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Li Y, Rao X, Yang C, Luo R, Cao D, Gan J. Prevalence of anxiety, depression, and posttraumatic stress disorder in caregivers of children with epilepsy: A meta-analysis. Epilepsy Behav 2025; 164:110301. [PMID: 39923720 DOI: 10.1016/j.yebeh.2025.110301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2024] [Revised: 02/01/2025] [Accepted: 02/02/2025] [Indexed: 02/11/2025]
Abstract
OBJECTIVES This systematic review with meta-analysis (PROSPERO: CRD42022377532) was performed to comprehensively assess the prevalence of anxiety, depression, and posttraumatic stress disorder (PTSD) in caregivers of children with epilepsy. METHODS A search was performed on June 2024, in 4 databases (PubMed, Embase, Web of Science, and PsycInfo) for original research reporting on caregivers of children with epilepsy, with no language restrictions. Two reviewers independently screened and extracted data. The methodological quality was assessed using the Healthcare Research and Quality of America (AHRQ) standardized appraisal tool. Random-effects models were used to calculate the pooled prevalence of anxiety, depression, and PTSD. The subgroup analysis was further conducted to identify possible sources of heterogeneity. All studies were reviewed by PRISMA guidelines. RESULTS A total of 2,588 records were screened and 38 studies with 6,593 participants across 18 countries were included for analysis: 25 studies provided prevalence estimates for anxiety, 33 for depression, and 5 for PTSD. Eleven studies were rated as high quality according to the AHRQ scale, 24 as moderate quality, and 3 as low quality. The pooled prevalence of anxiety was 34 % (95 %CI 0.28-0.41) with considerable heterogeneity (I2 = 96.18 %), 31 % for depression (95 %CI 0.24-0.37) with substantial heterogeneity (I2 = 97.60 %), and 21 % for PTSD (95 %CI 0.17-0.26) with moderate heterogeneity (I2 = 55.02 %). Significant heterogeneity was observed, particularly concerning anxiety and depression, which could be attributed to variations in screening methods. However, no statistical differences were found between subgroups based on gender, region, year of publication, type of seizure, economic development level of countries. In the gender subgroup analysis for PTSD, females had a higher prevalence (24 %) than males (6 %). In the sensitive analysis of PTSD, the prevalence was 23 % with low heterogeneity (I2 = 22.94 %) by excluding one study. CONCLUSION We systematically analyzed the prevalence of anxiety, depression, and PTSD in caregivers of children with epilepsy. Our findings highlight the high mental health burden among caregivers, with prevalence rates notably higher than those in the general population. These results emphasize the urgent need for early identification, interventions, and comprehensive support to improve the well-being and quality of life of these caregivers.
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Affiliation(s)
- Yanmei Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610066 China
| | - Xueyi Rao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610066 China
| | - Chunsong Yang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610066 China
| | - Rong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610066 China
| | - Dezhi Cao
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518000 China
| | - Jing Gan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610066 China; WCSUH-Tianfu·Sichuan Provincial Children's Hospital, Sichuan Province 620010, China
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Marcev I, Lannon-Boran C, Hyland P, McHugh Power J. The factors associated with paediatric medical post-traumatic stress: A systematic review. J Health Psychol 2024:13591053241272214. [PMID: 39344541 DOI: 10.1177/13591053241272214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
We examined and synthesised existing literature on factors associated with paediatric medical-related posttraumatic stress among children and their parents. Children experiencing a broad spectrum of medical conditions, diseases and injuries were of interest. A search of relevant literature concerning PMTS in children and their parents, as well as factors associated with PMTS, was conducted using Medline, PubMed and Scopus. Only studies published in English between January 2018 and November 2023 were included. Twelve articles met inclusion criteria. A broad range of correlates of PMTS were identified for children and parents, which were thematically organised into six key areas: hospital practices and environments; the parent-child relationship; parental mental wellbeing; psychological factors; sociodemographic factors; and the physical consequences of the condition. Bearing in mind constraints on causal inference due to the design of the included studies, knowledge of the factors associated with PMTS may enable clinicians to identify at-risk children and parents, with a view to intervention.
