Parental Posttraumatic Stress Research Articles

Short and Long-Term Parental Posttraumatic Stress After a Child\u2019s Accident: Prevalence and Associated Factors

Studies on the long-term prevalence of parental posttraumatic stress symptoms (PTSS) following child accidental injury are scarce, and findings on risk factors vary. In this follow-up study (T2, n = 69) we determined the prevalence of parental PTSS 2–4 years after accidental injury of their child, compared with 3 months after the accident (T1, n = 135). Additionally, we examined the association between parental and child factors and PTSS severity. Children were 8–18 years old at the time of the accident. Parent and child PTSS was assessed by self-report. Other data were retrieved from medical records and a telephone interview. Parental PTSS was 9.6% at T1 and 5.8% at T2. Acute parental stress as measured within 2 weeks of the child’s accident was significantly associated with parental PTSS severity (T1 and T2), as was the child’s hospitalization of more than 1 day at T1 and the child’s permanent physical impairment at T2. To prevent adverse long-term psychological consequences we recommend identifying and monitoring parents at risk and offering them timely treatment.

Child and parent perceptions of participating in multimethod research in the acute aftermath of pediatric injury

Background: Despite growing evidence that participation in psychological trauma research is well tolerated by children and parents, ethics boards may voice concerns regarding research with families with recent acute trauma exposure. Factors impacting child and parent experiences of research participation are not well documented, particularly for methodologies including observational components. Objectives: This study describes child and parent perceptions of research participation involving an observational task following an acute traumatic event and explores potential relationships between research experience and selected demographic factors (race/ethnicity, sex, age, prior trauma exposure), and post-traumatic stress symptoms. Methods: As part of a larger study on the role of biopsychosocial factors in post-traumatic stress symptoms, 96 child–parent dyads (ages 8–12 years, M = 10.6) participated in a three–time point study following hospitalization for pediatric injury. At baseline, children and parents completed measures of reactions to research participation, post-traumatic stress symptoms, and trauma history. Measures of post-traumatic stress symptoms were repeated at 6- and 12-week follow-up assessments. Results: The majority of families reported they were glad they participated in the research study (61% children; 72% parents) and felt good about helping others (74% children; 93% parents). Negative feelings were uncommon (<10% of families). Perceptions of participation were not related to race, sex, or trauma history, but child age significantly factored into trust of the research team and informed consent (Spearman’s ρ = .289, p < .01). Reactions to research were not significantly related to child or parent post-traumatic stress symptoms at any time point. Conclusion: Current results extend past research to suggest that most children’s and parents’ research experience is positive, even when completing an observational task during hospitalization for an injury. Children under the age of 10 years may perceive their participation as less voluntary, supporting prior findings that additional steps be taken to ensure their understanding of their choice in participation.

The role of parental acute psychological distress in paediatric burn re-epithelialization.

Following a paediatric burn, parents commonly experience high levels of acute psychological distress, which has been shown to increase child psychological distress as well as child procedural distress. The influence of psychological stress and perceived pain on wound healing has been demonstrated in several laboratory and medical populations. This paper investigates the influence of parental acute psychological distress and procedural behaviour on the child's rate of re-epithelialization, after controlling for child procedural distress. A prospective observational study with longitudinal outcome. Eighty-three parents of children 1-6years old reported acute psychological distress (post-traumatic stress symptoms [PTSS], guilt, pre-procedural fear, general anxiety/depression symptoms) in relation to their child's burn. A researcher observed parent-child behaviour at the first dressing change, and parents and nurses reported child procedural distress (pre-, peak-, and post-procedural pain and fear). These variables, along with demographic and injury information, were tested for predicting time to re-epithelialization. Date of re-epithelialization was determined by the treating consultant. Days to re-epithelialization ranged from 3 to 35days post-injury. A hierarchical multiple regression analysis found wound depth and size significantly accounted for 28% of the variance in time to re-epithelialization. In Block 2, child peak-procedural pain significantly accounted for 6% additional variance. In Block 3, parental PTSS significantly accounted for 5% additional variance. Parental PTSS appears to be an important but under-recognized factor that may influence their child's burn re-epithelialization. Further investigation is required to understand the mechanisms contributing to this association. Statement of contribution What is already known on this subject? Psychological stress delays wound healing, and this relationship has been found in paediatric burn populations with procedural pain. Parental psychological stress is often present after a child's burn and is related to the child's procedural coping and distress. What does this study add? Parental post-traumatic stress is related to delayed child burn re-epithelialization. This association is in addition to procedural pain delaying re-epithelialization.

