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Karahan S, Ay Kaatsiz MA, Erbas A, Kaya Y. A Qualitative Analysis on the Experiences of Mothers of Children in Burn Intensive Care Unit: "She burned on the outside, me inside...". J Burn Care Res 2024; 45:120-129. [PMID: 37625120 DOI: 10.1093/jbcr/irad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 08/27/2023]
Abstract
Mothers closely follow the complex process due to the burning of their children. Caring for and supporting the child can pose various challenges for mothers. With the phenomenological method, this study was conducted to investigate mothers' experiences staying with their children in the pediatric burn intensive care unit. Twelve mothers participated in the study. The semistructured face-to-face interviews obtained data. After each interview, the research team transcribed the interviews verbatim. Interpretive Phenomenological Analysis was used to analyze the data. The experiences of the mothers were classified in four contexts as a result of the interpretative phenomenological analysis; "first reactions to burn trauma" related to the awareness that the child has been burned, "being a mother in the burn intensive care unit" related to caring for the child as a companion in the burn intensive care unit, "coping" related to how they cope with the problems throughout the whole process, and "requirements" regarding the subjects it needs in the process. It was determined that mothers went through a physically and emotionally challenging process from the beginning of the burn trauma and throughout the intensive care unit. During this challenging process, it was observed that mothers could not use effective coping methods and did not receive the necessary professional support. In line with these results, it is recommended that psychological support programs be applied to the mothers and that care focused on the needs of the mothers should be provided.
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Affiliation(s)
- Sabri Karahan
- Surgical Nursing Department, Harran University Faculty of Health Science, 63100 Sanliurfa, Turkey
| | - Melike Ayça Ay Kaatsiz
- Psychiatric Nursing Department, Hacettepe University Faculty of Nursing, 06100 Ankara, Turkey
| | - Atiye Erbas
- Surgical Nursing Department, Duzce University Faculty of Health Science, 81000 Duzce, Turkey
| | - Yunus Kaya
- Department of Child Development, Faculty of Health Science, Aksaray University, 68000 Aksaray, Turkey
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Hocking P, Broadhurst M, Nixon RDV, Gannoni A. Validation of the Psychosocial Assessment Tool 2.0 for paediatric burn patients. Burns 2023; 49:1632-1642. [PMID: 37211476 DOI: 10.1016/j.burns.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The Psychosocial Assessment Tool 2.0 (PAT-B) is an adaptation of an existing screening tool with the aim of the present study to examine its effectiveness and suitability to identify children and families at risk of emotional, behavioral, and social maladjustment following paediatric burns. METHODS Sixty-eight children aged between 6 months - 16 years (M = 4.40) admitted into hospital following paediatric burns, and their primary caregivers, were recruited. The PAT-B comprises several dimensions including family structure and resources, social support, as well as caregiver and child psychological difficulties. Caregivers completed the PAT-B and several standardized measures for validation purposes (e.g., caregiver reports of family functioning, child emotional and behavioural problems, caregiver distress). Children old enough to complete measures reported on their psychological functioning (e.g., posttraumatic stress and depression). Measures were completed within 3 weeks of child admission and then again at 3 months after burn. RESULTS The PAT-B demonstrated good construct validity, evidenced by moderate to strong correlations between the PAT-B Total and subscale scores and several criteria measures (family functioning, child behaviour and caregiver distress, child depressive symptoms, rs ranging from 0.33 -0.74). Preliminary support for criterion validity of the measure was observed when examined against the three tiers of the Paediatric Psychosocial Preventative Health Model. The proportion of families falling within these tiers of risk (Universal [low risk], 58.2%; Targeted, 31.3%; or Clinical range, 10.4%) was consistent with prior research. Sensitivity of the PAT-B to identify children and caregivers at high risk of psychological distress was 71% and 83%, respectively. CONCLUSION The PAT-B appears to be a reliable and valid instrument for indexing psychosocial risk across families who have sustained a paediatric burn. However, further testing and replication using a larger sample size is recommended before the tool is integrated into routine clinical care.
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Affiliation(s)
- Phoebe Hocking
- College of Education, Psychology and Social Work, Flinders University; Adelaide, South Australia, Australia
| | - Miriam Broadhurst
- College of Education, Psychology and Social Work, Flinders University; Adelaide, South Australia, Australia
| | - Reginald D V Nixon
- College of Education, Psychology and Social Work, Flinders University; Adelaide, South Australia, Australia; Flinders University Institute for Mental Health and Wellbeing, Flinders University; Adelaide, South Australia, Australia.
| | - Anne Gannoni
- Department of Psychological Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Patterson KN, Beyene TJ, Lehman K, VerLee SN, Schwartz D, Fabia R, Thakkar RK. Evaluating effects of burn injury characteristics on quality of life in pediatric burn patients and caregivers. Burns 2023; 49:1311-1320. [PMID: 36764839 DOI: 10.1016/j.burns.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/02/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate pediatric burn patients' and caregivers' quality of life (QoL), while identifying clinical characteristics correlated with psychological stress. METHODS Pediatric burn patients at an ABA-verified institution from November 2019-January 2021 were included. Caregivers of patients 0-4 years completed the Infant's Dermatology QoL Index (IDQOL). Patients> 4-16 years completed the Children's Dermatology Life Quality Index (CDLQI). The Short Post-Traumatic Stress Disorder Rating Interview (SPRINT) measured caregivers' stress. Generalized linear mixed models evaluated associations between assessment scores and burn characteristics. RESULTS Overall, 27.3% (39/143) of IDQOL and 53.1.% (41/96) of CDLQI scores indicated that patients' burns caused moderate to extremely large effects on QoL. In caregivers, 4.5% (7/159) scored> 14 on the SPRINT, warranting further PTSD evaluation. For the IDQOL, each additional 1% TBSA burn was associated with a 2.75-point increase (p = 0.05), and patients sustaining 2nd degree deep partial thickness burns scored an average of 3.3 points higher compared to 2nd degree superficial partial thickness burns (P < 0.01). CLDQI and SPRINT scores demonstrated a similar pattern. CONCLUSIONS QoL is impacted in a substantial proportion of pediatric burn patients. Larger TBSA and increased burn depths cause significantly more psychological stress in children, and caregivers may require more extensive psychological evaluation.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Veteran Affairs Palo Alto Health System (VAPAHCS), Palo Alto, CA, USA,; Stanford University School of Medicine, Stanford, CA, USA
| | | | - Sarah N VerLee
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dana Schwartz
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Renata Fabia
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Rajan K Thakkar
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA; Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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May C, Miller PE, Naqvi M, Rademacher E, Klajn J, Hedequist D, Shore BJ. The Incidence of Posttraumatic Stress Symptoms in Children. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202308000-00007. [PMID: 37579777 PMCID: PMC10424889 DOI: 10.5435/jaaosglobal-d-22-00245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/17/2023] [Accepted: 06/30/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE To determine the incidence of posttraumatic stress disorder (PTSD) symptoms and risk factors for their development in children and adolescents undergoing orthopaedic surgery for trauma. DESIGN Prospective cohort study. SETTING Level-1 trauma center. PATIENTS Children (8 to 18), undergoing surgery for orthopaedic trauma. INTERVENTION Upper and lower extremity surgery for orthopaedic trauma. MAIN OUTCOME MEASUREMENTS PTSD symptoms at postoperative follow-up as determined by the Child PTSD Symptom Scale (CPSS). RESULTS A total of 176 children with an average age at surgery of 13 years (8 to 18.8 years) participated in the study. Twenty-six subjects had high levels of PTSD symptoms (15%; 95% CI = 10.0 to 21.1%). Univariable and multivariable analyses determined that female sex (OR 2.63, 95% CI = 1.06 to 6.67, P = 0.04), older age at surgery (OR 1.25, 95% CI = 1.04 to 1.51, P = 0.02), and undergoing a previous surgery (OR 2.86, 95% CI = 1.06 to 7.73, P = 0.04) were all associated with increased PTSD risk. CONCLUSIONS Children and adolescents experience a high level of PTSD symptoms (15%) after surgery for orthopaedic trauma. Clinicians should be aware of PTSD symptoms in children and adolescents after surgery for orthopaedic injuries and use comprehensive screening to facilitate timely intervention and treatment. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Collin May
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Patricia E. Miller
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Manahill Naqvi
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Emily Rademacher
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Justyna Klajn
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Daniel Hedequist
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Benjamin J. Shore
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
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Kairuz C, Hunter K, Bennett-Brook K, Ryder C, Holland AJA, Mackean T, Jacques M, Maze D, Scarcella M, Briscoe K, Coombes J. Codesigning informative resources for families of Aboriginal and Torres Strait Islander children who sustained a burn injury: a protocol for a participatory action research study. BMJ Open 2023; 13:e068530. [PMID: 37192809 DOI: 10.1136/bmjopen-2022-068530] [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] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Parents of children hospitalised in a burn unit experience psychological trauma and later post-traumatic stress. Aboriginal and Torres Strait Islander families whose child has been admitted to a burn unit encounter additional burdens through a culturally unsafe healthcare system. Psychosocial interventions can help reduce anxiety, distress and trauma among children and parents. There remains a lack of interventions or resources that reflect Aboriginal and Torres Strait Islander people's perspective of health. The objective of this study is to codevelop a culturally appropriate informative resource to assist Aboriginal and Torres Strait Islander parents whose child has been hospitalised in a burn unit. METHODS In this participatory research study, the development of a culturally safe resource will build on Aboriginal and Torres Strait Islander families' experiences and voices, complemented by the knowledge and expertise of an Aboriginal Health Worker (AHW) and burn care experts. Data will be collected through recorded yarning sessions with families whose child has been admitted to a burn unit, the AHW and burn care experts. Audiotapes will be transcribed and data will be analysed thematically. Analysis of yarning sessions and resource development will follow a cyclical approach. ETHICS AND DISSEMINATION This study has been approved by the Aboriginal Health and Medical Research Council (AH&MRC) (1690/20) and the Sydney Children's Hospitals Network ethics committee (2020/ETH02103). Findings will be reported to all participants and will be disseminated with the broader community, the funding body and health workers at the hospital. Dissemination with the academic community will be through peer-reviewed publications and presentations in relevant conferences.
