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The Effects of Family Functioning on the Development of Posttraumatic Stress in Children and Their Parents Following Admission to the PICU*

Nelson, Lara P., MD1,2,3; Lachman, Sage E., BA3; Li, Sara W., PsyD4; Gold, Jeffrey I., PhD1,2,3,5

Pediatric Critical Care Medicine: April 2019 - Volume 20 - Issue 4 - p e208–e215
doi: 10.1097/PCC.0000000000001894
Online Clinical Investigations

Objectives: To report the rate of acute stress and posttraumatic stress among children and parents following PICU admission and the relation between family function and posttraumatic stress.

Design: Prospective, longitudinal, multi-informant observational study. Pediatric patients (n = 69) and parents were recruited in the ICU. They completed measures evaluating acute stress and posttraumatic stress during their hospitalization and at 3-month follow-up. Parents completed measures of family functioning during the hospitalization. Pearson correlations and multiple regression models were used to examine the relations between family functioning and acute stress and posttraumatic stress.

Setting: An academic, urban, pediatric hospital in California.

Patients: Children, 8–17 years old, admitted to the PICU for greater than 24 hours and their English- or Spanish-speaking parents.

Interventions: None.

Measurements and Main Results: All children endorsed acute stress during their PICU admission, with 51% meeting criteria for acute stress disorder. At 3-month follow-up, 53% of the children continued to endorse posttraumatic stress with 13% meeting criteria for posttraumatic stress disorder. Among parents, 78% endorsed acute stress during admission with 30% meeting criteria for acute stress disorder, and at follow-up, 35% endorsed posttraumatic stress with 10% meeting criteria for posttraumatic stress disorder. In multiple linear regression modeling, child acute stress significantly predicted child posttraumatic stress (β = 0.36; p < 0.01). In the parent model, parent acute stress (β = 0.29; p < 0.01) and parent education (β = 0.59; p < 0.00) positively predicted parent’s posttraumatic stress. Family function was not a predictor of either’s posttraumatic stress.

Conclusions: Both children and parents have alarmingly high rates of acute stress and posttraumatic stress following the child’s PICU admission. Although family function did not emerge as a predictor in this study, further understanding of the influence of the family and the interplay between child and parent posttraumatic stress is needed to improve our understanding of the model of development of posttraumatic stress in this population to inform the intervention strategies.

1University of Southern California Keck School of Medicine, Los Angeles, CA.

2Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA.

3Children’s Hospital Los Angeles, Los Angeles, CA.

4Department of Psychiatry, Kaiser Permanente, San Mateo, CA.

5Departments of Anesthesiology and Psychiatry & Behavioral Sciences, Children’s Hospital Los Angeles, Los Angeles, CA.

*See also p. 394.

The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health.

Supported, in part, by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Award Number KL2TR000131.

Dr. Nelson was a KL2 Scholar awarded under the KL2 Mentoring Research Career Development Award through Southern California Clinical and Translational Science Institute at University of Southern California, Keck School of Medicine. Dr. Nelson, Ms. Lachman, and Dr. Gold received support for article research from the National Institutes of Health. Dr. Li disclosed that she does not have any potential conflicts of interest.

This work performed for this article was done at Children’s Hospital Los Angeles, Los Angeles, CA.

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©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies