An initial application of a biopsychosocial framework to predict posttraumatic stress following pediatric injury.

Abstract

Objectives Each year millions of children suffer from unintentional injuries resulting in poor emotional and physical health. This study examined selected bio-psycho-social factors (child heart rate, peri-trauma appraisals, early coping, trauma history) to elucidate their roles in promoting emotional recovery following injury. The study evaluated specific hypotheses that threat appraisals (global and trauma-specific) and coping would predict subsequent posttraumatic stress symptoms (PTSS), that coping would mediate the association between early and later PTSS, and that heart rate would predict PTSS and appraisals would mediate this association. Method 96 children hospitalized for injury participated in assessments at T1 (within two weeks of injury), T2 (6-week follow-up), and T3 (12-week follow-up). Participants completed measures of trauma history and appraisals at T1, coping at T2, and PTSS at T1, T2, and T3. Heart rate was abstracted from medical records. Structural equation modeling was employed to evaluate study hypotheses. Results Heart rate was not associated with PTSS or appraisals. Models including trauma history, appraisals, coping, and PTSS were constructed to test other study hypotheses and fit the data well. T1 global and trauma-specific threat appraisals were associated with T1 PTSS; T2 avoidant coping was a significant mediator of the relation between T1 and T3 PTSS. Conclusions Findings confirm a role for appraisals and coping in the development of PTSS over the weeks following pediatric injury. Early appraisals and avoidant coping may be appropriate targets for early preventive interventions. Future research should further explicate the utility of a bio-psycho-social framework in predicting PTSS.

The aftermath of burn injury from the child’s perspective: A qualitative study

“…cognitive restructuring, seeking social support, problem-solving), while a minority was more avoidance-oriented ( Aldridge and Roesch, 2007 ; Roth and Cohen, 1986 ). Specifically, avoidant coping has been associated with more posttraumatic stress ( Marsac et al, 2017 ; Stallard et al, 2001 ), while approach-oriented coping has not clearly been shown to reduce the risk of posttraumatic stress ( Marsac et al, 2017 ). In clinical practice, attention could be paid to the type of coping strategy used by the child.…”

Psychosocial care for hospitalized young survivors after the terror attack on Utøya Island: A qualitative study of the survivors’ experiences

“…Models including biological, psychological, and social factors have been proposed to understand the development of PTSR (Marsac et al, 2017). When exposed to a lifethreatening experience, the body reacts with a cascade of acute biological stress responses.…”

“…Peri-traumatic risk factors such as trauma severity, perceived life threat, emotional responses, dissociation, and loss of loved ones have been demonstrated to be particularly strong predictors of PTSR (Brewin, 2005;Furr, Comer, Edmunds, & Kendall, 2010;Kahana, 2006;Ozer et al, 2003;Skogstad et al, 2014). Early psychological reactions including PTSR, elevated heart rate, lack of social support, ongoing life stressors, early maladaptive appraisals, and avoidant coping have been demonstrated as significant post-trauma factors (Bisson, 2007;Brewin, 2005;Marsac et al, 2017;Ozer et al, 2003;A. Y. Shalev et al, 2019).…”

Commentary: Mediation and Moderation: An Historical Progress Report

“…Recently, Marsac et al (2017) hypothesized that coping and appraisals could serve as mediators of associations between early and later posttraumatic stress symptoms. This is a rare case in which the researchers provided a compelling case for the impact of the IV on hypothesized coping-related mediators.…”