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Affiliation(s)
- Camila Kairuz
- Guunu-maana (Heal), Aboriginal and Torres Strait Islander Health, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Kate Hunter
- Guunu-maana (Heal), Aboriginal and Torres Strait Islander Health, The George Institute for Global Health, Newtown, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Keziah Bennett-Brook
- Guunu-maana (Heal), Aboriginal and Torres Strait Islander Health, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Courtney Ryder
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew J A Holland
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Tamara Mackean
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Madeleine Jacques
- Burn Services, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Deborah Maze
- Burn Services, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Michele Scarcella
- The Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Karl Briscoe
- National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners, Phillip, ACT, Australia
| | - Julieann Coombes
- Guunu-maana (Heal), Aboriginal and Torres Strait Islander Health, The George Institute for Global Health, Newtown, New South Wales, Australia
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Townsend AN, Batra N, Lilenfeld L, Maurin E, Inverso H, Burd RS, Tully CB. Parent Traumatic Stress After Minor Pediatric Burn Injury. J Burn Care Res 2023; 44:329-334. [PMID: 35452502 DOI: 10.1093/jbcr/irac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 11/15/2022]
Abstract
Parents are at increased risk for psychological sequelae following their child's burn injury which has demonstrated negative impacts on the child. The current study sought to address gaps in the literature on risk factors for parental distress by examining the relationships among demographic variables, burn characteristics, and child functioning after burn injury, with parent post-traumatic stress symptoms (PTSS). Participants included parents of 660 pediatric burn patients from a regional burn clinic. Parents completed measures during their initial visit to the burn clinic. Additional demographic and burn data were retrospectively collected by medical chart review. Fifteen percent of parents reported at-risk levels of parent PTSS. Parent PTSS was independently associated with child burn characteristics of total body surface area (TBSA) affected by the burn, required hospitalization, number of nights hospitalized, and number of ambulatory burn appointments attended. Minority race was associated with higher parent PTSS than non-minority race status, with Asian parents endorsing the highest scores. Furthermore, when considered simultaneously, impaired child quality of life (QOL), a higher number of ambulatory burn appointments attended, and racial minority status were associated with higher parent PTSS. These findings highlight the need for routine parent trauma screening in pediatric burn clinics, while additionally identifying a feasible screening measure.
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Affiliation(s)
- Allie N Townsend
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA.,The Chicago School of Professional Psychology, Washington, DC 20005, USA
| | - Nikita Batra
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA
| | - Lisa Lilenfeld
- The Chicago School of Professional Psychology, Washington, DC 20005, USA
| | - Elana Maurin
- The Chicago School of Professional Psychology, Washington, DC 20005, USA
| | - Hailey Inverso
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA
| | - Randall S Burd
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA.,Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC 20020, USA
| | - Carrie B Tully
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA
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Song J, Widen SG, Wolf SE, EI Ayadi A. Skeletal muscle transcriptome is affected by age in severely burned mice. Sci Rep 2022; 12:21584. [PMID: 36517580 PMCID: PMC9748408 DOI: 10.1038/s41598-022-26040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Severe burn results in muscle wasting affecting quality of life in both children and adults. Biologic metabolic profiles are noticeably distinctive in childhood. We posit that muscle gene expression profiles are differentially regulated in response to severe burns in young animals. Twelve C57BL6 male mice, including young (5 weeks-old) and adults (11 weeks-old), received either scald burn, or sham procedure. Mouse muscle tissue was harvested 24 h later for Next Generation Sequence analysis. Our results showed 662 downregulated and 450 upregulated genes in gastrocnemius of young mice compared to adults without injury. After injury, we found 74/75 downregulated genes and 107/128 upregulated genes in both burned groups compared to respective uninjured age groups. VEGFA-VEGFR2, focal adhesion, and nuclear receptor meta-pathways were the top 3 gene pathways undergoing a differential change in response to age. Of note, the proteasome degradation pathway showed the most similar changes in both adult and young burned animals. This study demonstrates the characteristic profile of gene expression in skeletal muscle in young and adult burned mice. Prominent age effects were revealed in transcriptional levels with increased alterations of genes, miRNAs, pathways, and interactions.
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Affiliation(s)
- Juquan Song
- grid.176731.50000 0001 1547 9964Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0644 USA
| | - Steven G. Widen
- grid.176731.50000 0001 1547 9964Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX USA
| | - Steven E. Wolf
- grid.176731.50000 0001 1547 9964Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0644 USA
| | - Amina EI Ayadi
- grid.176731.50000 0001 1547 9964Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0644 USA
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Ridings LE, Davidson TM, Walker J, Winkelmann J, Anton MT, Espeleta HC, Nemeth LS, Streck CJ, Ruggiero KJ. Caregivers' and Young Children's Emotional Health Needs After Pediatric Traumatic Injury. Clin Pediatr (Phila) 2022; 61:560-569. [PMID: 35581720 PMCID: PMC9329229 DOI: 10.1177/00099228221097498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pediatric traumatic injury (PTI) is associated with emotional health difficulties, but most US trauma centers do not adequately address emotional recovery needs. This study aimed to assess families' emotional health needs following PTI and determine how technology could be used to inform early interventions. Individual semi-structured, qualitative interviews were conducted with caregivers of children admitted to a Level I trauma center in the Southeastern United States to understand families' experiences in-hospital and post-discharge. Participants included 20 caregivers of PTI patients under age 12 (M = 6.4 years; 70% male, 45% motor vehicle collision). Thematic analysis was used to analyze data from interviews that were conducted until saturation. Caregivers reported varying emotional needs in hospital and difficulties adjusting after discharge. Families responded enthusiastically to the potential of a technology-enhanced resource for families affected by PTI. A cost-effective, scalable intervention is needed to promote recovery and has potential for widespread pediatric hospital uptake.
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Affiliation(s)
- Leigh E. Ridings
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Tatiana M. Davidson
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | | | - Jennifer Winkelmann
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Margaret T. Anton
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Hannah C. Espeleta
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Lynne S. Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Christian J. Streck
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J. Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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A 20-years+ review of the Stanford Acute Stress Reaction Questionnaire (SASRQ): Psychometric properties and findings. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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10
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Patel KF, Rodríguez-Mercedes SL, Grant GG, Rencken CA, Kinney EM, Austen A, Hou C, Brady KJS, Schneider JC, Kazis LE, Ryan CM. Physical, Psychological, and Social Outcomes in Pediatric Burn Survivors Ages 5 to 18 Years: A Systematic Review. J Burn Care Res 2022; 43:343-352. [PMID: 34922361 PMCID: PMC9272085 DOI: 10.1093/jbcr/irab225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Acute pediatric burn injuries often result in chronic sequelae that affect physical, psychological, and social outcomes. To date, no review has comprehensively reported on the impact of burn injuries across all three domains in school-aged children. The aim of this systematic review was to identify published literature that focuses on the impact of burn injuries on physical, psychological, or social functioning, and report upon the nature of study characteristics and their outcomes. We included literature published after 1980, focusing on burn outcomes in children aged 5 to 18 years. Each eligible study was systematically reviewed and primary outcomes were classified into outcome domains based on existing frameworks. Fifty-eight studies met inclusion criteria, and reported on physical (n = 24), psychological (n = 47), and social (n = 29) domains. The majority of the studies had sample sizes of <100 participants, burn size of <40%, and findings reported by parents and/or burn survivors. Only eight of 107 different measures were used in three or more studies. Parents and burn survivors generally reported better physical and social outcomes and worse psychological functioning compared to non-burn populations. Physical disabilities were associated with psychological and social functioning in several studies. Follow-up data reported improvements across domains. This review demonstrates the importance of physical, psychological, and social status as long-term outcomes in burn survivors. Mixed findings across three outcome domains warrant long-term research. Findings of this review will guide the foundation of comprehensive burn and age-specific instruments to assess burn recovery.
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Affiliation(s)
- Khushbu F. Patel
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | | | | | - Camerin A. Rencken
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - Erin M. Kinney
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
| | - Amelia Austen
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
| | - Carina Hou
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
| | - Keri J. S. Brady
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis E. Kazis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Colleen M. Ryan
- Department of Clinical Research, Shriners Hospitals for Children – Boston®, Massachusetts, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Shriners Hospitals for Children – Boston®, Massachusetts, USA
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11
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Parental Internalizing Psychopathology and PTSD in Offspring after the 2012 Earthquake in Italy. CHILDREN-BASEL 2021; 8:children8100930. [PMID: 34682196 PMCID: PMC8535087 DOI: 10.3390/children8100930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
Post-traumatic stress disorder (PTSD) is common in youths after earthquakes, with parental psychopathology among the most significant predictors. This study investigated the contribution and the interactional effects of parental internalizing psychopathology, the severity of exposure to the earthquake, and past traumatic events to predict PTSD in offspring, also testing the reverse pattern. Two years after the 2012 earthquake in Italy, 843 children and adolescents (9-15 years) living in two differently affected areas were administered a questionnaire on traumatic exposure and the UCLA PTSD Reaction Index. Anxiety, depression, and somatization were assessed in 1162 parents through the SCL-90-R. General linear model showed that, for offspring in the high-impact area, predictors of PTSD were earthquake exposure, past trauma, and parental internalizing symptoms, taken individually. An interaction between earthquake exposure and parental depression or anxiety (not somatization) was also found. In the low-impact area, youth PTSD was only predicted by earthquake exposure. The reverse pattern was significant, with parental psychopathology explained by offspring PTSD. Overall, findings support the association between parental and offspring psychopathology after natural disasters, emphasizing the importance of environmental factors in this relationship. Although further research is needed, these results should be carefully considered when developing mental health interventions.
