title: Early psychological reactions in parents of children with a life threatening illness within a pediatric hospital setting.
abstract: BACKGROUND
  Parents of children with life threatening illness or injuries are at elevated risk of distress reactions, involving symptoms of acute stress disorder, depression and anxiety. Currently, the impact of child illness factors is unclear, and to date research systematically examining the prevalence of these psychological reactions across different illness groups with an acute life threat is sparse. This is important to explore given that studies show that parent functioning impacts on the psychological adjustment and recovery of the ill child. WHAT DOES THIS STUDY ADD?: At four weeks following a child's diagnosis of a serious illness, 49-54% of parents met DSM-IV criteria for acute stress disorder, across a number of illness groups, whereas 15-27% of parents were in the moderate/severe range for depression and anxiety, and 25-31% for stress. Results from this study demonstrate that rates and severity of these psychological reactions in parents of seriously ill children do not vary according to illness type.
  
  
  BACKGROUND
  A life threatening childhood illness/injury can lead to significant distress reactions in parents, with independent studies finding such reactions in several different illness groups. To date, there is limited research systematically comparing the prevalence of adverse parental psychological reactions across different childhood illness groups with an acute life threat. This study aimed to investigate the frequency and severity of symptoms of acute traumatic stress, depression, anxiety and general stress in parents, following admission of their child to hospital for a life threatening illness. The study also aimed to explore the relationship between these symptoms, and to determine whether they differ according to illness/injury.
  
  
  METHODS
  Cross-sectional data from a prospective, longitudinal study are reported. Participants were 194 parents of 145 children (49 couples), admitted to cardiology (n=53), oncology (n=40) and pediatric intensive care units (n=52), for serious illnesses/injuries. Parents completed self-report questionnaires within four weeks of hospital admission.
  
  
  RESULTS
  Rates of acute traumatic stress (P=0.262), depression (P=0.525), anxiety (P=0.453) and general stress symptoms (P=0.720) in parents were comparable across illness type, with 49-54% reaching criteria for acute stress disorder, 15-27% having clinical levels of depression and anxiety, and 25-31% for general stress. Anxiety was most strongly associated with acute traumatic stress (r=0.56), closely followed by stress (r=0.52) and depression (r=0.49), with all correlations highly significant (P<0.001).
  
  
  CONCLUSIONS
  These findings provide evidence that the child's medical condition is not associated with parents' experience of clinically significant psychological symptoms, and emphasize the importance for health care providers to be aware of these potential psychological reactions in parents, regardless of the type of illness.
authors.affiliation: Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia; Psychology Service, Royal Children's Hospital, Melbourne, Australia. Electronic address: frank.muscara@mcri.edu.au.
authors.forename: F
authors.initials: F
authors.lastname: Muscara
authors.affiliation: Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia; Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia.
authors.forename: M C
authors.initials: MC
authors.lastname: McCarthy
authors.affiliation: Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Woolf
authors.affiliation: Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: S J C
authors.initials: SJ
authors.lastname: Hearps
authors.affiliation: Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; The Parenting Research Centre, East Melbourne, Australia; Parenting and Family Support Centre, School of Psychology, University of Queensland, Queensland, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Burke
authors.affiliation: Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia; Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia; Psychology Service, Royal Children's Hospital, Melbourne, Australia.
authors.forename: V A
authors.initials: VA
authors.lastname: Anderson
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008137:Longitudinal Studies; D008297:Male; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D015995:Prevalence; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology
keywords: Approach; Psychiatric disorder; affective disorders (other), anxiety disorders (other), pediatrics, post-traumatic stress disorders; miscellaneous