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Irish M, Adams J, Cooper M. Investigating self-blame and trauma symptoms in parents of young people with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2024; 32:80-89. [PMID: 37585595 DOI: 10.1002/erv.3025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Caring for a young person with anorexia nervosa (AN) has been associated with psychological distress and found to be a traumatic experience. This can have an impact on patient and family outcomes. OBJECTIVE This study aimed to investigate whether self-blame cognitions contribute to post-traumatic stress disorder (PTSD) symptoms in parents of young people with AN. METHODS A cross-sectional design was used. One hundred and twenty-three parents of young people with AN completed a range of questionnaires assessing self-blame cognitions and PTSD symptoms. RESULTS Overall, levels of self-blame cognitions were significantly higher in those experiencing higher levels of PTSD symptoms compared to low levels. Additionally, levels of self-blame cognitions significantly predicted PTSD symptoms over and above demographic factors and illness severity, accounting for 22% of unique variance in PTSD symptoms. CONCLUSIONS The findings suggest that negative appraisals regarding self-blame for their child's eating disorder contributed to the potential maintenance of PTSD symptoms. Parents presenting with thoughts of self-blame would benefit from further support to reduce these feelings and, subsequently, reduce carer distress.
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Affiliation(s)
- Madeleine Irish
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Isis Education Centre, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Joanna Adams
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Isis Education Centre, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Myra Cooper
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Isis Education Centre, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Lou VWQ, Chung HF, Leung WCY, Chang RSK, Tsaw M, Lo CNR, Chiu ATG. Prevalence and predictors of depressive symptoms among caregivers of patients with epilepsy in Hong Kong. Epilepsy Behav 2023; 147:109411. [PMID: 37672823 DOI: 10.1016/j.yebeh.2023.109411] [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: 05/05/2023] [Revised: 08/13/2023] [Accepted: 08/19/2023] [Indexed: 09/08/2023]
Abstract
STUDY AIM To estimate the prevalence of high caregiving burden and depressive symptoms among caregivers (CG) of patients with epilepsy (PWEs) in Hong Kong and identify risk and protective factors for both outcomes after the Model of Stress and Carer Burden (MSCB). METHODS This cross-sectional study recruited participants from local epilepsy clinics to complete a 15-minute survey on a tablet. Caregiving burden (CB) was assessed using the 4-item Zarit Caregiver Burden Interview. Depressive symptoms were assessed using the 2-item Patient Health Questionnaire. Family functioning was assessed using the Short-Form Family Assessment Device General Functioning Subscale. Sociodemographic data of the caregivers and clinical data of the PWE they cared for were described. Hierarchical logistic regression models were used to analyze the factors associated with the outcomes. RESULTS A hundred and fifty-one CGs of PWEs were recruited for this study. The prevalence of high caregiving burden (ZBI-4 > 7) for CGs of PWEs was 58.9% (n = 89), whereas the prevalence of high depressive symptoms (PHQ2 > 2) was 23.8% (n = 36). Hierarchical logistic regression analysis revealed that entering patient characteristics and care situations did not enhance the model's predictability. In the full model, a high perceived CB was a risk factor for elevated depressive symptoms. Good physical health protects against depressive symptoms. CONCLUSIONS Among caregivers of PWE in Hong Kong, a high perceived caregiving burden was a risk factor for elevated depressive symptoms; however, the clinical characteristics of the PWEs were not. Self-reported physical health is a protective factor against increased depressive symptoms.
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Affiliation(s)
- Vivian W Q Lou
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong; Sau Po Centre of Ageing, University of Hong Kong, Hong Kong.
| | - Ho-Fung Chung
- Sau Po Centre of Ageing, University of Hong Kong, Hong Kong
| | - William C Y Leung
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Richard Shek-Kwan Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Meagan Tsaw
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Cheuk Nam Rachel Lo
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Annie Ting-Gee Chiu
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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5
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Yu X, Lim KS, Tang LY, Tang V, Lim YH, Fong SL, Tan CT. Caregiver burden for adults with epilepsy in Malaysian families: A qualitative study. Epilepsy Behav 2023; 147:109395. [PMID: 37619469 DOI: 10.1016/j.yebeh.2023.109395] [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: 06/30/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Caregivers of adults with epilepsy (AWE) play an important role in the healthcare pathway of AWE and are described as the "co-client." Being caregivers can be stressful and the negative impacts might accumulate over time, affecting their quality of life and well-being. OBJECTIVES This qualitative study aimed to explore the lived experience of caregivers of AWE in Malaysian families and understand their caregiving challenges. Individual semi-structured interviews were held with 12 primary caregivers of AWE. Interpretative Phenomenological Approach (IPA) was used. The interview transcripts were analyzed using NVivo12 software. RESULTS Primary caregivers of AWE were parents or siblings, with ages ranging from 56 to 80 years old and years of caregiving from 24 to 40 years. Most AWE (58%) were intellectually disabled and fully dependent on ADL needs. Two categories of themes emerged, including four themes on caregiver burden, i.e., physical, emotional, and social burdens, and challenges in future planning of care, and two themes on coping strategies (problem- or emotional-focused). In future planning of care, most caregivers especially parents carried a burden of responsibility and were reluctant to depend on others or institutional services. CONCLUSION The caregiving burden among caregivers for adult AWE was not confined to current burdens only but also challenges in future planning. A better understanding of the caregiving burden for AWE and coping strategies is needed to provide tailored psychoeducation or psychosocial intervention to support this population.