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12
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Post-traumatic Stress Disorder in Parents Following Their Child's Single-Event Trauma: A Meta-Analysis of Prevalence Rates and Risk Factor Correlates. Clin Child Fam Psychol Rev 2021; 24:725-743. [PMID: 34554357 PMCID: PMC8541994 DOI: 10.1007/s10567-021-00367-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
Evidence suggests parents of children who experience a trauma may develop Post-Traumatic Stress Disorder (PTSD), which can have significant consequences for their own and their child’s functioning. As such, identifying the rates and possible correlates for the development of PTSD in parents is of clinical and theoretical importance, and would enhance our understanding of how best to support families in the aftermath of trauma. This meta-analysis of 41 studies (n = 4370) estimated the rate of PTSD in parents following their child’s single-incident trauma to be 17.0% (95% CI 14.1–20.0%); when removing samples which were mixed, or not exclusively single-incident traumas the prevalence estimate dropped to 14.4% (95% CI 10.8–18.5%). Pooled effect sizes of 32 potential correlates for parents developing PTSD were also identified. Medium-to-large effects were found for factors relating to the parent’s post-traumatic cognition, psychological functioning and coping strategies alongside child PTSD. Small effects were found for pre-trauma factors, objective trauma-related variables and demographic factors for both parent and child. Results are consistent with cognitive models of PTSD, suggesting peri- and post-trauma factors are likely to play a substantial role in its development. These findings indicate the clinical need for screening parents most vulnerable to adverse post-traumatic reactions within the context of child trauma and tailoring interventions to include the family where necessary.
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13
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Thornton M, Harcourt D, Deave T, Kiff J, Williamson H. "Have We Done Enough?" A Cross-condition Exploration of the Experiences of Parents Caring for A Child with an Appearance-affecting Condition or Injury. Dev Neurorehabil 2021; 24:418-428. [PMID: 33852812 DOI: 10.1080/17518423.2021.1901150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Children and young people (CYP) with appearance-affecting conditions/injuries report common pervasive psychosocial difficulties, regardless of cause, nature or extent of their visible differences. Parents or carers can also experience psychosocial difficulties and challenges specific to having CYP with a visible difference. Current literature is confined to exploring condition-specific concerns of parents, typically in more prevalent appearance-affecting conditions/injuries, whilst the experiences of parents of CYP with other visible differences are unknown. Thirty-one interviews (parents n = 20, health and support professionals n = 11) and 4 parent focus groups (n = 25) were conducted. Three overarching themes were constructed: "Appearance does(n't) matter" describes the impact of having a child with a socially undesirable appearance; "Being 'battle' ready" reflects parents' desire to arm their child with resources to manage challenges, whilst "Walking the tightrope" reflects parents' lack of clarity about how best to approach this. Findings highlight shared and common cross-condition psychosocial difficulties among parents and carers.
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Affiliation(s)
- Maia Thornton
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Toity Deave
- Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - James Kiff
- Outlook Service, Southmead Hospital, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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14
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Batra N, Zheng Y, Alberto EC, Ahmed OZ, Cheng M, Shupp JW, Burd RS. Pediatric Treadmill Friction Burns to the Hand: Outcomes of an Initial Nonoperative Approach. J Burn Care Res 2021; 42:434-438. [PMID: 33022715 DOI: 10.1093/jbcr/iraa178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Treadmill burns that occur from friction mechanism are a common cause of hand burns in children. These burns are deeper and more likely to require surgical intervention compared to hand burns from other mechanisms. The purpose of this study was to identify the factors associated with healing time using an initial nonoperative approach. A retrospective chart review was performed examining children (<15 years) who were treated for treadmill burns to the hand between 2012 and 2019. Patient age, burn depth, total body surface area of the hand injury, and time to healing were recorded. Topical wound management strategies (silver sheet, silver cream, non-silver sheet, and non-silver cream) and associated treatment durations were determined. For patients with burns to bilateral hands, the features, treatment, and outcomes of each hand were assessed separately. Cox regression analysis was used to evaluate the association between time to healing and patient characteristics and treatment type. Seventy-seven patients with 86 hand burns (median age 3 years, range 1-11) had a median total body surface area per hand burn of 0.8% (range 0.1-1.5%). Full-thickness burns (n = 47, 54.7%) were associated with longer time to healing compared to partial-thickness burns (HR 0.28, CI 0.15-0.54, P < .001). Silver sheet treatment was also associated with more rapid time to healing compared to treatment with a silver cream (HR 2.64, CI 1.01-6.89, P = .047). Most pediatric treadmill burns can be managed successfully with a nonoperative approach. More research is needed to confirm the superiority of treatment with silver sheets compared to treatment with silver creams.
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Affiliation(s)
- Nikita Batra
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Yinan Zheng
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Emily C Alberto
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Omar Z Ahmed
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Megan Cheng
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
| | - Jeffrey W Shupp
- Burn Center, MedStar Washington Hospital Center, Department of Surgery, Georgetown University School of Medicine, District of Columbia
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, District of Columbia
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15
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Hussein S, Sadeh Y, Dekel R, Shadmi E, Brezner A, Landa J, Silberg T. Using a biopsychosocial approach to examine differences in post-traumatic stress symptoms between Arab and Jewish Israeli mothers following a child's traumatic medical event. Int J Equity Health 2021; 20:89. [PMID: 33789674 PMCID: PMC8011398 DOI: 10.1186/s12939-021-01429-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background Parents of children following traumatic medical events (TMEs) are known to be at high risk for developing severe post-traumatic stress symptoms (PTSS). Findings on the negative impact of TMEs on parents’ PTSS have been described in different cultures and societies. Parents from ethnic minority groups may be at particularly increased risk for PTSS following their child’s TME due to a host of sociocultural characteristics. Yet, differences in PTSS manifestation between ethnic groups following a child’s TME has rarely been studied. Objectives We aimed to examine: (1) differences in PTSS between Israeli-Arab and Israeli-Jewish mothers, following a child’s TME, and (2) risk and protective factors affecting mother’s PTSS from a biopsychosocial approach. Methods Data were collected from medical files of children following TMEs, hospitalized in a Department of Pediatric Rehabilitation, between 2008 and 2018. The sample included 47 Israeli-Arab mothers and 47 matched Israeli-Jewish mothers. Mothers completed the psychosocial assessment tool (PAT) and the post-traumatic diagnostic scale (PDS). Results Arab mothers perceived having more social support than their Jewish counterparts yet reported higher levels of PTSS compared to the Jewish mothers. Our prediction model indicated that Arab ethnicity and pre-trauma family problems predicted higher levels of PTSS among mothers of children following TMEs. Conclusions Despite reporting higher social support, Arab mothers reported higher levels of PTSS, as compared to the Jewish mothers. Focusing on ethnic and cultural differences in the effects of a child’s TME may help improve our understanding of the mental-health needs of mothers from different minority groups and aid in developing appropriate health services and targeted interventions for this population.
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Affiliation(s)
- Sewar Hussein
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Yaara Sadeh
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel.,Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Jana Landa
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Silberg
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel. .,Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.
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16
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Costa B, Thornton M, Guest E, Meyrick J, Williamson H. The effectiveness of interventions to improve psychosocial outcomes in parents of children with appearance-affecting health conditions: A systematic review. Child Care Health Dev 2021; 47:15-30. [PMID: 32876343 DOI: 10.1111/cch.12805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 08/23/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although many cope well, the impact of supporting a child with an Appearance-Affecting Health Condition (AAHC) can place a significant demand on parents. As such, it is vital that families have access to appropriate psychosocial support to reduce any potential difficulties. Although previous reviews have explored the effectiveness of psychosocial interventions for parents of Children and Young People (CYP) with general health conditions, the evidence of effectiveness remains limited. Further, little is known about the effectiveness of such interventions specifically among parents of CYP with AAHCs. This review aimed to identify and assess the evidence of effectiveness of psychosocial interventions among parents of CYP with AAHCs. METHODS Database searches were conducted using MEDLINE, PsychARTICLES, PsychINFO, CINAHL Plus, the British Nursing Database and the Cochrane Library. Results were reviewed against the inclusion criteria and data were extracted. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool, and a narrative synthesis was conducted. RESULTS Fifteen studies, evaluating 10 interventions, were included and overall seven interventions were found to be effective (effect sizes and methodological quality varied). CONCLUSIONS This review finds moderate to strong evidence of effectiveness of the Triple P Positive Parenting Program, the Early Family Intervention Program and general parent education/training interventions. These findings offer useful insights relating to the delivery of current support, as well as for the development of future parent and family interventions. Finally, recommendations for future intervention evaluation studies in this area are made.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Maia Thornton
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Ella Guest
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Jane Meyrick
- Department of Health and Social Science, University of the West of England, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, UK
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17
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Stoddard FJ. Working with Parents in Child Psychotherapy, 1948-2021. Psychiatry 2021; 84:131-133. [PMID: 34293280 DOI: 10.1080/00332747.2021.1924572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Seivert NP, Sommerhalder M, Stewart D, Ziegfeld S, Ostrander R, Reynolds EK, Parrish C. Routine Psychological Screening for Parent Depressive Symptoms in an Outpatient Pediatric Specialty Burn Clinic. J Burn Care Res 2020; 40:947-952. [PMID: 31304969 DOI: 10.1093/jbcr/irz130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pediatric burn injuries are stressful for parents, yet few burn clinics report screening caregivers. We evaluated psychometric properties of a two-item depression screener administered to parents of children with burns during outpatient clinic visits. We also examined associations between parent depression symptoms and child characteristics. We used a retrospective review of pediatric patients with burn injuries (n = 496, age range: 0-21 years; M = 5.0 years, SD = 4.4 years) from an outpatient specialty burn clinic. Sample was 54.8% male; ethnicity was 42.4% Black/African American and 42.2% White. Most children (94.7%) had a burn TBSA of 10% or less and partial thickness burns (87%). Depression measure was administered at two time points as part of routine care: T1 (n = 496) and T2 (n = 121). Score range was 0 to 8. The means were 1.17 (SD = 1.74) at T1 and 0.81 (SD = 1.40) at T2. The majority scored ≤3 (89.9% caregivers) at T1. The measure demonstrated satisfactory internal consistency at T1 (Cronbach α = .74) and T2 (α = .82). Scores at T1 and T2 for a subsample (n = 121) were related (r = .61, p < .001). Parents of non-White children tended to report higher depression scores at T1. At T2, being female and greater burn degree were associated with higher depression scores. This brief two-item scale used with caregivers of pediatric burn patients is a reasonable method for screening parental depression in this setting. Given the association between parental depression and child characteristics, further studies are needed, including examination of predictive validity of parental depression with pediatric outcomes.
