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Early psychological reactions in parents of children with a life threatening illness within a pediatric hospital setting

Published online by Cambridge University Press:  15 April 2020

F. Muscara ,
M.C. McCarthy ,
C. Woolf ,
S.J.C. Hearps ,
K. Burke  and
V.A. Anderson
F. Muscara*
Affiliation:
Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia Psychology Service, Royal Children's Hospital, Melbourne, Australia
M.C. McCarthy
Affiliation:
Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
C. Woolf
Affiliation:
Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia
S.J.C. Hearps
Affiliation:
Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia
K. Burke
Affiliation:
Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia The Parenting Research Centre, East Melbourne, Australia Parenting and Family Support Centre, School of Psychology, University of Queensland, Queensland, Australia
V.A. Anderson
Affiliation:
Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Australia Department of Pediatrics, School of Psychological Science, University of Melbourne, Melbourne, Australia Psychology Service, Royal Children's Hospital, Melbourne, Australia
*
⁎Corresponding author. Child Neuropsychology, Murdoch Childrens Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia. Tel.: +61 3 9936 6653. E-mail address:[email protected] (F. Muscara).
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Abstract

Research in context

Parents of children with life threatening illness or injuries are at elevated risk of distress reactions, involving symptoms of acute stress disorder, depression and anxiety. Currently, the impact of child illness factors is unclear, and to date research systematically examining the prevalence of these psychological reactions across different illness groups with an acute life threat is sparse. This is important to explore given that studies show that parent functioning impacts on the psychological adjustment and recovery of the ill child.

What does this study add?

At four weeks following a child's diagnosis of a serious illness, 49–54% of parents met DSM-IV criteria for acute stress disorder, across a number of illness groups, whereas 15–27% of parents were in the moderate/severe range for depression and anxiety, and 25–31% for stress. Results from this study demonstrate that rates and severity of these psychological reactions in parents of seriously ill children do not vary according to illness type.

Background

A life threatening childhood illness/injury can lead to significant distress reactions in parents, with independent studies finding such reactions in several different illness groups. To date, there is limited research systematically comparing the prevalence of adverse parental psychological reactions across different childhood illness groups with an acute life threat. This study aimed to investigate the frequency and severity of symptoms of acute traumatic stress, depression, anxiety and general stress in parents, following admission of their child to hospital for a life threatening illness. The study also aimed to explore the relationship between these symptoms, and to determine whether they differ according to illness/injury.

Methods

Cross-sectional data from a prospective, longitudinal study are reported. Participants were 194 parents of 145 children (49 couples), admitted to cardiology (n = 53), oncology (n = 40) and pediatric intensive care units (n = 52), for serious illnesses/injuries. Parents completed self-report questionnaires within four weeks of hospital admission.

Results

Rates of acute traumatic stress (P = 0.262), depression (P = 0.525), anxiety (P = 0.453) and general stress symptoms (P = 0.720) in parents were comparable across illness type, with 49–54% reaching criteria for acute stress disorder, 15–27% having clinical levels of depression and anxiety, and 25–31% for general stress. Anxiety was most strongly associated with acute traumatic stress (r = 0.56), closely followed by stress (r = 0.52) and depression (r = 0.49), with all correlations highly significant (P < 0.001).

Conclusions

These findings provide evidence that the child's medical condition is not associated with parents’ experience of clinically significant psychological symptoms, and emphasize the importance for health care providers to be aware of these potential psychological reactions in parents, regardless of the type of illness.

Keywords

Psychiatric disorderaffective disorders (other),anxiety disorders (other),pediatrics,post-traumatic stress disorders Approach,miscellaneous
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 5 , July 2015 , pp. 555 - 561
Copyright
Copyright © Elsevier Masson SAS 2015