Family Chaos and Asthma Control.

Asthma is a highly prevalent childhood chronic disease, with particularly high rates among poor and minority youth. Psychosocial factors have been linked to asthma severity but remain poorly understood. This study examined (1) relationships between parent and child depression and posttraumatic stress disorder (PTSD) symptoms, family functioning, and child asthma control in a sample of urban minority youth with uncontrolled asthma and (2) family functioning as a pathway linking parent depression and asthma outcomes. Data were drawn from the baseline cohort of a randomized trial testing community interventions for children aged 5 to 16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was defined by using the Asthma Control Test and Childhood Asthma Control Test, activity limitation, and previous-12-month asthma severity. Psychosocial measures included parent and child depression and PTSD symptoms, family chaos, and parent social support. Parent and child depression symptoms, but not PTSD, were associated with worse asthma control (β = -.20 [SE = 0.06] and β = -.12 [SE = -.03]; P < .001). Family chaos corresponded to worse asthma control, even when controlling for parent and child depression (β = -.33; [SE = 0.15]; P < .05), and was a mediator of the parent depression-asthma path. Emotional triggers of asthma also mediated the parent depression-asthma relationship. Findings highlight family chaos as a mechanism underlying the relationship between parent depression and child asthma control. Addressing parent and child depression, family routines, and predictability may optimize asthma outcomes.

Long-Term Impact of Parental Post-Traumatic Stress Disorder Symptoms on Mental Health of Their Offspring After the Great East Japan Earthquake.

Longitudinal studies of the long-term psychological impact of the Great East Japan Earthquake (GEJE) on parents and their children have been limited. The current study aimed to monitor parents’ post-traumatic stress disorder (PTSD) symptoms and behavioral problems among their children over time and to analyze their long-term associations among the survivors of the GEJE. We used data from the GEJE Follow-up for Children study, which recruited 4- to 6-year-old children and those children’s parents immediately after the GEJE in March 2011, with ongoing follow-up. Children’s total, internalizing, and externalizing behavioral problems were assessed using the Child Behavior Checklist (CBCL), and parental probable PTSD was assessed using the Impact of Event Scale-R (IES-R), in 2012 (baseline) and 2014 (follow-up). Parental PTSD symptoms and children’s behavioral problems declined slightly over time, and both showed a significant correlation between the surveys (r = 0.55–0.77, P < 0.001). The association between parental PTSD symptoms and children’s behavioral problems was investigated using multivariate logistic regression analysis adjusting for baseline children’s behavioral problems and other potential confounders. Cross-sectionally, while no significant association was detected in 2012, all types of children’s behavioral problems exhibited significant positive associations with parental PTSD symptoms in multiple logistic regression analysis adjusted odds ratio (AOR) = 3.03, 3.30, and 5.34 for total, internalizing, and externalizing behavior problems, respectively. Maternal educational attainment level (higher than high school education) showed a significant negative association with children’s total and externalizing behavioral problems (AOR = 0.30 and 0.13, respectively) in 2014. Longitudinally, parental PTSD symptoms in 2012 showed a significant association with children’s internalizing behavioral problems in 2014 after adjusting for children’s behavioral problems in 2012 and parental PTSD symptoms in 2014 (AOR = 4.62). These results suggest that the effect of the GEJE on parental PTSD symptoms and children’s behavioral problems was long-term, lasting for at least 3 years. These possibilities should be carefully considered in mental health support for parents and their offspring in areas affected by the GEJE.

