Parental Posttraumatic Stress Disorder Research Articles

Anxiety and post-traumatic stress disorder in parents of children born with esophageal atresia

Anxiety and post-traumatic stress disorder in parents of children born with esophageal atresia

Exploring the prevalence of post-traumatic stress disorder and post-traumatic stress symptoms in parents within 12 months of child burn injury: A systematic review.

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. 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 warrants 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.

Effect of tactile and/or kinesthetic stimulation therapy of preterm infants on their parents’ anxiety and depressive symptoms: A systematic review

BackgroundIn the case of preterm birth, the idealized postnatal period is replaced by an anxious and even traumatic experience for parents. Higher prevalence of parental anxiety, postnatal depression, and posttraumatic stress disorder has been observed in mothers of preterm infants up to 18 months after childbirth. There is increasing evidence that proprioceptive stimulation has a beneficial effect on preterms’ short-term outcomes. Could this care also have an impact on parental anxiety and depressive symptoms? We reviewed recent publications on the impact on parents’ anxiety and depressive symptoms of delivering tactile and/or kinesthetic stimulation to their premature newborn.MethodsWe conducted a systematic review by searching the PubMed, PsycInfo, Scopus, ScienceDirect and Google Scholar databases for English-language publications from the past 10 years. We focused on the mothers or fathers of infants born preterm (before 37 weeks of gestation) who provided tactile and/or kinesthetic stimulation to their premature newborn in the neonatal intensive care unit. Relevant outcomes were the parents’ anxiety, stress, depressive symptoms, and symptoms of posttraumatic stress disorder, assessed with reliable standardized inventories.ResultsEleven articles were included in the systematic review. Results suggested a beneficial effect of parents’ early tactile and kinesthetic stimulation of their preterm infants.ConclusionsThese interventions may act as protective factors against the occurrence of anxiety and depressive symptoms in parents and deserve to be studied further in this population.

A Specific, Measurable, Achievable, Relevant, Timed (SMART) Nursing Project Reduces Anxiety, Depression, and Post-Traumatic Stress Disorder in Parents of Childhood or Adolescent Osteosarcoma Patients.

Specific, measurable, achievable, relevant, timed (SMART) principle improves the nursing utility by setting individual goals for participants and helping them to achieve these goals. Our study intended to investigate the impact of a SMART nursing project on reducing mental stress and post-traumatic stress disorder (PTSD) in parents of childhood or adolescent osteosarcoma patients. In this randomized, controlled study, 66 childhood or adolescent osteosarcoma patients and 126 corresponding parents were enrolled and divided into SMART or normal care (NC) groups at a 1:1 ratio. All parents received a 3-month corresponding intervention and a 6-month interview. Our study revealed that the self-rating anxiety scale score at the 3rd month (M3) (P < 0.05) and the 6th month (M6) (P < 0.01), and anxiety rate at M3 (P < 0.05) and M6 (P < 0.05) were lower in parents in SMART group vs. NC group. The self-rating depression scale score at M3 and M6, and depression rate at M3 and M6 were lower in parents in SMART group vs. NC group (all P < 0.05). Impact of events scale-revised score at the 1st month (M1) (P < 0.05), M3 (P < 0.05), and M6 (P < 0.01) were lower in parents in SMART group vs. NC group. By subgroup analyses, the SMART nursing project showed better impacts on decreasing anxiety, depression, and PTSD in parents with an undergraduate education or above than in those with a high school education or less. Conclusively, SMART nursing project reduces anxiety, depression, and PTSD in parents of childhood or adolescent osteosarcoma patients, which is more effective in those with higher education.

Harsh parenting among veterans: parents' military-related PTSD, mentalization, and pre-military trauma.

