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Directed psychoeducational tool to prevent psychological sequelae following paediatric intensive care admission: a
Katy Bridges1, Bea Vickers2, Rebecca Bethany Mitting3
1Paediatric Intensive Care, Imperial College Healthcare NHS Trust Children's Services, London, UK.
Insights
An age-appropriate intervention significantly reduced post-traumatic stress disorder (PTSD) symptoms in parents of children aged 4 years and older discharged from the paediatric intensive care unit (PICU). The intervention involved an educational booklet and telephone support.
Area of Science:
- Pediatric Intensive Care
- Mental Health
- Trauma Psychology
Background:
- Parental mental health is crucial following pediatric intensive care unit (PICU) admission.
- Post-traumatic stress disorder (PTSD) is a significant concern for parents after a child's PICU stay.
- Existing treatments as usual (TAU) may not adequately address parental PTSD symptoms.
Purpose of the Study:
- To evaluate an age-appropriate intervention's effectiveness in reducing parental PTSD symptoms post-PICU discharge.
- To compare the intervention against treatment as usual (TAU).
- To assess outcomes in different age subgroups of children.
Main Methods:
- A randomized controlled trial (RCT) involving parents of children discharged from a PICU.
- Intervention group received an educational booklet and telephone support.
- Control group received TAU.
- Parental PTSD symptoms were measured using the Impact of Events Scale-Revised (IES-R) at 6 months.
Main Results:
- The intervention showed a significant reduction in PTSD symptoms for parents of children aged ≥4 years (p=0.008).
- No significant difference in PTSD symptoms was observed for the overall group or for parents of children <4 years.
- The intervention group for children ≥4 years had lower IES-R scores (13) compared to TAU (42).
Conclusions:
- An age-appropriate intervention, including an educational booklet and telephone support, is effective for reducing PTSD symptoms in parents of older children (≥4 years) after PICU discharge.
- The intervention did not demonstrate significant benefits for parents of younger children (<4 years).
- Further research may be needed to optimize interventions for parents of younger children.
Objective:
To determine if an age-appropriate intervention is more effective than treatment as usual (TAU) in reducing post-traumatic stress disorder (PTSD) symptoms in parents/guardians of children discharged from paediatric intensive care unit (PICU).
Design:
A two-arm, parallel-group, single-centre randomised controlled trial.
Setting:
PICU, St Mary's Hospital, London, UK.
Patients:
Children admitted to the PICU between July 2021 and September 2022, with a length of stay >24 hours, and a corrected gestational age of >36 weeks at the time of PICU admission, up to <16 years of age. Parents/guardians were required to be >18 years old. We predefined subgroups of children as those <4 years and those ≥4 years.
Intervention:
An age-appropriate educational booklet given at PICU discharge and a targeted telephone call at 6 weeks posthospital discharge.
Main Outcomes And Measures:
Parental PTSD symptoms 6 months after PICU discharge, measured by the Impact of Events Scale-Revised (IES-R).
Results:
679 children were admitted to PICU, 212 were eligible for enrolment, 81 declined and 131 were included, of which 126 completed the study. 64 were randomised to TAU and 62 to intervention. 6-month questionnaires were returned by 60 families (36 from TAU group and 24 from intervention group (p=0.049)). There was no significant difference in IES-R scores between the TAU and intervention groups overall (IES-R score 37 vs 17 (p=0.132)). The ≥4-year intervention group had lower IES-R scores compared with TAU (13 in intervention vs 42 in TAU (p=0.008)). There was no difference in the <4-year group or in any secondary outcome.
Conclusions:
This intervention was effective in reducing PTSD symptoms in parents of children ≥4 years after PICU discharge.
Trial Registration Number:
NCT04635449.
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