Acute and Post-Traumatic Stress in Family Members of Children Admitted to the Pediatric Intensive Care Unit

Background and Purpose

A previous study of parents caring for a child in the ICU showed that some will develop acute stress disorder (ASD) or posttraumatic stress disorder (PTSD). This study aims to assess the prevalence of ASD and PTSD among family members within the first 2 weeks of admission to the pediatric intensive care unit (PICU) and 3 months later. Not every individual exposed to their loved one’s hospitalization will develop a traumatic stress disorder. Thus it is particularly important to identify potential risk factors that may indicate family members more likely to have severe mental health effects when their child is admitted to the PICU.

Methods

This secondary analysis is based on data from the Improving Family Outcomes Study at Seattle Children Hospital, conducted between 2010 and 2014 (380 family members of 220 children). Children were enrolled in the study if physicians anticipated that they would exceed the 85th% in terms of length of stay (8 days), generally indicating children who were sicker at admission. All statistical analyses were computed via R 2.14.0 including summaries of demographic characteristics, the proportion of family members meeting criteria for ASD and PTSD, and the association of potential risk factors with ASD and PTSD symptom severity.

Results

Of the 380 family members completing the initial assessment, 59 (15.69%) met symptom criteria for ASD. Of the 349 family members completing a 3-month follow-up, 44 (12.6%) met symptom criteria for PTSD. Family members’ ASD symptom severity at T1 was associated with PTSD symptom severity at T3 (r = .21; p < .0001). Neither presence nor the symptom severity of ASD and PTSD was associated with family members’ demographic characteristics, such as ethnicity, and gender. Likewise, ASD and PTSD were not associated with child-related factors such as child’s age, prior hospitalization, prior ICU use, and the current ICU unit. However, perceived support and family relationship scores of family members’ were found to be associated with ASD and PTSD. Family members with higher perceived social support and better family functioning experienced less ASD and PTSD. And lastly, unexpected ICU admission creates more severe ASD symptoms than planned admissions.

Conclusions and Implications

A smaller number of family members reported PTSD at 3 months than was true in a previous study of PTSD in PICUs. Initial levels of ASD and later PTSD was not associated with the demographic characteristics of children and family members. Our findings confirmed the theoretical and empirical link between relational factors and distress symptoms. The dimensions of social relationships most strongly correlated with ASD and PTSD were all amenable to intervention by the healthcare team during and after the child’s hospitalization. At admission, clinicians should assess whether the admission was planned, the family relationship scores and the level of social support. For those with lower levels of perceived support and family relationship score, or have unplanned ICU admissions, increased supports may be beneficial in helping to prevent PTSD.