Veteran parents experiencing posttraumatic stress disorder (PTSD) may resort to harsh parenting. The indirect pathway from parental military-related PTSD to harsh parenting, and the moderating role of parents' pre-military trauma histories, has been less explored. Informed by mentalization theory, as well as trauma-sensitive and posttraumatic growth perspectives, we aim to explore the associations between veteran parents' military-related PTSD, mentalization, harsh parenting, and prior trauma before military service. Data were collected from an online research panel of 509 veteran parents with children under 10. We employed Structural Equation Models to test indirect and moderating effects. We identified an indirect effect of parental pre-mentalization from military PTSD to harsh parenting [corporal punishment: b = 0.35, p < 0.001, 95% CI (0.23, 0.46); psychological aggression: b = 0.14, p < 0.001, 95% CI (0.09, 0.19)]. Multi-group analysis on four parent groups (parents with only pre-military physical trauma, parents with only pre-military psychological trauma, parents with both pre-military physical and psychological trauma, and parents with no pre-military physical or psychological trauma) highlighted differences in these associations, particularly between parents with only pre-military physical trauma and those without any physical and psychological trauma. The military-related PTSD effects on psychological aggression, corporal punishment, and pre-mentalization were all significantly higher for parents without pre-military physical and psychological trauma. Modifying parents' interpretation of their child's mental states can potentially counteract the effects of veterans' military PTSD on harsh parenting. Family-based programs should be created considering veteran parents' pre-military trauma histories.

Cognitive-behavioral stress management relieves anxiety, depression, and post-traumatic stress disorder in parents of pediatric acute myeloid leukemia patients: a randomized, controlled study

ABSTRACT Objectives Cognitive-behavioral stress management (CBSM) is an effective psychological intervention to relieve psychological and symptomatic distress. This study aimed to investigate the effect of CBSM in anxiety, depression, and post-traumatic stress disorder (PTSD) in parents of pediatric acute myeloid leukemia (AML) patients. Methods Totally, 56 pediatric AML patients and 100 parents were randomized into the CBSM group (28 patients and 49 parents) and the normal control (NC) group (28 patients and 51 parents) to receive corresponding interventions for 10 weeks. The questionnaire scores were assessed at month M0, M1, M3, and M6. Results In parents of pediatric AML patients, self-rating anxiety scale score at M1 (p = 0.034), M3 (p = 0.010), and M6 (p = 0.003), as well as anxiety at M3 (p = 0.036) and M6 (p = 0.012) were decreased in the CBSM group versus the NC group. Self-rating depression scale score at M3 (p = 0.022) and M6 (p = 0.002), as well as depression at M6 (p = 0.019) were declined in the CBSM group versus the NC group. Symptom checklist-90 (a psychotic status questionnaire) score at M3 (p = 0.031) and M6 (p = 0.019) were declined in the CBSM group versus the NC group. Regarding PTSD, the impact of the events scale-revised score at M3 (p = 0.044) and M6 (p = 0.010) were decreased in the CBSM group versus the NC group. By subgroup analyses CBSM (versus NC) improved all outcomes in parents with anxiety at M0 and depression at M0 (all p < 0.050), but could not affect the outcomes in parents without anxiety or depression at M0 (all p > 0.050). Conclusion CBSM reduces anxiety, depression, and PTSD in parents of pediatric AML patients.

Experiences of Parental PTSD for Children Aged 9–17 in Military and Emergency First Responder Families

AbstractThis study is the first to examine the experiences of children aged 9–17 who have a military or emergency first responder (EFR) parent with post-traumatic stress disorder (PTSD). These experiences of children are important to understand through a lens of intergenerational trauma theory, given the high rates of PTSD in these service populations. Additionally, we need to know if they differ from the experiences of children of civilian parents with PTSD. To examine this, we conducted a total of 17 in-depth interviews in Australia with 5 service parents, 5 co-parents and 7 children aged 9–17 who have a parent who had formerly served in the military or an emergency service. Interviewees were not always from the same family. The families included single-parent, dual-parent, separated, and same-sex families. Gender and service type (military or EFR) were evenly distributed among interviewees. We used a critical humanist approach and undertook a reflexive thematic analysis of the interview data. The major themes were (1) parental emotional extremes, volatility, and unpredictability, (2) changes in home and family relations, (3) impacts on child wellbeing, and (4) PTSD awareness and help-seeking. We found evidence of specific impacts for children related to a combination of parental PTSD symptoms and service conditioning and culture. This study highlights the role of reduced parental capacity in the transmission of trauma from parent to child. It provides an evidence base to direct policy and research into targeted and culturally specific therapeutic interventions and support services for children and parents in service families living with PTSD.

