Child and Family Factors Associated With Posttraumatic Stress Responses Following a Traumatic Medical Event: The Role of Medical Team Support

Abstract

Objectives This study examined the contribution of pretrauma psychosocial factors (child emotional functioning, family resources, family functioning, and social support) and environmental factors (mother’s posttraumatic stress symptoms [PTSSs], medical team support [MTS]) to PTSSs of injured or seriously ill children within a pediatric rehabilitation setting. It was hypothesized that psychosocial variables would be strongly associated with child’s PTSS; that mother’s PTSS and MTS would mediate the association between psychosocial factors and child’s PTSS; that mother’s report on child’s PTSS would mediate the association between mother’s PTSS and child’s PTSS. Methods Participants were 196 children hospitalized following an injury/illness and assessed M = 47.7 days postevent. Children completed measures of PTSS, mothers completed measures of their own PTSS, child’s PTSS, and pretrauma psychosocial factors. Family’s therapist completed a MTS measure. Structural equation modeling was employed to evaluate the study hypotheses. Results Pretrauma family structure and resources were associated with child’s self-reported PTSS; each pretrauma variable and mother’s report of child’s PTSS was significantly associated. Although mother’s PTSS was not directly associated with child’s PTSS, this relationship was mediated by mother’s report of child’s PTSS. MTS mediated the relationship between pretrauma social support and mother’s PTSS. Conclusion This study further explicates the utility of a biopsychosocial framework in predicting childhood PTSS. Findings confirm the role of pretrauma factors and environmental factors at the peritrauma period in the development of PTSS following a pediatric injury/illness. Mother’s PTSS and MTS may be appropriate targets for prevention and early intervention.

Family Function and Post-Traumatic Stress Disorder in Children and Adolescents: A Meta-Analysis

“…Regarding the positive elements of family function, consistent with previous studies, the current results support the perspective that positive family affect (McCarthy & Thompson, 2010), family communication (Bal et al, 2004), family cohesion (Deane et al, 2018;Rowe et al, 2010), and family norms (Sadeh et al, 2020) were negatively associated with PTSD. In this regard, when a family encounters a stressful event, negative family affect is directly induced as a short-term unstable factor, such as irritable distress or worry (Gallo et al, 2019;McCarthy & Thompson, 2010), and has a temporarily strong relation with PTSD.…”

“…In addition, family norms of rigidness and closure may limit disclosure, hinder trauma processing, and promote PTSD-related distress, which can worsen the severity of PTSD (Belsher et al, 2012; Whealin et al, 2015). In contrast, a stable family structure and ample family resources as family norms are correlated with a lower prevalence of PTSD, possibly because of lower sensitivity and alertness to danger among children living in environments of higher socioeconomic status (Sadeh et al, 2020).…”

Families following pediatric traumatic medical events: identifying psychosocial risk profiles using latent profile analysis

“…For example, research shows that siblings who receive emotional and social support display improved behaviour, emotional well-being, and illness knowledge, resulting in better family functioning and greater patient and family satisfaction (Besier et al, 2010 ). These results align with research in the pediatric field that emphasises the importance of evaluating the relationship between risk factors in various domains of the family in order to target specific sources of psychosocial risk (Christofferson et al, 2020 ; Muscara et al, 2017 ; Sadeh et al, 2020 ; Sharkey et al, 2020 ). Incorporating trauma-informed and family-centred care requires recognition that these events can be traumatic for all members of the family (Christofferson et al, 2020 ).…”

“…Previous studies conducted in pediatric rehabilitation settings have indicated that approximately 20% of mothers report significant emotional distress (Silberg et al, 2016 ). Additionally, 21% of mothers and 27% of children following PTMEs have self-reported significant levels of PMTS (Sadeh et al, 2020 ), interacting with other psychosocial risk factors, which may in turn increase child's risk of developing PTSS (Sadeh et al, 2020 ).…”

Using a Biopsychosocial Approach to Examine Differences in Post-Traumatic Stress Symptoms Among Arab and Jewish Israeli Mothers Following A Child’s Traumatic Medical Event

“…Parents of children who have experienced a traumatic medical event (TME) are known to be at a high risk for developing severe stress responses [5][6][7][8]. Recently, the integrative biopsychosocial model of PTSS was developed by Marsac and colleagues [9,10], with the aim of identifying child, family and environmental factors associated with children's and parents' risk for developing PTSS, following these TMEs.…”