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

Abstract

Objectives: 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. Design: 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. Setting: An academic, urban, pediatric hospital in California. Patients: Children, 8–17 years old, admitted to the PICU for greater than 24 hours and their English- or Spanish-speaking parents. Interventions: None. Measurements and Main Results: 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. Conclusions: 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.

The therapeutic effects of journal writing for parents of PICU patients: A research brief

“…Although the perceived stress symptoms overall did not significantly differ between the experimental and control groups as expected at T2 or T3, there was a significant relationship between experimental parents' perceived stress during the child's hospitalization in the PICU and their posttraumatic stress symptoms after discharge. This is consistent with recent research that showed parents acute stress during their child's hospitalization positively predicted parent's posttraumatic stress 3 months after discharge (Nelson et al, 2019). The small sample size of this feasibility and acceptability study was not adequately powered to detect a statistically significant difference between groups.…”

Long-Term Outcomes and the Post-Intensive Care Syndrome in Critically Ill Children: A North American Perspective

“…PTSD is particularly common amongst critically ill children [ 70 ]. As many as 84.6% of PICU survivors compared to 6.2% of ward survivors met criteria for probable PTSD or actual Diagnosis and Statistics Manual of Mental Disorders 5th edition (DSM5) criteria, according to an Egyptian study [ 71 ], while other studies report that 13–32% of children screen positive for PTSD within a year of discharge [ 27 , 72 ]. PTSD symptoms are thought to improve over time [ 72 ].…”

“…Parental psychological health is closely linked to their child’s psychosocial wellbeing and their ability to support their child’s recovery [ 72 , 75 ]. In total, 21% of parents experience moderate to severe anxiety, and 9% reported moderate–severe depression [ 84 ].…”

Transitions from short to long-term outcomes in pediatric critical care: considerations for clinical practice

“…Maternal education (16,64,65) and mental illness (16,66,67) have repeatedly been identified as risk factors for child development, in addition to low socioeconomic status (16,68,69) and social support (70,71). Cheung and colleagues report that up to 30% of families have at least one social determinant of health on admission to PICU, with half of these having multiple needs (72).…”