Perceived parental depression and PTSD in adolescents: mediating roles of attachment insecurity and coping style

ABSTRACT Background: Earthquakes can cause negative psychological states in adolescents and their parents, such as post-traumatic stress disorder (PTSD) and depression. Previous cross-sectional studies have shown that adolescents who perceive parental depression after an earthquake are more likely to experience PTSD. However, the mechanism underlying this process remains unclear and previous studies have not examined the association between these factors. Objective: The current study explored the mediating roles of attachment insecurity and coping style in the association between perceived parental depression and PTSD in adolescents after the Jiuzhaigou earthquake. Method: In total, 391 participants completed follow-up questionnaires at 12, 21, and 27 months (T1–T3, respectively) after the Jiuzhaigou earthquake. Results: T1 perceived parental depression was not a direct predictor of T3 PTSD in adolescents. In the full mediation model, T1 perceived parental depression predicted T3 PTSD in adolescents indirectly via T2 attachment insecurities through T2 emotion-focused coping. Conclusion: The findings highlight that attachment insecurity and emotion-focused coping mediated the relationship between perceived parental depression and PTSD in adolescents following an earthquake. To alleviate PTSD in adolescents, efforts should be directed toward reducing perceived parental depressive symptoms and emotion-focused coping, and promoting the formation of secure attachment styles.

Trajectories of parental posttraumatic stress disorder and children's mental health following Super Typhoon Lekima: The mediating role of feeling of safety.

Several studies have examined the impact of parents' posttraumatic stress disorder (PTSD) on their children's mental health, but few have evaluated the role of parents' specific PTSD trajectories. The aim of this study was to assess the mechanisms underlying distinct trajectories of parental PTSD that affect children's PTSD and depression through the feeling of safety. The final sample comprised 242 dyads of parents and their children who experienced Super Typhoon Lekima in 2019. All participants were surveyed at three time points after the typhoon: 3 months (T1), 15 months (T2), and 27 months (T3). Parental PTSD symptoms at three time points and children's PTSD, depression, and feeling of safety at T3 were analyzed. Four parental PTSD trajectories were identified: recovery, resilience, delayed, and coping. Compared with the resilient group, children of parents with delayed PTSD trajectories reported higher levels of depression at T3, while children of parents in the coping group were more likely to experience severe PTSD at T3. Children of parents in the recovery group, with a reduced feeling of safety, exhibited more severe depression and PTSD at T3, whereas children of parents in the delayed group were at an increased risk of PTSD at T3. These findings highlight the heterogeneity of parental PTSD trajectories following natural disasters and their distinct effects on children's PTSD and depression. Furthermore, feeling of safety emerges as a crucial mechanism in this process.

Evaluation of post-traumatic stress disorder in parents of children with a history of anaphylaxis

IntroductionAnaphylaxis is a life-threatening systemic allergic reaction that has increased in prevalence in recent years. A meaningful proportion of children and parents showed post-traumatic stress disorder (PTSD) symptoms after anaphylaxis. ObjectiveThis study aims to reveal the presence of PTSD and clinical features associated with PTSD in parents of children with a history of anaphylaxis. Material and methodsThe study included 54 cases of anaphylaxis in children under the age of 18 years who applied to the pediatric allergy outpatient clinic of our hospital between 01.06.2020 and 31.05.2021 and their parents. Parents were evaluated with the “Posttraumatic Stress Disorder Checklist for DSM-5”. ResultsThe mean age of the children was 6.4±6.1 years and 28 (52%) of the patients were female. The triggering cause of anaphylaxis was determined from history-taking and physical examinations in 39 (72%) patients. The most common causative agents were foods (n=27, 50%), followed by drugs (n=7, 13%) and venom (n=5, 9%). PTSD was detected in 25 (46%) of parents. Factors affecting the development of PTSD in parents of children with a history of anaphylaxis were evaluated by logistic regression analysis. Accordingly, it was determined that having a history of food-induced anaphylaxis in the child (OR: 7.62, 95% confidence interval [CI]: 1.15–50.58), having a diagnosis of idiopathic anaphylaxis (OR: 9.91, 95% CI: 1.12–87.51), having severe anaphylaxis (OR: 9.09, 95% CI: 1.21–68.26) and having a child in the first two years of life (OR: 7.66, 95% CI: 1.16–50.42) increased the likelihood of PTSD in parents. ConclusionThe results of our study demonstrate that parents with children who have a history of anaphylaxis are at risk for PTSD. Psychological evaluation a part of routine medical examination of patients with anaphylaxis and their families may enable early detection of PTSD, which is strongly associated with a broad range of psychiatric disorders.

