Pediatric Critical Care–Associated Parental Traumatic Stress: Beyond the First Year*

Abstract

OBJECTIVES: Perform a longitudinal analysis of parental traumatic stress up to 30 months after PICU discharge. DESIGN: Prospective observational cohort study. SETTING: Two tertiary care children’s hospitals with mixed medical/surgical/cardiac PICUs. SUBJECTS: Parents of patients unexpectedly admitted to the PICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred sixty-five parents of 188 children were enrolled. Of the 195 parents who completed the 3–9-month assessments, 29 (14.8%) met posttraumatic stress disorder (PTSD) qualification on the PTSD Symptom Scale Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Multivariable analysis showed parents who met acute stress disorder (ASD) qualification (odds ratio [OR] 8.01; 95% CI 2.64–24.3), parents of children with Pediatric Overall Performance Category score of severe or coma at discharge (OR 5.21; 95% CI 1.65–16.4), parents who had concerns for their child’s permanent injury (OR 1.82; 95% CI 1.36–2.43), and parents who reported increased knowledge of child illness during admission (OR 1.82; 95% CI 1.13–2.93) had increased odds of developing parental PTSD. Of the 175 parents (66%) who completed the 18–30-month assessments, 22 (12.5%) met PTSD qualification. Multivariable analysis showed parents who met ASD qualification (OR 4.19; 95% CI 1.12–15.7), parents who had a history of a family member or themselves being admitted to ICU (OR 6.51; 95% CI 1.43–29.6), and parents who had concerns of child’s susceptibility to death post discharge (OR 1.58; 95% CI 1.19–2.09) had increased odds of developing parental PTSD. At 18–30 months post discharge, parents who met the PTSD qualification were more likely to report a decrease in household income following discharge (OR 9.23; 95% CI 1.71–49.9). CONCLUSIONS: Parental PTSD remains a significant morbidity of PICU admission for a subgroup of parents greater than 18 months post admission. Identifiable risk factors will inform the development of targeted interventions.