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Affiliation(s)
- Xuen Yu
- Neurology Division, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kheng-Seang Lim
- Neurology Division, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Li-Yoong Tang
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Malaysia
| | - Venus Tang
- Department of Clinical Psychology, Prince of Wales Hospital, Hospital Authority, Hong Kong; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Ying-Huan Lim
- Neurology Division, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Si-Lei Fong
- Neurology Division, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chong-Tin Tan
- Neurology Division, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Carmassi C, Pedrinelli V, Dell'Oste V, Bertelloni CA, Grossi C, Gesi C, Cerveri G, Dell'Osso L. PTSD and Depression in Healthcare Workers in the Italian Epicenter of the COVID-19 Outbreak. Clin Pract Epidemiol Ment Health 2022; 17:242-252. [PMID: 35173794 PMCID: PMC8728562 DOI: 10.2174/1745017902117010242] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/12/2021] [Accepted: 09/24/2021] [Indexed: 12/27/2022]
Abstract
Background: Increasing evidence highlights the susceptibility of Healthcare Workers to develop psychopathological sequelae, including Post-Traumatic Stress Disorder (PTSD) and depression, in the current COronaVIrus Disease-19 (COVID-19) pandemic, but little data have been reported in the acute phase of the pandemic. Objective: To explore Healthcare Workers’ mental health reactions in the acute phase of the COVID-19 pandemic in the first European epicenter (Lodi/Codogno, Italy), with particular attention to post-traumatic stress and depressive symptoms and their interplay with other psychological outcomes. Methods: 74 Healthcare Workers employed at the Azienda Socio Sanitaria Territoriale of Lodi (Lombardy, Italy) were recruited and assessed by means of the Impact of Event Scale- Revised, the Professional Quality of Life Scale-5, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 item, the Resilience Scale and the Work and Social Adjustment Scale. Socio-demographic and clinical variables were compared across three subgroups of the sample (No PTSD, PTSD only, PTSD and depression). Results: A total of 31% of subjects endorsed a diagnosis of PTSD and 28.4% reported PTSD comorbid with major depression. Females were more prone to develop post-traumatic stress and depressive symptoms. Subjects with PTSD and depression groups showed high levels of PTSD, depression, burnout and impairment in functioning. Anxiety symptoms were higher in both PTSD and depression and PTSD groups rather than in the No PTSD group. Conclusion: Our results showed high rates of PTSD and depression among Healthcare Workers and their comorbidity overall being associated with worse outcomes. Current findings suggest that interventions to prevent and treat psychological implications among Healthcare Workers facing infectious outbreaks are needed.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | | | - Chiara Grossi
- Department of Mental Health and Addiction, ASST Lodi, Lodi, Italy
| | - Camilla Gesi
- Department of Mental Health and Addiction, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Buselli R, Corsi M, Veltri A, Baldanzi S, Chiumiento M, Del Lupo E, Marino R, Necciari G, Caldi F, Perretta S, Foddis R, Guglielmi G, Cristaudo A. Quarantine and Mental Health Challenges for Occupational Medicine: The Case Report of a Nurse Infected With SARS-CoV-2. Workplace Health Saf 2022; 70:43-49. [PMID: 35037513 DOI: 10.1177/21650799211045715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This case study draws attention to the psychosocial difficulties that emerged in the context of the coronavirus disease 2019 (COVID-19) outbreak in relation to the remote management of subjects with psychiatric vulnerabilities following exposure to prolonged quarantine. The case involves a 56-year-old hospital nurse, followed by the Occupational Health Department of a major university hospital in central Italy for mood instability in the context of a cyclothymic temperament. She was quarantined for occupationally acquired COVID-19 and remained positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via swab test for more than 2 months between March and May 2020. In this case study, we discuss the challenges presented by the risk of a prolonged quarantine in a psychologically vulnerable employee, the need for occupational medicine to provide adequate health surveillance of all health care workers during the COVID-19 pandemic, the effectiveness of telepsychiatry, and the difficulties in formulating a proper treatment strategy.
