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The Risk of the Development of Secondary Post-Traumatic Stress Disorder among Pediatric Health Care Providers: A Systematic Review. REPORTS 2023. [DOI: 10.3390/reports6010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Background: Secondary PTSD is defined as the natural, consequential behaviors and emotions that result from knowledge about a traumatic event experienced by a significant other deriving from working with suffering individuals. Pediatric health providers with symptoms of PTSD report problems with relationships and general life dissatisfaction as well as and anxiety, depression and burnout syndrome. Aim: The aim of this systematic review was to estimate the risk of developing secondary PTSD among pediatric health care providers as well as all additional contributing factors. In more detail, we investigated the PTSD symptomatology between pediatric health care providers and the extent to which parameters such as the job, gender, department and other factors had an impact on the mental health status of pediatric health care providers. Methodology: We searched all published English papers in PubMed, Google Scholar and the Cochrane Library from September to November 2022. We excluded reviews, systematic reviews and meta-analyses as well as letters to editors. From a total of 748 papers, we included only 12 research articles that met the admission criteria. Results: According to our results, the prevalence of secondary PTSD ranges from 13% to 94%. Burnout, nurses, the female gender, intensive care units, past traumatic life events and a psychiatric history identified as factors contributing to the development of secondary PTSD. Conclusions: Health policy-makers should take the specificity in the working environment of the pediatric sector seriously into consideration, especially emergency departments.
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Xiong T, Kaltenbach E, Yakovenko I, Lebsack J, McGrath PJ. How to measure barriers in accessing mental healthcare? Psychometric evaluation of a screening tool in parents of children with intellectual and developmental disabilities. BMC Health Serv Res 2022; 22:1383. [PMID: 36411458 PMCID: PMC9677628 DOI: 10.1186/s12913-022-08762-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022] Open
Abstract
Caring for children with intellectual and developmental disabilities (IDD) can cause an enormous physical and emotional burden, and therefore these parents have an elevated risk to experience mental health problems. The characteristics of current healthcare systems and parents' responsibilities to care for their children seem to impede their access to mental healthcare. There is so far a lack of instruments to screen for such obstacles. The aim of this study was to develop and validate a scale for measuring barriers to accessing mental healthcare. The Parental Healthcare Barriers Scale (PHBS) was developed on the basis of an extensive literature research, input and discussion from experts and parents with lived experience. A cross-sectional survey was used to collect data from 456 parents of children with IDD. Physical health, mental health, social support, and parenting were measured for concurrent and discriminant validity of the PHBS. The PHBS scale revealed acceptable to good reliability and validity. It consists of four subscales (i.e., support accessibility, personal belief, emotional readiness, and resource availability). The PHBS found parents prioritized their children's treatments over their own mental health challenges (93.4%), did not have enough time (90.4%), and had financial concerns (85.8%). Parents in rural and remote areas had more limited resources. Findings from our study suggest increasing financial support for the parents seeking mental health services, introducing evidence-based treatments, increasing the availability of healthcare services for parents, and adjusting current services to their needs.
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Affiliation(s)
- Ting Xiong
- grid.17063.330000 0001 2157 2938University of Toronto, Toronto, Canada ,grid.414870.e0000 0001 0351 6983IWK Health Centre, 5980 University Ave #5850, Halifax, NS B3K 6R8 Canada
| | - Elisa Kaltenbach
- grid.414870.e0000 0001 0351 6983IWK Health Centre, 5980 University Ave #5850, Halifax, NS B3K 6R8 Canada
| | - Igor Yakovenko
- grid.55602.340000 0004 1936 8200Dalhousie University, Halifax, Canada
| | | | - Patrick J. McGrath
- grid.414870.e0000 0001 0351 6983IWK Health Centre, 5980 University Ave #5850, Halifax, NS B3K 6R8 Canada ,grid.55602.340000 0004 1936 8200Dalhousie University, Halifax, Canada
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Shlobin NA, Garcia RM, Bernstein M. Neuropalliative care for the neurosurgeon: a primer. J Neurosurg 2022; 137:850-858. [PMID: 34920433 DOI: 10.3171/2021.9.jns211872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022]
Abstract
Many neurosurgical conditions are incurable, leading to disability or severe symptoms, poor quality of life, and distress for patients and families. The field of neuropalliative care (NPC) addresses the palliative care (PC) needs of individuals living with neurological conditions. Neurosurgeons play an important role within multidisciplinary NPC teams because of their understanding of the natural history of and treatment strategies for neurosurgical conditions, longitudinal patient-physician relationships, and responsibility for neurosurgical emergencies. Moreover, patients with neurosurgical conditions have unique PC needs given the trajectories of neurosurgical diseases, the realities of prognostication, psychosocial factors, communication strategies, and human behavior. PC improves outcomes among neurosurgical patients. Despite the importance of NPC, neurosurgeons often lack formal training in PC skills, which include identifying patients who require PC, assessing a patient's understanding and preferences regarding illness, educating patients, building trust, managing symptoms, addressing family and caregiver needs, discussing end-of-life care, and recognizing when to refer patients to specialists. The future of NPC involves increasing awareness of the approach's importance, delineating priorities for neurosurgeons with regard to NPC, increasing emphasis on PC skills during training and practice, expanding research efforts, and adjusting reimbursement structures to incentivize the provision of NPC by neurosurgeons.