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References

American Psychiatric Association Diagnostic and statistical manual of mental disorders, 5th ed, Arlington, VA: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
Bayat, M., Erdem, E., Kuzucu, E.G.. Depression, anxiety, hopelessness, and social support levels of the parents of children with cancer. J Pediatr Oncol Nurs 2008;25(5):247–253.CrossRefGoogle ScholarPubMed
Bronner, M.B., Peek, N., Knoester, H., Bos, A.P., Last, B.F., Grootenhuis, M.A.. Course and predictors of posttraumatic stress disorder in parents after pediatric intensive care treatment of their child. J Pediatr Psychol 2010;35(9):966–974.CrossRefGoogle ScholarPubMed
Bryant, R.A., Moulds, M., Guthrie, R.. Acute Stress Disorder Scale: a self-report measure of acute stress disorder. Psychol Assess 2000;12:61–68.CrossRefGoogle ScholarPubMed
Bryant, R.A., Friedman, M.J., Spiegel, D., Ursano, R., Strain, J.. A review of acute stress disorder in DSM-5. Depress Anxiety 2011;28(9):802–817. [PubMed PMID: 21910186. Epub 2011/09/13].CrossRefGoogle ScholarPubMed
Burke, K., Muscara, F., McCarthy, M., Dimovski, A., Hearps, S., Anderson, V., et al.Adapting acceptance and commitment therapy for parents of children with life-threatening illness: pilot study. Fam Syst Health 2014;32(1):122–127.CrossRefGoogle ScholarPubMed
Carter, J.D., Mulder, R.T., Bartram, A.F., Darlow, B.A.. Infants in a neonatal intensive care unit: parental response. Arch Dis Child Fetal Neonatal ed 2005;90:109–113.CrossRefGoogle Scholar
Cohen, J.Statistical power analysis for the behavioral sciences, 2nd ed, Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.Google Scholar
Colville, G.A., Gracey, D.. Mothers’ recollections of the paediatric intensive care unit: associations with psychopathology and views on follow-up. Intensive Crit Care Nurs 2006;22:49–55.CrossRefGoogle ScholarPubMed
Crawford, J., Cayley, C., Lovibond, P., Wilson, P.H., Hartley, C.. Percentile norms and accompanying interval estimates from an Australian general adult population sample for self-report mood scales (BAI, BDI, CRSD, CES-D, DASS, DASS-21, STAI-X, STAI-Y, SRDS, and SRAS). Aust Psychol 2011;46:3–14.CrossRefGoogle Scholar
Doherty, N., McCusker, C.G., Molloy, B., Mulholland, C., Rooney, N., Craig, B., et al.Predictors of psychological functioning in mothers and fathers of infants born with severe congenital heart disease. J Reprod Infant Psychol 2009;27(4):390–400.CrossRefGoogle Scholar
Elbedour, S., Onwuegbuzie, A.J., Ghannam, J., Whitcome, J.A., Hein, F.A.. Post-traumatic stress disorder, depression, and anxiety among Gaza Strip adolescents in the wake of the second uprising (Intifada). Child Abuse Negl 2007;31:719–729.CrossRefGoogle Scholar
Fiser, D.H., Tilford, J.M., Robertson, P.K.. Relationship of illness severity and length of stay to function outcomes in the paediatric intensive care unit: a multi-institutional study. Crit Care Med 2000;28:1173–1179.CrossRefGoogle Scholar
Harvey, A.G., Bryant, R.. The relationship between acute stress disorder and posttraumatic stress disorder following motor vehicle accidents. J Consult Clin Psychol 1998;66:507–512.CrossRefGoogle Scholar
Henry, J.D., Crawford, J.R.. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 2005;44:227–239.CrossRefGoogle Scholar
Hox, J.J.Multilevel analysis: techniques and application. Mahwah, NJ: Lawrence Erlbaum; 2002.CrossRefGoogle Scholar
Kar, N., Bastia, B.K.Post-traumatic stress disorder, depression and generalised anxiety disorder in adolescents after a natural disaster: a study of comorbidity. Clin Pract Epidemiol Ment Health 2006;2:17–23.CrossRefGoogle ScholarPubMed
Kassam-Adams, N., Fleisher, C.L., Winston, F.K.Acute stress disorder and posttraumatic stress disorder in parents of injured children. J Trauma Stress 2009;22(4):294–302.CrossRefGoogle ScholarPubMed