Exploring the Perceived Impact of Parental PTSD on Parents and Parenting Behaviours—A Qualitative Study

A considerable number of adults who are currently living with posttraumatic stress disorder (PTSD) are also parents caring for at least one biological child. Evidence suggests that parental PTSD can be associated with impairments to certain parenting behaviours, particularly increasing the use of more negative practices. However, most of the evidence to date has been collected using quantitative methodology, which gives limited insight into why such effects might occur. The current study qualitatively explored study the lived experiences of parents currently living with PTSD, within the United Kingdom. Interviews were conducted with 30 parents (16 mothers, 14 fathers) who were recruited via a PTSD research registry, and who had children living at home under the age of 18 years at the time they experienced their trauma. Three main themes were identified: key impacts of the trauma to the parent personally; negative changes to specific parenting outcomes; impact of these parenting changes on the parent’s sense of parental efficacy; and recovery and coping. These findings provide novel insight into the experiences of both mothers and fathers with PTSD, and highlight the multiple challenges faced by parents living with PTSD that extend beyond impairments to themselves as individuals. Potential implications for the implementation of effective support for parents and their families following trauma exposure are considered.

Relationship between parental stress and post-traumatic stress disorder: The moderating effect of visitation restrictions in paediatric intensive care units during COVID-19.

Visitation restrictions due to COVID-19 kept parents from being with their children who were hospitalized in the PICU and from meeting with professional staff. This study examined the moderating effect of COVID-19-induced visitation restrictions on the relationship between stress and post-traumatic stress disorder in parents of children admitted to the paediatric intensive care unit. We conducted a descriptive, exploratory study involving 93 parents of children hospitalized in the paediatric intensive care unit using the Korean version of the Parental Stressor Scale: Paediatric Intensive Care Unit and the Revised Impact of Events Scale. Descriptive, Pearson's correlation, and logistic regression analyses were used to investigate the data. Self-reported survey questionnaires were provided for parents to complete in a separate area of the outpatient clinic when they visited for follow-up care after their children were discharged from the paediatric intensive care unit. Mothers showed significantly higher post-traumatic stress disorder scores than fathers. The relationship between all the sub-domains of perceived stress and post-traumatic stress disorder was statistically significant. Visitation restrictions because of the COVID-19 pandemic had significant moderating effects on the relationship between perceived parental stress and post-traumatic stress disorder. Moreover, the moderating effects of COVID-19 were exhibited when the two sub-domains-hyperarousal and intrusion-were investigated. Paediatric intensive care unit visitation may be an important intervention for parental post-traumatic stress disorder. Parental visitation should be enabled, and alternative interventions should be developed in situations where visitation is prohibited. It is necessary to develop and apply various and effective alternatives visitation that can prepare hospitals for visiting restrictions during pandemic situations which could emerge in the future.

Symptoms of post-traumatic stress disorder in parents of preterm newborns: A systematic review of interventions and prevention strategies.

Preterm 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. To assess the most effective non-pharmacological interventions to prevent and/or treat PTS symptoms in parents of preterm newborns. Systematic 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." Sixteen 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. There 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.

Resilience as Mediator in Relation to Parental Attachment and Posttraumatic Stress Disorder in Adolescents Following the Yancheng Tornado.

Resilience and secure parental attachment have been proven as important factors to alleviate the posttraumatic stress disorder (PTSD). However, the effects of the two factors on PTSD and the mechanisms of its effect at different time points in the aftermath of trauma are still unclear. This study explores the relationship among parental attachment, resilience, and development of PTSD symptoms in adolescents from a longitudinal perspective following the Yancheng Tornado. Using cluster sampling method, a total of 351 Chinese adolescents, survivors of a severe tornado, were tested on their PTSD, parental attachment and resilience at 12-months and 18-months after experiencing the natural disaster. The results showed that our proposed model fit the data well: χ2/df = 3.197, CFI = 0.967, TLI = 0.950, RMSEA = 0.079. It revealed that the resilience at 18-months partially mediated the relationship between parental attachment at 12-months and PTSD at 18-months. Research results showed that parental attachment and resilience are key resources for coping with trauma.