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Affiliation(s)
- R Buselli
- Azienda Ospedaliero-Universitaria Pisana
| | - M Corsi
- Azienda Ospedaliero-Universitaria Pisana
| | - A Veltri
- Azienda Ospedaliero-Universitaria Pisana
| | - S Baldanzi
- Azienda Ospedaliero-Universitaria Pisana
| | | | - E Del Lupo
- Azienda Ospedaliero-Universitaria Pisana
| | - R Marino
- Azienda Ospedaliero-Universitaria Pisana
| | - G Necciari
- Azienda Ospedaliero-Universitaria Pisana
| | - F Caldi
- Azienda Ospedaliero-Universitaria Pisana
| | - S Perretta
- Azienda Ospedaliero-Universitaria Pisana
| | - R Foddis
- Azienda Ospedaliero-Universitaria Pisana
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Abstract
OBJECTIVE Work-related stress presents a significant impact on work performance and physical health. It has been associated with the onset of a multitude of symptoms. The main aim of this investigation is to better understand the impact of post-traumatic stress symptomatology, using a specific self-assessment questionnaire, in subjects experiencing occupational stress with the rationale to address the variegated symptoms expressed by this particular population in a post-traumatic dimensional perspective. METHODS Authors collected socio-demographic, occupational, and clinical data. They utilized Trauma and Loss Spectrum Self Report (TALS-SR), a questionnaire investigating post-traumatic stress symptoms. The population size was 345 subjects who presented at the Occupational Health Department of a university hospital over a 3 years period (2016-2018). RESULTS Data analysis revealed 33.9% of subjects who met post-traumatic stress disorder (PTSD) criteria. Gender distribution of this set was (36.4% female, 31% male). A family history or personal history of mental disorders were related to higher scores in almost all TALS-SR domains and were related, respectively, to higher scores of criterion B "intrusion symptoms" (P = .014), criterion D "negative alterations in cognitions and mood" (P = .023), and criterion E "arousal" (P = .033) of PTSD. Differences in TALS-SR scores also emerged based on age and gender. CONCLUSIONS PTSD symptoms manifest at a significant level in those who experience work-related stress. Personal background of individuals, both in terms of family and personal history for mental disorders, seems to increase their vulnerability to develop post-traumatic stress symptoms. This study suggests the importance of evaluating occupational stress from a post-traumatic stress perspective also at an early stage.
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Post-traumatic stress disorder (PTSD) symptoms in children with severe epilepsy. Epilepsy Behav 2021; 122:108217. [PMID: 34352664 DOI: 10.1016/j.yebeh.2021.108217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess symptoms of post-traumatic stress disorder (PTSD) in children with severe epilepsy and the associations of trauma symptoms across age, comorbid symptoms, epilepsy-specific factors, parental resources, and psychopathology. METHODS Fifty children with severe epilepsy across three different age groups (0-5 yrs., 6-12 yrs., 13-18 yrs.) were assessed with developmental-sensitive and standardized PTSD assessment tools when hospitalized at the tertiary epilepsy center Filadelfia, Denmark. The Diagnostic Infant and Preschool Assessment (DIPA), the Darryl test, and the ITQ questionnaire were used to assess the three age groups, respectively. RESULTS Twenty-two percent of the overall sample met the criteria for PTSD, with a prevalence of symptoms increasing with age (6%, 28%, and 40%). Comorbid psychiatric symptoms in preschoolers were present in 81% of the children witnessing a high level of distress in this group. Behavioral difficulties were elevated across all three age groups, and 40% of the children with trauma symptoms had a parent with concurrent psychopathology. CONCLUSION To the authors' knowledge, this study is the first to assess trauma symptoms with standardized tests in children with more complicated epilepsies. Trauma symptoms in the group are high; however, there is a need for larger scale studies and research into trauma symptoms in children with more severe epilepsy than those assessable with the included assessment tools. The trauma perspective in severe childhood epilepsy might further clarify the complex associations of biological and contextual variables that affect the children's life quality and enable better preventative treatment options for this group.
