ArticleLiterature Review

Systematic Review: A Reevaluation and Update of the Integrative (Trajectory) Model of Pediatric Medical Traumatic Stress: Figure 1.

Authors:
  • Nemours Children’s Hospital - Delaware
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Objective: The objective of this systematic review is to reevaluate and update the Integrative Model of Pediatric Medical Traumatic Stress (PMTS; Kazak et al., 2006), which provides a conceptual framework for traumatic stress responses across pediatric illnesses and injuries. Methods: Using established systematic review guidelines, we searched PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and PubMed (producing 216 PMTS papers published since 2005), extracted findings for review, and organized and interpreted findings within the Integrative Model framework. RESULTS: Recent PMTS research has included additional pediatric populations, used advanced longitudinal modeling techniques, clarified relations between parent and child PMTS, and considered effects of PMTS on health outcomes. Results support and extend the model's five assumptions, and suggest a sixth assumption related to health outcomes and PMTS. CONCLUSIONS: Based on new evidence, the renamed Integrative Trajectory Model includes phases corresponding with medical events, adds family-centered trajectories, reaffirms a competency-based framework, and suggests updated assessment and intervention implications.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... 2,[11][12][13] Parents also experience heightened anxiety and depressed mood, with 40% to 83% reporting TSS within the first month of their child's diagnosis (18%-33% at 6 months; 7%-27% >10 months post-diagnosis). 4 The immediate impact of parent distress includes changes in parent-child interaction and diminished parent confidence in their ability to support their child during treatment (self-efficacy), overall family function, and quality of life. 3,4,12,[14][15][16][17] Despite these concerning symptoms, there are few empirically validated interventions for this age group and even fewer use a dyadic approach. ...
... 4 The immediate impact of parent distress includes changes in parent-child interaction and diminished parent confidence in their ability to support their child during treatment (self-efficacy), overall family function, and quality of life. 3,4,12,[14][15][16][17] Despite these concerning symptoms, there are few empirically validated interventions for this age group and even fewer use a dyadic approach. 18 Music therapy has become a standard palliative care service in many pediatric hospitals, with a growing body of research that supports the use of active music making interventions to reduce distress and improve well-being in young children with cancer. ...
... These findings contextualize the buffering effect of AME on TSS for this subset of parents, suggesting that AME is shifting parent perceptions-a factor that has been identified as a strong predictor for parent TSS. 4,16,[31][32][33][41][42][43] We also found that parent scores on the traumatic stress screener (PCL-6) moderated the effect of AME versus control for hyperarousal post-intervention. Like our other moderation analyses, there was a pattern of no relationship between parents PCL-6 scores and hyperarousal in AME parents and a positive association for control group parents. ...
Article
Full-text available
Objective This trial examined the effects of proximal/distal mediators and moderators of an Active Music Engagement (AME) intervention on young child/parent distress, quality of life, and family function outcomes. Methods Child/parent dyads (n = 125) were randomized to AME or Audio-storybooks attention control condition. Each group received 3 sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention (T2), and 30-days later (T3). Potential proximal mediators included within session child and parent engagement. Potential distal mediators included changes in perceived family normalcy, parent self-efficacy, and independent use of play materials. Potential moderators included parent/child distress with prior hospitalizations, parent traumatic stress screener (PCL-6), and child age. Outcomes included child emotional distress and quality of life; parent emotion, traumatic stress symptoms (IES-R), well-being; and family function. Mediation effects were estimated using ANCOVA, with indirect effects estimated using the percentile bootstrap approach. Moderation effects were tested by including appropriate interaction terms in models. Results No significant mediation effects were observed. Child distress with prior hospitalizations moderated AME effects for IES-R intrusion subscale scores at T2 (P = .01) and avoidance subscale scores at T3 (P = .007). Traumatic stress screener scores (PCL-6) moderated intervention effects for IES-R hyperarousal subscale scores at T2 (P = .01). There were no moderation effects for child age. Conclusions AME is a promising intervention for mitigating traumatic stress symptoms and supporting well-being in parents of children with cancer, particularly for parents who screen high for traumatic stress and whose children are more highly distressed with hospitalization.
... Therefore, it is important to recognize the diagnosis of post-traumatic stress disorder (PTSD) and assess post-traumatic stress disorder (PTSS) symptoms and their subclinical levels. Thus, we must consider the impact and suffering generated by the diagnosis and by the presence of symptoms of post-traumatic stress (Price et al., 2016;Schwartz et al., 2012;Stuber et al., 2011). ...
... Previous studies demonstrated a lack of consensus about the relationship between PTSS and PTG and the wide variability of results (Koutná et al., 2021;Klosky et al., 2014;Levine et al., 2008;Shakespeare-Finch & Lurie-Beck, 2014;Shand et al., 2015;Tedeschi & Calhoun, 2004;Tillery et al., 2016). The main contribution of our study was to identify the presence of three distinct profiles related to trauma in CC survivors (High PTG scores among childhood cancer survivors, High PTSS scores among childhood cancer survivors, and Childhood cancer survivors without changes), which represents the different trajectories after a pediatric medical trauma (Price et al., 2016). Furthermore, we found that the relationship between PTSS and PTG is not direct, as the path between them goes through the challenge of core beliefs and rumination. ...
... In particular, the path from challenge to core beliefs to PTSS passes through intrusive rumination and then to avoidance and increased arousal and reactivity symptoms. Concerning rumination, Zhou et al. (2015) reported that deliberate rumination medical trauma and the phase of acute medical care, most of the CC survivors demonstrate positive psychological adaptation and posttraumatic growth (Price et al., 2016). Since most families can cope effectively with PMTS and function adaptatively in daily life before the PMTS (Price et al., 2016), we can understand that participants in Cluster 1 are part of most families. ...
Article
Full-text available
The experience of childhood cancer (CC) could be a traumatic event that produces long-term emotional responses such as posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) in survivors. The relationship between both PTSS and PTG is not clear in CC survivors. Assessing challenges to core beliefs and rumination could give information regarding the different paths that lead to traumatic responses. Thus, this study aims to identify childhood cancer survivors’ profiles from PTSS and PTG measures and to examine the pathways of relationships between PTSS and PTG, rumination, and challenge to core belief. Sixty-two CC survivors completed surveys on their childhood cancer experience, PTSS, PTG, challenge to core beliefs, and rumination. High PTG scores among childhood cancer survivors (Cluster 1), High PTSS scores among childhood cancer survivors (Cluster 2), and Childhood cancer survivors without changes (Cluster 3). Network analysis found that the challenge to core beliefs is the central point in the relationship between the variables, in a direct and positive relationship with PTG. We found an indirect path from challenge to core beliefs to PTSS, mediated by intrusive and deliberative ruminations. The combined findings suggested that there are different profiles related to trauma in CC survivors and the relationship between PTSS and PTG is mediated by the challenge to core beliefs and deliberative and intrusive rumination.
... 9 However, not every parent who undergoes acute stress during their child's hospitalization has lasting psychological sequelae. 10 Multiple studies suggest that one's post-traumatic trajectory is highly influenced by an individual's subjective appraisal of real-time events. 6,10,11 The PICU environment makes it difficult to assess a parent's experience and their likelihood of long-term sequelae. ...
... 10 Multiple studies suggest that one's post-traumatic trajectory is highly influenced by an individual's subjective appraisal of real-time events. 6,10,11 The PICU environment makes it difficult to assess a parent's experience and their likelihood of long-term sequelae. Mental health resources are finite, and providers often rely on severity of illness to allocate these resources. ...
... [12][13][14] However, illness severity is less predictive than a parent's experiences: fear that one's child might die is more predictive of PTSD than the child's severity of illness. 6,7,10,11,15 Moreover, individuals manifest distress differently. Less conspicuous distress may be masked by the high medical and psychosocial acuity in the PICU. ...
Article
Introduction: Parents of children in the pediatric intensive care unit (PICU) experience substantial stress; a parent's perception of their child's illness severity, more than objective measures, predicts psychological outcomes. No tools exist to assess parents' real-time experiences. This pilot study evaluated the feasibility and acceptability of a text-based tool to measure parental experience. Methods: Inclusion criteria included PICU stay >48 h, physician approval, smartphone access, and English-speaking caregiver. Eligible parents received a text-based baseline survey and surveys every other day while hospitalized regarding their mood/experiences and optional open-ended questions regarding stressors. They received post-discharge follow-up surveys at 1 week and 1, 3, and 6 months. Follow-up surveys assessed mood and symptoms of depression, anxiety, and post-traumatic stress. Interviews and surveys about the interface were conducted 1 week and 3 months following discharge. Feasibility was assessed by descriptive statistics (eg, response rates), and acceptability was assessed by descriptive statistics (survey results) and thematic analyses of interviews. Results: Of 20 enrolled participants, the first 5 were excluded due to technical issues. Of the 15 included, results demonstrated feasibility and acceptability. Most participants (86%) completed all surveys during the PICU stay and continued to complete surveys at a high rate: 79%-94% 3 months post-discharge. All participants agreed that the system was easy to use and were satisfied with the system at discharge, and 91% remained satisfied 3 months post-discharge. Additionally, 76% reported comfort, and 69% reported benefit. From the interviews, participants lauded the system's convenience and applicability of content. Some proposed changes to improve ergonomics. Many suggested this interface could help teams better support families. Conclusions: A text-based interface for measuring experience in the PICU is feasible and acceptable to parents. Further research can explore how this could identify parents most at risk of adverse psychological sequelae and lead to earlier supportive interventions.
... Overall, parents of children with a newly diagnosed DSD experience elevated levels of psychological distress shortly after diagnosis, with improvements in adjustment over time for most (Ellens et al., 2017;Perez et al., 2021;Roberts et al., 2020;Sharkey et al., 2018). This trend is consistent with the Integrative Model of Pediatric Medical Traumatic Stress (PMTS), which posits that parents often experience elevated distress at the onset of their child's diagnosis or when encountering other potentially traumatic medical events (Price et al., 2016). Although most parents demonstrate resiliency and recover from distress, approximately 14% experience prolonged depressive symptoms, with some worsening over time (Perez et al., 2021). ...
... This may particularly be the case for mothers and families with lower incomes that are at greater risk for adjustment difficulties. These trends are reflected in the PMTS model (Price et al., 2016), which outlines how preexisting factors compound with potentially traumatic events, such as a child's medical diagnosis, to impact short-and long-term downstream adjustment. When applying this model to DSD, it is often the Interactions between parent type and gestational age. ...
... In sum, the PMTS Model (Price et al., 2016) postulates that extant stressors predispose parents to adjustment difficulties after their child's diagnosis. This study found partial support for considering birth-related experiences as an extant stressor when conceptualizing parents' adjustment following a DSD diagnosis at birth or closely thereafter. ...
Article
Objective: Differences/disorders of sex development (DSDs) are rare, congenital conditions involving discordance between chromosomes, gonads, and phenotypic sex and are often diagnosed in infancy. A key subset of parents of children newly diagnosed with a DSD experience clinically elevated distress. The present study examines the relationship between perinatal factors (i.e., gestational age, delivery method) and trajectories of parental adjustment. Methods: Parent participants (mothers = 37; fathers = 27) completed measures at baseline, 6- and 12-month follow-up. Multilevel linear regression controlled for clustering of the data at three levels (i.e., time point, parent, and family) and examined the relationship between perinatal factors and trajectories of depressive and anxious symptoms. Two-way interactions between perinatal factors and parent type were evaluated. Results: Overall depressive and anxious symptoms decreased over time. There were significant interactions between gestational age and parent type for depressive and anxious symptoms, with younger gestational age having a stronger negative effect on mothers vs. fathers. There was a significant interaction between time and gestational age for depressive symptoms, with 36 weeks' gestational age demonstrating a higher overall trajectory of depressive symptoms across time compared to 38 and 40 weeks. Findings for the delivery method were not significant. Conclusions: Findings uniquely demonstrated younger gestational age was associated with increased depressive symptoms, particularly for mothers compared to fathers. Thus, a more premature birth may predispose parents of infants with DSD to distress. Psychosocial providers should contextualize early diagnosis-related discussions within stressful birth experiences when providing support.
... In 2024, it is estimated that 9620 children (birth to age 14) and 5290 adolescents (age [15][16][17][18][19] will be diagnosed with cancer in the United States [1]. The psychosocial impact of a cancer diagnosis on pediatric patients and their families is well-documented. ...
... The time of diagnosis is known to be one of increased distress for pediatric patients diagnosed with cancer and their families [2,[18][19][20]. Psychologists are poised to offer a psychosocial and cognitive assessment, as well as intervention services, to mitigate distress when integrated into pediatric cancer care. ...
