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Children's psychological responses after critical illness and exposure to invasive technology
Janet E Rennick1, C Celeste Johnston, Geoffrey Dougherty
1Department of Nursing Research, The Montreal Children's Hospital, McGill University Health Centre, School of Nursing, McGill University, Montreal, Quebec, Canada.
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Pediatric intensive care unit (PICU) stays can negatively impact children
Area of Science:
- Pediatric Psychology
- Critical Care Medicine
- Child Health Outcomes
Background:
- Children in pediatric intensive care units (PICUs) undergo invasive treatments.
- Long-term psychological adjustment after PICU stays is not well understood.
Purpose of the Study:
- Compare psychological responses of children post-PICU versus general ward hospitalization.
- Identify factors influencing psychological outcomes in hospitalized children.
Main Methods:
- Prospective cohort study of 120 children for 6 months post-discharge.
- Assessed sense of control, medical fears, posttraumatic stress, and behavioral changes.
- Examined associations with age, invasiveness, illness severity, and length of stay.
Main Results:
- No significant differences between PICU and general ward groups.
- Younger age, severe illness, and invasive procedures correlated with increased medical fears, lower health control, and persistent posttraumatic stress.
- These effects persisted for 6 months post-discharge.
Conclusions:
- Hospital setting alone did not predict psychological outcomes.
- Invasiveness, illness severity, and length of stay are key factors impacting children's long-term psychological adjustment.
- Interventions should address these factors for vulnerable pediatric patients.
Abstract:
Children hospitalized in pediatric intensive care units (PICUs) are subjected to highly invasive interventions necessary in overcoming the critical period of their illness, yet little is known about their subsequent psychological adjustment. The purposes of this study were to compare the psychological responses of children hospitalized in a PICU with those of children hospitalized on a general ward and to identify clinically relevant factors that might be associated with psychological outcome. A prospective cohort design was used to follow 120 children for 6 months after PICU and ward discharge. Groups were compared on the children's sense of control over their health, their medical fears, posttraumatic stress, and changes in behavior. Relationships between children's responses and their age, the invasive procedures to which they were exposed, severity of illness, and length of hospital stay were also examined. No significant group differences were found. However, children who were younger, more severely ill, and who endured more invasive procedures had significantly more medical fears, a lower sense of control over their health, and ongoing posttraumatic stress responses for 6 months postdischarge. Findings indicate that regardless of the hospital setting, invasiveness coupled with length of stay and severity of illness in young children may have adverse long-term effects.