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Jakobsen AV, Elklit A. Self-control and coping responses are mediating factors between child behavior difficulties and parental stress and family impact in caregivers of children with severe epilepsy. Epilepsy Behav 2021; 122:108224. [PMID: 34352665 DOI: 10.1016/j.yebeh.2021.108224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/10/2021] [Accepted: 07/10/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To gain a better understanding of parental support needs by assessing parental individual psychological factors as mediating factors between child behavior difficulties and parental perceived stress and family impact of severe childhood epilepsy. METHODS One-hundred and sixty two parents of children with severe epilepsy were enrolled in the survey during the hospitalization of their child at the Danish Epilepsy Center. Questionnaires targeted the impact on the family, coping style responses, sense of control, and the level of parental perceived stress. RESULTS Serial mediation models demonstrated a mediating effect of self-control and emotional coping (EMCOP) response between child behavioral difficulties and both parental stress (F(4, 127) = 56.371, p < 0.001, R2 = 0.64) and family impact (F(3, 134) = 32.202, p < 0.001, R2 = 0.42). Low level of control was associated with a higher level of EMCOP response, and a high EMCOP response was associated with greater perceived stress and family impact. Social support ceased to be a protective factor for parental stress in the presence of decreased self-control and higher levels of EMCOP response. CONCLUSION Individual caregiver psychological factors influence the degree to which sequelae of epilepsy impact family life and perceived stress in parents. Coping interventions should direct awareness toward the life-control aspect, coping response styles, and illness-specific factors to ensure that appropriate support is provided. Maintaining parental resources is essential, and the parents' capacities to handle the child's behavioral difficulties should be considered.
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Affiliation(s)
- Anne Vagner Jakobsen
- Department of Neuropediatrics, The Danish Epilepsy Center, Filadelfia, Dianalund, Denmark.
| | - Ask Elklit
- Danish National Center of Psychotraumatology, Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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Yang C, Yao T, Huang Y, Zhao L, Zhang L. Prevalence and influencing factors of depression of caregivers in children with epilepsy in southwestern China: a cross-sectional study. Medicine (Baltimore) 2021; 100:e23571. [PMID: 33725809 PMCID: PMC7969277 DOI: 10.1097/md.0000000000023571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/04/2020] [Indexed: 01/05/2023] Open
Abstract
This study investigated the epidemiological status of depression and its influencing factors among caregivers of children with epilepsy in southwestern China.This was a cross-sectional study. Caregivers of children with epilepsy were recruited from February to June 2018 at the Pediatric Neurology Department of the West China Second Hospital. Depression status was assessed using the Zung Self-Rating Depression Scale. Multiple linear regression analysis was used to assess correlations between depression status and its influencing factors.A total of 319 participants were included. The mean Zung Self-Rating Depression Scale score was 36.37 ± 10.178 and 5.3% (17/319) of participants were classified as depressed. Regression analysis showed that place of residence (B = 0.114; standard error = 0.643; P = .039), attitude towards seizures (B = -0.121; standard error = 1.215; P = .029), medical expenses payment (B = -0.111; standard error = 2.002; P = .044), and children's medication adherence (B = -0.124; standard error = 0.393; P = .025) were related to depression.Some caregivers of children with epilepsy in southwestern China experience depression. Health care providers should pay particular attention to caregivers who live in rural areas, who fear seizures, who experience difficulty paying medical expenses, and whose children show low medication adherence.
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Affiliation(s)
- Chunsong Yang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China second hospital, Sichuan University. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Department of Epidemiology, West China School of Public Health, and West China Fourth Hospital, Sichuan University
| | - Tang Yao
- Department of Neurology, Cheng Du Shang Jin Nan Fu hospital, Sichuan University
| | - Yuanlong Huang
- Chengdu Xinhua Hospitale, Department of Health Policy and Management, West China School of Public Health/West China Fourth Hospital, Sichuan University
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health/West China Fourth Hospital, Sichuan University, Diseases of Women and Children (Sichuan University), Ministry of Education
| | - Lingli Zhang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China second hospital, Sichuan University. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
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Post-traumatic stress, anxiety, and depressive symptoms in caregivers of children tested for COVID-19 in the acute phase of the Italian outbreak. J Psychiatr Res 2021; 135:256-263. [PMID: 33508545 PMCID: PMC7825987 DOI: 10.1016/j.jpsychires.2021.01.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/14/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The recent COVID-19 pandemic pointed out new burdens for researchers on mental health and that evidence-based (EB) studies on vulnerable populations are timely needed. The present paper aims at analysing the impact of suspicious of SARS-COV-2 infection in a cohort of parents presented at 3 major hospitals (spread between north and center of Italy) during the Italian COVID-19 pandemic phase 1. METHODS Participants of the present cross-sectional, multicenter study were parental couples of children suspected to have COVID-19 who underwent testing with nasopharyngeal swabbing. All subjects were assessed by means of the: Impact of Event Scale-Revised (IES-R), Generalized Anxiety Disorder 7-Item (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) in order to evaluate Post-traumatic stress (PTSS), anxiety, and depressive symptoms, respectively. OUTCOMES Results evidenced that parents whose children tested positive for COVID-19 were more prone to developing PTSS, anxiety and depressive symptoms. The same results emerged for parents who had quarantined as opposed to those who had not. Moreover, patients who suffered economic damage showed a higher prevalence of anxiety and depressive symptoms, whereas PTSS was more common among unemployed subjects and among mothers. INTERPRETATION This study identified a mental health strain represented by parenting a child who tested positive for SARS-CoV-2 infection. Further EB research is needed to develop evidence-driven strategies to reduce adverse psychological impacts and related psychiatric symptoms in caregivers of COVID-19 infected children during the next phases of the pandemic.