Kazak, A.E., Stuber, M.L., Barakat, L.P., Meeske, K., Guthrie, D., Meadows, A.T.Predicting posttraumatic stress symptoms in mothers and fathers of survivors of childhood cancers. J Am Acad Child Adolesc Psychiatr 1998;37(8):823–831 [PubMed PMID: 1998-10648-006].CrossRefGoogle ScholarPubMed
Kazak, A.E., Cant, C.M., Jensen, M.M., McSherry, M., Rourke, M., Hwang, W.T., et al.Identifying psychosocial risk indicative of subsequent resource use in families of newly diagnosed pediatric oncology patients. J Clin Oncol 2003;21:3220–3225.CrossRefGoogle ScholarPubMed
Kazak, A.E., Alderfer, M., Streisand, R., Simms, S., Rourke, M.T., Barakat, L.P., et al.Treatment of posttraumatic stress symptoms in adolescent survivors of childhood cancer and their families: a randomized clinical trial. J Fam Psychol 2004;18(3):493–504 [PubMed PMID: 15382974].CrossRefGoogle ScholarPubMed
Kazak, A.E., Kassam-Adams, N., Schneider, S., Zelikovsky, N., Alderfer, M.A., Rourke, M.An integrative model of pediatric medical traumatic stress. J Pediatr Psychol 2006;31(4):343–355 [PubMed PMID: 16093522. Epub 2005/08/12].CrossRefGoogle ScholarPubMed
Kazak, A.E., Rourke, M., Alderfer, M.A., Pai, A.L., Reilly, A., Meadows, A.T.Evidence-based assessment, intervention and psychosocial care in paediatric oncology: a blueprint for comprehensive services across treatment. J Pediatr Psychol 2007;32:1099–1110.CrossRefGoogle Scholar
Kolaitis, G., Giannakopoulos, G., Liakopoulou, M., Pervanidou, P., Charitaki, S., Mihas, C., et al.Predicting pediatric posttraumatic stress disorder after road traffic accidents: the role of parental psychopathology. J Trauma Stress 2011;24(4):414–421.CrossRefGoogle ScholarPubMed
Landolt, M.A., Vollrath, M.E., Ribi, K., Gnehm, H.E., Sennhauser, F.H.Incidence and associations of parental and child posttraumatic stress symptoms in pediatric patients. J Child Psychol Psychiatry 2003;44(8):1199–1207.CrossRefGoogle ScholarPubMed
Landolt, M.A., Ystrom, E., Sennhauser, F.H., Gnehm, H.E., Vollrath, M.E.The mutual prospective influence of child and parental post-traumatic stress symptoms in pediatric patients. J Child Psychol Psychiatry 2012;53(7):767–774 [Epub 2012/01/04].CrossRefGoogle ScholarPubMed
Lefkowitz, D.S., Baxt, C., Evans, J.R.Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the neonatal intensive care unit (NICU). J Clin Psychol Med Settings 2010;17(3):230–237.CrossRefGoogle Scholar
Lovibond, P., Lovibond, S.The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventory. Behav Res Ther 1995;33(3):335–343.CrossRefGoogle Scholar
Manne, S., Duhmel, K., Redd, W.H.Association of psychological posttraumatic stress symptomatology in mothers of pediatric cancer survivors. Psychooncology 2000;9:372–384.3.0.CO;2-1>CrossRefGoogle Scholar
Marsac, M.L., Hildenbrand, A.K., Kohser, K.L., Winston, F.K., Yimei, L., Kassam-Adams, N.Preventing posttraumatic stress following pediatric injury: a randomized controlled trial of a web-based psycho-educational intervention for parents. J Pediatr Psychol 2013;38(10):1101–1111.CrossRefGoogle ScholarPubMed
McCarthy, M.C., Ashley, D.M., Lee, K.J., Anderson, V.Predictors of acute and posttraumatic stress symptoms in parents following their child's cancer diagnosis. J Trauma Stress 2012;25(5):558–566 [PubMed PMID: 23055298. Epub 2012/10/12].CrossRefGoogle ScholarPubMed
McGraw, K.O., Wong, S.P.Forming inferences about some intraclass correlation coefficients. Psychol Methods 1996;1:30–46.CrossRefGoogle Scholar
Ozer, E.J., Best, S.R., Lipsey, T.L., Weiss, D.S.Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 2003;129(1):52–73.CrossRefGoogle ScholarPubMed
Pai, A.L., Greenley, R.N., Lewandowski, A., Drotar, D., Youngstrom, E., Peterson, C.C.A meta-analytic review of the influence of pediatric cancer on parent and family functioning. J Fam Psychol 2007;21(3):407–415.CrossRefGoogle ScholarPubMed
Parfitt, Y.M., Ayers, S.The effect of post-natal symptoms of post-traumatic stress and depression on the couple's relationship and parent–baby bond. J Reprod Infant Psychol 2009;27(2):127–142.CrossRefGoogle Scholar