Article
Full-text available
Simple Summary Increased distress is a common initial response for youth and their families following the diagnosis of childhood cancer. The New Oncology Program in Psychology (NOPP) was established to provide education and information on what to expect at diagnosis, as well as ways to support coping with treatment. This project examined how NOPP participation relates to caregivers’ perceptions surrounding the navigation of difficult emotions, and of the awareness of potential cognitive/academic challenges their child may experience. Caregivers completing NOPP visits felt more informed about difficult emotions and how these may change over time. They felt more prepared for and equipped with strategies and support to manage difficult emotions. Lastly, caregivers felt more aware of and prepared for the potential effects of the diagnosis and treatment on patient cognitive/academic functioning. The results highlight important domains for universal assessment and intervention with pediatric patients and families at the time of a new cancer diagnosis. Abstract Background/Objectives: Pediatric oncology patients and families are at risk for increased distress at diagnosis. The New Oncology Program in Psychology (NOPP) aligns psychological care with the established standards of care at diagnosis. This project aimed to evaluate NOPP and understand the differences between caregivers’ perceptions of feeling informed and prepared to navigate psychosocial concerns for those who did and did not receive psychological services at diagnosis. Methods: A survey was administered via a virtual platform. Frequency analyses summarize caregiver experiences and concerns. Mann–Whitney U tests assess the differences in caregiver knowledge and preparedness between caregivers who did and did not receive psychological services. Results: Caregivers reported difficult emotions at diagnosis and expressed concern for the impact of diagnosis and treatment across broad domains of patient functioning. Caregivers of patients who received psychology consultation felt more informed about difficult emotions and how these may change over time. They felt more prepared and equipped with strategies to manage difficult emotions. Caregivers of patients who completed a cognitive assessment also felt more informed and prepared regarding the potential effects of the diagnosis and treatment on patient cognitive/academic functioning. Conclusions: Psychological services were associated with caregivers’ positive perceptions surrounding the management of difficult emotions and with their knowledge regarding the cognitive/academic impact. The results inform the ongoing modification of NOPP.
... 9 Another reason is that whether or not a child experiences posttraumatic stress depends on the subjective interpretation of the event. 36 Hospitalised children with cancer may not be adequately informed about the severity of their disease, 37 so they have a low incidence of PTSS. ...
... Consistent with previous research results, our results showed that children at the early diagnosis and relapse stage [46][47][48] and parents whose children were diagnosed less than three months ago 6 had high PTSS. At the early stage of diagnosis, hospitalised children with cancer may frequently experience medical events, such as invasive procedures, complex treatment and painful treatment side effects, 36 which increase the risk of children's PTSS. In addition, PTSS increases with multiple traumas, 17 so the occurrence of recurrence, a new cancer-related traumatic event, may increase the risk of PTSS in children. ...
Article
Full-text available
Objective This study aimed to examine the prevalence and risk factors of Post-Traumatic Stress Symptoms (PTSS) in hospitalised children with cancer and their parents and explore the PTSS correlation between parents and children. Methods Data were collected using the University of California at Los Angeles (UCLA) Posttraumatic Stress Disorder-Reaction Index for DSM-IV and the Chinese version of the Impact of Event Scale-Revised Questionnaire. Results Out of 203 families with hospitalised children with cancer, 77.3% of parents and 7.9% of children experienced PTSS. Time since diagnosis of less than 3 months (β = −0.063, P < 0.001), actively seeking financial help (β = −0.190, P = 0.031), children living in rural areas (β = 0.166, P = 0.023) and having a daughter with cancer (β = 0.135, P = 0.040) were risk factors for parental PTSS. At the early stages of diagnosis (β = 0.118, P = 0.017), recurrence (β = 0.140, P = 0.042) and low monthly household income (β = −0.283, P = 0.003) were risk factors for children's PTSS. No significant correlation between parental PTSS and children's PTSS (r = −0.06, P > 0.05). Conclusions The hospitalised children with cancer had a low prevalence of PTSS, but their parents' PTSS prevalence was high. No significant correlation was observed between parental and children's PTSS. Attention should be given to the mental health of families with hospitalised children with cancer. Early psychosocial support should be provided, especially to families with poor economic situations and a newly diagnosed or relapsed child.
... These findings, coupled with the unmet needs identified by parents (e.g., lack of support and opportunities for self-care), which is in line with previous qualitative studies, e.g., [28,30], raise an important contribution to healthcare research, in this area, underlining the need for parents' psychological support and screening. The Integrative (Trajectory) Model of Pediatric Medical Traumatic Stress [50] provides a useful framework to guide psychosocial assessment and intervention for both pediatric patients and families, considering subjective responses/appraisals and offering specific intervention goals for each medical phase (i.e., peri-trauma, acute medical care, and ongoing care or discharge from care). According to this model, psychosocial screening and trauma-informed care should be provided at hospital admission [50]. ...
... The Integrative (Trajectory) Model of Pediatric Medical Traumatic Stress [50] provides a useful framework to guide psychosocial assessment and intervention for both pediatric patients and families, considering subjective responses/appraisals and offering specific intervention goals for each medical phase (i.e., peri-trauma, acute medical care, and ongoing care or discharge from care). According to this model, psychosocial screening and trauma-informed care should be provided at hospital admission [50]. In addition, regarding parents' maladjustment outcomes, a recent study highlighted the pressing need to include caregivers in the burn survivors' care plan starting at hospital admission [29]. ...
Article
Full-text available
Pediatric burn injuries are a critical medical condition that triggers a series of ongoing multifactorial stressors that affect both children and their families. To inform healthcare research and clinical practice, this study aimed to understand and describe the perceptions and experiences of the parents of burn-injured children during hospital stay. Forty-six parents (thirty-eight mothers) of forty-six children (eighteen girls) with a mean age of 2.28 years (SD = 1.52) answered ten open-ended questions. This qualitative study was conducted in a referral hospital in the northern region of Portugal. Qualitative data were analyzed using an inductive content analysis. Five key themes emerged from the data analysis: diving into the crisis of the child burn injury, being together and in good hands, becoming aware of an uncertain future, enhancing supportive care and environment, and finding ways to guide parents. Qualitative findings underlined the pressing need for integrated care within this context. Parents were significantly burdened and distressed during the inpatient phase. These parents should be included in the integrated care plan starting from admission. Understanding and addressing parents’ healthcare needs and psychosocial adjustment difficulties is paramount to the development of future intervention programs and the delivery of suitable integrated healthcare.
... Certain pediatric diseases (e.g., cancer) and physical injuries (e.g., burns) are more prevalent in young children [16], with acute lymphoblastic leukemia (ALL) being the most common type of childhood cancer between two and five years of age [17], and burns being more frequent in children under five years [18]. Despite the reduction in mortality associated with pediatric burn injuries and ALL, there are several long-term consequences, with a significant impact on the HRQoL of these populations [19,20]. ...
... Despite the reduction in mortality associated with pediatric burn injuries and ALL, there are several long-term consequences, with a significant impact on the HRQoL of these populations [19,20]. Both ALL and burn injuries have similar medical events, including hospitalizations and invasive/painful procedures, being intensive and distressing experiences [16]. Indeed, the literature has shown that a significant percentage of children with burn injuries and ALL continue to show a significant decrease in long-term QoL [21,22] and lower QoL levels when compared to healthy children [23,24]. ...
Article
Full-text available
In Portugal, there are few generic and specific instruments to assess health-related quality of life (HRQoL) in children, especially those of preschool age. This study aimed to adapt and validate the Portuguese version of the Preschool Children Quality of Life Questionnaire (TAPQoL) in a community and clinical sample of children aged 0–6 years. The parents of 409 healthy children and 137 children undergoing treatment for burns and acute lymphoblastic leukemia completed the TAPQoL and were assessed on psychological morbidity and family functioning. Exploratory and confirmatory factor analyses were performed, as well as analysis of the psychometric properties as shown by internal consistency measures, convergent validity, and average variance extracted. Confirmatory factor analysis confirmed an 11-factor structure with good psychometric properties. The current version of the TAPQoL is a valid and reliable instrument for assessing HRQoL in Portuguese preschool children in community and clinical settings.
... A diagnosis of childhood cancer has been described as a life-changing experience for caregivers that causes significant disruptions in a child's and family's life. Caregivers face multiple and inescapable stressors associated with their child's illness, diagnostic procedures, and cancer treatment [1]. Childhood cancer increases the risk of long-term emotional strain [2] and the risk of developing psychosocial distress [3]. ...
Article
Background Psychological distress (PD) is a common mental health problem faced by caregivers of children with cancer. The involvement of families in childcare was found to be associated with lower levels of distress. Objective The study aims to determine the associations between family-centered care (FCC) and PD among caregivers of children with cancer receiving treatment at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. Methods An institution-based, cross-sectional study was conducted from June to December 2022. Caregivers of children with cancer aged 0-14 years receiving cancer treatment at the pediatric oncology unit completed a face-to-face, interviewer-administered, structured questionnaire during a routine inpatient or outpatient visit. The questionnaire included questions on the characteristics of the child and caregiver, PD (measured by the Kessler Psychological Distress Scale [K10]), FCC (measured by the Measure of Processes of Care [MPOC-20]), and social support (measured by the Oslo-3 Social Support Scale [OSS-3]). Data were collected using the Kobo toolbox and exported to SPSS (version 26; IBM Corp) for cleaning and analysis. A multivariable logistic regression model was used. An odds ratio with a 95% CI was calculated, and a P value less than .05 was considered statistically significant. Results A total of 384 caregivers of children with cancer participated in the study. The total PD score ranged from 10 to 50, with a mean score of 17.30 (SD 8.96; 95% CI 16.84-18.60). The proportion of caregivers found to have mild, moderate, and severe levels of PD was 43 (11.2%), 35 (9.1%), and 51 (13.3%), respectively. The overall prevalence of mild to severe PD symptoms was 33.6% (95% CI 28.9%-38.3%). A statistically significant negative association was found between FCC and PD (adjusted odds ratio [AOR] 0.68, 95% CI 0.53-0.86). In addition, having no formal education (AOR 2.87, 95% CI 1.28-6.45), having a history of relapse (AOR 3.24, 95% CI 1.17-9.02), beginning cancer treatment at TASH (AOR 2.82, 95% CI 1.4-4.85), beginning treatment within the last 3 months (AOR 3.99, 95% CI 1.73-9.23), and beginning treatment within the last 4 to 18 months (AOR 2.68, 95% CI 1.25-5.76) were significantly associated with higher level of PD. Conclusions A total of 1 in 3 caregivers have reported PD. FCC was found to be protective of PD. The finding of this study suggests the need for FCC intervention to improve the mental health condition of caregivers. In addition, the intervention needs to consider the educational status of the caregivers, the time since the cancer diagnosis, and the history of relapse.
... This procedural distress can have a major impact on the hospital experience of sick children and their parents, resulting in anticipatory anxiety and distrust in healthcare professionals (HCPs) and can even develop into a post-traumatic stress syndrome. Subsequently, it might have an impact on an organizational level, such as a delay in performing necessary procedures and pressure on HCPs to use restraint [3,4]. ...
Article
Full-text available
Children with negative procedural experiences have an increased risk of fear and distress, with psychological consequences for subsequent procedures and future healthcare behaviors. Gaining control and feeling trust are important aspects for children to decrease fear. To enable professionals providing personal care during medical procedures, a systematic, evidence-based approach that supports children in expressing their preferences is needed. This study will gain insight into the experiences and needs of professionals involved in small invasive medical procedures to meet the coping strategies and preferences of children undergoing these procedures. A qualitative design was used to gain insight into professionals’ perspectives. Data were collected through online focus groups with various professionals involved in medical procedures, such as anesthetists, laboratory staff, nurses, and pediatricians. Five interdisciplinary focus groups, with a total of 32 participants, were held. One overarching theme was revealed: “Balancing between different actors within the context of the hospital.” Professionals reported they had to deal with different actors during a medical procedure: the child, the parent, the colleague, and themselves. Each actor had its own interests. They were aware of the child and parents’ priority to gain control and feel trust. Nevertheless, they perceive organizational and personal aspects that hinder addressing these needs. Conclusion: To provide personalized care, professionals experience balancing between the needs and interests of diverse actors during medical procedures. The findings underscore the importance of a policy supporting HCPs in integrating patient-centered care into practice through practical tools and training initiatives such as scenario training.What is Known: • Unresolved pain and stress arising from medical procedures can have significant short- and long-term impacts on children. Empowering children to gain control and fostering a sense of trust are crucial factors in reducing fear associated with medical procedures. • Children and parents expect to receive child-tailored care from professionals including respect for their own, unique needs, and boundaries. Professionals should build trustful relationships and provide appropriately tailored autonomy around medical procedures. What is New: • Healthcare professionals vary in their awareness of children’s needs during a medical procedure. Beside this, the organizational dynamics of the hospital, along with the presence of actors such as the child, parent, colleague, and oneself, collectively influence the conduct of medical procedures. • Providing person-centered care during medical procedures can present challenges. The results highlight the significance of a policy to assist healthcare professionals in incorporating patient-centered care into their practice through practical tools and a culture of self-reflections regarding patient-centered values.