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Affiliation(s)
- Nicholas P Seivert
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mackenzie Sommerhalder
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dylan Stewart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan Ziegfeld
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rick Ostrander
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth K Reynolds
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carisa Parrish
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
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19
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Zheng H, Wu K, Zhou Y, Fu L, Zhang D, Liu Z. Prevalence and associated factors of post-traumatic stress disorder in burned patients and their family members. Burns 2020; 47:1102-1109. [PMID: 33303262 DOI: 10.1016/j.burns.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is common among burn patients and their family members. The objective of this study was to document the prevalence of PTSD and explore the sociodemographic and burn-specific associated factors of PTSD among Chinese burn survivors and their family members. METHODS A total of 131 adult patients with unintentional burns and 194 family members of burn patients were recruited from two burn units. All participants completed a general information form and the PTSD Checklist for the DSM-5 (PCL-5). RESULTS Fifty-five (42.0%) burn victims and ninety-nine (51.0%) family members of burn victims met the criteria for PTSD; the average score of the sample was 31.21 ± 21.56 and 33.16 ± 19.30. Logistic regression analysis revealed that middle age (45-55 years), poor economic status, greater total body surface area (TBSA) and longer time since the burn incident positively predicted the PTSD of patients and that female family members had a higher risk of PTSD. CONCLUSIONS Burn patients and their family members are susceptible to PTSD. Suitable and long-term psychological intervention programmes should be executed for burn patients and their family members.
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Affiliation(s)
- Hao Zheng
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Kankan Wu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yueyue Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Lin Fu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Daiyu Zhang
- Aiwuhen Burn Rehabilitation and Care Center, Beijing, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.
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20
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The development and validation of the CARe Burn Scale: Child Form: a parent-proxy-reported outcome measure assessing quality of life for children aged 8 years and under living with a burn injury. Qual Life Res 2020; 30:239-250. [PMID: 32902793 PMCID: PMC7847857 DOI: 10.1007/s11136-020-02627-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) identify patient needs and therapeutic progress. This paper outlines the development and validation of the CARe Burn Scale: Child Form, a parent-proxy-reported outcome measure that assesses quality of life in children aged 8 and under living with a burn injury. METHODS A literature review and interviews with 12 parents of children with a burn and seven health professionals informed the development of a conceptual framework and draft PROM. Cognitive debriefing interviews with 18 parents and eight health professionals provided feedback to ascertain content validity, and 311 parents took part in field testing. Rasch and traditional psychometric analyses were conducted to create a shortened version. Further psychometric analyses with 133 parents tested the shortened CARe Burn Scale in relation to other parent-proxy measures. RESULTS The final conceptual framework included 5 domains: Social and Emotional Difficulties, Social and Emotional Well-Being, Wound/Scar Discomfort, Wound/Scar Treatment and Physical Abilities. Two scales fulfilled Rasch and traditional psychometric analyses, providing evidence of construct validity, acceptability, and reliability. Three scales did not fulfil the Rasch criteria and were retained as checklists. Compared to other parent-proxy measures, individual CARe Burn Scales correlated moderately with similar constructs and had low correlations with dissimilar constructs, indicating evidence of criterion validity (concurrent and discriminant). CONCLUSIONS The CARe Burn Scale: Child Form can be used to measure children's quality of life after having a burn injury which can inform rehabilitation and surgical decision-making.
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21
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Ridings LE, Anton MT, Winkelmann J, Davidson TM, Wray L, Streck CJ, Ruggiero KJ. Trauma Resilience and Recovery Program: Addressing Mental Health in Pediatric Trauma Centers. J Pediatr Psychol 2020; 44:1046-1056. [PMID: 31298276 DOI: 10.1093/jpepsy/jsz053] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/23/2019] [Accepted: 06/03/2019] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Approximately 225,000 children sustain injuries requiring hospitalization annually. Posttraumatic stress disorder (PTSD) and depression are prevalent among pediatric patients and caregivers post-injury. Most U.S. trauma centers do not address patients' mental health needs. Better models of care are needed to address emotional recovery. This article describes the engagement and recovery trajectories of pediatric patients enrolled in the Trauma Resilience and Recovery Program (TRRP), a stepped-care model to accelerate emotional recovery following hospitalization. METHODS TRRP is designed to (a) provide in-hospital education about post-injury emotional recovery and assess child and caregiver distress; (b) track mental health symptoms via a 30-day text-messaging program; (c) complete 30-day PTSD and depression phone screens; and (d) provide evidence-based treatment via telehealth or in-person services or referrals, if needed. All 154 families approached were offered TRRP services, 96% of whom agreed to enroll in TRRP. Most patients were boys (59.8%), and average age was 9.12 years [standard deviation (SD) = 5.42]. Most injuries (45.8%) were sustained from motor vehicle accidents. RESULTS In hospital, 68.5% of caregivers and 78.3% of children reported clinically significant distress levels. Over 60% of families enrolled in the texting service. TRRP re-engaged 40.1% of families for the 30-day screen, 35.5% of whom reported clinically significant PTSD (M = 13.90, SD = 11.42) and/or depression (M = 13.35, SD = 11.16). Most (76%) patients with clinically significant symptomology agreed to treatment. CONCLUSIONS Our intervention model was feasible and increased reach to families who needed services. Efforts to improve follow-up engagement are discussed, as are initial successes in implementing this model in other pediatric trauma centers.
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Affiliation(s)
| | | | | | | | - Lauren Wray
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Center, Medical University of South Carolina
| | - Christian J Streck
- Department of Surgery, College of Medicine, Medical University of South Carolina
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22
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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: 1.5] [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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23
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Bayuo J, Wong FKY. Issues and concerns of family members of burn patients: A scoping review. Burns 2020; 47:503-524. [PMID: 32534893 DOI: 10.1016/j.burns.2020.04.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The issues and concerns that emerge in the families of burn patients have received minimal attention. OBJECTIVE To map out what is known about the challenges facing the family members of burn patients. METHODS The review followed the PRISMA Extension guidelines for scoping reviews and the review approach by Arksey and O'Malley to synthesize the available evidence. Twenty-six (26) papers from various database searches were identified and included in the review. The citation retrieval and retention methods are reported in a PRISMA statement. RESULTS Although most of the studies included parents (n=21), the evidence suggests that the shared concerns of family members include taking on new roles, and psychosocial and financial issues. Uniquely, parents had to endure blame, shame and guilt; partners/spouses were faced with difficulties in re-establishing an emotional connection with the patient; siblings simultaneously expressed jealousy and feelings of being outsiders; and children with a burn parent had to deal with feelings of exclusion from the care delivery process. Aside from these individuals, friends, neighbours and in-laws may also assume a caregiving role, with grandparents playing a supporting role. Family members are unprepared for their roles, as they are forced into them suddenly. Although distress may occur among family members, its determinants, severity, pattern and recovery process remain unclear. CONCLUSION A burn is a family injury that creates the need for family-centred care. Future studies need to explore the nature of psychological distress, family members' recovery pathways, and how family members can prepare for their roles in the period after discharge.
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Affiliation(s)
- Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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24
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van Meijel EPM, Gigengack MR, Verlinden E, van der Steeg AFW, Goslings JC, Bloemers FW, Luitse JSK, Boer F, Grootenhuis MA, Lindauer RJL. Short and Long-Term Parental Posttraumatic Stress After a Child's Accident: Prevalence and Associated Factors. Child Psychiatry Hum Dev 2020; 51:200-208. [PMID: 31494749 PMCID: PMC7067753 DOI: 10.1007/s10578-019-00924-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Studies on the long-term prevalence of parental posttraumatic stress symptoms (PTSS) following child accidental injury are scarce, and findings on risk factors vary. In this follow-up study (T2, n = 69) we determined the prevalence of parental PTSS 2-4 years after accidental injury of their child, compared with 3 months after the accident (T1, n = 135). Additionally, we examined the association between parental and child factors and PTSS severity. Children were 8-18 years old at the time of the accident. Parent and child PTSS was assessed by self-report. Other data were retrieved from medical records and a telephone interview. Parental PTSS was 9.6% at T1 and 5.8% at T2. Acute parental stress as measured within 2 weeks of the child's accident was significantly associated with parental PTSS severity (T1 and T2), as was the child's hospitalization of more than 1 day at T1 and the child's permanent physical impairment at T2. To prevent adverse long-term psychological consequences we recommend identifying and monitoring parents at risk and offering them timely treatment.
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Affiliation(s)
- Els P M van Meijel
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands. .,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
| | - Maj R Gigengack
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Eva Verlinden
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Alida F W van der Steeg
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & VU University, Amsterdam, The Netherlands.,Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J Carel Goslings
- Trauma Unit Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Jan S K Luitse
- Emergency Department, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frits Boer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Pediatric Psychology Department of the Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.,de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
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25
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Li Y, Shi X, McReynolds LS, Tang H, Chen H, Wang T, Zhang Y, Geng F, Fan F, Hoven CW. Depressive symptoms between parent and adolescent survivors: A longitudinal actor-partner interdependence model. J Affect Disord 2020; 265:139-145. [PMID: 32090735 DOI: 10.1016/j.jad.2020.01.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/04/2019] [Accepted: 01/11/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The association between parent-child depression following disasters has been well documented. However, longitudinal studies of posttraumatic depression using parent-child dyadic are scarce. This study aimed to investigate inter-related effects between parent and child depression, as well as predictors of depressive symptoms, in a large sample of Wenchuan earthquake survivors. METHODS Data are from the Wenchuan Earthquake Adolescent Health Cohort (WEAHC) Study that included 685 parent-child dyads exposed to the earthquake. Depression was assessed with the Self-Rating Depression Scale (for parents) and Depression Self-Rating Scale for Children, at 12 (T12m) and 18 months (T18m) post-earthquake. Longitudinal actor-partner interdependence models (APIMs) were employed to examine depression within dyads. Predictors of depressive symptoms were assessed by the cart algorithm throughout the 6-month follow-up. RESULTS Adjusting for earthquake exposure and previous depressive symptoms, parents' depression at 12 months predicted children's depressive symptoms at 18 months, and vice versa (β = 0.14 for parents and β = 0.12 for children). Psychomotor retardation in parents, and dysphoria/social isolation and positive affect in children were identified as crucial screening indicators identifying parents and children at increased risk for depression. CONCLUSION A bidirectional association was found between parent and child depression following a mass disaster. Both parent and child depression status should be examined when implementing interventions to identify and treat depression in earthquake survivors.
