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Psychiatric outcome following paediatric intensive care unit (PICU) admission: a cohort study
Gwyneth Rees1, Julia Gledhill, M Elena Garralda
1The Academic Unit of Child and Adolescent Psychiatry, St Mary's Campus, Imperial College London, Norfolk Place, London, W2 1PG, UK.
Insights
Children admitted to a paediatric intensive care unit (PICU) have higher rates of post-traumatic stress disorder (PTSD) compared to those on general wards. This study highlights the need for psychological support for families following PICU stays.
Area of Science:
- Pediatric critical care medicine
- Child and adolescent psychiatry
- Trauma psychology
Background:
- Paediatric intensive care unit (PICU) admissions represent a significant stressor for children and their families.
- Previous research has explored the psychological impact of critical illness, but specific comparisons between PICU and general ward admissions are less defined.
Purpose of the Study:
- To investigate the association between paediatric intensive care unit (PICU) admission and psychiatric morbidity in children and their parents.
- To compare the prevalence of psychiatric symptoms in children and parents after PICU versus general paediatric ward admissions.
Main Methods:
- Retrospective cohort study design.
- Inclusion of children aged 5-18 years and their parents, with follow-up 6-12 months post-discharge.
- Utilized validated psychometric scales including the Clinician Administered Post Traumatic Stress Disorder (PTSD) Scale for Children (CAPS-C) and Impact of Event Scale (IES).
Main Results:
- Children discharged from PICU showed a significantly higher incidence of Post-Traumatic Stress Disorder (PTSD) (21%) compared to general ward admissions (0%), p=0.02.
- Parents of children admitted to the PICU were more likely to screen positive for PTSD (27%) than parents of children admitted to general wards (7%), p=0.04.
- Irritability and avoidance of admission reminders were more common PTSD features in PICU-admitted children; other psychopathology measures did not differ significantly.
Conclusions:
- Post-traumatic stress disorder (PTSD) diagnosis and symptomatology are significantly more prevalent in families following a child's PICU admission.
- Psychological support services should be considered for children and parents after PICU discharge to address trauma-related symptoms.
- Findings underscore the distinct psychological impact of intensive care compared to general paediatric care.
Objective:
To determine whether paediatric intensive care unit (PICU) admission is associated with greater psychiatric morbidity in children and parents as compared with general paediatric ward admissions.
Design:
Retrospective cohort study.
Setting:
Paediatric intensive care unit and two general paediatric wards of a London teaching hospital.
Participants:
Children aged 5-18 years discharged from PICU (exposed cohort) and general paediatric wards (unexposed cohort) 6-12 months previously, together with their parents.
Measurements And Results:
Children: the Clinician Administered Post Traumatic Stress Disorder (PTSD) Scale for Children (CAPS-C), the Impact of Event Scale (IES), Strengths and Difficulties Questionnaire, Birleson Depression Scale, Revised Children's Manifest Anxiety Scale, Child Somatization Inventory. Parents: IES, General Health Questionnaire, Beck Depression Inventory, Hospital Anxiety and Depression Scale. Thirty-five of 46 (76%) PICU-discharged families and 33 of 41 (80%) from general paediatric wards participated. Valid CAPS-C data were obtained for 19 PICU-admitted children and 27 children admitted only to the general paediatric ward; 4/19 (21%) of PICU-discharged children developed PTSD (compared with none of 27 ward admissions), p=0.02. PICU children had significantly more PTSD features of irritability and persistent avoidance of reminders of the admission. Parents of PICU children were more likely to screen positive for PTSD (9/33 (27%) compared with 2/29 (7%) parents of ward-admitted children), p=0.04. There were no significant differences between the groups for other measures of psychopathology.
Conclusion:
Post traumatic stress disorder diagnosis and symptomatology is significantly more common in families where a child has been admitted to the PICU. Consideration should be given to providing psychological support for children and parents after PICU admission.