Prospective Evaluation of Parent Distress Following Pediatric Burns and Identification of Risk Factors for Young Child and Parent Posttraumatic Stress Disorder
Prospective Evaluation of Parent Distress Following Pediatric Burns and Identification of Risk Factors for Young Child and Parent Posttraumatic Stress Disorder
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DOI：
10.1089/cap.2013.0066
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发表时间：
2014-02-01
影响因子：
1.9
通讯作者：
Kimble, Roy M.
中科院分区：
文献类型：
--
作者：
De Young, Alexandra C.;Hendrikz, Joan;Kimble, Roy M.
目的：幼儿期是暴露于潜在创伤性医疗事件的高危时期。我们之前报道过，10%的幼儿在烧伤后6个月仍然患有创伤后应激障碍（PTSD）。本研究旨在1)记录儿童烧伤后6个月内父母心理困扰的发生率和预期变化；2)确定幼儿及其父母创伤后应激症状（PTSS）的危险因素。方法：参与者为120名1-6岁意外烧伤儿童的父母。数据收集在烧伤2周，1个月和6个月内使用发育敏感的诊断访谈和问卷调查。结果：在第一个月内，大约25%的父母有可能被诊断为创伤后应激障碍，并且有中度到极严重的抑郁、焦虑和压力。随着时间的推移，痛苦程度显著下降；然而，5%的父母在6个月时仍然可能患有创伤后应激障碍。层次多元回归和路径分析表明，父母创伤后应激反应对儿童创伤后应激障碍的发展和维持有显著影响。儿童创伤后应激障碍的其他危险因素包括发病前的情绪和行为困难以及较大的烧伤面积。父母ptsd的危险因素包括先前的创伤史、急性痛苦、大量的儿童侵入性手术、内疚和儿童ptsd。结论：本研究的结果表明，父母对创伤性事件的反应可能在幼儿的心理康复中起着特别重要的作用。然而，需要进一步的研究来确定孩子与父母痛苦之间关系的方向。本研究确定了可以纳入筛查工具或早期干预方案的变量，以防止医疗创伤后儿童和父母持续性ptsd的发展。
Objective: Early childhood is a high-risk time for exposure to potentially traumatic medical events. We have previously reported that 10% of young children continue to have posttraumatic stress disorder (PTSD) 6 months after burn injury. This study aimed to 1) document the prevalence and prospective change in parental psychological distress over 6 months following their child's burn injury and 2) identify risk factors for posttraumatic stress symptoms (PTSS) in young children and their parents. Methods: Participants were 120 parents of 1-6-year-old children with unintentional burn injuries. Data were collected within 2 weeks, 1 month, and 6 months of burn injury using developmentally sensitive diagnostic interviews and questionnaires. Results: Within the first month, approximate to 25% of parents had a probable PTSD diagnosis, and moderate to extremely severe levels of depression, anxiety, and stress. Distress levels decreased significantly over time; however, 5% of parents still had probable PTSD at 6 months. Hierarchical multiple regression and path analyses indicated that parent posttraumatic stress reactions contributed significantly to the development and maintenance of child PTSS. Other risk factors for child PTSS included premorbid emotional and behavioral difficulties and larger burn size. Risk factors identified for parent PTSS included prior trauma history, acute distress, greater number of child invasive procedures, guilt, and child PTSS. Conclusions: The findings from this study suggest that parents' responses to a traumatic event may play a particularly important role in a young child's psychological recovery. However, further research is needed to confirm the direction of the relationship between child and parent distress. This study identified variables that could be incorporated into screening tools or targeted by early intervention protocols to prevent the development of persistent child and parent PTSS following medical trauma.