Risk of childhood psychiatric disorders in children of refugee parents with post-traumatic stress disorder: a nationwide, register-based, cohort study

Children of refugees are often exposed to the consequences of parental post-traumatic stress disorder (PTSD), potentially leaving them vulnerable to intergenerational transmission of psychopathology. The present study aimed to determine whether parental PTSD is associated with childhood psychiatric morbidity among children of refugees. This study is a two-generation nationwide cohort study using the Danish Immigration Services database. We followed up children younger than 18 years with at least one refugee parent until psychiatric contact, end of the study, their 18th birthday, emigration, or death. We excluded children if their parents were diagnosed only with psychiatric diagnoses other than PTSD or if they had received a psychiatric contact before parental PTSD diagnosis. Information on parental PTSD and offspring psychiatric morbidity was obtained from the Danish Psychiatric Central Research Register. We used Cox proportional hazards regression models to assess the risk of psychiatric contacts among children of refugees with PTSD compared with children of refugees with no psychiatric diagnosis. Between Jan 1, 1995, and Dec 31, 2015, 102 010 refugees obtained residency permission in Denmark and 62 239 biological children of refugees were born in Denmark before Dec 31, 2015. 51 793 were eligible and included in the study (median follow-up 7·15 years [IQR 3·37-11·78]); of these, 1307 (2·5%) children had a psychiatric contact. 7486 (14·5%) children of refugees were exposed to parental PTSD. Parental PTSD significantly increased the risk of psychiatric contact in offspring (hazard ratio 1·49 [95% CI 1·17-1·89] for paternal PTSD, p=0·0011; 1·55 [1·20-2·01] for maternal PTSD, p=0·00084) after adjustment for sociodemographic variables. Children of refugees exposed to parental PTSD are at increased risk of psychiatric morbidity. Targeted screening and interventions are necessary to prevent psychiatric morbidity and ensure access to adequate care. Section for Immigrant Medicine, Department of Infectious Diseases, Copenhagen University Hospital Hvidovre.

Parents’ memories and appraisals after paediatric burn injury: a qualitative study

ABSTRACT Background: It is well established that a paediatric burn injury can lead to parental post-traumatic stress symptoms. The content of parents’ memories and appraisals may reveal the traumatic experiences that need attention. Objective: To inform clinical practice, the aim of this study was to qualitatively examine parents’ (intrusive) memories and appraisals, and associated emotions, concerning the injury, the hospitalisation, and its consequences. Method: Approximately three to six months after the burn event, semi-structured interviews were conducted with parents of 18 children (0–16 years old) that had been hospitalised for a burn injury. Thematic analysis was carried out to obtain themes. Results: A central element in parents’ memories and appraisals was a sense of external or internal threat. Intrusive memories were predominantly related to the accident and first aid (i.e. threat of the injury), whereas parents’ memories about the child’s suffering were emotional but not experienced as intrusive. Later appraisals of the burn injury and its consequences included negative appraisals of the child’s increased vulnerability, responsibility of self or other, the child’s prolonged suffering and (risk of) permanent change, as well as appraisals of positive outcome and recovery. Emotions commonly reported in the context of memories and appraisals were fear, sadness, guilt, and relief. Conclusions: This study offers insight into the traumatic nature of paediatric burn injury from the parent’s perspective and provides directions for the delivery of trauma-informed (after)care.

Resilient, recovering, distressed: A longitudinal qualitative study of parent psychosocial trajectories following child critical injury

