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The Course of Posttraumatic Stress in Children: Examination of Symptom Trajectories and Predictive Factors Following
Robyne M Le Brocque1, Belinda L Dow2, Hayley McMahon3
1The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Qld, Australia.
Insights
Most children (83.8%) admitted to pediatric intensive care recover from trauma symptoms. However, maternal distress and pre-existing child internalizing behaviors predict chronic post-intensive care symptoms.
Area of Science:
- Pediatric Intensive Care Medicine
- Child Psychology
- Trauma Studies
Background:
- Pediatric intensive care admission can be a traumatic event for children.
- Understanding long-term psychological outcomes is crucial for effective care.
- Limited research exists on trauma symptom trajectories in this population.
Purpose of the Study:
- To investigate trauma symptom trajectories in children (2-16 years) after pediatric intensive care admission.
- To identify predictors of these trauma symptom trajectories.
- To inform targeted interventions for at-risk children.
Main Methods:
- Prospective longitudinal study in two tertiary pediatric intensive care units (PICUs).
- Assessed maternal-reported child posttraumatic stress symptoms up to 12 months post-admission using the Trauma Symptom Checklist for Young Children.
- Utilized semiparametric group-based trajectory analyses and assessed risk factors including maternal distress and child's premorbid functioning.
Main Results:
- Identified three trauma symptom trajectories: resilient (83.8%), chronic symptoms (12.9%), and rapid resolution (3.3%).
- Maternal report of child's premorbid internalizing behavior predicted both chronic and recovery trajectories.
- Maternal acute distress significantly predicted chronic symptom trajectories in children.
Conclusions:
- The majority of children demonstrate resilience post-PICU, but a notable minority experience chronic symptoms.
- Maternal acute distress and pre-existing child internalizing behaviors are key predictors of ongoing psychological distress.
- Early screening post-PICU admission can identify at-risk children for timely, targeted interventions.
Objectives:
This study investigated trauma symptom trajectories of children 2-16 years old following admission to pediatric intensive care and identified factors that predicted a child's trauma symptom trajectory.
Design:
Prospective longitudinal design.
Setting:
Two tertiary care PICUs in Brisbane, Qld, Australia.
Patients:
Children 2-16 years old admitted to PICU for longer than 8 hours.
Measurements Main Results:
Maternal reported child posttraumatic stress symptoms (n = 272) on the Trauma Symptom Checklist for Young Children were used to assess posttraumatic stress symptoms up to 12 months post admission. Semiparametric group-based trajectory analyses were completed to identify patterns over time. Age, gender, length of stay, premorbid functioning, maternal perceived threat to life, and maternal acute distress were assessed as potential risk factors. Three likely trajectory groups were identified. The majority of children were resilient (83.8%); however, a significant minority experienced chronic symptoms (12.9%) or elevated stress symptoms which resolved quickly (3.3%). After controlling for other variables, maternal report of premorbid internalizing behavior significantly predicted both chronic (odds ratio, 6.3) and recovery (odds ratio, 38.0) trajectories. Maternal acute distress significantly predicted child chronic symptom trajectories (odds ratio, 5.2).
Conclusions:
Children with elevated trauma symptoms postintensive care need timely and effective intervention. The majority of children with high levels of acute symptoms will continue to have chronic, ongoing posttraumatic stress symptoms. In addition, acute maternal distress and preexisting internalizing child behavior predict ongoing psychologic distress after discharge from the PICU. Screening in the acute period post-PICU admission may identify children likely to experience ongoing chronic posttraumatic distress symptoms and enable targeted treatment of children at risk. This is the first study to examine symptom trajectories in children following pediatric intensive care admission and includes a sample of very young children.
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