Study protocol: development and randomized controlled trial of a preventive blended care parenting intervention for parents with PTSD

BackgroundChildren of parents with post-traumatic stress disorder (PTSD) are at increased risk of adverse psychological outcomes. An important risk mechanism is impaired parental functioning, including negative parenting behavior, perceived incompetence, and lack of social support. Several parenting interventions for trauma-exposed parents and parents with psychiatric disorders exist, but none have specifically targeted parents with PTSD. Our objective is to evaluate the effectiveness of a blended care preventive parenting intervention for parents with PTSD.MethodsThe intervention was adapted from an existing online intervention, KopOpOuders Self-Help. In co-creation with parents with PTSD and partners, the intervention was adapted into KopOpOuders-PTSD, by adding PTSD-specific content and three in-person-sessions with a mental health prevention professional. Effectiveness will be tested in a randomized controlled trial among N = 142 parents being treated for PTSD at Arkin Mental Health Care (control condition: treatment as usual, n = 71; intervention condition: treatment as usual + intervention, n = 71). Online questionnaires at pretest, posttest, and three-month follow-up and ecological momentary assessment at pretest and posttest will be used. Intervention effects on primary (parenting behavior) and secondary outcomes (perceived parenting competence, parental social support, parenting stress, child overall psychological problems and PTSD symptoms) will be analyzed using generalized linear mixed modeling. We will also analyze possible moderation effects of parental PTSD symptoms at pretest on primary and secondary outcomes.DiscussionThis study protocol describes the randomized controlled trial of KopOpOuders-PTSD, a blended care preventive parenting intervention for parents with PTSD. Findings can contribute to understanding of the effectiveness of parenting support in clinical practice for PTSD.Trial registrationThis protocol (Version 1) was registered on 11-02-2022 at ClinicalTrials.gov under identification number NCT05237999.

Risk factors of post-traumatic stress disorder after hospitalization in a pediatric intensive care unit: a systematic literature review.

The number of studies on post-traumatic stress disorder after hospitalization in a pediatric intensive care unit raised since 2004. The objective of this systematic review was to summarize and critically examine the literature about risk factors for these children to develop post-traumatic stress disorder following admission to an intensive care unit. The data sources were PubMed, Cochrane, Web of Science, PsycInfo, SUDOC, Scopus, and ScienceDirect. Studies were selected if they were in English or French and published between 01/01/2004 and 31/01/2022. Studies were excluded if patients were less than 1month old and if no post-traumatic stress disorder was found. The internal validity and risk of bias were assessed using the National Institutes of Health Study Quality Assessment Tools for observational studies and the Ottawa Scale was used for the interventional study. The search yielded 523 results and 22 articles met inclusion criteria. Three common risk factors were identified from the data: parental post-traumatic stress disorder (especially in mothers), severity of illness and delusional memories. Internalizing behavior in children, acute parent and child stress, emergency admission and sepsis are also potential risk factors that require further investigation. The prevalence of this pathology is substantial (between 14 and 36%) and increasing awareness among pediatricians and psychologists seems necessary. Prevention programs are being studied to reduce the incidence of post-traumatic stress disorder in this population. Child and adolescent psychiatry liaison should collaborate with pediatric teams to support this objective.

Editor's Choice Articles for February.

Editor's Choice Articles for February.

Pediatric Critical Care-Associated Parental Traumatic Stress: Beyond the First Year.

Perform a longitudinal analysis of parental traumatic stress up to 30 months after PICU discharge. Prospective observational cohort study. Two tertiary care children's hospitals with mixed medical/surgical/cardiac PICUs. Parents of patients unexpectedly admitted to the PICU. None. Two hundred sixty-five parents of 188 children were enrolled. Of the 195 parents who completed the 3-9-month assessments, 29 (14.8%) met posttraumatic stress disorder (PTSD) qualification on the PTSD Symptom Scale Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Multivariable analysis showed parents who met acute stress disorder (ASD) qualification (odds ratio [OR] 8.01; 95% CI 2.64-24.3), parents of children with Pediatric Overall Performance Category score of severe or coma at discharge (OR 5.21; 95% CI 1.65-16.4), parents who had concerns for their child's permanent injury (OR 1.82; 95% CI 1.36-2.43), and parents who reported increased knowledge of child illness during admission (OR 1.82; 95% CI 1.13-2.93) had increased odds of developing parental PTSD. Of the 175 parents (66%) who completed the 18-30-month assessments, 22 (12.5%) met PTSD qualification. Multivariable analysis showed parents who met ASD qualification (OR 4.19; 95% CI 1.12-15.7), parents who had a history of a family member or themselves being admitted to ICU (OR 6.51; 95% CI 1.43-29.6), and parents who had concerns of child's susceptibility to death post discharge (OR 1.58; 95% CI 1.19-2.09) had increased odds of developing parental PTSD. At 18-30 months post discharge, parents who met the PTSD qualification were more likely to report a decrease in household income following discharge (OR 9.23; 95% CI 1.71-49.9). Parental PTSD remains a significant morbidity of PICU admission for a subgroup of parents greater than 18 months post admission. Identifiable risk factors will inform the development of targeted interventions.