IntroductionThe psychological distress and risk of mental health problems for parents of children with critical injury is well-established. There has been little exploration, however, of parent experiences and psychosocial trajectories over time following child critical injury. To address this knowledge gap, a longitudinal qualitative study was conducted to explore parent experiences and support needs and identify parent psychosocial trajectories in the 12 months following child critical injury. MethodsSemi- structured in-depth interviews were conducted with 27 parents at three time points over a 12 month period: the immediate hospital period post-child injury, and 6 and 12 months following injury, resulting in a total of 81 interviews. Data were analysed using a longitudinal within and across-case thematic analysis of patterns emerging over time. FindingsThree parent trajectory patterns were identified: resilient trajectory where parents were temporarily disrupted by the child’s injury and hospitalisation, but recovered their mental and emotional wellbeing quickly, which was maintained over time; recovering trajectory where parents were initially disrupted at the time of injury but their mental and emotional wellbeing fluctuated over time and had not been fully restored by 12 months; and distressed trajectory where parents experienced significant psychosocial disruption due to their child’s injury and struggled to adapt and regain their wellbeing over time, remaining emotionally distressed about the circumstances and impacts of the injury on their child and family. Illustrative narratives that represent each trajectory are presented. ConclusionsThis is the first qualitative study to report the psychosocial trajectories of parents of critically injured children. Clinical application of insights provided by these trajectories can assist clinicians to use targeted strategies to help strengthen parental adaptation and prevent adverse mental health outcomes, and address families’ psychosocial support needs following child injury. Screening for parent psychological distress and post-traumatic stress disorder is needed from the time of the child’s admission, and a dedicated trauma support role can facilitate an integrated care approach for children and families with complex needs across the care continuum.

The Effects of Family Functioning on the Development of Posttraumatic Stress in Children and Their Parents Following Admission to the PICU.

To report the rate of acute stress and posttraumatic stress among children and parents following PICU admission and the relation between family function and posttraumatic stress. Prospective, longitudinal, multi-informant observational study. Pediatric patients (n = 69) and parents were recruited in the ICU. They completed measures evaluating acute stress and posttraumatic stress during their hospitalization and at 3-month follow-up. Parents completed measures of family functioning during the hospitalization. Pearson correlations and multiple regression models were used to examine the relations between family functioning and acute stress and posttraumatic stress. An academic, urban, pediatric hospital in California. Children, 8-17 years old, admitted to the PICU for greater than 24 hours and their English- or Spanish-speaking parents. None. All children endorsed acute stress during their PICU admission, with 51% meeting criteria for acute stress disorder. At 3-month follow-up, 53% of the children continued to endorse posttraumatic stress with 13% meeting criteria for posttraumatic stress disorder. Among parents, 78% endorsed acute stress during admission with 30% meeting criteria for acute stress disorder, and at follow-up, 35% endorsed posttraumatic stress with 10% meeting criteria for posttraumatic stress disorder. In multiple linear regression modeling, child acute stress significantly predicted child posttraumatic stress (β = 0.36; p < 0.01). In the parent model, parent acute stress (β = 0.29; p < 0.01) and parent education (β = 0.59; p < 0.00) positively predicted parent's posttraumatic stress. Family function was not a predictor of either's posttraumatic stress. Both children and parents have alarmingly high rates of acute stress and posttraumatic stress following the child's PICU admission. Although family function did not emerge as a predictor in this study, further understanding of the influence of the family and the interplay between child and parent posttraumatic stress is needed to improve our understanding of the model of development of posttraumatic stress in this population to inform the intervention strategies.

Parental immigration and offspring post-traumatic stress disorder: A nationwide population-based register study

ObjectivesThe aim of this study was to investigate the association between parental immigration status and a diagnosis of post-traumatic stress disorder (PTSD) in their offspring. MethodsThis nested matched case-control study was based on a Finnish national birth cohort for 1987–2010 and cases were diagnosed with PTSD by 2012 from the Care Register for Health Care. We identified 3639 cases and 14,434 controls individually matched for gender, place and date of birth (±30 days). Conditional logistic regression analyses were conducted to examine the association between parental immigration status, parents’ region of birth and time since paternal immigration, and PTSD after controlling for confounding factors. ResultsThe likelihood of being diagnosed with PTSD was significantly increased among children with an immigrant father (OR 1.8, 95% CI 1.3 - 2.4) than those with two Finnish parents and one immigrant mother. There was no significant association between having an immigrant mother or two immigrant parents and receiving a diagnosis of PTSD. The likelihood of being diagnosed with PTSD was increased if the children's fathers had migrated less than five years before their birth (OR 1.4, 95% CI 1.03 - 1.9) and if their immigrant fathers had been born in North Africa or the Middle East (OR 2.1, 95% CI 1.4 - 3.3). LimitationsThe sample included a heterogeneous migrant group without information on the reason for migration. The cases were identified from hospital diagnosis that may have only included severe cases. ConclusionThe increased likelihood of a diagnosis of PTSD underlines the need for psychosocial services among second-generation immigrants.

