Posttraumatic Stress Following Acute Medical Trauma in Children: A Proposed Model of Bio-Psycho-Social Processes During the Peri-Trauma Period

Abstract

Millions of children worldwide experience acute medical events. Children’s responses to these events range from transient distress to significant posttraumatic stress disorder symptoms (PTSS). While many models suggest explanations for the development and maintenance of PTSS in adults, very few have focused on children. Current models of child PTSS are primarily restricted to the post-trauma period, thus neglecting the critical peri-trauma period when screening and preventive interventions may be most easily implemented. Research on PTSS in response to pediatric medical trauma typically examines predictors in isolation, often overlooking potentially important interactions. This paper proposes a new model utilizing the bio-psycho-social framework and focusing on peri-trauma processes of acute medical events. Understanding the relationships among bio-psycho-social factors during peri-trauma can inform early identification of at-risk children, preventive interventions, and clinical care. Recommendations for future research, including the need to examine PTSS in the context of multiple influences, are discussed.

The role of appraisals and coping in predicting posttraumatic stress following pediatric injury.

“…In this model, biological, psychological, and social factors before (pre-), during (peri-), and after (post-) the medical event have independent and interactional relationships that influence the development and maintenance of PTSS. Three of the central psychological constructs for understanding persistent PTSS highlighted by this model are child PTSS cognitive appraisals, and coping in the peri-trauma period (See Figure 1 and Marsac et al (2014) for a full description of this model). Examining these psychological components via prospective studies of injured children can support identification of malleable peri-trauma variables (e.g., cognitive appraisals, coping) during injury and the early stages of recovery.…”

Knowledge and training in paediatric medical traumatic stress and trauma-informed care among emergency medical professionals in low- and middle-income countries

“…Further, as time constraints were frequently identified as a barrier to providing trauma-informed care, training programmes that are developed for staff in these regions should aim to be brief and time efficient. It is important to note that medical and nursing staff would not be expected to replace mental health workers but rather provide routine medical care in a way that acknowledges the impact of trauma and minimizes distress, thus altering the subjective experience of the event and the immediate aftermath (Kazak et al, 2006; Marsac et al, 2014; Price et al, 2015). Several preventative approaches including the DEF protocol (Stuber, Schneider, Kassam-Adams, Kazak, & Saxe, 2006) which provide evidence based guidelines on implementing trauma-informed care and information provision (Kenardy et al, 2008) are designed to be incorporated into routine care and add little burden on time (in the Medical Traumatic Stress Toolkit: Kassam-Adams, 2014; Kenardy et al, 2008; Ko et al, 2008; Marsac et al, 2015).…”

“…Paediatric medical traumatic stress is defined as ‘a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures and invasive or frightening treatment experiences’ (National Child Traumatic Stress Network, 2003). Paediatric medical traumatic stress can impair typical childhood development, result in lower health-related quality of life, compromise physical functioning and recovery, and lead to a greater reliance on the health care system (Landolt, Vollrath, Gnehm, & Sennhauser, 2009; Marsac, Kassam-Adams, Delahanty, Widaman, & Barakat, 2014; Price et al, 2015). …”

“…The peri-traumatic period immediately post-injury has been identified as a critical period for the prevention of the development of paediatric medical traumatic stress. It is in this period that interventions can still target the child’s subjective experience of the event (Kazak et al, 2006; Marsac et al, 2014). Research has recognized the important role that medical and nursing professionals, who treat injured children in this acute peri-traumatic period, have in the prevention and identification of paediatric medical traumatic stress (Horowitz et al, 2001; Kassam-Adams, 2014; Marsac et al, 2015; Patel et al, 2007).…”

Family Report Compared to Clinician‐Documented Diagnoses for Psychiatric Conditions Among Hospitalized Children

“…Anxiety disorders are a risk factor for worse outcomes in children with chronic physical conditions, 3,[35][36][37] and acute hospitalization is associated with posthospital anxiety symptoms. 38,39 Thus, anxiety disorders are particularly relevant to hospital care and are a priority for research on the differences between families' and clinicians' perspectives on children's psychiatric diagnoses.…”