Feature Article

Longitudinal Trajectories of Caregiver Distress and Family Functioning After Community-Acquired Pediatric Septic Shock

Murphy, Lexa K. PhD¹; Palermo, Tonya M. PhD^1,2; Meert, Kathleen L. MD³; Reeder, Ron PhD⁴; Dean, J. Michael MD⁴; Banks, Russell MS⁴; Berg, Robert A. MD⁵; Carcillo, Joseph A. MD⁶; Chima, Ranjit MD⁷; McGalliard, Julie BA⁸; Haaland, Wren MPH⁸; Holubkov, Richard PhD⁴; Mourani, Peter M. MD⁹; Pollack, Murray M. MD¹⁰; Sapru, Anil MD¹¹; Sorenson, Samuel BS⁴; Varni, James W. PhD¹²; Zimmerman, Jerry MD, PhD⁸

Author Information

¹Center for Child Health Behavior and Development, Seattle Children’s Research Institute, Seattle, WA.

²Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.

³Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, MI.

⁴Department of Pediatrics, University of Utah, Salt Lake City, UT.

⁵Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA.

⁶Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.

⁷Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, OH.

⁸Department of Pediatrics, Seattle Children’s Hospital, Seattle Research Institute, University of Washington School of Medicine, Seattle, WA.

⁹Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital of Colorado, Aurora, CO.

¹⁰Department of Pediatrics, Children’s National Health System, Washington, DC.

¹¹Department of Pediatrics, Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, CA.

¹²Department of Pediatrics, Texas A&M University, College Station, TX.

This investigation was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, R01HD073362, and was supported, in part, by the following cooperative agreements: UG1HD050096, UG1HD049981, UG1HD049983, UG1HD063108, UG1HD083171, UG1HD083166, UG1HD083170, U10HD050012, U10HD063106, and U01HD049934.

Drs. Murphy, Palermo, Meert, Reeder, and Dean, Mr. Banks, and Drs. Berg, Carcillo, Chima, Holubkov, Mourani, Pollack, and Sapru, Mr. Sorenson, and Drs. Varni and Zimmerman received support for article research from the National Institutes of Health (NIH). Drs. Palermo, Meert, Reeder, Dean, Berg, Holubkov, Mourani, Pollack, Sapru, and Varni’s institutions received funding from the NIH. Mr. Banks, Dr. Carcillo, Mr. Sorenson, and Dr. Zimmerman’s institution received funding from the National Institutes of Child Health and Human Development. Mr. Banks and Mr. Sorenson disclosed government work. Ms. McGalliard disclosed work for hire. Dr. Holubkov received funding for biostatistical consulting from Physicians Committee for Responsible Medicine and DURECT, and he received funding for Data Safety Monitoring Board work from Pfizer, MedImmune, Revance, and Armaron Bio. Dr. Zimmerman’s institution received funding from Immunexpress, and he received funding from Elsevier (royalties) and the Society of Critical Care Medicine. Dr. Haaland has disclosed that he does not have any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

Pediatric Critical Care Medicine 21(9):p 787-796, September 2020. | DOI: 10.1097/PCC.0000000000002404

Abstract

Objectives:

To identify trajectories and correlates of caregiver distress and family functioning in families of children who survived community-acquired septic shock. We hypothesized that: 1) a substantial subset of families would demonstrate trajectories of persistent elevated caregiver distress and impaired family functioning 12 months after hospitalization and 2) sociodemographic and clinical risk factors would be associated with trajectories of persistent distress and family dysfunction.

Design:

Prospective cohort.

Setting:

Fourteen PICUs in the United States.

Patients:

Caregivers of 260 children who survived community-acquired septic shock.

Interventions:

None.

Measurements and Main Results:

Caregivers completed ratings of distress on the Brief Symptom Inventory and of family functioning on the Family Assessment Device at baseline, 1, 3, 6, and 12 months after hospitalization. Results from group-based trajectory modeling indicated that 67% of the current sample was characterized by persistent low caregiver distress, 26% by persistent moderate to high distress that remained stable across 12 months (high-risk caregiver distress group), and 8% by initial high distress followed by gradual recovery. Forty percent of the sample was characterized by stable high family functioning, 15% by persistent high dysfunction across 12 months (high-risk family functioning group), 12% by gradually improving functioning, and 32% by deteriorating function over time. Independently of age, child race was associated with membership in the high-risk caregiver distress group (non-white/Hispanic; effect size, –0.12; p = 0.010). There were no significant sociodemographic or clinical correlates of the high-risk family functioning group in multivariable analyses.

Conclusions:

Although the majority of families whose children survived community-acquired septic shock were characterized by resilience, a subgroup demonstrated trajectories of persistently elevated distress and family dysfunction during the 12 months after hospitalization. Results suggest a need for family-based psychosocial screening after pediatric septic shock to identify and support at-risk families.

Secondary Logo

Journal Logo

Longitudinal Trajectories of Caregiver Distress and Family Functioning After Community-Acquired Pediatric Septic Shock