... While research about traumatic stress in parents of children with CHD is limited, the body of evidence has grown substantially over the past 5 years, and findings are concerning for both parents and their children. Rates of traumatic stress among parents of children with heart disease are considerably higher than national rates 3,4,6,13,14,16,18,20,21,19,23,24,27,38,17,50 and contribute to negative outcomes for both parents and children. 6,18,21,24,35,37,17 Developing an understanding of the full psychological profile, including the factors related to post-traumatic growth in parents of children with heart disease, may help inform interventions that support trajectories towards healthy coping and growth. ...
Article
Full-text available
Congenital heart disease is the most common birth defect in the United States, with many of the affected infants requiring surgical and/or interventional procedures within their first year of life. The parental impacts of a child’s diagnosis, subsequent hospitalization, and transition to home after discharge are numerous and burdensome, and many experience symptoms of traumatic stress along this trajectory. The purpose of this scoping review was to summarize current available literature related to the traumatic stress experienced by parents of children with heart disease to better understand the prevalence, related factors, and consequences. The Joanna Briggs Institute Scoping Review Framework was implemented to identify 31 relevant peer-reviewed articles published between 2000 and early 2024, including 25 quantitative studies, 3 qualitative studies, and 3 systematic reviews or meta-analyses. This scoping review provides an overview of parent traumatic stress for clinicians caring for children with heart disease at every stage of their clinical course.
... The impact of prior trauma exposure and pre-existing mental health concerns on the development of PTSD following subsequent trauma exposure, including potentially traumatic medical events, is well established (Birk et al., 2019;Carlson et al., 2016;Haerizadeh et al., 2020;Hall & Hall, 2017;Kaltman et al., 2010;Keane et al., 2006;Price et al., 2016;Sareen et al., 2013;Zatzick et al., 2002). However, there is little emphasis on the role of medical stressors in exacerbating prior clinically significant trauma responses. ...
Article
Full-text available
Prior trauma exposure significantly increases the risk of developing PTSD following medical stressors and may contribute to the development of medically induced PTSD. However, healthcare systems often overlook the interaction between prior trauma and current medical stressors, contributing to negative psychosocial and health-related outcomes for patients. Integration of both trauma-informed and trauma-focused practices into psychosocial programming in medical settings may be key to effectively addressing the needs of trauma-exposed patients. Yet, there is a lack of practical guidance on how clinical psychologists in medical settings can respond to trauma’s effects in routine clinical practice. This paper aims to provide an overview of trauma-focused theory, assessment, and treatment considerations within medical settings, emphasizing the importance of incorporating trauma-focused intervention into integrated psychosocial programming to address prior trauma and its impacts on care in order to improve patient outcomes.
... [18][19][20][21] Kosir et al. showed that a significant number of survivors are at risk of developing symptoms of post-traumatic stress. 19 The traumatic stress model of Price et al. 22 proposes that, on average, stress levels peak at the beginning after a medical diagnosis and decrease over time. However, some people (30%) have higher than average rates of stress levels close after a medical diagnosis, and this group may experience persistent stress for a longer period. ...
Article
Full-text available
Background Pediatric brain tumor patients are at risk of developing neurocognitive impairments and associated white matter alterations. In other populations, post-traumatic stress symptoms (PTSS) impact cognition and white matter. This study aims to investigate the effect of PTSS on neurocognitive functioning and limbic white matter in pediatric brain tumor patients. Methods Sixty-six patients (6–16 years) completed neuropsychological assessment and brain MRI (1-year post-diagnosis) and parents completed PTSS proxy questionnaires (CRIES-13; 1–3 months and 1-year post-diagnosis). Mean Z-scores and percentage impaired (>1SD) for attention, processing speed, executive functioning, and memory were compared to normscores (t-tests, chi-square tests). Multi-shell diffusion MRI data were analyzed for white matter tractography (fractional anisotropy/axial diffusivity). Effects of PTSS on neurocognition and white matter were explored with linear regression models (FDR correction for multiple testing), including age at diagnosis, treatment intensity, and tumor location as covariates. Neurocognition and limbic white matter associations were explored with correlations. Results Attention (M = −0.49, 33% impaired; P < .05) and processing speed (M = −0.57, 34% impaired; P < .05) were significantly lower than healthy peers. PTSS was associated with poorer processing speed (β = −0.64, P < .01). Treatment intensity, age at diagnosis, and tumor location, but not PTSS, were associated with limbic white matter metrics. Neurocognition and white matter metrics were not associated. Conclusions Higher PTSS was associated with poorer processing speed, highlighting the need for monitoring, and timely referrals to optimize psychological well-being and neurocognitive functioning. Future research should focus on longitudinal follow-up and explore the impact of PTSS interventions on neurocognitive performance.
... Models of child PTSS following paediatric injury conceptualise how medical teams can provide psychological and emotional support. For example, the Paediatric Medical Traumatic Stress model Price et al., 2016) and the bio-psycho-social model of PTSS (Marsac et al., 2014) each highlight the value of clinicians providing anticipatory guidance about emotional recovery to children and families, and screening for potential PTSS. Therefore, the earlypost trauma period provides an opportunity for clinicians to provide low-intensity and timely support for children's post-trauma psychological recovery. ...
Article
Full-text available
Introduction: The early post-trauma period is a key time to provide psychological support to acutely injured children. This is often when they present to emergency departments (EDs) with their families. However, there is limited understanding of the feasibility of implementing psychological support for children and their families in EDs. The aim of this study was to explore UK and Irish ED clinicians' perspectives on developing and implementing psychosocial care which educates families on their children's post-trauma psychological recovery. Methods: Semi-structured individual and group interviews were conducted with 24 UK and Irish ED clinicians recruited via a paediatric emergency research network. Results: Clinicians expressed that there is value in offering psychological support for injured children and their families; however, there are barriers which can prevent this from being effectively implemented. Namely, the prioritisation of physical health, time constraints, understaffing, and a lack of training. Therefore, a potential intervention would need to be brief and accessible, and all staff should be empowered to deliver it to all families. Conclusion: Overall, participants' views are consistent with trauma-informed approaches where a psychosocial intervention should be able to be implemented into the existing ED system and culture. These findings can inform implementation strategies and intervention development to facilitate the development and delivery of an accessible digital intervention for acutely injured children and their families.
... Po podatkih ameriškega Nacionalnega združenja otrok s travmatskim stresom se približno 80 % otrok in njihovih družin sooča z nekaj simptomi travmatskega stresa zaradi izkušenj s težko, življenje ogrožajočo boleznijo, poškodbami in bolečimi medicinskimi posegi. Približno 20-30 % staršev in 15-25 % otrok pa doživlja trajen travmatski stres, ki lahko ovira njihovo vsakodnevno delovanje ter vpliva na potek zdravljenja in okrevanja (National Child Traumatic Stress Network, 2003;Price, 2015). ...
Article
Full-text available
Pediatrični medicinski travmatski stres (PMTS) je niz psiholoških in fizioloških odzivov otrok ter njihovih staršev na bolečino, poškodbe, hude bolezni in druge izkušnje z medicinskim okoljem. Pri pediatrični obliki raka je najvišja prevalenca PMTS, saj vključuje niz stresorjev, ki sprožijo številne negativne psihološke odzive. Z raziskavo smo želeli proučiti prisotnost PMTS pri otrocih, obolelih za rakom, in njihovih starših zaradi soočanja s težko boleznijo in zapleti zdravljenja glede na spol, vrsto raka, trajanje in intenzivnost zdravljenja ter hospitalizacije v enoti za intenzivno terapijo otrok. V raziskavi je sodelovalo 183 staršev ter 62 otrok in mladostnikov, ki so bili ali so se v času raziskave še zdravili na Kliničnem oddelku za otroško hematologijo in onkologijo Pediatrične klinike v Ljubljani. Podatke smo zbrali s pomočjo Lestvice intenzivnosti zdravljenja – IRT-2, Ček liste posttravmatske stresne motnje/starši za otroke – PCL-C/PR, Ček liste posttravmatske stresne motnje – PCL-5 in Lestvice simptomov posttravmatske stresne motnje pri otroku – CPSS-5. Ugotovili smo, da je PMTS prisoten tako pri otrocih kot pri njihovih starših. Ugotovitve bodo prispevale k sistematičnemu uvajanju ukrepov za preprečevanje PMTS in k prizadevanju za oskrbo, ki vključuje zavedanje in ozaveščanje o travmi pri otrocih z rakom.
... Thus, PTSS following pediatric injury represents a substantial health burden as 3.5 million children sought emergency department care after injury in the USA in 2020 with over 121,994 children under 17 years of age hospitalized for non-fatal injuries [7]. Risk factors for PTSS include pre-injury child adjustment problems such as anxiety, post-injury reactions to the trauma, subjective life threat and fear, low social support and parental PTSS [8][9][10][11][12]. Interestingly, injury severity itself is not associated with development of PTSS symptoms [13]. ...
Article
Full-text available
Background Post-traumatic stress symptoms develop in a quarter to half of injured children affecting their longer-term psychologic and physical health. Evidence-based care exists for post-traumatic stress; however, it is not readily available in some communities. We have developed an eHealth program consisting of online, interactive educational modules and telehealth therapist support based in trauma-focused cognitive behavioral therapy, the Reducing Stress after Trauma (ReSeT) program. We hypothesize that children with post-traumatic stress who participate in ReSeT will have fewer symptoms compared to the usual care control group. Methods This is a randomized controlled trial to test the effectiveness of the ReSeT intervention in reducing symptoms of post-traumatic stress compared to a usual care control group. One hundred and six children ages 8–17 years, who were admitted to hospital following an injury, with post-traumatic stress symptoms at 4 weeks post-injury, will be recruited and randomized from the four participating trauma centers. The outcomes compared across groups will be post-traumatic stress symptoms at 10 weeks (primary outcome) controlling for baseline symptoms and at 6 months post-randomization (secondary outcome). Discussion ReSeT is an evidence-based program designed to reduce post-traumatic stress symptoms among injured children using an eHealth platform. Currently, the American College of Surgeons standards suggest that trauma programs identify and treat patients at high risk for mental health needs in the trauma system. If effectiveness is demonstrated, ReSeT could help increase access to evidence-based care for children with post-traumatic stress within the trauma system. Trial registration ClinicalTrials.gov NCT04838977. 8 April 2021.
... O hospital é um ambiente ansiogênico e desconhecido, capaz de reproduzir ruptura no cotidiano do paciente hospitalizado e de seus familiares (Gomes;Nóbrega, 2015). A respeito da hospitalização infantil, tal ruptura assume aspectos mais amplos, havendo interferência Intervenção de Terapia Ocupacional junto a mães de bebês prematuros hospitalizados no desenvolvimento esperado desta criança, exposição a procedimentos invasivos e dolorosos, limitação no desempenho das principais ocupações na infância e alteração brusca na dinâmica e papéis dos familiares (Price et al., 2016). ...
Article
Full-text available
Tornar-se mãe antes do tempo programado e vivenciar os primeiros dias ou até mesmo meses do filho, em um hospital, tende a repercutir em questões relacionadas ao aumento de tensão, medo, angústia, dificuldade no estabelecimento de vínculo, além de uma ruptura brusca nas demais ocupações e papéis desempenhados por ela. Oferecer atenção integral à mãe, ainda em ambiente hospitalar, contribui diretamente para seu bem-estar e para o cuidado futuro ao bebê. Este relato de experiência tem como objetivo apresentar a intervenção realizada junto a sete mães de prematuros hospitalizados na Unidade de Cuidados Intermediários Neonatais de um Hospital Universitário no interior de São Paulo, em comemoração ao Dia das Crianças. A intervenção visou ressignificar a data comemorativa e todo o processo de hospitalização do neonato. É retratada em dois momentos distintos. O primeiro trata da confecção de capas de super-heróis pelas mães dos bebês e o segundo, relata a sessão de fotos na qual os neonatos vestiram as capas elaboradas pelas mães. A experiência oportunizou que as mães participassem de atividades que lhes trouxeram significado, retomassem ocupações e padrões de desempenho interferidos, construíssem uma rede de apoio-socialização e, principalmente, que assumissem papel central no cuidado ao neonato prematuro. Mostrou potencial para contribuir não só com as mães desta intervenção, mas com todas que vivenciam a maternidade com neonato prematuro, além de qualificar o processo de formação do estudante de graduação em Terapia Ocupacional.