Prevalence and associated factors of post-traumatic stress disorder in parents whose infants have single ventricle heart disease.

Post-traumatic stress disorder occurs in parents of infants with CHD, contributing to psychological distress with detrimental effects on family functioning and well-being. We sought to determine the prevalence and factors associated with post-traumatic stress disorder symptoms in parents whose infants underwent staged palliation for single ventricle heart disease. A large longitudinal multi-centre cohort study evaluated 215 mothers and fathers for symptoms of post-traumatic stress disorder at three timepoints, including post-Norwood, post-Stage II, and a final study timepoint when the child reached approximately 16 months of age, using the self-report questionnaire Impact of Event Scale - Revised. The prevalence of probable post-traumatic stress disorder post-Norwood surgery was 50% of mothers and 39% of fathers, decreasing to 27% of mothers and 24% of fathers by final follow-up. Intrusive symptoms such as flashbacks and nightmares and hyperarousal symptoms such as poor concentration, irritability, and sudden physical symptoms of racing heart and difficulty breathing were particularly elevated in parents. Higher levels of anxiety, reduced coping, and decreased satisfaction with parenting were significantly associated with symptoms of post-traumatic stress disorder in parents. Demographic and clinical variables such as parent education, pre-natal diagnosis, medical complications, and length of hospital stay(s) were not significantly associated with symptoms of post-traumatic stress disorder. Parents whose infants underwent staged palliation for single ventricle heart disease often reported symptoms of post-traumatic stress disorder. Symptoms persisted over time and routine screening might help identify parents at-risk and prompt referral to appropriate supports.

Testing an attachment- and trauma-informed intervention approach for parents and young children after interparental violence: protocol for a randomized controlled trial

BackgroundInterparental violence has persistent adverse effects on victimized parents and children. Young children, including infants and toddlers, are at particular risk to develop long-lasting negative outcomes, and yet specific evidence on effective intervention approaches for this vulnerable group is still lacking. This study will test the effectiveness of an attachment- and trauma-informed intervention approach in a sample of parent-child dyads who have experienced severe interparental violence. We test the individual and combined effects of two interventions: (1) “Nederlandse Interventie Kortdurend op Atypisch oudergedrag” (NIKA; Dutch, short-term intervention focused on atypical parenting behavior) aimed at improving the attachment relationship and (2) eye movement desensitization and reprocessing (EMDR) therapy aimed at reducing parental post-traumatic stress disorder (PTSD) symptoms.MethodsThis study uses a multicenter randomized controlled design across multiple domestic violence shelters in the Netherlands. We aim to recruit 150 parent-child dyads with children aged between 0.5 and 6 years old. The study design consists of two phases. During the first phase for testing the effect of NIKA only, eligible dyads are randomly allocated to either NIKA or a waitlist usual care group. A pre-test is conducted prior to the treatment period and a post-test takes place directly afterwards (6 weeks after the pre-test). Phase 2 follows directly for testing the effects of EMDR and the combination of NIKA and EMDR. Parents who report clinical PTSD symptoms are randomly allocated to either EMDR therapy or a waitlist usual care group. Parents who do not report clinical PTSD symptoms only receive care as usual. Six weeks later, a post-test of phase 2 is conducted for all participating dyads. Primary study outcomes are disrupted parenting behavior, sensitive parenting behavior, and parental PTSD symptoms. Secondary study outcomes include PTSD symptoms and behavioral and emotional problems of the child.DiscussionThis study will inform and enhance the clinical field by providing new insights regarding effective treatment combinations for traumatized parents and their young children after interparental violence.Trial registrationNetherlands Trial Register (NTR) NL9179. Registered 7 January 2021