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Corsi M, Orsini A, Pedrinelli V, Santangelo A, Bertelloni CA, Carli N, Buselli R, Peroni D, Striano P, Dell'Osso L, Carmassi C. PTSD in parents of children with severe diseases: a systematic review to face Covid-19 impact. Ital J Pediatr 2021; 47:8. [PMID: 33446246 PMCID: PMC7807213 DOI: 10.1186/s13052-021-00957-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
CONTEXT The literature agrees on the impact of post-traumatic stress symptoms in parents of seriously ill children but there is less clarity about the real extent and gender differences of this psychopathological risk. The recent Covid-19 outbreak highlighted new burdens for researchers on Post Traumatic Stress Disorder (PTSD) and clear evidence-based knowledge on this issue is timely needed. OBJECTIVE In this review, we present a synthesis of the updated evidence on PTSD rates in parents of children with severe diseases. We also aim to try to understand if research in this field has been refined over time with the long-term intent to better face the new challenges of Covid-19 in the paediatric field. DATA SOURCES The PubMed database was searched. STUDY SELECTION Studies were included if they assessed PTSD in parents of children diagnosed with physical illnesses. DATA EXTRACTION Of 240 studies, 4 were included. RESULTS Analysis of the 4 studies revealed 2 studies with PTSD rates around 20% and in line with previous best-evidence. All 4 studies tried to provide more data on fathers, however, all the studies present the lack of a control group. LIMITATIONS The limited number of studies, which also differ widely in the methodology used. CONCLUSIONS Methodological errors evidenced in all the 4 studies limit their reliability, making the understanding of the paediatric caregiver's concern regarding PTSD still difficult. More sound research is needed.
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Affiliation(s)
- Martina Corsi
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alessandro Orsini
- Department of Clinical and Experimental Medicine, Pediatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy.
- Pediatric Neurology, Pediatric Department, Azienda Ospedaliero- Universitaria Pisana, University of Pisa, Pisa, Italy.
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Santangelo
- Department of Clinical and Experimental Medicine, Pediatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Niccolò Carli
- Department of Clinical and Experimental Medicine, Pediatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Rodolfo Buselli
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Pediatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
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Post-Traumatic Stress Symptoms in Caregivers and Children with Hydrocephalus. World Neurosurg 2020; 148:e66-e73. [PMID: 33307254 DOI: 10.1016/j.wneu.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Hydrocephalus is a disorder of cerebrospinal fluid dynamics, traditionally treated by placement of a ventricular shunt. Shunts are effective but imperfect as they fail in an unpredictable pattern, and the patient's well-being is dependent on adequate shunt function. The omnipresent threat of shunt failure along with the potential need for invasive investigations can be stressful for patients and caregivers. Our objective was to measure post-traumatic stress symptoms (PTSS) in children with hydrocephalus and their caregivers. METHODS A cross-sectional analysis of children with hydrocephalus and their caregivers was conducted. Caregivers completed a measure of their own PTSS (the Post-Traumatic Stress Disorders Checklist for the Diagnostic and Statistical Manual of Mental Disorders-V) and resilience (the Connor Davidson Resilience Scale). Pediatric patients rated their own PTSS and resilience using the Acute Stress Checklist for Kids and Connor Davidson Resilience Scale. RESULTS Ninety-one caregivers completed the Post-Traumatic Stress Disorders Checklist for the Diagnostic and Statistical Manual of Mental Disorders-V. Mean score was 17.0 (standard deviation 15.7; median 13.0). Fourteen percent scored above 33, the threshold suggestive of a preliminary diagnosis of post-traumatic stress disorder. There was a statistically significant association between caregiver post-traumatic stress and marital status, child's race, and caregiver education. More than half (52%) of caregivers reported their child's hydrocephalus as the most significant source of their PTSS. Children did not have markedly elevated levels of PTSS. Forty-one percent of caregivers and 60% of children scored in the lowest resilience quartile compared with the general population. CONCLUSIONS Results from this study suggest that post-traumatic stress affects caregivers with hydrocephalus, yet levels of resilience for caregivers and pediatric patients are low.