... These are major sources of stress in children, causing pain and fear [1][2][3][4]. Children who frequently experience these negative feelings are at risk for both short-and long-term consequences on their mental and physical health, leading to increased procedure-related pain, a lower sense of control over their well-being, and ongoing posttraumatic stress responses [5][6][7][8]. Therefore, an effective approach minimizing pain and fear is paramount for children who frequently undergo invasive medical procedures. ...
Article
Full-text available
Invasive medical procedures in hospitals are major sources of stress in children, causing pain and fear. Non-pharmacological interventions are indispensable in effective pain and fear management. However, these interventions must be personalized to be effective. This qualitative study aims to gain insight into children’s and parents’ experiences, needs, and wishes related to supporting children to develop and express their coping preferences for dealing with pain and fear during minor invasive medical procedures in order to decrease pain and fear. A qualitative study using thematic analysis was performed. Data were collected through semi-structured interviews with children and parents who had undergone at least five minor invasive medical procedures in the last year. Nineteen children (8–18 years) and fourteen parents were interviewed individually. The experiences, needs, and wishes expressed in the interviews could be classified into one overarching theme, that of the personal process, and two content-related sub-themes: feeling trust and gaining control. The personal process was divided into two different phases, that of developing and of expressing coping preferences. Children and parents both reported it as a continuous process, different for every child, with their own unique needs. Children and parents expected personalized attention and tailored support from professionals. Conclusion: Professionals must combine clinical skills with child-tailored care. In the process of searching for and communicating about coping preferences, children’s unique needs and personal boundaries will thereby be respected. This gives children and parents increased trust and control during invasive medical procedures. What is Known: • Untreated pain and stress caused by medical procedures can have severe and important short- and long-term consequences for children. Personalized non-pharmacological interventions are an essential element of procedural pain management. What is New: • A personalized coping strategy is important for children when undergoing medical procedures. Each individual child has a personal way of expressing their own coping strategy. Children and their parents need information and the space to develop and express their individual coping preferences. • Children and parents expect to receive child-tailored care from professionals including respect for their own, unique needs and boundaries. Professionals should build trustful relationships and provide appropriately tailored autonomy around medical procedures.
... This suggests that the impact of cancer diagnosis and treatment trajectory on emotions such as sadness or worry is rather generic. This is in line with the pediatric medical stress model which describes that events that cause pediatric medical stress are mostly unrelated to disease group [29]. ...
Article
Full-text available
Background: Comprehensive insight in the longitudinal development of health-related quality of life (HRQOL) after childhood cancer diagnosis could improve quality of care. Thus, we aimed to study the course and biopsychosocial determinants of HRQOL in a unique national cohort of children with cancer. Methods: HRQOL of 2154 children with cancer was longitudinally reported (median: 3 reports) between diagnosis and 5 years after, using the pediatric quality of life inventory generic core scales (PedsQL). HRQOL was modelled over time since diagnosis using mixed model analysis for children 2-7 years (caregiver-reports) and ≥ 8 years (self-reports). Differences in the course between hematological, solid and central nervous system malignancies were studied. Additional associations of demographics, disease characteristics (age at diagnosis, relapse, diagnosis after the national centralization of childhood cancer care and treatment components) and caregiver distress (Distress thermometer) were studied. Results: Overall, HRQOL improved with time since diagnosis, mostly in the first years. The course of HRQOL differed between diagnostic groups. In children aged 2-7 years, children with a solid tumor had most favorable HRQOL. In children aged ≥ 8 years, those with a hematological malignancy had lower HRQOL around diagnosis, but stronger improvement over time than the other diagnostic groups. In both age-groups, the course of HRQOL of children with a CNS tumor showed little or no improvement. Small to moderate associations (β: 0.18 to 0.67, p < 0.05) with disease characteristics were found. Centralized care related to better HRQOL (β: 0.25 to 0.44, p < 0.05). Caregiver distress was most consistently associated with worse HRQOL (β: - 0.13 to - 0.48, p < 0.01). Conclusions: The HRQOL course presented can aid in identifying children who have not fully recovered their HRQOL following cancer diagnosis, enabling early recognition of the issue. Future research should focus on ways to support children, especially those with a CNS tumor, for example by decreasing distress in their caregivers.
... Medical trauma, as defined by Hall and Hall (2016), is characterized as a complex interaction between the patient, medical staff, medical environment, and procedural experiences filtered through an individual's personality and psychological makeup. The intersections between FA-related emergencies, ED visits, use of EAIs, food challenges, early introduction of allergenic foods and psycho-emotional experiences have not been well-investigated, but this lens may be a useful addition to understanding how a patient's experiences with the healthcare system may give rise to unintended negative psychological and related physiological responses (Price et al., 2016). These aspects also should be assessed by future studies. ...
Chapter
Medical trauma is a subjective, relational, contextual, and psychophysiological trauma that develops through a complex interaction between patient, medical staff, medical environment, and the diagnostic and/or procedural experience with potentially powerful psychological impact arising from the patient's unique interpretation of events. Food-induced anaphylaxis, an urgent medical emergency for patients and/or caregivers, can produce post-traumatic stress symptoms. Applying appropriate conceptual frameworks and examining clinical examples supports better understanding of medical trauma in food allergy management and the treatment of FA-induced anaphylaxis. The intersection of food allergy-related emergency healthcare, medical traumatic stress, psychological well being, and health related quality of life is spotlighted.
Article
The post-transplant course of pediatric kidney transplant recipients is marked by a myriad of challenges, encompassing medical complications, recurrent hospitalizations, physical and dietary restrictions, and mental health concerns such as depression, anxiety, and post-traumatic stress disorder. Moreover, pediatric recipients are at risk of neurodevelopmental impairment, which may result in neurocognitive deficits and pose significant psychosocial obstacles. Addressing these multifaceted demands necessitates a multidisciplinary approach to pediatric kidney transplant care. However, the existing literature on the effective implementation of such a model remains scarce. This review examines the psychosocial and neurodevelopmental challenges faced by pediatric kidney transplant recipients and their families, discussing their impact on long-term transplant outcomes. Furthermore, it provides insights into risk assessment strategies and potential interventions within a multidisciplinary framework, aiming to enhance patient care and optimize post-transplant outcomes. A higher resolution version of the Graphical abstract is available as Supplementary information
Article
We examined and synthesised existing literature on factors associated with paediatric medical-related posttraumatic stress among children and their parents. Children experiencing a broad spectrum of medical conditions, diseases and injuries were of interest. A search of relevant literature concerning PMTS in children and their parents, as well as factors associated with PMTS, was conducted using Medline, PubMed and Scopus. Only studies published in English between January 2018 and November 2023 were included. Twelve articles met inclusion criteria. A broad range of correlates of PMTS were identified for children and parents, which were thematically organised into six key areas: hospital practices and environments; the parent-child relationship; parental mental wellbeing; psychological factors; sociodemographic factors; and the physical consequences of the condition. Bearing in mind constraints on causal inference due to the design of the included studies, knowledge of the factors associated with PMTS may enable clinicians to identify at-risk children and parents, with a view to intervention.
Article
Background Solid organ transplant recipients experience a period of unique vulnerability during adolescence, when normative developmental changes intersect with health‐related variables to influence psychological health. Methods This article builds on previous reviews of psychological health in solid organ transplant recipients and proposes opportunities for clinical intervention during adolescence. Results Transplant recipients often experience neurocognitive changes, particularly with respect to executive functions, that impact health management tasks and autonomous care. Recipients should be monitored for the development of anxiety, depression, and posttraumatic stress symptoms during adolescence, which in turn can negatively impact adherence to immunosuppression. Recent research in posttraumatic growth and resiliency factors may represent a promising avenue of intervention, leveraging normative developmental processes during this time period. Conclusions As pediatric transplant providers, adolescence represents a developmental period for targeted interventions to foster adjustment and adherence and promote a successful transition to adult care.
Article
Medical events in both childhood and adulthood, including components of the illness or injury and subsequent medical intervention, recovery, and disability, are increasingly being recognized as potentially traumatic. There has been an increased focus on scholarly work related to medical trauma and medically induced posttraumatic stress disorder (PTSD). Existing evidence suggests that trauma‐focused treatment can promote both physical and psychological recovery. However, there continues to be a dearth of clinical guidance on how to (a) best identify and treat prior trauma exposure that complicates adjustment to illness and increases the risk for medically induced PTSD and (b) address medically induced PTSD while concurrently targeting health‐related concerns (e.g., pain, adjustment to illness, acquired disability) that may negatively impact recovery. Originally presented as a premeeting institute at the 2023 Annual Meeting of the International Society for Traumatic Stress Studies, this paper describes the biopsychosocial impacts of medical trauma on adults and considerations for assessment and intervention in both traditional trauma and integrated care settings. This includes clinical applications, including assessment, case conceptualization, and health and rehabilitation interventions, that can promote health‐related adjustment and coping within the context of trauma‐focused treatment.
Article
Cardiovascular diseases are a leading cause of disability and mortality among the working population, necessitating the development and implementation of new, more effective treatment and rehabilitation methods for such patients, including the use of modern cellular and tissue technologies. In this review, an analysis and summary of research results over the past decades regarding the effectiveness of various types of stem cells in heart pathology were conducted. Priority directions include the search for more accessible and safe sources of stem cells, the development of new effective methods for their cultivation, and the use of scaffolds for transplantation. Given the pathogenetic mechanisms of cardiovascular pathology and myocardial regeneration, particular interest for clinical application is drawn to tissue-specific progenitors from the myocardium for replacing injured cardiomyocytes, endothelial progenitors for correcting accompanying endothelial dysfunction, and multipotent mesenchymal cells of various origins with low immunogenicity that exhibit trophic, anti-inflammatory, immunomodulatory, and anti-apoptotic effects. Questions regarding the optimal method, dose, and frequency of stem cell administration, as well as the standardization of criteria for their quality and effectiveness, remain open. Additionally, the combined use of different types of stem cells may serve as a new priority strategy in assessing the effectiveness and safety of cell therapy, especially considering the paradigm of repeated transplantation. The successful translation of obtained preclinical results into further large, well-planned, placebo-controlled clinical trials will enhance the safety and effectiveness of cell therapy for cardiovascular diseases, which is one of the current challenges of modern regenerative medicine.
Article
Parents of children hospitalized in the pediatric intensive care unit (PICU) may have expectations which could contribute to their emotional experiences both during and after hospitalization. This study aimed to evaluate community parents' knowledge and perceptions of the PICU to enhance understanding of preexisting concerns that may influence PICU experiences. English-speaking parents who had a child between the ages of 6 and 12 years old participated. Participants (n = 211) were mostly female (77%), white (72%), and married (72%). Participants completed an online survey regarding demographics and PICU knowledge. Participants were randomized to read a vignette in which a friend disclosed their child's PICU hospitalization either due to surgery, an accident, or chronic health condition. After reading the vignette, participants reported on the expected length of stay (LOS), survival expectations, and expected level of distress. Parents responded to open-ended questions regarding anticipated stressors, parent needs, and PICU resources. Parents overestimated the LOS and underestimated the survival rate. They expected PICU hospitalization to be highly distressing, primarily due to concerns about their hospitalized child, and that parents would need and have emotional support available to them. Parents may come into the PICU with preexisting concerns regarding medical outcomes. It is important that PICU providers assess for and address any parent misperceptions about their child's illness immediately upon admission and frequently throughout hospitalization. It is important to offer and encourage the use of psychosocial support services.
