Mediators of Initial Acute and Later Posttraumatic Stress in Youth in a PICU*

Abstract

Youth in a pediatric intensive care unit are at increased risk for posttraumatic stress disorder and should be screened for acute stress disorder.

Advancing Our Understanding of the Psychological Impact of PICU Hospitalization

“…Others are not. The authors conclude that parent-rated negative effect in youth, including elevated levels of anxiety or depression, may serve as a bridge from ASD to later PTSD (12). Although this may be the case, others have found trauma-exposed youth to be at risk for major depression and anxiety disorders comorbid with PTSD (13,14), lending support to the suggestion that future research should consider outcomes other than PTSD.…”

“…The findings of Stowman and colleagues (12) suggest it may be time to pause and reflect on this relatively new field of post-PICU traumatic stress. When viewed within the context of a broad developmental model of childhood traumatic stress (13), their findings raise important questions about how we are conceptualizing traumatic stress in the PICU population.…”

“…Their model highlights the inherent complexity of traumatic experience and the importance of framing childhood responses to trauma within the context of child development. For example, Stowman and colleagues (12) found that the relationship between youth ASD and PTSD was not mediated by parent variables. However, in examining the ecology of the child, Pynoos et al identified numerous parent factors that potentially impact the child's response to trauma.…”

“…However, a review of psychiatric morbidity in pediatric critical illness survivors concluded that future research would benefit from considering outcomes other than PTSD, focusing on children within a particular developmental stage (trauma-exposed adolescents, for example, may be at even greater risk for subsequent psychopathology than younger children), and clarifying whether psychiatric morbidity results from premorbid factors, the critical illness itself, or children's subsequent treatments (6). In one of the first articles to examine mediators of acute stress disorder (ASD) and later PTSD in critically ill youth after PICU hospitalization, In this issue of Pediatric Critical Care Medicine, Dr. Stowman and colleagues (12) have begun to address some of these concerns.…”

“…Stowman and colleagues (12) suggest that researchers consider specific strategies to prevent the development of PTSD among youth after PICU hospitalization. Certainly, the high percentage of youth (and parents) with PTSD in their study strongly supports that recommendation.…”