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Parent Medical Traumatic Stress and Associated Family Outcomes After Pediatric Critical Illness: A Systematic Review*

Yagiela, Lauren M. MD, MS1; Carlton, Erin F. MD2,3; Meert, Kathleen L. MD1; Odetola, Fola O. MD, MPH2,3,4; Cousino, Melissa K. PhD2

Pediatric Critical Care Medicine: August 2019 - Volume 20 - Issue 8 - p 759-768
doi: 10.1097/PCC.0000000000001985
Review Article
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Objectives: To critically review, analyze, and synthesize the literature on parent medical traumatic stress from a child’s critical illness requiring PICU admission and its association with outcomes of parent mental and physical health, and family functioning.

Data Sources: Systematic literature search of Pubmed, Embase, CINAHL, and PsychInfo.

Study Selection: Two reviewers identified peer-reviewed published articles with the following criteria: 1) published between January 1, 1980, and August 1, 2018; 2) published in English; 3) study population of parents of children with a PICU admission; and 4) quantitative studies examining factors associated with outcomes of parent mental health, parent physical health, or family functioning.

Data Extraction: Literature search yielded 2,476 articles, of which 23 studies met inclusion criteria. Study data extracted included study characteristics, descriptive statistics of parent outcomes after critical illness, and variables associated with parent and family outcomes.

Data Synthesis: Studies examined numerous variables associated with parent and family outcomes and used multiple survey measures. These variables were categorized according to their phase in the Integrative Trajectory Model of Pediatric Medical Traumatic Stress, which included peri-trauma, acute medical care, and ongoing care or discharge from care. The majority of objective elements of a child’s illness, such as severity of illness and length of hospitalization, did not have a clear relationship with parent and family outcomes. However, familial preexisting factors, a parent’s subjective experience in the PICU, and family life stressors after discharge were often associated with parent and family outcomes.

Conclusions: This systematic literature review suggests that parent and family outcomes after pediatric critical illness are impacted by familial preexisting factors, a parent’s subjective experience in the PICU, and family life stressors after discharge. Developing parent interventions focused on modifying the parent’s subjective experience in the PICU could be an effective approach to improve parent outcomes.

1Critical Care Medicine, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI.

2Department of Pediatrics, University of Michigan, Ann Arbor, MI.

3Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI.

4Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI.

*See also p. 787.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

This work was supported by the Department of Pediatrics at Children’s Hospital of Michigan and the Department of Pediatrics at the University of Michigan.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: lyagiela@dmc.org

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