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Affiliation(s)
- Yuanyuan Li
- School of Psychology, Center for Studies of Psychological Application, and Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, South China Normal University, Shipai Road, Guangdong 510631, China
| | - Xuliang Shi
- College of education, Hebei University, Baoding, China
| | - Larkin S McReynolds
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Huilan Tang
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Huilin Chen
- Department of Psychology, University of Bath, Bath, Somerset, UK
| | - Tong Wang
- School of Psychology, Center for Studies of Psychological Application, and Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, South China Normal University, Shipai Road, Guangdong 510631, China
| | - Yuechu Zhang
- School of Psychology, Center for Studies of Psychological Application, and Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, South China Normal University, Shipai Road, Guangdong 510631, China
| | - Fulei Geng
- School of Psychology, Center for Studies of Psychological Application, and Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, South China Normal University, Shipai Road, Guangdong 510631, China
| | - Fang Fan
- School of Psychology, Center for Studies of Psychological Application, and Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, South China Normal University, Shipai Road, Guangdong 510631, China.
| | - C W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
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Suurmond J, Bakker A, Van Loey N. Psychological distress in ethnic minority parents of preschool children with burns. Burns 2020; 46:407-415. [DOI: 10.1016/j.burns.2019.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/05/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
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Lernevall L, Moi A, Gjengedal E, Dreyer P. Staff Members’ Experience of Providing Parental Support in a National Burn Centre. Open Nurs J 2019. [DOI: 10.2174/1874434601913010211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Paediatric burn injuries affect not only the child but the whole family, especially the parents. Knowledge of how parents are affected psychologically has increased, but there is an ongoing dearth of literature on parental support while hospitalised. There is also very little documentation of the ways in which burn staff members support parents.
Objectives
To explore staff members’ lived experiences of supporting parents with children hospitalised at a burn centre due to a burn injury.
Methods
Four focus group interviews were conducted in 2017 with a total of 21 staff members at the National Burn Centre in Norway. Seven different burn staff professions participated. Data were analysed using a Ricoeur-inspired method for text analysis and managed using NVivo 12Plus.
Results
Four themes were identified in the treatment trajectory: creating a safe, secure and trusting environment from the moment parents enter the burn centre; helping parents deal with feelings of guilt; helping parents navigate in their daily routines while continuing to be a mother or father; and gradually involving parents in wound treatment as preparation for discharge.
Conclusion
Staff must carefully consider their verbal and non-verbal (body) language and how to approach parents from the very moment they enter the burn ward. Most parents are affected by feelings of guilt and these feelings must be addressed and processed. During the treatment trajectory, parents are guided to participate in the daily care of their child and are gradually assisted in taking over the wound treatment prior to discharge.
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Enlow PT, Brown Kirschman KJ, Mentrikoski J, Szabo MM, Butz C, Aballay AM, Duncan CL. The Role of Youth Coping Strategies and Caregiver Psychopathology in Predicting Posttraumatic Stress Symptoms in Pediatric Burn Survivors. J Burn Care Res 2019; 40:620-626. [PMID: 31032515 DOI: 10.1093/jbcr/irz067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Caregiver psychosocial functioning is repeatedly linked with postburn adjustment in pediatric burn survivors. However, few studies have examined youth characteristics as predictors, such as coping strategies. Furthermore, research has not explored how caregiver psychopathology and youth coping strategies interact to predict youth postburn adjustment. The aim of this study was to examine how youth coping strategies and caregiver anxiety and depression predict youth posttraumatic stress symptoms (PTSS). Forty-six youth between 7 and 17 years old (M = 12.5, SD = 2.65) and their caregivers were recruited from two U.S. burn centers. Youth and parents completed questionnaires that assessed demographics, caregiver anxiety, and depression, youth self-reports of coping strategies, and youth PTSS. Burn injury data (e.g. TBSA, time since injury) was obtained from medical record reviews. Hierarchical regressions were conducted with caregiver psychopathology (depression, anxiety), youth coping strategies (active, avoidant, distraction, social support), and the interaction between caregiver psychopathology and youth coping strategies as predictors and youth PTSS as the outcome variable. Higher levels of caregiver anxiety (βs = .36 to .42) and avoidance coping (βs = .38 to .43) were associated with more PTSS. Caregiver anxiety and depression moderated the association between youth use of distraction coping and youth PTSS. These findings reinforce the importance of assessing psychosocial functioning in pediatric burn survivors and their caregivers, and providing interventions to promote better psychosocial outcomes. Coping strategies may help reduce PTSS and buffer against the harmful influence of caregiver psychopathology. Future research may wish to pilot interventions that promote healthy coping.
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Affiliation(s)
- Paul T Enlow
- Center for Healthcare Delivery Science, Nemours/A.I. duPont Hospital for Children, Wilmington, Delaware
| | | | - Janelle Mentrikoski
- Developmental and Behavioral Sciences, Children's Mercy, Kansas City, Missouri
| | - Margo M Szabo
- Department of Child & Adolescent Psychiatry and Behavioral Sciences/Division of Gastroenterology, Hepatology, & Nutrition, Children's Hospital of Philadelphia, Pennsylvania
| | - Catherine Butz
- Department of Psychology, Nationwide Children's Hospital, Columbus, Ohio
| | - Ariel M Aballay
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Christina L Duncan
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania.,Department of Psychology, West Virginia University, Morgantown, West Virginia
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29
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Nelson S, Uhl K, Wright LA, Logan D. Pain is Associated With Increased Physical and Psychosocial Impairment in Youth With a History of Burn Injuries. THE JOURNAL OF PAIN 2019; 21:355-363. [PMID: 31400474 DOI: 10.1016/j.jpain.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/23/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
Burn injuries are significantly painful and associated with physical and psychological impairment. However, little research to-date has examined the potential role of the subjective experience of pain in either physical or psychological impairment in this population. This may be particularly important to examine, given that the pain experience can often be a significant barrier to recovery in other pediatric populations. The current study examined the cross-sectional and predictive relationships between patient-reported experience of pain (operationalized as PROMIS pain interference and self-reported pain intensity) and physical and psychosocial outcomes. Data were gathered as part of the Burn Model System National Database (1994-2018) with the data request inclusive of pediatric self-report PROMIS measures, child PTSD, and post-traumatic growth symptoms assessed at 6- and 12-month postdischarge following initial injury. A total of 65 youth between the ages of 6 and 16 years at the time of their injury were included in the dataset. Correlational and regression analyses indicated that pain interference was cross-sectionally and longitudinally associated with decreased physical functioning, depressive symptoms, and peer relationships. Pain intensity was significantly associated with and predictive of physical functioning and pain interference. Results of the current study are an important first step in understanding the pain experience and associated outcomes in youth with a history of burn injuries. Future research is needed to further examine these relationships. PERSPECTIVE: This study presents preliminary findings from a national database on pain-related outcomes both cross-sectionally and longitudinally in youth with a history of burn injury. To-date, pain-related outcomes are poorly understood in this population and the results of this study serve to inform future research and treatment-related efforts.
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Affiliation(s)
- Sarah Nelson
- Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| | - Kristen Uhl
- Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Laura A Wright
- Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Deirdre Logan
- Division of Pain Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Coy K, Brock P, Pomeroy S, Cadogan J, Beckett K. A Road Less Travelled: using Experience Based Co-Design to map children's and families' emotional journey following burn injury and identify service improvements. Burns 2019; 45:1848-1855. [PMID: 31395461 DOI: 10.1016/j.burns.2019.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The emotional impact after a child's burn injury is poorly understood. Greater insight into the emotional journey can aid services' ability to meet patients/families' needs. To bridge the gap, this study employed an abbreviated form of Experience Based Co-Design (EBCD) to explore the emotional/experiential aspects of moderate to severe burn injuries in children. METHOD Following EBCD, parents and health professionals were invited to share their experiences. Interviews were analysed and a short film was produced and shown at a focus group event for health professionals and families. Both positive and negative aspects of the journey were identified along with potential service improvements. RESULTS Families' journeys could be described by the following five distinct phases: life overturned, dawning reality, riding the emotional roller-coaster, aftershocks and, adapting to a new normal. Key areas for improvements were: communication, isolation, dressing changes and managing expectations. DISCUSSION EBCD facilitated collaborative discussion between researchers, families and health professionals. Families felt empowered to shape the future of burn care and health professionals felt included. Study challenges were mainly in participant engagement and the scheduling of interviews and the focus event. Overall the study outcome was successful in generating ideas for service improvements, and the production of a training video for healthcare professionals.
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Affiliation(s)
- K Coy
- Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom.
| | - P Brock
- Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom.
| | - S Pomeroy
- Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom.
| | - J Cadogan
- Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom.
| | - K Beckett
- University of the West of England, Bristol, United Kingdom.