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The broad autism phenotype in real-life: clinical and functional correlates of autism spectrum symptoms and rumination among parents of patients with autism spectrum disorder. CNS Spectr 2020; 25:765-773. [PMID: 31747980 DOI: 10.1017/s1092852919001615] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Increasing literature reported higher rates of psychiatric disorders in parents of children with autism spectrum disorder (ASD), as well as of autistic-like features in social and cognitive functioning. However, little attention has been paid to the association between autistic traits (AT) and global functioning in this population. The aim of the present work was to investigate clinical and functional correlates of AT among parents of ASD children, with a specific focus on ruminative thinking. METHODS One hundred and twenty parents of ASD children were assessed by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), the Ruminative Response Scale (RRS), the Social and Occupational Functioning Assessment Scale (SOFAS). RESULTS Subjects with at least 1 psychiatric disorder (39.2%) showed significantly higher AdAS Spectrum and RRS scores. Subjects with a history of school difficulties and with language development alterations scored significantly higher on specific AdAS Spectrum domains. A significant negative correlation was found between SOFAS and AdAS Spectrum scores, as well as between SOFAS and RRS scores. AdAS Spectrum nonverbal communication domain score was identified has a statistically predictive variable for the presence of psychiatric disorders and lower SOFAS scores. Finally, we found a significant indirect effect of AdAS total score on SOFAS score, which was fully mediated by RRS total score. CONCLUSIONS AT in parents of ASD children seem to be associated with a higher vulnerability toward psychopathology and with a lower global functioning. Ruminative thinking may play a role in the relationship between AT and functional outcome.
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The impact of severe pediatric epilepsy on experienced stress and psychopathology in parents. Epilepsy Behav 2020; 113:107538. [PMID: 33238238 DOI: 10.1016/j.yebeh.2020.107538] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To assess the prevalence of psychopathology and the level of stress in parents of children with severe epilepsy to gain a better understanding of parental support needs. METHODS Questionnaires were completed by parents of children with severe epilepsy during the hospitalization of their child at the Danish Epilepsy Center. The questions targeted symptoms of post-traumatic stress disorder (PTSD), complex PTSD (CPTSD), depression, and anxiety, and the level of perceived stress. RESULTS A total of 162 caregivers of 140 children with epilepsy participated in the survey. Mothers were more often unemployed than fathers (38% vs. 11%, p < 0.01), and nearly half of the children (47%) attended special needs classes. Psychopathology symptoms were found in 43.5% of parents, fulfilling criteria for one or more diagnoses, and an additional 11% showed symptoms of sub-clinical PTSD. Parent-rated child difficulties were significantly associated with PTSD (Mdiff = 5.51, p = 0.001), depression (Mdiff = 4.50, p < 0.000), and anxiety (Mdiff = 4.61, p = 0.01), and with higher levels of perceived stress (p < 0.001). CONCLUSION Caring for a child with severe epilepsy has a significant psychopathological impact on caregivers. Caregivers' resources and the degree of behavioral difficulties in the child, rather than epilepsy-related factors, are highly correlated with distress and psychopathological symptoms in caregivers.