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Affiliation(s)
- Nathan A Shlobin
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Roxanna M Garcia
- 1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark Bernstein
- 2Division of Neurosurgery, Toronto Western Hospital, University of Toronto; and
- 3Temmy Latner Center for Palliative Care, Mount Sinai Hospital, University of Toronto, Ontario, Canada
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Tang AR, Chen JW, Sellyn GE, Chen H, Zhao S, Gannon SR, Shannon CN, Bonfield CM. Evaluating caregiver stress in craniosynostosis patients. J Neurosurg Pediatr 2022; 30:224-231. [PMID: 35561696 DOI: 10.3171/2022.4.peds21596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Caregiver stress from a child's diagnosis can impact a caregiver's ability to participate in treatment decisions, comply, and manage long-term illness. The aim of this study was to compare caregiver stress in children with craniosynostosis at diagnosis and postoperatively. METHODS This prospective study included caregivers of pediatric patients with craniosynostosis receiving operative intervention. Demographics and Parenting Stress Index, Short Form (PSI-SF) and Pediatric Inventory for Parents (PIP) surveys at baseline (preoperatively) and 3 and 6 months postoperatively were completed. PSI-SF scores between 15 and 80 are considered normal, with > 85 being clinically significant and requiring follow-up. Higher PIP scores represent increased frequency and difficulty of stressful events due to the child's illness. Pairwise comparisons were performed using the Wilcoxon signed-rank test. Multivariate analysis was performed to assess for PSI-SF and PIP predictors. RESULTS Of 106 caregivers (84% Caucasian), there were 62 mothers and 40 fathers. There were 68 and 45 responses at 3 and 6 months postoperatively, respectively. Regarding the baseline group, more than 80% were between 20 and 40 years of age and 58% had less than 2 years of college education. The median household income fell in the $45,001-$60,000 bracket. There was no significant difference between median baseline PSI-SF score (65, IQR 51-80) and those at 3 months (p = 0.45) and 6 months (p = 0.82) postoperatively. Both median PIP frequency (89 vs 74, p < 0.01) and difficulty (79 vs 71, p < 0.01) scores were lower at 3 months, although no significant difference was observed at 6 months (frequency: 95 vs 91, p = 0.67; difficulty: 82 vs 80, p = 0.34). Female sex, uninsured status, and open surgery type were all risk factors for higher parental stress. CONCLUSIONS Stress levels ranged from normal to clinically significant in the caregivers, with sex, uninsured status, and open repair predicting higher stress. Stress decreased at 3 months postoperatively before increasing at 6 months. Intervention targeting caregiver stress should be explored to maintain lower stress observed at 3 months after surgery.
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Affiliation(s)
- Alan R Tang
- 1Vanderbilt University School of Medicine, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Jeffrey W Chen
- 1Vanderbilt University School of Medicine, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Georgina E Sellyn
- 1Vanderbilt University School of Medicine, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Heidi Chen
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
- 3Department of Biostatistics, Vanderbilt University, Nashville; and
| | - Shilin Zhao
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
- 3Department of Biostatistics, Vanderbilt University, Nashville; and
| | - Stephen R Gannon
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Chevis N Shannon
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher M Bonfield
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Levy Erez D, Meyers MR, Raman S, Thomas M, Furth S, Forrest CB, Denburg M. When Dialysis "Becomes Life": Pediatric Caregivers' Lived Experiences Obtained From Patient-Reported Outcomes Measures. Front Pediatr 2022; 10:864134. [PMID: 35676900 PMCID: PMC9168233 DOI: 10.3389/fped.2022.864134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Qualitative research reveals significant caregiver impact resulting from managing children requiring chronic dialysis but offers few quantitative measures of their lived experiences. Materials and Methods This cross-sectional study included 25 caregivers of children on chronic peritoneal dialysis (PD) and hemodialysis (HD) enrolled from 2018 to 2019 at a large pediatric dialysis program in the U.S.Patient Reported Outcomes Measures Information System (PROMIS) measures and free text commentary were collected and analyzed to evaluate the self-reported impact and wellbeing of these caregivers. Results Among all dialysis modalities, caregivers' positive affect (43.4 ± 10) and general life satisfaction (45.1 ± 11.5) were significantly lower than the general adult population. Compared with HD caregivers, PD caregivers demonstrated significantly more fatigue and sleep disturbance and less positive affect and life satisfaction. Amongst HD caregivers, sleep disturbance, positive affect, and meaning/purpose differed significantly from the general population. Analyses of text commentary revealed that caregivers also expressed the feelings of loss, importance of knowing the impact of dialysis prior to initiation, need for a support group, and value of home nursing. Conclusions Caregivers of children on chronic dialysis had significantly poorer self-rated health and wellbeing compared with the general adult population. This may be due in part to their feelings of social isolation. Our findings highlight opportunities to improve caregivers' lived experiences.
