Sleep Disturbances and Internalizing Behavior Problems Following Pediatric Traumatic Injury
Sleep Disturbances and Internalizing Behavior Problems Following Pediatric Traumatic Injury
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DOI：
10.1037/neu0000420
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发表时间：
2018-02-01
期刊：
影响因子：
2.4
通讯作者：
Ewing-Cobbs, Linda
中科院分区：
文献类型：
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作者：
Fischer, Jesse T.;Hannay, H. Julia;Ewing-Cobbs, Linda
目的：这项前瞻性纵向研究调查了儿童和青少年创伤性损伤（包括创伤性脑损伤（TBI）或颅外/身体损伤（EI））后的睡眠障碍（SD）和内化问题，相对于典型发育（TD）儿童。我们还研究了SD和创伤后内化问题之间的纵向关系。方法：参与者（N = 87）年龄8-15岁，包括TBI，EI和TD儿童的青年。受伤组是从1级创伤中心招募的，在遭受与车辆有关的伤害后。父母报告的SD和内在化问题在伤前/基线、伤后6个月和12个月进行评估。采用线性混合模型评价各组与评价时间对疗效的关系。结果如下：在控制年龄的情况下，合并创伤组的SD（p = 0.042）和内化问题（p = 0.024）明显高于TD儿童;然而，TBI和EI损伤组之间没有差异。损伤严重程度仅与EI组SD呈正相关，但两组SD均与其他损伤后后遗症相关，包括疲劳和外化行为问题。内化问题预测SD的后续发展，但反之亦然。1年后损伤与SD之间的关系与损伤后6个月内在化问题的调解一致。结论：与健康儿童相比，患有两种类型创伤的儿童表现出更高的SD和内化问题。内在化问题发生之前或之后的儿科损伤可能是创伤后SD的危险因素。因此，内化问题可能是一个有希望的干预目标，以改善可持续发展和相关的调整问题。
Objective: This prospective longitudinal study investigated sleep disturbance (SD) and internalizing problems after traumatic injury, including traumatic brain injury (TBI) or extracranial/bodily injury (EI) in children and adolescents, relative to typically developing (TD) children. We also examined longitudinal relations between SD and internalizing problems postinjury. Method: Participants (N = 87) ages 8-15 included youth with TBI, EI, and TD children. Injury groups were recruited from a Level 1 trauma center after sustaining vehicle-related injuries. Parent-reported SD and internalizing problems were assessed at preinjury/baseline, and 6 and 12 months postinjury. Linear mixed models evaluated the relation of group and time of assessment on outcomes. Results: Controlling for age, the combined traumatic injury group experienced significantly higher postinjury levels of SD (p = .042) and internalizing problems (p = .024) than TD children; however, TBI and EI injury groups did not differ from each other. Injury severity was positively associated with SD in the EI group only, but in both groups SD was associated with additional postinjury sequelae, including fatigue and externalizing behavior problems. Internalizing problems predicted subsequent development of SD but not vice versa. The relation between injury and SD 1 year later was consistent with mediation by internalizing problems at 6 months postinjury. Conclusions: Children with both types of traumatic injury demonstrated higher SD and internalizing problems than healthy children. Internalizing problems occurring either prior to or following pediatric injury may be a risk factor for posttraumatic SD. Consequently, internalizing problems may be a promising target of intervention to improve both SD and related adjustment concerns.