Article
Background Youth with lower limb deficiency (LLD) may be at increased risk for mental health difficulties. However, guidelines around psychosocial screening are not well established. Objective To describe the implementation and results of a mental health screening process in a multidisciplinary prosthetics clinic. Design Survey. Setting Outpatient specialty care clinic located within a children's hospital. Patients All patients ages 0–18 years with LLD seen at a monthly multidisciplinary prosthetics clinic between September 2019 and January 2023 ( n = 75). Interventions Not applicable. Main Outcomes Measures Quality of life was measured by the Patient‐Reported Outcomes Measurement Information System (PROMIS) pediatric proxy survey. Psychological functioning was measured using the Strengths and Difficulties Questionnaire (SDQ). Results Descriptive statistics were used to determine the proportion of patients who endorsed clinically significant concerns. Of the 75 clinic visits during the study time frame, the psychosocial screeners were completed at 38 (51%). A total of 25 unique patients completed the screeners; 12 patients completed the screener more than once. The most commonly endorsed concerns on the PROMIS were issues with physical mobility (65%) and upper extremity function (40%). The SDQ revealed that a majority (62.5%) of the screened patients had an overall score above the clinical cutoff, indicating psychosocial distress in more than one area. The most commonly reported mental health concern was peer problems (62.5%). Post hoc analysis of repeat screenings indicated that most problems identified during the first screening persisted at follow‐up screenings. Conclusions Clinically significant psychological concerns were common among the sample, indicating the need to address this aspect of patients' well‐being. Preliminary data on repeat screenings suggest that clinically significant concerns may not self‐resolve. Routine psychosocial screening is critical for early identification of mental health problems and timely referral to evidence‐based psychological interventions.
Article
Purpose This article reviews the literature focused on the psychological effects of craniofacial care for patients and their families. It provides an overview of pediatric medical traumatic stress (PMTS) associated with craniofacial conditions and related care, along with a review of its risk and protective factors. Findings from studies of PMTS in craniofacial populations are also reviewed. Conclusions The article concludes with strategies for identifying, addressing, and preventing medical traumatic stress in the context of craniofacial care. Specific implications for speech-language pathologists are also shared with respect to ways of minimizing risks for medical traumatic stress in craniofacial care. Future directions are also delineated and include strategies to improve screening and support for patients with craniofacial conditions and their families, along with the development of interventions aimed at increasing resilience.
Article
The mental health of youth with chronic kidney disease (CKD) has been increasingly recognized as an area of clinical need. The development of mental health concerns is influenced by a range of physiological, psychological, and environmental factors. Some of these factors are common across child development, but some are more unique to youth with CKD. Mental health concerns are associated with increased risk for a range of poor medical outcomes (e.g., adherence, risk of transplant rejection) and quality of life concerns. In this educational review, we discuss the current evidence base regarding the development of mental health concerns in youth with CKD. The review covers multiple domains including mood and anxiety disorders, traumatic stress, and neurodevelopmental disorders. Estimated prevalence and hypothesized risk factors are outlined, and the potential impact of mental health on medical care and functional outcomes are reviewed. Finally, we introduce options for intervention to support positive mental health and offer recommendations for building access to mental health care and improving the mental health education/training of medical professionals. “A higher resolution version of the Graphical abstract is available as Supplementary information”
Article
Background: Children with cancer (ages 3-8 years) and their parents experience significant, interrelated distress associated with cancer treatment. Active music engagement (AME) uses music-based play and shared music-making to mitigate this distress. To advance our understanding about how AME works and its essential features, we interviewed parents who received the AME intervention as part of a multi-site mechanistic trial. The purpose of this qualitative analysis was to describe parents' experiences of AME for themselves and their child and to better understand how the intervention worked to lower parent-child distress. Procedure: We conducted a total of 43 interviews with parents/caregivers, and purposively analyzed all interviews from underrepresented groups based on race/ethnicity and parent role. We used thematic analysis and achieved thematic redundancy after analyzing 28 interviews. Results: The following statement summarizes resulting themes: Music therapists skillfully use AME to create a safe and healthy space (Theme 1), where parents/children have transformative experiences (Theme 2) that lead to learning and enactment (Theme 3) of new skills that counteract suffering (Theme 4) through empowerment, connectedness, and sustained relief. Conclusions: This work elucidates how AME works to counteract stressful qualities of cancer treatment. As parents witnessed positive and transformative changes in their child, they experienced relief and reported shifts in their perspective about cancer treatment. This led to learning and use of music as a coping strategy that extended beyond therapist-led sessions. Accessible, music-based interventions, like AME, offer a developmentally appropriate and effective way to support parents and young children during treatment.
Article
Kinder, die aufgrund einer Erkrankung auf künstliche Ernährung angewiesen sind, haben oft Schwierigkeiten, ein normales Essverhalten zu entwickeln. Der Schwerpunkt zeigt Gründe für eine Fütterungsstörung auf und schildert, welche Therapiemöglichkeiten es bei einer Sondendependenz gibt.
Article
Objective How youth think about injury risk can affect their decisions about whether to engage in behaviors that can lead to injury. Appraisals also influence the development of post-traumatic stress symptoms (PTSS), which occur in approximately 20% of children after a medically treated injury. The current study examined how the injury appraisals of youth are associated with the development of PTSS post-skateboarding injury, and if PTSS or perceived benefits of the sport are also associated with youths’ intentions to return to the sport. Method One hundred three youth who had a medically treated skateboarding injury within the last year provided survey data on injury appraisals, PTSS, the benefits of skateboarding, and intentions to return to the sport. Results A two-stage moderated statistical mediation path model was specified. In the first stage, there was a positive relationship between pain at injury and PTSS, which was attenuated by the moderator, perceived bad luck. PTSS fully mediated the association between perceived pain at the time of injury and intentions to return to skateboarding. In the second stage of the mediation model, the moderator perceived benefits of skateboarding, reversed the negative relationship between PTSS and intentions to return to skateboarding. Conclusions Skateboarders are a group at risk for injury that can lead to PTSS, and they also are likely to return to the sport despite PTSS. This research identifies factors that impact the decision to return to skateboarding after injury. Limitations of the study and implications for mental health support and injury prevention are provided.
Article
Full-text available
Background New research in the field of psychological trauma has emphasized (a) the heterogeneity of psychological reactions after traumatic events and (b) the existence of distinct symptom trajectories. Aims In this study, existing data on post‐traumatic stress disorder (PTSD) symptoms in 66 parent–child dyads were re‐examined in the light of this literature in order to establish whether a similar pattern of symptom trajectories also applies to this population. Study Design A prospective observational cohort study. Participants' PTSD symptoms were assessed 3 and 12 months after discharge from a paediatric intensive care unit (PICU), using a short form of the Davidson Trauma Scale with parents and the Child Revised Impact of Events Scale with children aged 7–17 years. Results Results confirmed that the majority of children (58%) and parents (46%) exhibited a ‘Resilient’ PTSD trajectory over the year, in the sense that their scores remained in the non‐clinical range at both timepoints. Children displaying a ‘Resilient’ trajectory were more likely to have a parent who also displayed a ‘Resilient’ trajectory ( p = .018). However, there was also evidence of a ‘Recovery’ trajectory in a significant minority in this sample and over 1 in 4 children and parents exhibited a ‘Chronic’ or ‘Delayed’ symptom trajectory. Conclusions Although average PTSD scores reduced over time in this sample and ‘Resilient’ trajectories were common, a significant proportion of children and parents exhibited ‘Chronic’ and ‘Delayed’ symptom trajectories. Relevance to Clinical Practice These results suggest that, although the majority do well, a significant number of children and family members may develop chronic or delayed symptoms of PTSD in the year following PICU discharge. The monitoring of individual family members' symptoms beyond 3 months post‐discharge may help to determine those who might most benefit from further support.
Article
Objective: The objectives of this topical review are to (1) increase understanding of pediatric medical traumatic stress (PMTS) in pediatric urology populations through literature review, (2) identify a theoretical model to guide prevention of PMTS in this population, and (3) provide clinical care recommendations based on the model identified. Authors introduce a new term "uropsychology" to describe psychological practice that specializes in the treatment of urology patients. Methods: Pediatric uropsychologists from 5 pediatric medical care centers gathered to discuss their experience with treating PMTS in their settings and to review existing literature related to PMTS in pediatric urology, PMTS in other populations, and established models for prevention. Authors provide recommendations based on literature review for preventing PMTS in a pediatric urology population. Results: Gaps in the evidence base for preventing PMTS in this population are identified. Authors provide a series of clinical care recommendations, utilizing clinical experience, and the Pediatric Psychosocial Preventative Health Model (PPPHM) as a framework. Conclusions: While there is limited research on PMTS in pediatric urology populations, urologic interventions can be perceived as invasive, painful, distressing, and traumatic. Application of the PPPHM can guide prevention and intervention efforts. Future research is needed to characterize PMTS in this population, evaluate the efficacy of trauma-informed prevention and intervention practices, and develop screening measures that accurately identify at-risk patients. Authors recommend intradisciplinary collaboration among uropsychologists, urology specialists, and patients and families to create formal standards of care, avenues for other future research, and equitable access to uropsychology care.
Article
Obesity care in pediatric populations has entered a new era. The recent discovery of molecular genetic causes for abnormal weight gain, development of antiobesity medications, mounting data on the robust efficacy and favorable safety profile of bariatric surgery, and implementation of clinical guidelines fill a long-standing gap in the care of children affected by obesity, one of the most challenging pediatric diseases. However, these novel clinical approaches do not appear to have reached every individual who is in need, particularly children with chronic health conditions (CHCs), raising important questions for equitable medical care. In this study, we discuss specific etiologies, challenges, and ideas for future directions in diagnosing and managing obesity in children with CHCs. Although this article is not intended to be utilized as clinical guidelines, it underscores potential practical solutions for the current issues.
Article
Full-text available
Objectives: To assess psychopathology and medical traumatic stress in children with intestinal failure (IF) and identify associated risk factors. Methods: Two-center study, performed from September 2019 until April 2022 (partly during COVID-19 pandemic), including children (1.5-17y) with IF, dependent on parenteral nutrition (PN) or weaned off PN, treated by a multidisciplinary IF-team. Psychopathology in children was evaluated with a semi-structured interview assessing psychiatric classifications and validated questionnaires assessing emotional (internalizing) and behavioral (externalizing) problems. Medical traumatic stress was assessed with a validated questionnaire. Problem scores were compared with normative data. Associations between clinical characteristics and outcomes were analyzed with linear regression analyses. Results: Forty-one (of 111 eligible) children were included (median age 8.9y (IQR 5.5-11.8), 54% female, 73% born preterm). Median PN-duration was 17.3 months (IQR 6.9-54.0); 17 children (41%) were still PN-dependent. One third of the children met criteria for at least one psychiatric classification (compared with 14% in age-matched general population). Anxiety disorders and attention deficit hyperactivity disorder were most common. In school-aged children (n=29, 6-17y), significantly increased emotional problems were consistently reported by children (p=0.011), parents (p<0.001) and teachers (p=0.004). In preschool children (n=12, 1.5-5y), no significant differences with normative data were found. Subclinical or clinical emotional problems were reported in 19 children (46%). Medical traumatic stress was present in 14%, and 22% of children had received psychological help for trauma before. Lower gastrointestinal related quality of life was associated with more emotional problems, but not PN-duration. Conclusions: Children with IF, particularly school-aged children, are at risk for psychological problems which is reflected by the high rate of received psychotherapy and the high rate of emotional problems and psychiatric classifications.
Article
Amaç: Bu çalışmada Türkiye’de pediatrik onkoloji hastalarının bakım verenlerine uygulanan psikososyal girişimlerin ruhsal semptomlara olan etkisini inceleyen araştırmaların incelenmesi hedeflenmiştir. Yöntem: Deneysel ve yarı deneysel araştırmalar PRISMA protokolü doğrultusunda dokuz veri tabanında; (Pubmed, Cochrane, MEDLINE, CINAHL, EMBASE, Google Akademik, Web of Science, Ulusal Tez Merkezi, ULAKBİM), Ocak 2010-2021 tarihleri arasında başlık ve özete göre tarandı. ‘Kanserli çocuk’ veya ‘pediatrik onkoloji, ‘psikososyal uygulamalar’, ‘hemşirelik’, ‘ruhsal semptomlar’, ‘bakım verenler’ veya ‘ebeveynler’ anahtar sözcükleri Türkçe ve İngilizce olarak kullanılarak veri tabanlarında arama yapıldı. Referans yönetimi için Endnote X9 kullanıldı. Araştırmaların kalite indeksi Joanna Briggs Enstitüsü’nün kontrol listeleri kullanılarak değerlendirildi. Bulgular: Derlemeye beş araştırma dahil edildi. Dahil edilen araştırmaların üçü doktora tezi, ikisi ise bireysel araştırmadır. Psikososyal girişim olarak teori temelli hemşirelik uygulaması, psikoeğitim programı, tedavi ve hastalığa uyuma yönelik eğitimlerin verildiği belirlendi. Psikososyal girişimlerin, bakım verenlerin hastalığa yönelik belirsizlik ve umutsuzluk algısı, kaygı düzeyi, bakım yükü, depresyon ve ruhsal sorunlarını azalttığı; yaşam doyumu ve stresle baş etme becerilerini arttırdığı belirlendi. Sonuç: Pediatrik onkoloji hastalarının bakım verenlerine uygulanan psikososyal girişimlerin bakım verenlerin ruhsal sorunlarını azaltma ve iyilik hallerini arttırmada olumlu etkiye sahip olduğu belirlendi. Bu müdahalelerin etkinliğini iyileştirmek ve potansiyel etkilerini yaygınlaştırmak amacıyla daha fazla çalışmaların yürütülmesi önerilmektedir.