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Affiliation(s)
- Daniella Levy Erez
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Schneider Children's Medical Center, Petah Tikva, Israel
| | - Melissa R. Meyers
- Division of Nephrology, Children's National Medical Center, Washington, DC, United States
- George Washington University School of Medicine, Washington, DC, United States
| | - Swathi Raman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Melissa Thomas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Susan Furth
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Christopher B. Forrest
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michelle Denburg
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Zimmerman K, Shlobin NA, Salehani A, Rocque BG. Psychological comorbidities in pediatric neurosurgery: an opportunity to improve care. J Neurosurg Pediatr 2022; 29:358-359. [PMID: 34798601 DOI: 10.3171/2021.9.peds21417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kathrin Zimmerman
- 1Division of Pediatrics, Department of Neurosurgery, University of Alabama at Birmingham
| | - Nathan A Shlobin
- 2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arsalaan Salehani
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Brandon G Rocque
- 1Division of Pediatrics, Department of Neurosurgery, University of Alabama at Birmingham
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Turgoose DP, Kerr S, De Coppi P, Blackburn S, Wilkinson S, Rooney N, Martin R, Gray S, Hudson LD. Prevalence of traumatic psychological stress reactions in children and parents following paediatric surgery: a systematic review and meta-analysis. BMJ Paediatr Open 2021; 5:e001147. [PMID: 34337164 PMCID: PMC8287603 DOI: 10.1136/bmjpo-2021-001147] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children undergoing surgery and their parents are at risk of developing post-traumatic stress reactions. We systematically reviewed the literature to understand the prevalence of this issue, as well as potential risk factors. METHODS We conducted a systematic review and meta-analysis, using PubMed, PsycInfo, Web of Science and Google Scholar, with searches conducted in February 2021. Papers were included if they measured post-traumatic stress in children and/or parents following paediatric surgery and were excluded if they did not use a validated measure of post-traumatic stress. Data were extracted from published reports. FINDINGS Our search yielded a total of 1672 papers, of which 16 met our inclusion criteria. In meta-analysis, pooled studies of children estimated an overall prevalence of 16% meeting criteria for post-traumatic stress disorder post surgery (N=187, 95% CI 5% to 31%, I2=80%). After pooling studies of parents, overall prevalence was estimated at 23% (N=1444, 95% CI 16% to 31%, I2=91%). Prevalence rates were higher than those reported in the general population. Risk factors reported within studies included length of stay, level of social support and parental mental health. INTERPRETATION There is consistent evidence of traumatic stress following surgery in childhood which warrants further investigation. Those delivering surgical care to children would benefit from a raised awareness of the potential for post-traumatic stress in their patients and their families, including offering screening and support.
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Affiliation(s)
- David Paul Turgoose
- Leeds Institute of Health Sciences, Leeds medical school, University of Leeds, Leeds, UK.,Department of Psychology and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stephanie Kerr
- Department of Specialist and Neonatal Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paolo De Coppi
- Department of Specialist and Neonatal Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Developmental Biology and Cancer, Great Ormond Street UCL Institute of Child Health, London, UK
| | - Simon Blackburn
- Department of Specialist and Neonatal Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon Wilkinson
- Department of Psychology and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Natasha Rooney
- Department of Psychology and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Martin
- Department of Anaesthethics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Suzanne Gray
- Department of Psychology and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lee Duncan Hudson
- Department of Psychology and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of General Paediatrics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, London, UK.,Population, Policy and Practice Department, Great Ormond Street UCL Institute of Child Health, London, UK
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