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Parental Adverse Childhood Experiences and Post-PICU Stress in Children and Parents
Patrice Pryce1, Maalobeeka Gangopadhyay2, Jeffrey D Edwards1
1Section of Critical Care, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
Insights
Adverse childhood experiences (ACEs) are common in parents of children in the pediatric intensive care unit (PICU). Parental ACEs significantly increase the risk of post-PICU PTSD in parents, but not in children.
Area of Science:
- Pediatric critical care medicine
- Psychotraumatology
- Family mental health
Background:
- Pediatric intensive care unit (PICU) admission is stressful for children and parents.
- Posttraumatic stress disorder (PTSD) is a common outcome after PICU discharge.
- Pre-illness traumatic events, like adverse childhood experiences (ACEs), may be risk factors for PTSD.
Purpose of the Study:
- To assess the feasibility of screening for parental ACEs in a PICU setting.
- To determine the prevalence of ACEs among parents of PICU patients.
- To investigate the association between parental ACEs and post-PICU PTSD symptoms in parents and children.
Main Methods:
- A single-center prospective observational study was conducted.
- 145 children (2-18 years) and their parents admitted to a pediatric academic children's hospital were enrolled.
- Data collected included parental demographics, ACEs, coping skills, PICU stressors, and patient clinical data. PTSD symptoms were assessed one month post-discharge.
Main Results:
- 95% of parents completed the ACE questionnaire; 58% reported at least one ACE, and 14% reported substantial ACEs (≥4).
- 16% of parents met criteria for provisional PTSD.
- Parents with ≥4 ACEs had a 10-fold increased odds of developing PTSD (aOR=10.2, p=0.047).
- 56% of children screened at risk for PTSD, with no significant association with parental ACEs.
Conclusions:
- Adverse childhood experiences are prevalent among parents of critically ill children.
- Substantial parental ACEs are linked to parental PTSD following PICU admission.
- Parental ACEs do not appear to be associated with PTSD risk in children.
- Family-centered care in the PICU should consider parental ACEs to mitigate stress.
Objectives:
Hospitalization in a PICU is a stressful experience for children and their parents, with many experiencing posttraumatic stress disorder (PTSD) after discharge. Risk factors may include preillness traumatic events, such as adverse childhood experiences (ACEs). We sought to assess the feasibility of screening ACEs in parents of children admitted to a PICU, their prevalence, and their association with post-PICU PTSD symptoms in them and their children.
Design:
Single-center prospective observational study.
Setting:
Urban academic children's hospital from January to December 2021.
Patients:
One hundred forty-five children (2-18 yr old, admitted ≥ 2 d) and their parents.
Interventions:
None.
Measurements And Main Results:
Data on parental demographics, ACEs, coping skills, and PICU environmental stressors, as well as patient clinical data, were collected. One month after PICU discharge, parents completed inventories assessing PTSD symptoms in them and their children. Bivariate and logistic regression analyses were used to explore associations of ACEs with post-PICU PTSD. Of 145 enrolled parents, 95% completed the ACE questionnaire, 58% of whom reported greater than or equal to 1 ACE, and 14% had substantial (≥ 4) ACEs. Parent and patient follow-up was 79% and 70%, respectively. Sixteen percent of parents had provisional PTSD. Regression analysis showed parents with greater than or equal to 4 ACEs had 10 times greater odds of parental PTSD, compared to parents with less than 4 ACEs, (adjusted odds ratio [aOR] = 10.2; 95% CI, 1.03-100.9; p = 0.047). Fifty-six percent of patients screened at risk for PTSD. There was no association between substantial parental ACEs and patients' risk for PTSD (aOR = 3.5 [95% CI, 0.56-21.31]; p = 0.18).
Conclusions:
ACEs were common among parents of critically ill children. Having substantial parental ACEs was associated with provisional parental PTSD after their child's PICU admission, but not with PTSD in the children. Family-centered care that seeks to mitigate post-PICU stress should be mindful of the potential relevance of parental ACEs.
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