JPP Student Journal Club Commentary: Parental Posttraumatic Stress Symptom Trajectories of Children With Serious Illnesses/Injuries.

JPP Student Journal Club Commentary: Parental Posttraumatic Stress Symptom Trajectories of Children With Serious Illnesses/Injuries.

Transgenerational effects of the genocide against the Tutsi in Rwanda: A post-traumatic stress disorder symptom domain analysis

Background: A number of studies have investigated transgenerational effects of parental post-traumatic stress disorder (PTSD) and its repercussions for offspring. Few studies however, have looked at this issue in the African context. Methods: The present study addresses this gap, utilizing confirmatory factor analysis (CFA), to investigate symptom severity within the three Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) PTSD symptom domains in mothers exposed to the genocide against the Tutsi in Rwanda (n=25) and offspring (n=25), and an ethnically matched control group of mothers (n=25) and offspring (n=25) who were outside of Rwanda during the genocide. All mothers were pregnant during the time of the genocide with the offspring included in the study. Missing data were excluded from the analyses. Results: We found that among the three symptom domains of PTSD, the re-experiencing symptom domain loaded most strongly onto PTSD among mothers directly exposed to the genocide (Beta = 0.95). In offspring of exposed mothers, however, the three symptom domains of PTSD yielded almost equal loading values (Beta range = 0.84-0.86). Conversely, among non-exposed mothers and their offspring, the hyperarousal symptom domain of PTSD loaded most strongly onto PTSD (Beta = 1.00, Beta = 0.94, respectively). As a secondary analysis, we also explored the relation between DNA methylation in the glucocorticoid receptor (NR3C1) locus, an important stress modulating gene, and individual PTSD symptom domains, finding a strong association between DNA methylation and re-experiencing among genocide-exposed mothers that exceeded any other observed associations by approximately two-fold. Conclusions: This is the first report, to our knowledge, of a symptom-based analysis of transgenerational transmission of PTSD in Africa. These findings can be leveraged to inform further mechanistic and treatment research for PTSD.

Experiences of children exposed to parental post-traumatic stress disorder while growing up in military and veteran families: a systematic review protocol.

The objective of this review is to understand how parental Post-Traumatic Stress Disorder (PTSD) might impact children growing up in military and veteran families. The following question will guide and inform the review: What is the experience of children growing up in military families where the military or veteran parent is living with post-traumatic stress disorder?

Behavioral symptoms and psychiatric disorders in child and adolescent long-term survivors of childhood acute lymphoblastic leukemia treated with chemotherapy only.

Prevalence of emotional, behavioral, and psychiatric outcomes in child and adolescent survivors of childhood acute lymphoblastic leukemia treated on a chemotherapy-only protocol were not well defined. Self- and parent-reported emotional and behavioral symptoms were assessed for 161 survivors of childhood acute lymphoblastic leukemia (51.0% female; mean [SD] age 12.1[2.6] years; 7.5[1.6] years post-diagnosis). Age- and sex-adjusted scores were calculated for standardized measures and compared with 90th percentile of norms. Frequencies of survivor psychiatric disorders from structured diagnostic interviews with parents were compared with the general population. Parent emotional distress and post-traumatic stress symptoms were assessed. Associations between child symptoms/disorders and parent distress were examined with log-binomial models, adjusting for highest parent education. Compared with population expectations (10%), more survivors self-reported symptoms of inattention (27.9; 95% CI, 21.0%-35.7%), hyperactivity/impulsivity (26.0%; CI, 19.2%-33.6%), and oppositional-defiant behavior (20.1%; CI, 14.1%-27.3%). Parents reported survivors with more symptoms of inattention (23.6%; CI, 17.2%-31.0%), higher frequencies of obsessive-compulsive disorder (10.3% vs 2%) and oppositional defiant disorder (16.0% vs 9.5%), but not attention-deficit/hyperactivity disorder (7.1% vs 7.8%) or generalized anxiety disorder (3.2% vs 4.1%), compared with national norms. Parent-report of child anxiety disorders was associated with parent self-reported emotional distress but not survivor self-report of anxiety. A significant minority of survivors have long-term psychiatric morbidity, multi-informant assessment is important to understand these symptom profiles and to inform selection of appropriate interventions. Interventions targeting inattention and oppositional behavior in children and emotional distress in parents are warranted in families with survivors who display behavioral problems.

