Factors Related to Acute Traumatic Stress Responses in Parents of Children with a Serious Illness or Injury

Frank Muscara DPsych. & Maria McCarthy Ph.D.

Similar to other traumatic events, a life threatening injury or illness in children can elicit significant acute stress reactions in their parents that can develop into longer-term mental health problems. A number of studies have examined posttraumatic stress reactions in parents of very sick children (e.g., Kassam-Adams et al., 2009; Landolt, Ystrom, Sennhauser, Gnehm, & Vollrath, 2012). However, few studies have investigated parents’ acute stress reactions within the first four weeks of their child’s diagnosis and hospitalization, and the factors linked with higher levels of parent psychological symptoms.

To date, research indicates that psychosocial variables such as parent trait anxiety and parents’ subjective appraisal of the impact of the illness have been consistently linked with the severity of their acute stress responses. In contrast, demographic factors, like age, gender, and ethnicity have been found to inconsistently predict parent traumatic stress reactions. Finally, medical factors associated with the child’s illness, such as severity of illness and length of hospital stay, have not generally been found to be related to early distress reactions in parents (see Woolf et al. (2015) for a review). Even though illness factors are weakly related to acute stress responses in parents, no studies have specifically investigated acute stress responses across different illness groups and various hospital treatment experiences. Increased understanding of parents’ responses to across different illnesses and treatment conditions has implications for the development of psychological interventions aimed at reducing parent distress, and secondarily improving child outcomes.
 
This study investigated the factors that are related with acute stress symptoms in parents of seriously ill children, across a range of illnesses and treatment settings (i.e. those admitted to the Cardiology, Oncology and Intensive Care Units, within a pediatric hospital setting). A total of 171 parents from 127 eligible families agreed to participate (Cardiology = 49; Oncology = 65; Intensive Care = 57). The study results showed that there were no differences in the severity of acute stress symptoms in parents across each treatment setting. Further, the results indicated that psychosocial factors accounted for 37% of the parent acute stress responses, that demographic variables accounted for a further 4%, and that illness-related factors did not contribute to parent responses. Specific psychosocial factors linked with parents outcomes were parent trait anxiety and depression levels, as well as parent-reported child problems such as quick changes in mood or having developmental concerns or delays. With regard to demographic factors, younger parental age was linked with greater acute stress symptoms. These findings highlight the role of pre-existing psychosocial factors in understanding early parent responses to serious childhood illness or injury.

The current study was the first to identify that these mental health factors are related with acute stress reactions across various treatment experiences and illness groups within a hospital setting. Given that psychosocial variables were found to be the factors most strongly linked with acute parent distress, screening of parent and family psychosocial risk factors upon their child’s hospital admission may assist clinicians to identify which families may be at greater risk of developing acute distress reactions and more chronic mental health issues. This may help clinicians to direct often scarce psychosocial resources to those parents and families most likely to benefit (Kazak et al., 2007). Importantly, since illness factors and treatment settings do not appear to play a significant role in predicting early parent reactions, the findings of this study suggest that a general, hospital-wide psychosocial screening approach for parents and families might be possible and warranted. These results also support the idea that rather than developing parents interventions for specific illness groups, that more generic early psychosocial interventions could be developed and delivered to parents irrespective of the child’s illness type or treatment setting (Burke et al., 2014; Rayner et al., 2016). Given that these early parent reactions predict later parent adjustment and mental health (McCarthy et al., 2012), and that more distressed parents tend to use significantly more hospital resources (Kazak et al., 2003), the acute period when the ill child remains hospitalized provides a unique opportunity for screening and early intervention.

Discussion Questions: 

1. What approaches to screening for parent psychological distress in the pediatric hospital setting should be considered? 

2. What are the implications of these study findings on allocation of hospital psychosocial resources? 

3. How might the findings of this study influence approaches to the development interventions for parents of seriously ill children? 

Author biographies: 

Frank Muscara, DPsych: Dr Frank Muscara is a senior researcher at the Murdoch Children’s Research Institute, and a clinical neuropsychologist at The Royal Children’s Hospital, Melbourne, Australia. His research interests include long-term social and functional outcomes following acquired brain injury in childhood and adolescence, and long-term psychosocial outcomes in parents following a life threatening illness or injury in their child.  

Maria McCarthy Ph.D.: Dr Maria McCarthy is a research fellow with the Murdoch Children’s Research Institute and a senior mental health clinician in the Children’s Cancer Centre at The Royal Children’s Hospital, Melbourne, Australia. Dr McCarthy’s research interests include psychosocial impacts of childhood cancer and other serious childhood illness, adolescent and young adult cancer, cancer survivorship and bioethical issues associated with serious childhood illness. 

References

Burke, K., Muscara, F., McCarthy, M., Dimovski, A., Hearps, S., Anderson, V., & Walser, R. (2014). Adapting acceptance and commitment therapy for parents of children with life-threatening illness: Pilot study. Families, Systems, & Health, 31(1), 122-127. doi:10.1037/fsh0000012 

Kassam-Adams, N., Fleisher, C. L., & Winston, F. K. (2009). Acute stress disorder and posttraumatic stress disorder in parents of injured children. J Trauma Stress, 22(4), 294-302. doi:10.1002/jts.20424 

Kazak, A. E., Rourke, M., Alderfer, M., Pai, A., Reilly, A., & Meadows, A. (2007). Evidence-based assessment, intervention and psychosocial care in pediatric oncology: A blueprint for comprehensive services across treatment. Journal Of Pediatric Psychology, 32(9), 1099 -1110.  

Kazak, A., et al. (2003). Identifying psychosocial risk indicative of subsequent resource use in families of newly diagnosed pediatric oncology patients. Journal of Clinial Oncology, 21, 3220-3225.  

Landolt, M. A., Ystrom, E., Sennhauser, F., Gnehm, H., & Vollrath, M. (2012). The mutual prospective influence of child and parental post-traumatic stress symptoms in pediatric patients. Journal of Child Psychology & Psychiatry, 53(7), 767-774.  

McCarthy, M. C., Ashley, D. M., Lee, K. J., & Anderson, V. A. (2012). Predictors of acute and posttraumatic stress symptoms in parents following their child's cancer diagnosis. Journal of Traumatic Stress, 25(5), 558-566. doi:10.1002/jts.21745 

Rayner, M., Dimovski, A., Muscara, F., Yamada, J., Burke, K., McCarthy, M., . . . Nicholson, J. M. (2016). Participating from the comfort of your living room: Feasibility of a group videoconferencing intervention to reduce distress in parents of children with a serious illness or injury. Child and Family Behavior Therapy. 38 (3), 209-224.  

Woolf, C., Muscara, F., Anderson, V. A., & McCarthy, M. C. (2015). Early traumatic stress responses in parents following a serious illness in their child: A systematic review. Journal of Clinical Psychology in Medical Settings, 23(1), 53-66.