title: Guilt is associated with acute stress symptoms in children after road traffic accidents.
abstract: BACKGROUND
  Although previous research has consistently found considerable rates of acute stress disorder (ASD) in children with accidental injuries, knowledge about determinants of ASD remains incomplete. Guilt is a common reaction among children after a traumatic event and has been shown to contribute to posttraumatic stress disorder. However, its relationship to ASD has never been examined.
  
  
  OBJECTIVE
  This study assessed the prevalence of ASD in children and adolescents following road traffic accidents (RTAs). Moreover, the association between peritraumatic guilt and ASD was investigated relying on current cognitive theories of posttraumatic stress and controlling for female sex, age, socioeconomic status (SES), injury severity, inpatient treatment, pretrauma psychopathology, and maternal posttraumatic stress symptoms (PTSS).
  
  
  METHODS
  One hundred and one children and adolescents (aged 7-16 years) were assessed by means of a clinical interview approximately 10 days after an RTA. Mothers were assessed by questionnaires.
  
  
  RESULTS
  Three participants (3.0%) met diagnostic criteria for full ASD according to DSM-IV, and 17 (16.8%) for subsyndromal ASD. In a multivariate regression model, guilt was found to be a significant predictor of ASD severity. Female sex, outpatient treatment, and maternal PTSS also predicted ASD severity. Child age, SES, injury severity, and pretraumatic child psychopathology were not related to ASD severity.
  
  
  CONCLUSIONS
  Future research should examine the association between peritraumatic guilt and acute stress symptoms in more detail. Moreover, guilt appraisals in the acute phase after an accident might be a relevant target for clinical attention.
authors.affiliation: Department of Psychosomatics and Psychiatry, University Children's Hospital, Zurich, Switzerland.|Children's Research Center, University Children's Hospital, Zurich, Switzerland.
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Haag
authors.affiliation: Clienia Schloessli AG, Oetwil am See, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Zehnder
authors.affiliation: Department of Psychosomatics and Psychiatry, University Children's Hospital, Zurich, Switzerland.|Children's Research Center, University Children's Hospital, Zurich, Switzerland.|Department of Child and Adolescent Health Psychology, Institute of Psychology, University of Zurich, Switzerland; markus.landolt@kispi.uzh.ch.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Landolt
keywords: Trauma; childhood; cognitive appraisals; injury