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31
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Foster K, Mitchell R, Young A, Van C, Curtis K. Resilience-promoting factors for parents of severely injured children during the acute hospitalisation period: A qualitative inquiry. Injury 2019; 50:1075-1081. [PMID: 30573290 DOI: 10.1016/j.injury.2018.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/22/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Paediatric injury impacts the entire family. Many parents experience stress and anxiety following paediatric injury, but little is known about factors that support parents' wellbeing and how they successfully manage the adversity of child injury during acute hospitalisation. AIM To explore parent experiences and resilience-promoting factors that facilitate the wellbeing of parents with severely injured children during the acute hospitalisation period. METHODS A qualitative inquiry conducted across four major Australian paediatric trauma services. Semi-structured interviews were conducted with a purposive sample of 40 parents of 30 severely injured children aged 0-12 years during the acute post-injury hospitalisation period. Interviews explored parents' experiences and how parents had managed the stress of their child's injury during the acute hospitalisation period. Data were analysed using directed content analysis. RESULTS Parents identified a range of individual characteristics and resources, and those of their children and families, communities, and the hospital environment, which facilitated their wellbeing during the initial post-injury period. Three themes were derived from analysis: Drawing on inner strengths; Having positive and supportive relationships; Being in a safe place with the right help. CONCLUSION Resilience-promoting factors for parents of injured children can be used to inform development of brief online intervention modules to enhance parent resilience. Routine screening and targeted psychological first aid for parental distress are recommended.
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Affiliation(s)
- Kim Foster
- Australian Catholic University, School of Nursing, Midwifery & Paramedicine, 115 Victoria Parade, Fitzroy, Victoria, 3065, Australia; Northwestern Mental Health, Melbourne Health, Grattan Street, Parkville, Victoria, 3050, Australia.
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University NSW 2109, Australia
| | - Alexandra Young
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown NSW 2006, Australia
| | - Connie Van
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown NSW 2006, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown NSW 2006, Australia; Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University NSW 2109, Australia; Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus Street, Wollongong NSW 2500, Australia; Illawarra Health and Medical Research Institute, Building 32, University of Wollongong, Northfields Avenue, Wollongong NSW 2522, Australia; The George Institute for Global Health, Level 5, 1 King Street, Newtown NSW 2042, Australia
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32
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Labrell F, Câmara-Costa H, Dufour C, Grill J, Chevignard M. Maternal stress and pediatric brain cancer: A French study. J Psychosoc Oncol 2018; 37:96-109. [PMID: 30592250 DOI: 10.1080/07347332.2018.1529009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Despite evidence that pediatric cancer induces a trajectory of parental stress, studies including mothers of children with malignant brain tumors remain scarce. The present work aims to add to the scientific literature by evaluating maternal stress with a French translation of the Pediatric Inventory for Parents (PIP) in a population of mothers whose children have been diagnosed with a brain tumor. PROCEDURE The mothers of 35 children with malignant brain tumors completed the Pediatric Inventory for Parents (PIP), the State-Trait Anxiety Inventory (STAI) and the Family Assessment Device (FAD) at a mean time since diagnosis of 2.3 years. RESULTS The PIP showed good internal consistency and correlated significantly with the STAI and the FAD. Maternal stress scores were higher in younger mothers and in mothers of younger children. Emotional functioning was the most affected domain. CONCLUSIONS Emotional stress as assessed by the PIP in mothers of children with malignant brain tumors is considerable, and should be routinely assessed, in order to implement appropriate specific psychosocial interventions when needed.
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Affiliation(s)
- Florence Labrell
- a Université Paris-Saclay, Université Paris-Sud, UVSQ , Villejuif , France.,b INSHEA (National higher institute for training and research on special needs education) , Suresnes , France
| | - Hugo Câmara-Costa
- a Université Paris-Saclay, Université Paris-Sud, UVSQ , Villejuif , France
| | - Christelle Dufour
- c Department of Pediatric and Adolescent Oncology , Gustave Roussy , Villejuif , France
| | - Jacques Grill
- c Department of Pediatric and Adolescent Oncology , Gustave Roussy , Villejuif , France
| | - Mathilde Chevignard
- d Rehabilitation Department for children with acquired neurological injury , Saint Maurice Hospitals , Saint Maurice , France.,e Sorbonne Universités , Paris , France.,f GRC No18, Handicap Cognitif et Réadaptation (HanCRe) , Paris , France
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33
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Hawkins L, Centifanti LCM, Holman N, Taylor P. Parental Adjustment following Pediatric Burn Injury: The Role of Guilt, Shame, and Self-Compassion. J Pediatr Psychol 2018; 44:229-237. [DOI: 10.1093/jpepsy/jsy079] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/09/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Laura Hawkins
- School of Psychology, University of Liverpool, Brownlow Hill, Liverpool, L69 3GB
| | - Luna C M Centifanti
- School of Psychology, University of Liverpool, Brownlow Hill, Liverpool, L69 3GB
| | - Natalie Holman
- Psychological Services, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP
| | - Peter Taylor
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Sciences Centre, M13
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34
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Parrish C, Shields A, Morris A, George A, Reynolds E, Borden L, Hankinson J, Ziegfeld S, Stewart D, Ostrander R. Parent Distress Following Pediatric Burn Injuries. J Burn Care Res 2018; 40:79-84. [DOI: 10.1093/jbcr/iry048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Carisa Parrish
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ashley Shields
- Department Cardiology, Children’s Hospital of Wisconsin, Milwaukee, WI
| | - Adam Morris
- Department of Psychiatry, University of Albany, New York
| | - Anna George
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Elizabeth Reynolds
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lindsay Borden
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Jessica Hankinson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Susan Ziegfeld
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Dylan Stewart
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rick Ostrander
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
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35
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Garfin DR, Thompson RR, Holman EA. Acute stress and subsequent health outcomes: A systematic review. J Psychosom Res 2018; 112:107-113. [PMID: 30097129 DOI: 10.1016/j.jpsychores.2018.05.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/13/2018] [Accepted: 05/30/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To systematically review the relationship between acute posttraumatic stress symptoms (<1 month) and subsequent physical and mental health outcomes other than posttraumatic stress disorder (PTSD). METHODS A systematic search of electronic databases (PubMed, PsycINFO, CINAHL, and Web of Science) was conducted to identify longitudinal studies examining the link between acute posttraumatic stress and physical and mental health. Inclusion criteria required assessment of acute posttraumatic stress (<1 month post-event) and at least one follow-up assessment of a physical or mental health outcome (not PTSD). RESULTS 1,051 articles were screened; 22 met inclusion criteria. Fourteen studies examined physical health outcomes and 12 examined non-PTSD mental health outcomes. Early psychological responses to trauma were associated with a variety of short- (<1 year) and long- (≥1 year) term physical and mental health outcomes. Physical health outcomes included poor general physical health, increased pain and disability, lower quality of life, and higher risk of all-cause mortality. Significant psychological outcomes included more cumulative psychiatric disorders, depression, and anxiety. Significant psychosocial outcomes included increased family conflict. CONCLUSIONS Methodologically rigorous longitudinal studies support the utility of measuring acute psychological responses to traumatic events as they may be an important marker of preventable trauma-related morbidity and mortality that warrants long-term monitoring and/or early intervention.
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36
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Currie R, Anderson VA, McCarthy MC, Burke K, Hearps SJ, Muscara F. Parental distress in response to childhood medical trauma: A mediation model. J Health Psychol 2018; 25:1681-1691. [PMID: 29692208 DOI: 10.1177/1359105318770728] [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] [Indexed: 11/16/2022] Open
Abstract
This study explored the relationship between individual and family-level risk in predicting longer-term parental distress following their child's unexpected diagnosis of serious illness. A mediation model was tested, whereby parents' pre-existing psychosocial risk predicts longer-term posttraumatic stress symptoms, indirectly through parents' acute stress response. One hundred and thirty-two parents of 104 children participated. Acute stress response partially mediated the relationship between psychosocial risk and posttraumatic stress symptoms, with a moderate indirect effect (r2 = .20, PM = .56, p < .001). Findings demonstrated that cumulative psychosocial risk factors predispose parents to acute stress and longer-term posttraumatic stress symptoms, highlighting the need for psychosocial screening in this population.
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Affiliation(s)
| | - Vicki A Anderson
- Murdoch Children's Research Institute, Australia.,The University of Melbourne, Australia.,The Royal Children's Hospital Melbourne, Australia
| | - Maria C McCarthy
- Murdoch Children's Research Institute, Australia.,The Royal Children's Hospital Melbourne, Australia
| | - Kylie Burke
- Parenting Research Centre, Australia.,The University of Queensland, Australia
| | | | - Frank Muscara
- Murdoch Children's Research Institute, Australia.,The University of Melbourne, Australia.,The Royal Children's Hospital Melbourne, Australia
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37
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Shi X, Zhou Y, Geng F, Li Y, Zhou J, Lei B, Chen S, Chen X, Fan F. Posttraumatic stress disorder symptoms in parents and adolescents after the Wenchuan earthquake: A longitudinal actor-partner interdependence model. J Affect Disord 2018; 226:301-306. [PMID: 29028591 DOI: 10.1016/j.jad.2017.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 09/26/2017] [Accepted: 10/01/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous research has examined the association between parents' and children's posttraumatic stress disorder symptoms (PTSS) after a variety of traumatic events. However, longitudinal parent-child dyadic studies are scarce. METHODS Independent self-reports were collected from parent-adolescent dyads (n = 688) after the 2008 Wenchuan earthquake. Adolescents (Mean = 15.22 years; 61.63% female) and one of their parents (Mean = 41.04 years; 58.14% female) each reported on their PTSS at 12 (T12m) and 18 months (T18m) following the earthquake. Longitudinal actor-partner interdependence models (APIMs) were used to examine PTSS within dyads. RESULTS The prevalence rates of probable PTSD at T12m and T18m were 18.90% and 11.92% in adolescents; as well as 22.09% and 15.12% in parents, showing a significant decline over time. After adjusted for earthquake exposure, both maternal and paternal PTSS at T12m prospectively predicted adolescent girls' and boys' PTSS at T18m (mother to daughter: β = 0.13; mother to son: β = 0.17; father to daughter: β = 0.17; father to son: β = 0.33), while adolescent girls' and boys' PTSS at T12m only predicted maternal PTSS at T18m (daughter to mother: β = 0.20; son to mother: β = 0.20), but not paternal PTSS at T18m. LIMITATIONS Self-reported measures other than clinical reviews were used to collect data. CONCLUSIONS This study highlights the mutual impacts of adolescent and parental (especially maternal) PTSS after a disaster. Psychological prevention and intervention for adolescent disaster survivors should adopt a whole family approach.
