Parents: distress

POST TRAUMATIC STRESS IN PARENTS

Background

A number of studies show significant rates of post-traumatic stress in parents, several months after PICU admission, in US and UK. (Largest n reported  = 1681). Evidence that PICU parents are more distressed than parents after general paediatric admission 2,3 and that that acute stress at time of admission is related to later post-traumatic stress1.

Research to date on prevalence of post-traumatic stress in parents

  • Parents report significant levels of post-traumatic stress.  The percentage scoring above a recognised cut-off in studies carried out to date are given below: 

%

n

follow up

place*

18%

34

8 mths

SGH4,5

32%

50

4 mths

SGH6

45%

102

3 mths

GOS7

29%

72

1 yr

GOS7

20%

71

21mths

S'ton8

KEY

SGH = St George's Hospital

GOS = Great Ormond Street Hospital

S'ton = Southampton General Hospital 

Research to date on associations with post-traumatic stress in parents

  • Post-traumatic stress not related to illness severity or length of stay4,6, but higher for emergency admissions than elective ones6
  • Initial cross-sectional study (n=34) showed association between particular aspects of parents’ experience on PICU (as measured retrospectively by PSS:PICU9) and post-traumatic stress4
  • Subsequent study (n=50) replicated this association prospectively  and post hoc analysis of this data indicated that an abbreviated form of the PSS:PICU9 showed good specificity and sensitivity as a post-traumatic stress screen10
  • Some evidence that avoidance in children at 3 mths is associated with poorer post-traumatic stress outcome in parents at 1yr6

Ideas for future work

  • The finding that particular aspects of parents’ experience on PSS:PICU9 are predictive of later post-traumatic stress, has implications for screening at time of admission. NICE guidelines on the treatment of PTSD advise against blanket intervention and suggest screening of at risk populations to target interventions appropriately11
  • Abbreviated form of the PSS:PICU9 could be tested prospectively as a screener
  • Why is it that some parents improve, some stay symptomatic and some become newly symptomatic?

References

  1. Balluffi et al (2004)
  2. Rees et al (2004)
  3. Board & Ryan-Wenger (2000)
  4. Colville & Gracey (2006)
  5. Colville et al (2008)
  6. 'Evaluation of the impact of a paediatric intensive care follow-up clinic on parents’ psychological outcome: a randomised controlled trial' (in preparation)
  7. 'Post-traumatic stress in child-parent pairs in the year following discharge from paediatric intensive care' (in preparation). See also 'Patterns of post-traumatic stress in child-parent pairs after Pediatric Intensive Care Treatment' presented at ISTSS Annual meeting, Baltimore, Nov 2007 ppt/handout
  8. See 'Predictors of long term post-traumatic stress in mothers and fathers after a child’s admission to PICU' presented at PICS Annual Meeting, Nottingham UK, Sept 2007 ppt/handout
  9. Carter & Miles (1989)
  10. See 'Screening for post traumatic stress in parents after their child’s admission to PICU' presented at PICS Annual Meeting, Oxford, Sept 2005  ppt/handout 
  11. NICE guidelines on PTSD (2005)
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