title: Traumatic Stress, Depression, and Recovery: Child and Parent Responses After Emergency Medical Care for Unintentional Injury.
abstract: OBJECTIVE
  To assess psychological symptoms in injured children (aged 8-17 years) and their parents after emergency department (ED) care to examine the relationship between posttraumatic stress and depression symptoms, co-occurrence of symptoms within families, and the relationship of these symptoms to parent-reported overall recovery.
  
  
  METHODS
  Children and parents (n = 263 child-parent dyads) were enrolled during ED treatment for unintentional injury. Approximately 5 months later, children and parents (n = 178 dyads) completed standardized measures of posttraumatic stress and depression symptoms and parents reported on child overall recovery.
  
  
  RESULTS
  Follow-up assessments found significant posttraumatic stress symptoms in 15% of children and 5% of parents, significant depression symptoms in 13% of children and 16% of parents, and problematic overall recovery in 17% of children. For both children and parents, posttraumatic stress and depression symptom severity were strongly associated. Child and parent symptoms were only modestly associated with each other, and there were few families in which both child and parent had significant posttraumatic stress or depression. Parent symptoms, but not child symptoms, were inversely associated with children's overall recovery.
  
  
  CONCLUSIONS
  For about 1 in 6 children and parents, unintentional injury treated in the ED can be associated with negative psychological sequelae and suboptimal recovery. Within families, child and parent responses may differ; their relative association with overall recovery deserves additional research. To promote emotional recovery, ED clinicians should be aware of the potential psychological impact of unintentional injury, provide timely evidence-based anticipatory guidance, and communicate these concerns to primary care clinicians.
authors.affiliation: From the *Center for Injury Research and Prevention, Children's Hospital of Philadelphia; and †Division of Emergency Medicine, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; ‡Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam; and §Association of Dutch Burns Centres, Beverwijk, The Netherlands; and ∥Department of Psychiatry and ¶Division of General Pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Kassam-Adams
authors.forename: Anne
authors.initials: A
authors.lastname: Bakker
authors.forename: Meghan L
authors.initials: ML
authors.lastname: Marsac
authors.forename: Joel A
authors.initials: JA
authors.lastname: Fein
authors.forename: Flaura Koplin
authors.initials: FK
authors.lastname: Winston
mesh_terms: D000293:Adolescent; D002648:Child; D003863:Depression / Q000209:etiology*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology*; D014947:Wounds and Injuries / Q000150:complications* / Q000523:psychology* / Q000628:therapy