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Affiliation(s)
- Xuliang Shi
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Ya Zhou
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Fulei Geng
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Yuanyuan Li
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Jieying Zhou
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Binbin Lei
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Siyi Chen
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Xiaoyan Chen
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Fang Fan
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China.
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38
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Brown EA, De Young A, Kimble R, Kenardy J. Review of a Parent’s Influence on Pediatric Procedural Distress and Recovery. Clin Child Fam Psychol Rev 2018; 21:224-245. [DOI: 10.1007/s10567-017-0252-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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39
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Bitton S, Tuval-Mashiach R, Freedman S. Distress Levels among Parents of Active Duty Soldiers during Wartime. Front Psychol 2017; 8:1679. [PMID: 29018394 PMCID: PMC5622972 DOI: 10.3389/fpsyg.2017.01679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/12/2017] [Indexed: 11/25/2022] Open
Abstract
Objective: Military service is a highly stressful period both for the soldiers serving and for their parents. Surprisingly, parents’ experience has been mostly ignored in the research. This study’s goal is to shed light on the experience and distress levels of parents of active duty combat soldiers during Operation Protective Edge, a military operation carried out by the Israel Defense Forces during July and August of 2014. Methods: During the advanced stages of the operation, 69 parents of Israeli male combat soldiers (55 mothers and 14 fathers) completed an online survey measuring symptoms of Posttraumatic Stress Disorder (PTSD-Checklist-5) and distress (Brief Symptom Inventory-18). Participants were recruited using a convenience sample, by posting ads on the public Facebook pages of the researchers and of the groups dedicated to parents of Israeli soldiers. Results: Parents’ depression and anxiety symptom levels were higher than depression and anxiety symptom levels of the adult community norms in Israel. General distress rates of parents were similar to those presented by adults in southern Israel who were exposed for 7 years to the ongoing threat of daily rocket fire from Gaza, and higher than rates of a non-threatened Israeli population. Finally, 20.2% of the parents presented PTSD-like symptoms, a higher percentage than the probable PTSD diagnosis rates that were found in the general population in Israel during previous terror waves. Conclusion: This study provides preliminary evidence of soldiers’ parents’ distress and indicates the need for a better understanding of the impact of military service on soldiers’ parents.
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Affiliation(s)
- Shahar Bitton
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | | | - Sara Freedman
- School of Social Work, Bar-Ilan University, Ramat Gan, Israel
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40
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Rechenberg K, Grey M, Sadler L. Stress and Posttraumatic Stress in Mothers of Children With Type 1 Diabetes. JOURNAL OF FAMILY NURSING 2017; 23:201-225. [PMID: 28795899 PMCID: PMC5611825 DOI: 10.1177/1074840716687543] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The onset of acute and chronic illness in children frequently triggers episodes of stress and posttraumatic stress symptoms (PTSS) in mothers. Mothers of children with type 1 diabetes (T1D) consistently report high levels of stress and PTSS. The purpose of this integrative review was to review and synthesize the published empirical research. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct this integrative literature review. A total of 19 studies were identified from a sample of 128. Stress and PTSS were prevalent in mothers of youth with T1D. While PTSS was most severe at disease onset, symptoms often persisted 1 to 5 years after diagnosis. The diagnosis of T1D in a child was traumatic for mothers. Stress and PTSS in mothers adversely affected children's health. Management of stress symptoms in mothers may lead to improved behavioral and metabolic outcomes in children.
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Morley J, Holman N, Murray CD. Dressing changes in a burns unit for children under the age of five: A qualitative study of mothers' experiences. Burns 2017; 43:757-765. [PMID: 28069342 DOI: 10.1016/j.burns.2016.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 11/17/2016] [Accepted: 11/29/2016] [Indexed: 01/17/2023]
Abstract
This study aimed to investigate the experiences of mothers who had attended their child's burn dressing changes. Participants were recruited from a burns unit based within a children's hospital. Face-to-face interviews were conducted with five mothers of children under the age of five who had undergone a series of dressing changes taking place on the burns unit. The interview guide explored parents' experience of initial and subsequent dressing changes. Participants were prompted to explore their expectations, thoughts, feelings and behaviours associated with these experiences. The interviews were recorded and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis. The analysis identified four themes: 'needing to fulfil the responsibilities associated with being a mother'; 'emotional synchrony between mother and child'; 'being informed and knowing what to expect'; and 'the importance of establishing rapport with nurses performing dressing changes'. Findings from this research can inform services to help optimise mothers' experiences of dressing changes in this stage of pediatric burn care.
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Affiliation(s)
- Jessica Morley
- Faculty of Health & Medicine, Lancaster University, Lancaster, UK
| | - Natalie Holman
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Craig D Murray
- Faculty of Health & Medicine, Lancaster University, Lancaster, UK.
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Foster K, Young A, Mitchell R, Van C, Curtis K. Experiences and needs of parents of critically injured children during the acute hospital phase: A qualitative investigation. Injury 2017; 48:114-120. [PMID: 27692666 DOI: 10.1016/j.injury.2016.09.034] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/23/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Physical injury is a leading cause of death and disability among children worldwide and the largest cause of paediatric hospital admission. Parents of critically injured children are at increased risk of developing mental and emotional distress in the aftermath of child injury. In the Australian context, there is limited evidence on parent experiences of child injury and hospitalisation, and minimal understanding of their support needs. The aim of this investigation was to explore parents' experiences of having a critically injured child during the acute hospitalisation phase of injury, and to determine their support needs during this time. METHODS This multi-centre study forms part of a larger longitudinal mixed methods study investigating the experiences, unmet needs and well-being of parents of critically injured children over the two-year period following injury. This paper describes parents' experiences of having a child 0-13 years hospitalised with critical injury in one of four Australian paediatric hospitals. Semi-structured interviews were conducted with forty parents and transcribed verbatim. The data were managed using NVIVO 10 software and thematically analysed. FINDINGS Forty parents (26 mothers and 14 fathers) of 30 children (14 girls and 16 boys aged 1-13 years) from three Australian States participated. The majority of children were Australian born. Three main themes with sub-themes were identified: navigating the crisis of child injury; coming to terms with the complexity of child injury; and finding ways to meet the family's needs. CONCLUSIONS There is a need for targeted psychological care provision for parents of critically injured children in the acute hospital phase, including psychological first aid and addressing parental blame attribution. Parents and children would benefit from the implementation of anticipatory guidance frameworks informed by a family-centred social ecological approach to prepare them for the trauma journey and for discharge. This approach could inform care delivery throughout the child injury recovery trajectory. The development and implementation of a major trauma family support coordinator in paediatric trauma centres would make a tangible difference to the care of critically injured children and their families.
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Affiliation(s)
- Kim Foster
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University & Northwestern Mental Health, Melbourne Health, Australia; Sydney Nursing School, The University of Sydney, Australia
| | | | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Australia
| | - Connie Van
- Sydney Nursing School, The University of Sydney, Australia
| | - Kate Curtis
- Sydney Nursing School, The University of Sydney, Australia; St. George Hospital, Sydney, Australia
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Brown RC, Nugent NR, Hawn SE, Koenen KC, Miller A, Amstadter AB, Saxe G. Predicting the Transition From Acute Stress Disorder to Posttraumatic Stress Disorder in Children With Severe Injuries. J Pediatr Health Care 2016; 30:558-568. [PMID: 26776839 PMCID: PMC4945483 DOI: 10.1016/j.pedhc.2015.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/20/2015] [Accepted: 11/30/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this study was to examine predictors of risk for and the transition between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in a longitudinal sample of youth with severe injuries admitted to the hospital. These data would assist with treatment and discharge planning. METHODS Youth were assessed for ASD during the initial hospital stay and were followed-up over an 18-month period for PTSD (n = 151). Youth were classified into four groups, including Resilient (ASD-, PTSD-), ASD Only (ASD+, PTSD-), PTSD Only (ASD-, PTSD+), and Chronic (ASD+, PTSD+). Demographic, psychiatric, social context, and injury-related factors were examined as predictors of diagnostic transition. RESULTS The results of multivariate analysis of variance and pairwise comparisons found that peritraumatic dissociation, gender, and socioeconomic status were significant predictors after controlling for multiple testing. DISCUSSION Results suggest that both within-child and contextual factors contribute to the longitudinal response to trauma in children. Clinicians should consider early screening and discharge planning, particularly for children most at risk.
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Noel M, Wilson AC, Holley AL, Durkin L, Patton M, Palermo TM. Posttraumatic stress disorder symptoms in youth with vs without chronic pain. Pain 2016; 157:2277-2284. [PMID: 27276275 PMCID: PMC5028262 DOI: 10.1097/j.pain.0000000000000642] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chronic pain and posttraumatic stress disorder (PTSD) symptoms have been found to co-occur in adults; however, research has not examined this co-occurrence in adolescence, when pediatric chronic pain often first emerges. The aims of this study were to compare the frequency and intensity of PTSD symptoms and stressful life events in cohorts of youth with (n = 95) and without (n = 100) chronic pain and their parents and to determine the association between PTSD symptoms, health-related quality of life, and pain symptoms within the chronic pain sample. All participants completed questionnaire measures through an online survey. Findings revealed that youth with chronic pain and their parents had significantly higher levels of PTSD symptoms as compared with pain-free peers. More youth with chronic pain (32%) and their parents (20%) reported clinically significant elevations in PTSD symptoms than youth without chronic pain (8%) and their parents (1%). Youth with chronic pain also reported a greater number of stressful life events than those without chronic pain, and this was associated with higher PTSD symptoms. Among the chronic pain cohort, higher levels of PTSD symptoms were predictive of worse health-related quality of life and were associated with higher pain intensity, unpleasantness, and interference. Results suggest that elevated PTSD symptoms are common and linked to reduced functioning among youth with chronic pain. Future research is needed to examine PTSD at the diagnostic level and the underlying mechanisms that may explain why this co-occurrence exists.