Very Young Child Well-being in Military Families: A Snapshot

Since the September 11th attacks on the U.S., more than 2 million children have experienced parental deployment during their early years, with potentially lasting impact. When a parent is deployed, a number of factors may affect the well-being of the service member and his/her family. One parental factor—posttraumatic stress disorder or distress—might be particularly powerful in its effect on young children and the family system. We analyzed baseline data from an intervention development project which focused on supporting military families with very young children during post-deployment. The purpose of this research is to understand the relationships between parental mental health status, parenting stress, couple functioning, and young child well-being. The effects of mental health status of home-front and service member parents and the role of couple functioning on parent–child interactions and behavioral problems of young children were examined in a sample of military families during the post-deployment period. Findings suggest that service member posttraumatic stress symptoms are associated with higher parental report of child behavior problems. Higher quality of the couple relationship appears to lessen the impact of parental posttraumatic stress but is not related to parent perceptions of child behavior concerns. Implications for future research with military families are discussed.

Prediction of parental posttraumatic stress, anxiety and depression after a child's critical hospitalization

ObjectiveTo study the role of parental resilience, emotions accessed during admission and perceived stress in predicting the degree of parental posttraumatic stress disorder (PTSD), anxiety and depression symptoms after a child's treatment in intensive care. MethodsThis was prospective longitudinal cohort study. A total of 196 parents of pediatric intensive care survivors completed questionnaires assessing resilience, perceived stress, emotions experienced during admission, 48h post-discharge (T0). Sociodemographic and medical data were also collected. Main outcomes were anxiety, depression and PTSD, three (T1) and six (T2) months later. ResultsAt T2, 23% of parents reported clinically significant levels of symptoms of PTSD, 21% reported moderate-severe anxiety, and 9% reported moderate-severe depression. These rates were not statistically different to rates at T1. Path analyses indicated that 47% of the variance in psychopathology symptoms at T2 could be predicted from the variables assessed at T0. Resilience was a strong negative predictor of psychopathology symptoms, but this effect was mostly indirect, mediated by the stress that parents perceive during their child's critical hospitalization. ConclusionsMobilizing coping in order to maintain resilience and to decrease their perceived stress levels could improve parents' mental health outcomes following their child's intensive care treatment.

The Parent Trauma Response Questionnaire (PTRQ): development and preliminary validation

ABSTRACTBackground: Following a child’s experience of trauma, parental response is thought to play an important role in either facilitating or hindering their psychological adjustment. However, the ability to investigate the role of parenting responses in the post-trauma period has been hampered by a lack of valid and reliable measures.Objectives: The aim of this study was to design, and provide a preliminary validation of, the Parent Trauma Response Questionnaire (PTRQ), a self-report measure of parental appraisals and support for children’s coping, in the aftermath of child trauma.Methods: We administered an initial set of 78 items to 365 parents whose children, aged 2–19 years, had experienced a traumatic event. We conducted principal axis factoring and then assessed the validity of the reduced measure against a standardized general measure of parental overprotection and via the measure’s association with child post-trauma mental health.Results: Factor analysis generated three factors assessing parental maladaptive appraisals: (i) permanent change/damage, (ii) preoccupation with child’s vulnerability, and (iii) self-blame. In addition, five factors were identified that assess parental support for child coping: (i) behavioural avoidance, (ii) cognitive avoidance, (iii) overprotection, (iv) maintaining pre-trauma routines, and (v) approach coping. Good validity was evidenced against the measure of parental overprotection and child post-traumatic stress symptoms. Good test–retest reliability of the measure was also demonstrated.Conclusions: The PTRQ is a valid and reliable self-report assessment of parenting cognitions and coping in the aftermath of child trauma.