Article
Full-text available
Posttraumatic stress disorder (PTSD) is a common and disabling anxiety disorder that may occur in the aftermath of exposure to potentially traumatic life events. PTSD is moderately heritable, but few specific molecular variants accounting for this heritability have been identified. Genes regulating the hypothalamic-pituitary-adrenal (HPA) axis, such as corticotrophin-releasing hormone type 1 receptor gene ( CRHR1 ), have been implicated in traumatic-stress related phenotypes but have yet to be studied in relation to PTSD. The present study sought to examine the relation between 9 single nucleotide polymorphisms (SNPs) in the CRHR1 gene and posttraumatic stress symptoms in a prospective study of pediatric injury patients ( n = 103) who were first assessed in the acute aftermath of their injury at the hospital. Results indicated that multiple SNPs were associated with acute symptoms at a univariate level, and after correction for multiple testing, rs12944712 was significantly related to acute PTSD symptoms. Longitudinal latent growth curve analyses suggest that rs12944712 is also related to both acute symptom level and trajectory of symptoms over time. The present study adds support for the role of CRHR1 in the stress response following potentially traumatic event exposure in youth. It should be noted that the sample size in this study was small, and therefore statistical power was low; following, results from this study should be considered preliminary. Although results are not definitive, the findings from this study warrant future replication studies on how variation in this gene relates to response to traumatic event exposure in youth.
Article
Full-text available
Objective: This study examines traumatic stress reactions in couples that were followed prospectively for 18 months after a burn event to their child. Method: The participants included 186 mothers and 159 fathers of 198 preschool children. Parents' self-reported traumatic stress reactions were measured with the Impact of Event Scale (IES). Predictors included parental emotions and the perceived life-threatening character of the child's injury. Results: Rates for clinically significant symptoms (IES ≥ 26) decreased from 50% within the first month to 18% at 18 months postburn for mothers and from 27% to 6% for fathers. The decline in symptoms was not entirely linear. Mothers had higher scores than fathers, but the discrepancy in intrusion symptoms among couples diminished over the course of time. Early appraisal of life threat and emotions about the burn event were significant predictors. Conclusions: Both mothers and fathers are seriously affected by a burn event of their young child. Despite a general decrease over time, a subgroup of parents is at risk for chronic symptoms. The results call for the integration of prolonged parent support in family centered pediatric burn aftercare programs.
Article
Full-text available
Objective: Symptoms of posttraumatic stress disorder are a well-recognized phenomenon in mothers of preterm infants, with implications for maternal health and infant outcomes. This randomized controlled trial evaluated 6-month outcomes from a skills-based intervention developed to reduce symptoms of posttraumatic stress disorder, anxiety, and depression. Methods: One hundred five mothers of preterm infants were randomly assigned to (1) a 6- or 9-session intervention based on principles of trauma-focused cognitive behavior therapy with infant redefinition or (2) a 1-session active comparison intervention based on education about the NICU and parenting of the premature infant. Outcome measures included the Davidson Trauma Scale, the Beck Depression Inventory II, and the Beck Anxiety Inventory. Participants were assessed at baseline, 4 to 5 weeks after birth, and 6 months after the birth of the infant. Results: At the 6-month assessment, the differences between the intervention and comparison condition were all significant and sizable and became more pronounced when compared with the 4- to 5-week outcomes: Davidson Trauma Scale (Cohen's d = -0.74, P < .001), Beck Anxiety Inventory (Cohen's d = -0.627, P = .001), Beck Depression Inventory II (Cohen's d = -0.638, P = .002). However, there were no differences in the effect sizes between the 6- and 9-session interventions. Conclusions: A brief 6-session intervention based on principles of trauma-focused cognitive behavior therapy was effective at reducing symptoms of trauma, anxiety, and depression in mothers of preterm infants. Mothers showed increased benefits at the 6-month follow-up, suggesting that they continue to make use of techniques acquired during the intervention phase.
Article
Full-text available
The purpose of this study was to develop and conduct a preliminary validation of a screening tool to assess psychosocial adjustment in young children and their parents following an unintentional pediatric burn-injury. Parents (N = 62) of young children receiving medical treatment for a pediatric burn injury completed our newly developed Psychosocial Adjustment to Burn Questionnaire (PABQ), a 35-item psychosocial risk screening measure for children aged 0-5 that contains Child, Parent, and Regression subscales. Parents completed additional assessments of child and parent posttraumatic stress symptoms and an assessment of optimism. The PABQ-Child and PABQ-Parent subscales demonstrated strong internal consistency and test/retest reliability. Consistent with hypotheses, the PABQ-Child and PABQ-Parent subscales were positively correlated with the Child Stress Disorder Checklist, Behavior Assessment Scale for Children (Second Edition), and the PTSD Checklist. Lastly, discriminant validity was demonstrated using the Life Orientation Test-Revised. The PABQ is a promising screening tool for psychosocial risk in young pediatric burn patients and their parents. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Article
Full-text available
BACKGROUND Road traffic accidents (RTA) and burns are frequent events in children. Although many children recover spontaneously, a considerable number develop long-term psychological sequelae. Evidence on early psychological interventions to prevent such long-term problems is still scarce for school-age children and completely lacking for pre-school children. OBJECTIVES To evaluate the efficacy of an early two-session cognitive-behavioral intervention in 108 children ages 2-16 after RTAs and burns. METHODS Children assessed at risk for the development of posttraumatic stress disorder (PTSD) were randomly assigned to either a control group offered treatment as usual or an intervention group. Primary outcomes were PTSD, behavioral problems, and depression symptoms. Baseline and blinded 3- and 6-month follow-up assessments were conducted. RESULTS In pre-school children, no intervention effects were found. School-age children in the intervention group exhibited significantly fewer internalizing problems at 3-month follow-up relative to controls and a borderline significant time-by-group effect for PTSD intrusion symptoms was found (p=0.06). CONCLUSIONS This is the first study examining the efficacy of an indicated, early psychological intervention among both school-age and pre-school-age children. Because the intervention was ineffective for young children, no evidence-based practice can currently be suggested. Given that parents of pre-school children perceived the intervention as helpful, brief counseling of parents in terms of psychoeducation and training in coping skills still should be provided by clinicians, despite the current lack of evidence. To prevent trauma-related disorders in school-age children, the intervention might be used in a step-wise manner, where only children at risk for long-term psychological maladjustment are provided with psychological support.
Article
Full-text available
Objective: Contemporary models of trauma suggest that posttraumatic stress and growth should be related and that symptoms of stress resulting from a perceived trauma (e.g., childhood cancer) are prerequisite for posttraumatic growth (PTG) to occur. However, empirical data regarding the relationship of posttraumatic stress and growth have been equivocal. The purpose of this study is to examine the relationship between posttraumatic stress symptoms (PTSS) and PTG among adult survivors of childhood cancer. Methods: Survey methods were used to collect data from 6,162 survivors participating in the Childhood Cancer Survivor Study (CCSS). Nonparametric correlation was examined pairwise between PTG and PTSS using Spearman's correlation coefficient with 95% confidence intervals, with nonlinear canonical correlation analysis being conducted to examine relationships between subscales. A multivariable partial proportional odds model was also fit for PTG total quartiles focusing on associations with PTSS total quartiles while adjusting for sociodemographic and medical variables. Results: Examination of unadjusted PTSS and PTG total scores revealed a Spearman correlation of 0.11 (p < .001), with coefficients ranging from 0.03 to 0.17 between total and subscale scores. The nonlinear canonical correlation analyses resulted in two dimensions with eigenvalues of 0.15 and 0.14, resulting in a fit value of 0.30 and evidence that little variability in the data (15%) was explained by the weighted combinations of the variables. Conclusions: Although statistically significant, these results do not indicate a robust relationship between PTSS and PTG among adult survivors of childhood cancer. Theories suggesting that PTSS is a prerequisite for PTG should be reconsidered.
Article
Full-text available
We piloted a novel parent-targeted intervention, Take A Breath (TAB), for parents of children diagnosed with a life-threatening illness (LTI) with the aim of reducing parental distress. Parents were assisted to adapt to their child's diagnosis, treatment, and recovery via TAB's combined acceptance and commitment therapy (ACT) and problem-solving skills training (PSST) approach. Participants were 11 parents of children with a diagnosis of cancer, or who had life-saving cardiac surgery at least 4 months prior. Parents completed questionnaires at pre, post, and 6-month follow-up assessing parent posttraumatic stress symptoms (PTSS), the emotional impact of the child's LTI (e.g., feelings of uncertainty, guilt and sorrow, emotional resources), and psychological elements targeted by the intervention (parental psychological flexibility and mindfulness). Parents reported significant reductions in PTSS and emotional impact from their child's LTI, along with significant improvements in parental psychological flexibility and mindfulness. Effect sizes were medium to large, and improvements were maintained at 6-month follow-up. Our pilot indicates the TAB intervention has promise for preventing or reducing parental distress associated with child LTI and warrants more rigorous evaluation. Although preliminary, these findings suggest that targeting parents' subjective perceptions of their child's LTI may be an effective approach to reducing parental distress. Our results also indicate the potential for such an approach to be adopted across diverse child diagnoses in the acute pediatric setting. Further, our findings provide early indications that ACT combined with PSST is an appropriate therapeutic approach within this context. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Article
Full-text available
Healthcare providers working in addiction facilities do not often implement integrated treatment of comorbid substance use disorder (SUD) and posttraumatic stress disorder (PTSD) while there is empirical evidence to do so. This study aims to get insight into the views of clinicians with regard to the diagnosis and treatment of PTSD in SUD patients. A qualitative research method was chosen. Fourteen treatment staff members of different wards of an addiction care facility were interviewed by an independent interviewer. Despite acknowledging adverse consequences of trauma exposure on SUD, severe underdiagnosis of PTSD was mentioned and treatment of PTSD during SUD treatment was not supported. Obstacles related to the underestimation of PTSD among SUD patients and to the perceptions of SUD clinicians concerning the treatment of comorbid SUD/PTSD were reported. It is concluded that SUD facilities should train their clinicians to enable them to provide for integrated treatment of SUD/PTSD.
Article
Full-text available
Objective: Early childhood is a high-risk time for exposure to potentially traumatic medical events. We have previously reported that 10% of young children continue to have posttraumatic stress disorder (PTSD) 6 months after burn injury. This study aimed to 1) document the prevalence and prospective change in parental psychological distress over 6 months following their child's burn injury and 2) identify risk factors for posttraumatic stress symptoms (PTSS) in young children and their parents. Methods: Participants were 120 parents of 1-6-year-old children with unintentional burn injuries. Data were collected within 2 weeks, 1 month, and 6 months of burn injury using developmentally sensitive diagnostic interviews and questionnaires. Results: Within the first month, ∼ 25% of parents had a probable PTSD diagnosis, and moderate to extremely severe levels of depression, anxiety, and stress. Distress levels decreased significantly over time; however, 5% of parents still had probable PTSD at 6 months. Hierarchical multiple regression and path analyses indicated that parent posttraumatic stress reactions contributed significantly to the development and maintenance of child PTSS. Other risk factors for child PTSS included premorbid emotional and behavioral difficulties and larger burn size. Risk factors identified for parent PTSS included prior trauma history, acute distress, greater number of child invasive procedures, guilt, and child PTSS. Conclusions: The findings from this study suggest that parents' responses to a traumatic event may play a particularly important role in a young child's psychological recovery. However, further research is needed to confirm the direction of the relationship between child and parent distress. This study identified variables that could be incorporated into screening tools or targeted by early intervention protocols to prevent the development of persistent child and parent PTSS following medical trauma.
Article
Full-text available
OBJECTIVES: To evaluate the effectiveness and most powerful selection of predictors of an early screening tool for posttraumatic stress disorder (PTSD) in a sample of 87 children ages 2 to 6 years after unintentional injury. METHODS: The examined screener was administered within 6 to 13 days post accident and consisted of an adapted version of the Pediatric Emotional Distress Scale (PEDS), the PEDS-ES (PEDS Early Screener), and questions on 5 additional risk factors (preexisting child behavioral problems, parental preexisting chronic mental or physical illness, pretraumatic life events in the family, parental feelings of guilt, parental posttraumatic stress). The PTSD Semi-structured Interview and Observational Record for Infants and Young Children served as criterion measure 6 months after the accident. A case was deemed positive when meeting criteria for full or partial PTSD. RESULTS: Use of the PEDS-ES without the additional risk factors performed best, with good sensitivity (85%) and moderate specificity (63%) for full or partial PTSD. CONCLUSIONS: The PEDS-ES allows for successful early screening of preschool-aged children after single accidental trauma. It may be used within a stepped-care model for early identification of individuals designated for possible secondary preventative interventions.
