title: Predictors of parent post-traumatic stress symptoms after child hospitalization on general pediatric wards: a prospective cohort study.
abstract: OBJECTIVE
  The aim of this study was to identify predictors of parental post-traumatic stress symptoms following child hospitalization.
  
  
  METHODS
  In this prospective cohort study, a sample of 107 parents completed questionnaires during their child's hospitalization on pediatric (non-intensive care) wards and again three months after discharge. Eligible parents had a child expected to be hospitalized for three or more nights. Standardized questionnaires were used to assess parent distress during the child's hospitalization, parent coping strategies and resources, and symptoms of post-traumatic stress after the hospitalization. Correlations and multiple regressions were used to determine whether parent distress during hospitalization and coping strategies and resources predicted post-traumatic stress symptoms three months after the child's discharge, while controlling for relevant covariates.
  
  
  RESULTS
  Three months after the child's hospital discharge, 32.7% of parents (n=35) reported some degree of post-traumatic stress symptoms, and 21.5% (n=23) had elevated (≥34) scores consistent with a probable diagnosis of post-traumatic stress disorder. In the multivariable model, parent anxiety and uncertainty during hospitalization and use of negative coping strategies, such as denial, venting and self-blame, were associated with higher post-traumatic stress symptoms scores at three months post-discharge, even after controlling for the child's health status. Parental anxiety and depression during hospitalization moderated the relationship between negative coping strategies and post-traumatic stress symptoms.
  
  
  CONCLUSIONS
  More than one quarter of parents of children hospitalized on pediatric (non-intensive care) wards experienced significant post-traumatic stress symptoms after their child's discharge. Parents' hospital-related anxiety, uncertainty and use of negative coping strategies are potentially modifiable factors that most strongly influenced post-traumatic stress symptoms. Further research is urgently needed to test the effectiveness of different methods to provide psychological, emotional and instrumental support for parents, focusing on increasing parent coping resources and reducing distress during hospitalization.
authors.affiliation: University of California, San Francisco, United States; University College London, United Kingdom. Electronic address: linda.franck@nursing.ucsf.edu.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Franck
authors.affiliation: University College London, United Kingdom; Great Ormond Street Hospital, London, United Kingdom.
authors.forename: Jo
authors.initials: J
authors.lastname: Wray
authors.affiliation: University of California, San Francisco, United States.
authors.forename: Caryl
authors.initials: C
authors.lastname: Gay
authors.affiliation: Oxford Children's Hospital, United Kingdom.
authors.forename: Annette K
authors.initials: AK
authors.lastname: Dearmun
authors.affiliation: University College London, United Kingdom.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Lee
authors.affiliation: University of California, San Francisco, United States.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cooper
mesh_terms: D002648:Child; D006760:Hospitalization; D006801:Humans; D010290:Parents / Q000523:psychology*; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D006113:United Kingdom
keywords: Anxiety; Child hospitalization; Coping; Depression; Parents; Post-traumatic stress symptoms; Uncertainty