Biopsychosocial Predictors of Quality of Life Outcomes in Pediatric Congenital Heart Disease.

The purpose of this prospective multi-center cross-sectional study was to identify key biopsychosocial factors that impact quality of life (QOL) of youth with congenital heart disease (CHD). Patient-parent pairs were recruited at a regular hospital follow-up visit. Patient- and parent-proxy-reported QOL were assessed using the Pediatric Cardiac Quality of Life Inventory (PCQLI). Wallander's and Varni's disability-stress coping model guided factor selection, which included disease factors, educational impairment, psychosocial stress, child psychological and parent/family factors. Measures utilized for these factors included the Pediatric Inventory for Parents, Self-Perception Profile for Children/Adolescents, Child Behavior Checklist, Revised Children's Manifest Anxiety Scale, Child PTSD Symptom Scale, State-Trait Anxiety Inventory, and Posttraumatic Diagnostic Scale. Ordinary least squares regression was applied to test the theoretical model, with backwards stepwise elimination process. The models accounted for a substantial amount of variance in QOL (Patient-reported PCQLI R 2=0.58, p<0.001; Parent-proxy-reported PCQLI R 2=0.60, p<0.001). For patient-reported QOL, disease factors, educational impairment, poor self-esteem, anxiety, patient posttraumatic stress, and parent posttraumatic stress were associated with lower QOL. For parent-proxy-report QOL, disease factors, educational impairment, greater parental medical stress, poorer child self-esteem, more child internalizing problems, and parent posttraumatic stress were associated with lower QOL. The results highlight that biopsychosocial factors account for over half the variance in QOL in CHD survivors. Assessing and treating psychological issues in the child and the parent may have a significant positive impact on QOL.

The Role of Parental Posttraumatic Stress, Marital Adjustment, and Dyadic Self-Disclosure in Intergenerational Transmission of Trauma: A Family System Approach.

Research indicates that posttraumatic stress symptoms (PTSS) induced by war trauma may be transmitted to veterans' wives and offspring (secondary traumatic stress; STS). However, the interplay between family members' characteristics has not been accounted for in such processes. Taking a family systems perspective, we examine the contributions of fathers' PTSS, mothers' STS, marital adjustment, and self-disclosure of both parents to offspring's STS and test whether marital quality applies as a mechanism of parent-child transmission. Combat veterans and former prisoners of war (N=123), their spouses, and adult offspring were investigated in a multiple-step mediation analysis. The results highlight the mother's crucial role in trauma transmission and suggest that strengthening the marital relationship may buffer the transmission of fathers' PTSS to offspring.

Child Mental Health Symptoms Following Parental Deployment: The Impact of Parental Posttraumatic Stress Disorder Symptoms, Marital Distress, and General Aggression

The current study examined the impact of active duty service members’ symptoms following a combat deployment on child mental health symptoms. Soldiers from a brigade combat team ( N = 974) participated in the study 2 months following return from a 15-month combat deployment to Afghanistan, of which 169 soldiers (17.3%) reported having at least one child living at home. Results supported two research hypotheses examining the interrelationship between parental posttraumatic stress disorder (PTSD) symptoms, general aggression, and marital distress on child mental health. First, the study documented a moderate association between parental PTSD symptoms and child mental health symptoms during the postdeployment reintegration period. This association was significant even after accounting for marital distress. Second, the study demonstrated that the impact of PTSD symptoms on child mental health symptoms may be explained by parental general aggression such that aggression mediated the PTSD symptoms–child mental health association.