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Affiliation(s)
- Melanie Noel
- Department of Psychology, University of Calgary and Alberta Children’s Hospital Research Institute
| | - Anna C. Wilson
- Oregon Health and Science University, Institute on Development and Disability
| | | | - Lindsay Durkin
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital Research Institute
| | | | - Tonya M. Palermo
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital Research Institute
- Departments of Anesthesiology, Pediatrics, and Psychiatry, University of Washington
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Holley AL, Wilson AC, Noel M, Palermo TM. Post-traumatic stress symptoms in children and adolescents with chronic pain: A topical review of the literature and a proposed framework for future research. Eur J Pain 2016; 20:1371-83. [PMID: 27275585 DOI: 10.1002/ejp.879] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE The co-occurrence of chronic pain and post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) has gained increasing research attention. Studies on associations among pain and PTSS or PTSD in youth have largely been conducted in the context of acute injury or trauma. Less is known about the risk for co-occurrence with paediatric chronic pain. In this review, we (1) propose a conceptual framework to outline factors salient during childhood that may be associated with symptom severity, co-occurrence and mutual maintenance, (2) present relevant literature on PTSS in youth with acute and chronic pain and identify research gaps and (3) provide recommendations to guide paediatric research examining shared symptomatology. DATABASES AND DATA TREATMENT Electronic databases (PubMed and Google Scholar) were used to identify relevant articles using the search terms 'child, adolescent, paediatric, chronic pain, acute pain, post-traumatic stress symptoms and post-traumatic stress disorder'. Studies were retrieved and reviewed based on relevance to the topic. RESULTS Our findings revealed that existing biobehavioural and ecological models of paediatric chronic pain lack attention to traumatic events or the potential development of PTSS. Paediatric studies are also limited by lack of a conceptual framework for understanding the prevalence, risk and trajectories of PTSS in youth with chronic pain. CONCLUSIONS Our new developmentally informed framework highlights individual symptoms and shared contextual factors that are important when examining potential associations among paediatric chronic pain and PTSS. Future studies should consider bidirectional and mutually maintaining associations, which will be aided by prospective, longitudinal designs. WHAT DOES THIS REVIEW ADD?: This review presents relevant literature on pain and PTSS in youth and proposes a conceptual framework to examine factors salient during childhood that may be associated with symptom severity, comorbidity and mutual maintenance of chronic pain and PTSS in paediatric populations. We highlight dynamic factors that may change across children's development and provide recommendations to guide paediatric research examining potential associations among PTSS and chronic pain.
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Affiliation(s)
- A L Holley
- Division of Psychology, Oregon Health & Science University, Portland, USA.
| | - A C Wilson
- Division of Psychology, Oregon Health & Science University, Portland, USA
| | - M Noel
- Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, AB, Canada
| | - T M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington and Seattle Children's Research Institute, USA
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Rayner M, Muscara F, Dimovski A, McCarthy MC, Yamada J, Anderson VA, Burke K, Walser R, Nicholson JM. Take A Breath: study protocol for a randomized controlled trial of an online group intervention to reduce traumatic stress in parents of children with a life threatening illness or injury. BMC Psychiatry 2016; 16:169. [PMID: 27234569 PMCID: PMC4884427 DOI: 10.1186/s12888-016-0861-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/12/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND A substantial proportion of parents whose child is diagnosed with a life-threatening illness, experience high levels of distress that can lead to long-term difficulties in mental health, family functioning and child adjustment. This study evaluates the efficacy of an Acceptance Commitment Therapy-based group intervention designed to reduce distress symptoms in these parents. The program is delivered using videoconferencing to overcome factors that prevent participation in traditional face-to-face therapy. METHOD/DESIGN The study is a randomized control trial of the Take A Breath group intervention for parents demonstrating elevated symptoms of acute stress, delivered via videoconferencing in six 90 min group sessions. Participants are the primary caregivers of children aged 0 to 18 years admitted for a life threatening illness or injury to the Oncology, Cardiology, Neurology or Intensive Care Departments of a tertiary pediatric hospital. Parents will be randomized to intervention or waitlist control 4-10 months after their child's diagnosis. Measures will be collected prior to and immediately post intervention for intervention and waitlist parents to assess program efficacy. Intervention parents will be followed up at 6 months to assess the maintenance of program effects. We predict that intervention parents will show fewer symptoms post intervention than waitlist parents (primary outcomes: traumatic stress, depression, anxiety, stress symptoms), reflecting improvements in the psychological skills addressed in the intervention (mediating factors). It is anticipated that reductions in mental health difficulties for intervention parents will be maintained up to 6 months post-intervention and will be associated with broader improvements in parents' adjustment, child adjustment and child wellbeing (secondary outcomes). DISCUSSION This study is unique in evaluating a group intervention delivered to parents of children affected by of a diverse range life-threatening illness or injury. Online communication technology is employed to reduce participation barriers. If proven efficacious, this trans-diagnostic approach offers the potential for broad use as part of the suite of psychosocial services provided to families through tertiary pediatric settings. TRIAL REGISTRATION ACTRN12611000090910 . Trial Registration Date: 14/09/2011 Protocol Date/version: September 2015, version M Study Status: Ongoing.
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Affiliation(s)
- Meredith Rayner
- Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Frank Muscara
- Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Anica Dimovski
- Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Maria C McCarthy
- Children's Cancer Centre, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Jackie Yamada
- Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Vicki A Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Kylie Burke
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Robyn Walser
- University of California, Berkeley and TL Consultation Services, Menlo Park, California, USA
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, 215 Franklin St, Melbourne, Victoria, 3000, Australia
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Sveen J, Bondjers K, Willebrand M. Psychometric properties of the PTSD Checklist for DSM-5: a pilot study. Eur J Psychotraumatol 2016; 7:30165. [PMID: 27098450 PMCID: PMC4838990 DOI: 10.3402/ejpt.v7.30165] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/11/2016] [Accepted: 03/28/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To date there is a lack of studies assessing the psychometric properties of the recently revised PTSD Checklist (PCL), the PTSD Checklist for DSM-5 (PCL-5). The aim of this pilot study was to examine the psychometric properties of the PCL-5 in parents of children with burns. METHODS The participating parents (N=62, mean age=38) completed self-report questionnaires, 0.8-5.6 years after their child's burn. Measures were the PCL-5, the Impact of Event Scale-Revised (IES-R), the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Perceived Stress Scale (PSS). Burn severity of the child and sociodemographic variables was obtained. RESULTS The parents' average PCL-5 scores were low to moderate. The internal consistency of the PCL-5 was satisfactory, with Cronbach's alpha ranging from 0.56 to 0.77 and mean inter-item correlations ranging from 0.22 to 0.73 for the four PCL-5 subscales and the PCL-5 total. The PCL-5 subscales were moderately to highly correlated with the corresponding IES-R subscales as well as MADRS and PSS (p<0.05), whereas associations with sociodemographics and burn severity were low to moderate. CONCLUSIONS This study provides preliminary support for the use of PCL-5. The results indicate satisfactory psychometric properties of the PCL-5 as measured with internal consistency, test-retest reliability, and aspects of convergent validity.
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Affiliation(s)
- Josefin Sveen
- Department of Neuroscience (Psychiatry), Uppsala University, Uppsala, Sweden;
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Measuring the burden of pediatric burn injury for parents and caregivers: informed burn center staff can help to lighten the load. J Burn Care Res 2016; 36:421-7. [PMID: 25522152 DOI: 10.1097/bcr.0000000000000095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study sought to identify which commonly experienced burn-related issues parents/caregivers of burn-injured youth deemed most stressful, difficult, and disruptive during their child's initial acute burn care hospitalization, and following the child's discharge. Parents completed an 11-item survey, asking them to rate the difficulty of items regarding their child's burn injury. The scale was created by burn doctors, nurses, and psychologists with an average of 10.5 (SD ± 4.8) years of experience. Items selected were among common parental problems reported in the burn literature. Respondents included 69 parents/caregivers of previously hospitalized, burn-injured youth. The majority were mothers, n = 51 (74%), and n = 34 (49%) were Caucasian. The most represented age group was 37 to 45 years, n = 31 (45%). Children were on average, 6.04 years out from their initial injury. All parents reported their child's pain as the most difficult part of the injury, n = 69 (100%). The second most common issue was the child's first hospital stay. The other two items found to be "very hard" or "pretty hard" were the time spent away from their other children, and feelings of hopelessness in being unable to fix everything for their child. In this study, key parental problems occurred during the child's initial hospitalization. Burn staff cannot alleviate all problems, however, staff education regarding distressing problems faced by parents, as well as possible solutions, can be made available.
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Willebrand M, Sveen J. Injury-related fear-avoidance and symptoms of posttraumatic stress in parents of children with burns. Burns 2016; 42:414-20. [PMID: 26775217 DOI: 10.1016/j.burns.2015.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/10/2015] [Accepted: 08/07/2015] [Indexed: 11/16/2022]
Abstract
Parents of children with burns experience a range of psychological reactions and symptoms, and parents' health is known to impact children's health. So far, there is little research into potential mechanisms that maintain parents' symptoms. The aim was to investigate parental injury-related fear-avoidance, and its associations with injury severity and health measures. Parents (n=107) of children aged 0.4-18 years that sustained burns 0.1-9.0 years previously completed questionnaires on fear-avoidance, posttraumatic stress, and health of the child. Analyses showed that the average level of fear-avoidance was low and positively associated with measures of injury severity and parents' symptoms of posttraumatic stress, and negatively associated with parents' ratings of their child's health. In two separate multiple regressions with parents' symptoms of PTSD and the child's health as dependent variables, fear-avoidance made the largest contribution in both models while injury severity was non-significant. Results were not related to comorbid conditions of the child, scarring, or parent-related socio-demographic variables. In summary, injury-related fear-avoidance is more likely among parents whose children sustain more severe burns. In turn, fear-avoidance contributes significantly to parents' symptoms of PTSD and to poorer health ratings regarding the child, irrespective of injury severity or child comorbidity.
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Affiliation(s)
- M Willebrand
- Department of Neuroscience, Psychiatry, Uppsala University, Sweden.
| | - J Sveen
- Department of Neuroscience, Psychiatry, Uppsala University, Sweden
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