Children: distress

PSYCHOLOGICAL IMPACT OF PICU ON CHILDREN

Background

A number of studies show significant rates of psychological distress, including post-traumatic stress symptoms, in children several months after PICU admission, in the US and the UK.

There is however mixed evidence as to whether they are more distressed than control paediatric patients1,2. There is an assumption that children are traumatised by what happens to them on PICU, but this appears to be contradicted by the finding that they remember very little of admission and that their memories are predominantly neutral3.  See recent review article for a more detailed discussion of these issues4.

Research to date on prevalence

  • A significant proportion of children (28%) (n=102) report significant levels of post- traumatic stress at 3 mths5
  • For a number of children, these symptoms are a long term problem - at one year 26% children were still scoring above cut off, with approximately half of cases newly symptomatic6

Research to date on associations with other variables

  • Child post-traumatic stress score at 3 mths independently associated with emergency status and delusional memories (but not factual memories)5
  • Child post-traumatic stress score at 3 mths significantly related to score at one year 6
  • Child’s avoidance subscale score at 3 mths was more strongly associated than total post-traumatic stress score with one year total post-traumatic stress score6
  • Child’s post-traumatic stress as likely to relate to events immediately preceding admission, eg accident or medical deterioration, as to events during admission7

Ideas for future work:

  • Why is it that some children improve, some stay symptomatic and some become newly symptomatic?
  • It would be interesting to explore the phenomenon of positive change after adversity, eg post-traumatic growth, with this population of children.  There is very little on this topic in the literature although the phenomenon has been described in qualitative work on children after road accidents and cancer (see references on Post-traumatic growth)

References

  1. Rees et al (2004)
  2. Rennick et al (2004)
  3. Playfor et al (2000)
  4. Colville G (2008)
  5. Colville et al (2008)  (See also 'Children’s factual and delusional memories of PICU'  presented at 36th SCCM Conference, Florida US, Feb 2007 ppt/handout)
  6. See 'Predictors of post-traumatic stress in children after PICU' - presented at WFPICCS, Geneva, June 2007 ppt/handout
  7. Patterns of post-traumatic stress in child-parent pairs after the child's admission to paediatric intensive care (2012) pdf

 

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