Pöder, U., Ljungman, G., von Essen, L.Posttraumatic stress disorder among parents of children on cancer treatment: a longitudinal study. Psychooncology 2008;17(5):430–437 [PubMed PMID: 2009929258].CrossRefGoogle ScholarPubMed
Ribi, K., Vollrath, M.E., Sennhauser, F.H., Gnehm, H.E., Landolt, M.A.Prediction of posttraumatic stress in fathers of children with chronic diseases or unintentional injuries: a six-month follow-up study. Child Adolesc Psychiatr Ment Health 2007;1:16–25.CrossRefGoogle ScholarPubMed
Roberts, B., Ocaka, K.F., Browne, J., Oyok, T., Sondorp, E.Factors associated with post-traumatic stress disorder and depression amongst internally displaced persons in northern Uganda. BMC Psychiatry 2008;8:38–46.CrossRefGoogle ScholarPubMed
Roth, R.S., Geisser, M.E., Bates, R.The relation of post-traumatic stress symptoms to depression and pain in patients with accident-related chronic pain. J Pain 2008;9:588–596.CrossRefGoogle ScholarPubMed
Sahler, O.J.Z., Fairclough, D.L., Phipps, S., Mulhern, R.K., Dolgin, M.J., Noll, R.B., et al.Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: report of a multisite randomized trial. J Consult Clin Psychol 2005;73(2):272–283 [PubMed PMID: 15796635].CrossRefGoogle ScholarPubMed
Shalev, A.Y., Freedman, S., Peri, T., Brandes, D., Sahar, T., Orr, S.P., et al.Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry 1998;155:630–637.CrossRefGoogle ScholarPubMed
Shaw, R.J., Bernard, R.S., Deblois, T., Ikuta, L.M., Ginzburg, K., Koopman, C.The relationship between acute stress disorder and posttraumatic stress disorder in the neonatal intensive care unit. Psychosomatics 2009;50(2):131–137.CrossRefGoogle ScholarPubMed
Shrout, P.E., Fleiss, J.L.Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979;86(2):420–428.CrossRefGoogle ScholarPubMed
Solberg, O., Grønning Dale, M.T., Holmstrøm, H., Eskedal, L.T., Landolt, M.A., Vollrath, M.E.Long-term symptoms of depression and anxiety in mothers of infants with congenital heart defects. J Pediatr Psychol 2011;36(2):179–187.CrossRefGoogle ScholarPubMed
Station, C. editor. StataCorp. Stata Statistical Software: Release 12. Texas: StataCorp LP; 2011.Google Scholar
Stuber, M.L., Kazak, A.E., Meeske, K., Barakat, L., Guthrie, D., Garnier, H., et al.Predictors of posttraumatic stress symptoms in childhood cancer survivors. Pediatrics 1997;100(6):958–964 [PubMed PMID: 9374564].CrossRefGoogle ScholarPubMed
Stuber, M.L., Meeske, K.A., Leisenring, W., Stratton, K., Zeltzer, L.K., Dawson, K., et al.Defining medical posttraumatic stress among young adult survivors in the Childhood Cancer Survivor Study. Gen Hosp Psychiatry 2011;33(4):347–353 [PubMed PMID: 21762831. PubMed Central PMCID: 3140002. Epub 2011/07/19].CrossRefGoogle ScholarPubMed
van Oers, H.A., Haverman, L., Limperg, P.F., van Dijk-Lokkart, E.M., Maurice-Stam, H., Grootenhuis, M.A.Anxiety and depression in mothers and fathers of a chronically ill child. Matern Child Health J 2014;18(8):1993–2002.CrossRefGoogle ScholarPubMed
Winston, F.K., Kassam-Adams, N., Vivarelli-O’Neill, C., Ford, J., Newman, E., Baxt, C., et al.Acute stress disorder symptoms in children and their parents after pediatric traffic injury. Pediatrics 2002;109(6):e90 [PubMed PMID: 12042584. Epub 2002/06/04].CrossRefGoogle ScholarPubMed
Yeates, K.O., Swift, E., Taylor, H.G., Wade, S.L., Drotar, D., Stancin, T., et al.Short- and long-term social outcomes following pediatric traumatic brain injury. J Int Neuropsychol Soc 2004;10:412–426.CrossRefGoogle Scholar
Young, G.S., Mintzer, L.L., Seacord, D., Castañeda, M., Mesrkhani, V., Stuber, M.L.Symptoms of posttraumatic stress disorder in parents of transplant recipients: incidence, severity, and related factors. Pediatrics 2003;111:e725–e731.CrossRefGoogle ScholarPubMed
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