Article
Full-text available
Objective: The current study evaluates a treatment intervention developed with the goal of reducing symptoms of posttraumatic stress, depression, and anxiety in parents of premature infants. Methods: A total of 105 mothers of preterm infants (25-34 weeks' gestational age; >600 g) were randomized to receive a 6-session intervention developed to target parental trauma as well as facilitate infant redefinition (n = 62) or to an active comparison group (n = 43). Mothers in the intervention group received a combination of trauma-focused treatments, including psychoeducation, cognitive restructuring, progressive muscle relaxation, and development of their trauma narrative. The intervention also incorporated material targeting infant redefinition, defined as the process of changing the mother's negative perceptions of her infant and the parenting experience. Results: Mothers in the intervention group reported a greater reduction in both trauma symptoms (Cohen's d = 0.41, P = .023) and depression (Cohen's d = 0.59, P < .001) compared with the comparison group. Patients under both conditions improved significantly in terms of anxiety, with no differences between groups. Results of the moderator analysis showed that mothers with higher ratings of baseline NICU stress benefited more from the intervention compared with mothers who had lower ratings (P = .036). Conclusions: This short, highly manualized intervention for mothers of preterm infants statistically significantly reduced symptoms of trauma and depression. The intervention is feasible, can be delivered with fidelity, and has high ratings of maternal satisfaction. Given that improvements in mothers' distress may lead to improved infant outcomes, this intervention has the potential for a high public health impact.
Article
Full-text available
The study objective is to evaluate the feasibility and efficacy of a web-based intervention for parents (AfterTheInjury.org [ATI]) in promoting emotional recovery following pediatric injury. 100 children with injuries requiring medical attention and their parents were randomly assigned to the intervention or usual care. Efficacy outcomes included parent knowledge and child and parent posttraumatic stress symptoms (PTSS). All parents in the intervention group completed the intervention (directed use of ATI) in the hospital. 56% reported using ATI online post-discharge, and 100% of these parents found it helpful. Parent knowledge increased immediately post-intervention, but there was no significant intervention impact on parent knowledge or PTSS at a 6-week follow-up. Relationships between knowledge and PTSS were identified. Brief web-based interventions introduced during child hospitalization are a feasible strategy to reach many parents following pediatric injury. Preventing psychological symptoms may require more than parental education alone.
Article
Full-text available
Objective: To investigate the prevalence and nature of trauma symptoms in mothers and fathers of infants who had cardiac surgery. Method: Parents of infants who underwent cardiac surgery before 3 months of age were recruited at the time of surgery. 77 mothers and 55 fathers completed the Acute Stress Disorder Scale 1 month after their infant was discharged from hospital. Results: 26 of 77 (33.8%) mothers and 10 of 55 (18.2%) fathers satisfied criteria for acute stress disorder. For all symptom clusters, except dissociation, mothers had significantly higher mean scores (and therefore higher levels of symptoms) than did fathers, ps = .01, -.02. 83 percent of parents endorsed at least 1 trauma symptom and 11.4% endorsed only 1 symptom at a clinical level. Symptoms of dissociation were the most commonly endorsed by both parents, with each symptom in that cluster being endorsed at a clinical level by at least 26% of parents. Conclusions: Consistent with our hypotheses, approximately one-third of parents overall, as well as one-third of mothers and close to one-fifth of fathers, experienced trauma symptoms consistent with a diagnosis of acute stress disorder. Most parents experienced at least one symptom at a clinical level, with symptoms of dissociation being the most commonly endorsed symptom cluster. These findings highlight the need for clinical supports for parents.
Article
Full-text available
Review articles serve an important purpose in synthesizing knowledge in the field of pediatric psychology, highlighting new topic areas, innovative concepts, and contemporary issues in the field. In the arena of treatment, a high-quality systematic review may answer questions about the efficacy of psychological treatments for specific pediatric problems by synthesizing quantitative results from relevant studies about specific interventions. As new treatments are developed in the field and new conditions are being tackled with pediatric psychology interventions, efficacy will need to be established. Such results may inform pediatric psychologists and other health providers about which interventions to use. Moreover, such results may guide decision making concerning whether the strength of the evidence warrants that a specific intervention for a particular childhood medical condition be made available to patients and financed. Another important benefit of careful systematic reviews is that they may reveal gaps in the evidence base or challenging methodological problems that may lead to advances or improvements in future research.
Article
Full-text available
Objective: This multicenter study examines acute stress reactions in couples following a burn event to their preschool child. Methods: Participants were 182 mothers and 154 fathers, including 143 couples, of 193 children (0-4 years) with acute burns. Parents' self-reported acute stress reactions and emotions regarding the burn event were measured within the first month postburn. Results: More mothers than fathers reported clinically significant acute stress reactions. Multilevel analysis revealed that individual parent reactions were associated with parent gender and negative emotions about the burn event. Interestingly, avoidance symptoms overlapped to an important extent within couples, whereas intrusion symptoms were mainly intra-individual. Burn characteristics, such as burn size, contributed to acute stress within couples. Conclusions: Mothers and fathers are seriously affected by their child's burn trauma and share a part of their acute stress reactions. These results emphasize the importance of a family-based approach to support adjustment after pediatric medical trauma.
Article
Full-text available
To date there is no quantitative review of predictors of posttraumatic stress disorder (PTSD) symptoms in youth experiencing illnesses or injuries. This article presents a meta-analysis of variables associated with the development of PTSD among those youth. Twenty-six studies were included: 18 involving children experiencing injuries and 8 with pediatric illnesses. Among injured youth, socioeconomic status and social impairment were small to moderate correlates of PTSD, whereas depressive and anxious symptoms, dissociation, acute stress disorder, and the appraisal of trauma severity and life threat displayed large effect sizes with PTSD severity. Among ill youth, social support and the appraisal of illness severity and life threat emerged as small to moderate predictors of posttraumatic symptoms. The current findings are exploratory in nature, as a primary limitation of the current study includes the limited number of independent studies that have evaluated these predictors. Current findings further our understanding of PTSD through exploration of possible indicators of at-risk youth who have experienced illness and injury.
Article
Full-text available
Previous studies found notable rates of post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) in pediatric patients and their parents and suggest a significant association between child and parent PTSS. However, little is known about mutual influences between child and parental PTSS over time. This study prospectively examined the presence of PTSS and PTSD and the mutual influence of child and parental PTSS in a large sample of pediatric patients with different medical conditions. A total of 287 children (aged 6.5-16 years) and their mothers (n = 239) and fathers (n = 221) were assessed at 5-6 weeks and 1 year after an accident or a new diagnosis of cancer or diabetes mellitus type 1 in the child. At the first assessment 11.1% and at the second assessment 10.2% of the children had moderate to severe PTSS. At 5-6 weeks 29.3% of mothers and 18.6% of fathers met criteria for PTSD. At 1 year the rates were 14.6% for mothers and 7.9% for fathers. There were considerable differences of PTSS among different medical diagnostic groups in children and parents. Mothers were more vulnerable than fathers. Structural equation analysis revealed that initially high PTSS in mothers and fathers were longitudinally related to poorer recovery from PTSS in the child. Cross-lagged effects from the child to the parents and from one parent to the other were not significant. This study highlights the long-term influence of parental PTSS on the child's recovery after trauma and calls for a family systems approach and for early interventions in the treatment of traumatized pediatric patients.
Article
Full-text available
This study evaluated the potential benefits of a centrally acting selective serotonin reuptake inhibitor, sertraline, versus placebo for prevention of symptoms of posttraumatic stress disorder (PTSD) and depression in burned children. This is the first controlled investigation based on our review of the early use of a medication to prevent PTSD in children. Twenty-six children aged 6-20 were assessed in a 24-week double-blind placebo-controlled design. Each child received either flexibly dosed sertraline between 25-150 mg/day or placebo. At each reassessment, information was collected in compliance with the study medication, parental assessment of the child's symptomatology and functioning, and the child's self-report of symptomatology. The protocol was approved by the Human Studies Committees of Massachusetts General Hospital and Shriners Hospitals for Children. The final sample was 17 subjects who received sertraline versus 9 placebo control subjects matched for age, severity of injury, and type of hospitalization. There was no significant difference in change from baseline with child-reported symptoms; however, the sertraline group demonstrated a greater decrease in parent-reported symptoms over 8 weeks (-4.1 vs. -0.5, p=0.005), over 12 weeks (-4.4 vs. -1.2, p=.008), and over 24 weeks (-4.0 vs. -0.2, p=0.017). Sertraline was a safe drug, and it was somewhat more effective in preventing PTSD symptoms than placebo according to parent report but not child report. Based on this study, sertraline may prevent the emergence of PTSD symptoms in children.
Article
Full-text available
Posttraumatic stress disorder (PTSD) is a common and disabling anxiety disorder that may occur in the aftermath of exposure to potentially traumatic life events. PTSD is moderately heritable, but few specific molecular variants accounting for this heritability have been identified. Genes regulating the hypothalamic-pituitary-adrenal (HPA) axis, such as corticotrophin-releasing hormone type 1 receptor gene (CRHR1), have been implicated in traumatic-stress related phenotypes but have yet to be studied in relation to PTSD. The present study sought to examine the relation between 9 single nucleotide polymorphisms (SNPs) in the CRHR1 gene and posttraumatic stress symptoms in a prospective study of pediatric injury patients (n=103) who were first assessed in the acute aftermath of their injury at the hospital. Results indicated that multiple SNPs were associated with acute symptoms at a univariate level, and after correction for multiple testing, rs12944712 was significantly related to acute PTSD symptoms. Longitudinal latent growth curve analyses suggest that rs12944712 is also related to both acute symptom level and trajectory of symptoms over time. The present study adds support for the role of CRHR1 in the stress response following potentially traumatic event exposure in youth. It should be noted that the sample size in this study was small, and therefore statistical power was low; following, results from this study should be considered preliminary. Although results are not definitive, the findings from this study warrant future replication studies on how variation in this gene relates to response to traumatic event exposure in youth.
Article
Full-text available
To review the recent empirical literature concerning development of posttraumatic stress symptoms following pediatric injury and summarize risk and predictive factors that will inform clinical practice and research. A systematic search of online databases such as PsycInfo, PILOTS, MedLine, and PubMed was performed. Further studies were identified through the reference lists of selected articles. Pre-injury psychological problems, the child's subjective experience of trauma severity/life threat, elevated heart rate immediately following the trauma, beliefs regarding initial symptoms, active thought suppression, and parental posttraumatic stress appear to be consistent predictors of persisting posttraumatic stress in children following injury. Specific variables may be useful in predicting posttraumatic stress following injury, which are discussed in terms of existing models of pediatric traumatic stress. Methodologies of included studies are also discussed.
Article
Full-text available
Researchers have recently used a framework of traumatic stress to describe the psychological functioning of children experiencing a chronic illness and their families; however, few studies are available directly comparing symptoms across disease groups. This study compared traumatic stress symptoms of youth being considered for solid organ and bone marrow transplantation, youth diagnosed with human immunodeficiency virus, youth diagnosed with sickle cell disease and their parents. Correlates of traumatic stress across these populations were also examined. Participants included 64 youth and caregiver dyads with previously scheduled appointments at 1 of 3 specialty clinics. Parents completed measures of family demographics, traumatic stress symptoms, and child functional status. Youth (n = 45) and parents each completed self-report and parent-proxy measures of youth traumatic stress symptoms. Ten percent of youth by self-report, 18% of youth by parent-proxy report, and 13% of caregivers described symptoms suggestive of posttraumatic stress disorder. Parents of pediatric transplant self-reported greater symptoms than caregivers of youth with human immunodeficiency virus and sickle cell disease (p < .05). Although child functional impairment did not predict child symptoms, a trend was found where parents experiencing more traumatic stress symptoms themselves reported their children experienced greater symptoms by parent-proxy report (p =.07). Findings suggest that although most children and parents across disease groups report subclinical levels of traumatic stress symptoms, traumatic stress symptoms may be especially salient for families of pediatric transplant candidates. Although interventions are currently available to treat posttraumatic stress disorder symptoms, they will likely need to be individualized to meet the needs of specific disease groups.
