Patterns of post-traumatic stress symptoms in families after paediatric intensive care.
OBJECTIVE
To establish longitudinal rates of post-traumatic stress in a cohort of child-parent pairs; to determine associations with poorer outcome.


METHODS
This was a prospective longitudinal cohort study set in a 21-bed unit. In total 66 consecutive admissions aged 7-17 years were screened with one parent at 3 and 12 months post-discharge. Measures used were the Children's Revised Impact of Event Scale (CRIES-8) and the SPAN (short form of Davidson Trauma Scale).


RESULTS
In total 29 (44 %) child-parent pairs contained at least one member who scored above cut-off 12 months after discharge, with scores increasing over time for 18 parents and 26 children. At 3 months, 28 (42 %) parents and 20 (32 %) children scored above cut-off; at 12 months the rates were 18 (27 %) parents and 17 (26 %) children. Parents scoring above cut-off at 12 months were more likely to have had a child admitted non-electively (100 % vs. 77 %, p = 0.028); had higher 3-month anxiety scores (11.5 vs. 4.5, p = 0.001) and their children had higher post-traumatic stress scores at 3 months (14 vs. 8, p = 0.017). Children who scored above cut-off at 12 months had higher 3-month post-traumatic stress scores (18 vs. 7, p = 0.001) and higher Paediatric Index of Mortality (PIM) scores on admission (10 vs. 4, p = 0.037).


CONCLUSIONS
The findings that (a) nearly half of families were still experiencing significant symptoms of post-traumatic stress 12 months after discharge; (b) their distress was predicted more by subjective than by objective factors and (c) many experienced delayed reactions, indicate the need for longer-term monitoring and more support for families in this situation.
Paediatric Psychology Service, St George's Hospital, 2nd Floor Clare House, London, SW17 0QT, UK. gcolvill@sgul.ac.uk
Gillian
G
Colville
Christine
C
Pierce
D001007:Anxiety / Q000175:diagnosis / Q000209:etiology; D002648:Child; D016638:Critical Illness; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D005195:Family Relations; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008137:Longitudinal Studies; D008297:Male; D010287:Parent-Child Relations; D011594:Psychometrics; D012307:Risk Factors; D013223:Statistics as Topic; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology; D013315:Stress, Psychological / Q000150:complications*; D015599:Trauma Severity Indices