; however, little is known about patterns of PTS in these families. Cluster analysis was applied to the Posttraumatic Stress Disorder (PTSD) Reaction Index scores of 98 couples parenting adolescent childhood cancer survivors to describe patterns of PTS in families, yielding the following 5 clusters: Minimal PTS, Mothers Elevated, Disengaged, Fathers Elevated, and Elevated PTS. The clusters were validated using data from a structured psychiatric interview, an additional self-report measure of PTS, and an index of family functioning. These clinically meaningful patterns reveal that a majority of families had at least one parent with moderate to severe PTS, which supports development of family-based interventions for this population.