Article
Full-text available
Trajectory analyses were used to empirically differentiate patterns of posttraumatic stress symptoms in parents following child accidental injury and explore the relationship between parent and child recovery patterns. Parent (n = 189) self-reported symptoms from acute to 2 years post accident were examined to (1) identify distinct parent symptom trajectories; (2) identify risk factors; and (3) explore the patterns of children and parents together. Analysis revealed three distinct symptom trajectory groups for parents: resilient (78%); clinical level acute symptoms that declined to below clinical level by 6 months (recovery 8%); and chronic subclinical (14%). Children of resilient parents were most likely to be resilient. Half of the children of parents with chronic subclinical trajectories were likely to have chronic trajectories. Clinicians cannot rely only on clinical level symptoms in parents to identify high risk families but include families where the parent has subclinical level symptoms.
Article
Full-text available
To review the prevalence of psychiatric syndromes in pediatric critical illness survivors as well as to summarize data on vulnerabilities and pediatric intensive care unit exposures that may increase risk of developing these syndromes. MEDLINE (1966-2009), the Cochrane Library (2009, issue 3), and PsycINFO (1967-2009) as of August 9, 2009. Case-control, cross-sectional, prospective cohort and retrospective cohort studies as well as randomized controlled trials. Hospitalization for the treatment of a critical illness. Assessments of psychiatric symptoms/disorders at least once after discharge. Seventeen studies were eligible. The most commonly assessed psychiatric disorders were posttraumatic stress disorder and major depression. The point prevalence of clinically significant posttraumatic stress disorder symptoms ranged from 10% to 28% (5 studies). The point prevalence of clinically significant depressive symptoms ranged from 7% to 13% (2 studies). Preillness psychiatric and/or developmental problems and parental psychopathology were associated with vulnerability to psychiatric morbidity. Neither age nor sex of a child consistently increased vulnerability to postillness psychopathology. Exposure to increased severity of medical illness and pediatric intensive care unit service-delivery characteristics (eg, invasive procedures) were predictors of psychiatric illness in some but not all studies. Early postillness psychiatric symptoms were predictors of later psychiatric morbidity. Psychiatric morbidity appears to be a substantial problem for pediatric critical illness survivors. Future research should include more in-depth assessment of post-critical illness depressive, anxiety, and psychotic symptoms, validate existing psychiatric instruments, and clarify how vulnerability factors, pediatric intensive care unit service-delivery characteristics, and severity of critical illnesses are associated with subsequent psychopathology.
Article
Full-text available
Road traffic accidents (RTAs) are the leading health threat to children in Europe, resulting in 355,000 injuries annually. Because children can suffer significant and long-term mental health problems following RTAs, there is considerable interest in the development of early psychological interventions. To date, the research in this field is scarce, and currently no evidence-based recommendations can be made. To evaluate the effectiveness of a single-session early psychological intervention, 99 children age 7-16 were randomly assigned to an intervention or control group. The manualised intervention was provided to the child and at least one parent around 10 days after the child's involvement in an RTA. It included reconstruction of the accident using drawings and accident-related toys, and psychoeducation. All of the children were interviewed at 10 days, 2 months and 6 months after the accident. Parents filled in questionnaires. Standardised instruments were used to assess acute stress disorder (ASD), posttraumatic stress disorder (PTSD), depressive symptoms and behavioural problems. The children of the two study groups showed no significant differences concerning posttraumatic symptoms and other outcome variables at 2 or at 6 months. Interestingly, analyses showed a significant intervention x age-group effect, indicating that for preadolescent children the intervention was effective in decreasing depressive symptoms and behavioural problems. This study is the first to show a beneficial effect of a single-session early psychological intervention after RTA in preadolescent children. Therefore, an age-specific approach in an early stage after RTAs may be a promising way for further research. Younger children can benefit from the intervention evaluated here. However, these results have to be interpreted with caution, because of small subgroup sizes. Future studies are needed to examine specific approaches for children and adolescents. Also, the intervention evaluated here needs to be studied in other groups of traumatised children. Clinical Trial Registry: ClinicalTrials.gov: NCT00296842.
Article
Full-text available
To examine the role of cortisol in posttraumatic stress symptomatology among mothers of children newly diagnosed with cancer. Mothers (N = 27) completed standardized measures of posttraumatic stress symptoms and provided salivary cortisol samples at the time of their child's cancer diagnosis and then monthly for 1 year. Random effects regression analyses of 351 person-by-time observations revealed that high levels of cortisol were associated with higher levels of posttraumatic stress symptoms (B = .12, p < .02). The mothers who exhibited higher cortisol levels at the time of their child's diagnosis showed statistically significant declines in symptomatology from diagnosis to 12 months postdiagnosis (B = .97, p < .0001) compared to mothers who exhibited lower cortisol levels at diagnosis (B = .003, p < .05). These findings offer some suggestions into possible neurobiological processes underlying posttraumatic stress symptoms and directions for future research and clinical intervention.
Article
Full-text available
The aim of this article was to evaluate the effectiveness of an information provision web-based early intervention via a randomized controlled trial for children and their parents following pediatric unintentional injury. Participants were randomly assigned to an intervention (n = 29) or a control group (n = 27) following baseline measurements. Further assessment was taken at 4-6 weeks and 6 months post-trauma event. Analyses revealed that children within the intervention group reported improved anxiety, in comparison to a worsening of symptoms for children in the control group. Furthermore, children who had higher baseline trauma scores reported the intervention to be helpful. The intervention showed promising results in its ability to aid child recovery.
Article
Full-text available
There is little knowledge on health-related quality of life (HRQOL) of injured children and adolescents after road traffic accidents (RTA). Although findings in injured adults suggest that post-traumatic stress symptoms (PTSS) may be important predictors of HRQOL, this issue has never been prospectively examined in children. The aim of the present study was therefore to prospectively assess HRQOL in children after RTA and specifically examine the impact of PTSS on HRQOL. Sixty-eight children (aged 6.5-14.5 years) were interviewed 1 month and 1 year after an RTA using the Child PTSD Reaction Index and the Toegepast Natuurwetenschappelijk Onderzoek-Academisch Ziekenhuis Leiden (TNO-AZL) Questionnaire for Children's Health-Related Quality of Life. Parents and physicians were assessed with questionnaires. Eleven children (16.2%) showed moderate to severe post-traumatic stress reactions at 1 month, and 12 children (17.6%) at 1 year. At 1 month, patients reported reduced motor functioning and autonomy and impairments in some parts of emotional functioning compared to a community sample. At 1 year all dimensions of HRQOL were within or above normal ranges. Multivariate analysis indicated that PTSS at 1 month significantly predicted HRQOL at 1 year. This prospective study provides evidence for a long-term negative influence of early PTSS on HRQOL in injured children. The return of injured children to pre-injury HRQOL may therefore not only depend on optimal medical care but also on awareness and timely interventions regarding PTSS.
Article
Full-text available
Group-based trajectory modeling was used to identify patterns of posttraumatic stress symptom (PTSS) in children 6-16 years following accidental injury. The aims were to: (a) identify probable groups of children following distinct trajectories, and (b) identify risk factors affecting the probability of group membership. Children's Impact of Events Scale (n = 190) was used to assess PTSS up to 2 years post injury. Age, gender, type of injury, and preinjury behavior were assessed as risk factors. Three distinct trajectory groups were identified: resilient (57%), elevated stress symptoms which recovered quickly (33%), and chronic (10%). Younger children were more likely to be in the recovery group. Those with serious injuries were more likely to be in the chronic group. Preinjury child behavior problems were predictive of recovery and high chronic symptoms. Identification of distinct PTSS trajectory groups has implications for understanding the course and treatment of PTSS in children.
Article
Full-text available
To estimate PTSD prevalence in parents of children with chronic illnesses or undergoing invasive procedures, and its association with higher risk of PTSD among parents. Sixteen studies reporting prevalence of PTSD in parents of children with chronic illnesses were identified through a systematic review in Pubmed, Web of Science, Pilots and PsycINFO databases. Pooled current PTSD prevalence was calculated for parents from these studies. Pooled PTSD prevalence ratios were obtained by comparing parents of children with chronic diseases with parents of healthy children. Meta-regression was used to identify variables that could account for the lack of homogeneity. Pooled PTSD prevalence was 19.6% in mothers, 11.6% in fathers, and 22.8% in parents in general (p < .001). Pooled prevalence ratio for the four studies reporting on mothers and comparison healthy groups was 4.2 (p < .001). The high prevalence of PTSD found in this population highlights the importance of promptly assessing and treating post-traumatic symptoms in parents of children with chronic diseases as a key step to prevent the negative consequences of PTSD and preserve their competency as caregivers.
Article
Full-text available
Symptoms of posttraumatic stress disorder (PTSD) after life-threatening medical illness have been found to predict poor outcome in preliminary studies of adults and children. However, these symptoms are rarely recognized in general medical or pediatric settings. Here we report on the first large investigation to assess prevalence and correlates of self-reported symptoms of posttraumatic stress in a nonreferred sample of adolescent liver, heart, and kidney transplant recipients. One hundred four adolescents, ages 12 to 20 years (mean: 15.7; SD: 2.1), completed and returned the University of California, Los Angeles, PTSD Index for the Diagnostic and Statistical Manual of Mental Disorders. All participants were at least 1 year post-initial transplant and were fluent speakers of English and/or Spanish. More than 16% of the adolescents met all symptom criteria for PTSD, and an additional 14.4% met 2 of 3 symptom-cluster criteria. Regression analysis indicated no effect of gender, ethnicity, age at interview, organ type, time since transplant, or age at transplant. As has been found with other life-threatening pediatric conditions, solid organ transplantation can precipitate symptoms of posttraumatic stress. Symptoms are not predicted by what would be considered objective factors increasing life threat, suggesting a greater salience of subjective appraisal of threat, as has been seen in studies of childhood cancer survivors.
Article
Full-text available
To determine the prevalence, course, and predictors of posttraumatic stress disorder (PTSD) in mothers and fathers of children with newly diagnosed type 1 diabetes. Forty-nine mothers and 48 fathers of 52 children (response rate 65%) with newly diagnosed diabetes (age 6.5-15 years) were assessed at 6 weeks, 6 months, and 12 months after the diagnosis with the Posttraumatic Diagnostic Scale. The prevalence of current PTSD in mothers was 22.4% at 6 weeks, 16.3% at 6 months, and 20.4% at 12 months. In fathers, PTSD was found in 14.6%, 10.4%, and 8.3%, respectively. Mothers endorsed more symptoms of PTSD at all assessments. Multivariate analyses controlling for demographics, metabolic control, and threat appraisals revealed that in mothers, the number of preceding life events and PTSD symptoms at 6 months predicted PTSD at 12 months. In fathers, PTSD severity at 6 months was the only significant predictor for PTSD at 12 months. The results suggest that the diagnosis and treatment of diabetes in their child constitute traumatic events for parents. The findings confirm the applicability of a posttraumatic stress model for investigating the psychological impact of diabetes on parents.
Article
Long-term survivors of pediatric cancer have an increased risk of post-traumatic stress symptoms (PTSS) and dysfunctional anxiety. However, there is a lack of evidence-based psychotherapy tailored to the needs of this target group. In this single-arm pilot study, an Internet-based psychological intervention ("Onco-STEP") for adolescent and young adult survivors was developed, and its efficacy in reducing PTSS and anxiety was evaluated. Former patients of pediatric cancer older than 15 years manifesting clinically relevant PTSS or anxiety were eligible. The cognitive-behavioral treatment consists of ten writing sessions and comprises two modules: the first aiming to reprocess the traumatic cancer-related experiences and the second aiming to build coping strategies with current cancer-related fears. Treatment was delivered via written messages on a secure Internet platform. Outcomes were assessed by the Post-traumatic Stress Diagnostic Scale, the Hospital Anxiety and Depression Scale, and the Fear of Progression/Relapse Questionnaire. A total of 20 participants completed the intervention (mean age 27.3 ± 4.8 years at study; 13.8 ± 4.7 years since diagnosis; 70 % female). PTSS, anxiety, and fear of progression/relapse significantly declined at the end of the intervention, with pre-post effect sizes of 0.63, 0.74, and 0.48. In addition, we found a significant decrease in symptoms of depression. Except for the improvement in depression, all effects were sustained 3 months after the end of treatment. The results show that the intervention is efficacious in reducing symptoms of post-traumatic stress and anxiety. Onco-STEP is a promising new way to treat young adult long-term survivors of pediatric cancer with late psychological effects. Future efforts need to focus on investigating specific evidence of the intervention in a randomized controlled trial.