Pediatric Critical Care–Associated Parental Traumatic Stress: Beyond the First Year*

Abstract

MEASUREMENTS AND MAIN RESULTS: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 18-30month 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). CONCLUSIONS: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.

Editor’s Choice Articles for February

“…Whyte-Nesfield MW, Kaplan D, Eldridge P, et al: Pediatric Critical Care Associated Parental Traumatic Stress: Beyond the First Year (2).…”

Is It Time for the “Trauma-Informed” PICU?*

“…In this context, Whyte-Nesfield et al (4) add to this knowledge base by reporting on the long-term psychologic follow-up of parents of children admitted to PICU, in this issue of Pediatric Critical Care Medicine. The main findings of the study by Whyte-Nesfield et al (4) are that 1) parental distress related to traumatic aspects of the child’s admission continued well into the second year after discharge, 2) parents who were acutely more distressed and those who feared their child might suffer permanent injury or die reported higher levels of PTSD symptoms at around 6 months and around 2 years post discharge, and 3) parents whose symptoms met criteria for a diagnosis of posttraumatic stress disorder (PTSD) were more likely both to suffer a significant loss of income associated with this status and to divorce or separate over the time period studied.…”

“…Although the majority of families do well in this difficult situation, the study by Whyte-Nesfield et al (4) emphasizes that a child’s admission to PICU is a life-changing experience for many parents. As Hoehn has argued forcefully (11), we cannot ignore the mounting evidence of the psychologic impact on families in this situation.…”

“…The article by Whyte-Nesfield et al (4) addresses an important topic, as the results of analyses of the associations with different potential risk factors have the potential to inform the future identification of “at risk” groups, thereby improving the long-term psychologic care of the whole family unit. The study by Whyte-Nesfield et al (4) demonstrates that, for a significant minority, the troubling psychologic symptoms triggered by a PICU admission do not resolve spontaneously by the second year after discharge and, in some cases, get worse.…”

“…The article by Whyte-Nesfield et al (4) addresses an important topic, as the results of analyses of the associations with different potential risk factors have the potential to inform the future identification of “at risk” groups, thereby improving the long-term psychologic care of the whole family unit. The study by Whyte-Nesfield et al (4) demonstrates that, for a significant minority, the troubling psychologic symptoms triggered by a PICU admission do not resolve spontaneously by the second year after discharge and, in some cases, get worse. Their findings have significant implications not only in relation to highlighting the chronicity of parental distress but also because there is evidence in the existing literature of a prospective association between parent PTSD symptoms and both subsequent child PTSD symptoms (14) and later family dysfunction (15).…”