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Carmassi C, Foghi C, Dell'Oste V, Cordone A, Bertelloni CA, Bui E, Dell'Osso L. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry Res 2020; 292:113312. [PMID: 32717711 PMCID: PMC7370915 DOI: 10.1016/j.psychres.2020.113312] [Citation(s) in RCA: 369] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/18/2020] [Accepted: 07/18/2020] [Indexed: 12/13/2022]
Abstract
The COronaVIrus Disease-19 (COVID-19) pandemic has highlighted the critical need to focus on its impact on the mental health of Healthcare Workers (HCWs) involved in the response to this emergency. It has been consistently shown that a high proportion of HCWs is at greater risk for developing Posttraumatic Stress Disorder (PTSD) and Posttraumatic Stress Symptoms (PTSS). The present study systematic reviewed studies conducted in the context of the three major Coronavirus outbreaks of the last two decades to investigate risk and resilience factors for PTSD and PTSS in HCWs. Nineteen studies on the SARS 2003 outbreak, two on the MERS 2012 outbreak and three on the COVID-19 ongoing outbreak were included. Some variables were found to be of particular relevance as risk factors as well as resilience factors, including exposure level, working role, years of work experience, social and work support, job organization, quarantine, age, gender, marital status, and coping styles. It will be critical to account for these factors when planning effective intervention strategies, to enhance the resilience and reduce the risk of adverse mental health outcomes among HCWs facing the current COVID-19 pandemic.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudia Foghi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Department of Biotechnology Chemistry and Pharmacy, University of Siena, Siena, Italy.
| | - Annalisa Cordone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Carmassi C, Bertelloni CA, Avella MT, Cremone I, Massimetti E, Corsi M, Dell'Osso L. PTSD and Burnout are Related to Lifetime Mood Spectrum in Emergency Healthcare Operator. Clin Pract Epidemiol Ment Health 2020; 16:165-173. [PMID: 32874191 PMCID: PMC7431684 DOI: 10.2174/1745017902016010165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/21/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022]
Abstract
Background: PTSD and burnout are frequent conditions among emergency healthcare personnel because exposed to repeated traumatic working experiences. Increasing evidence suggests high comorbidity between PTSD and mood symptoms, particularly depression, although the real nature of this relationship still remains unclear. The purpose of this study was to investigate the relationship between PTSD, burnout and lifetime mood spectrum, assessed by a specific scale, among health-care professionals of a major University Hospital in Italy. Methods: N=110 Emergency Unit workers of the Azienda Ospedaliero-Universitaria Pisana (Pisa, Italy) were assessed by the TALS-SR, MOODS-SR lifetime version and the ProQOL R-IV. Results: Approximately 60% of participants met at least one PTSD symptom criterion (criterion B, 63.4%; criterion C, 40.2%; criterion D 29.3%; criterion E, 26.8%), according to DSM-5 diagnosis. Almost sixteen percent of the sample reported a full symptomatic DSM-5 PTSD (work-related) diagnosis, and these showed significantly higher scores in all MOODS-SR depressive domains, as well as in the rhythmicity domain, compared with workers without PTSD. Further, mood-depressive and cognition-depressive MOODS-SR domains resulted to be predictive for PTSD. Significant correlations emerged between either PTSD diagnosis and criteria or ProQOL subscales and all the MOOD-SR domains. Conclusion: A significant association emerged among PTSD, burnout and lifetime MOOD Spectrum, particularly the depressive component, in emergency health care operators, suggesting this population should be considered at-risk and undergo regular screenings for depression and PTSD.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Maria Teresa Avella
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ivan Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrico Massimetti
- ASST, Bergamo Ovest, SSD Servizio Psichiatrico diagnosi e cura, Treviglio, Italy
| | - Martina Corsi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Post-traumatic stress spectrum symptoms in parents of children affected by epilepsy: Gender differences. Seizure 2020; 80:169-174. [PMID: 32593140 DOI: 10.1016/j.seizure.2020.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To investigate psychopathological reaction to traumatic stress, addressing in particular gender difference, in parental couples of children affected by epilepsy. METHODS 50 mothers and 50 fathers, paired for one's child, of children followed at the Pediatric Unit of a major Italian University Hospital with a diagnosis of epilepsy were enrolled, screened by means of the Semi-structured Clinical Interview for DSM-5 (SCID-5) and filled the Trauma and Loss Spectrum Self-Report (TALS-SR), an international instrument to evaluate post-traumatic stress symptomatology. RESULTS 25 % of the total sample presented a diagnosis of PTSD with a statistically higher prevalence of mothers (36 % and 14 %, respectively; p = .021). Furthermore, 44 % (48 % mothers and 40 % fathers) presented a partial PTSD. Important gender differences emerged also for all cluster dimensions of the TALS-SR except for the Avoidance. Finally, the analysis of the single items of the TALS-SR evidenced that in mothers subgroup prevail cognitive symptoms of fear and sadness as well as somatic manifestations. CONCLUSIONS Our results point out the differences between mothers and fathers in trauma response and underline the need to develop gender targeted models of healthcare prevention and assistance.
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