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

Abstract

Objective Given the millions of children who experience potentially traumatic injuries each year and the need to maximize emotional and physical health outcomes following pediatric injury, the current study examined the individual and collective contributions of the malleable variables of appraisals and coping in predicting PTSS in children following injury. Method This study combined data from three prospective investigations of recovery from pediatric injury (N = 688), in which children ages 8–17 years were recruited shortly after an injury (within 4 weeks). At baseline (T1), children completed measures of their threat appraisals of the injury event and PTSS. Six to twelve weeks later (T2) children completed a measure of coping and PTSS. Finally, PTSS was assessed again 6 months post-injury (T3). Results Structural equation modeling analyses provide evidence that appraisals and coping contribute to PTSS. Further, results suggest that escape coping mediates the relationship between threat appraisals and PTSS. Conclusions Early interventions designed to prevent or reduce PTSS after pediatric injury may be more successful if they primarily target modifying escape coping behaviors. To best inform clinical practice, future research should examine factors influencing the development of children’s appraisals and coping behaviors in the context of potentially traumatic events.

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

“…However, neither global nor trauma-specific appraisals served as a significant predictor of future PTSS when the relationship between appraisals and baseline PTSS was accounted for in the model. This latter finding differs from past research (Bryant, Salmon, Sinclair, & Davidson, 2007; Ehlers, et al, 2003; Marsac, et al, 2016). One possible explanation is that some past studies did not control for the association of PTSS and appraisals at baseline (e.g., Ehlers, et al, 2003).…”

“…Certain types of threat appraisals have been shown to be associated with more PTSS in children (Ehlers, et al, 2003; Marsac, et al, 2016; Meiser-Stedman, Dalgleish, et al, 2009). The current study extends past work by finding that global and trauma- specific appraisals, assessed in the early aftermath of an injury, had unique, independent relationships with PTSS development.…”

“…PTSS severity has been associated with children’s perception of threat during the traumatic event, global negative appraisals about vulnerability to future harm, and negative interpretation of PTSS symptoms (Ehlers, Mayou, & Bryant, 2003; Marsac, et al, 2016; Stallard & Smith, 2007). Studies to date have varied in whether they assess children’s global appraisals (i.e.…”

“…Studies to date have varied in whether they assess children’s global appraisals (i.e. general appraisals of self and the world) versus trauma-specific appraisals (Marsac, et al, 2016; Meiser-Stedman, Dalgleish, Glucksman, Yule, & Smith, 2009; Stallard & Smith, 2007), and this variation may be important in interpreting results: If global appraisals affect a child’s recovery from exposure to a trauma, universal screening during routine health care could help identify children to participate in a primary prevention program (i.e., work to re-shape global appraisals without requiring exposure to trauma) whereas if trauma-specific appraisals are the best predictors of PTSS, early secondary prevention programs post-trauma exposure may be a better resource. Assessing global and trauma-specific appraisals within the same study could help to clarify the relationship between appraisals and PTSS.…”

“…Stallard and Smith (2007) found that appraisals and coping together accounted for 64% of the variance in concurrent PTSD symptoms eight months after injury. Marsac et al (2016) assessed appraisals and coping in the peri-trauma period and PTSS six to twelve months later, finding that escape coping (a type of avoidant coping) served as a mediator in the relationship between peri-trauma negative appraisals and subsequent PTSS. However, the evidence so far is not clear how appraisals and coping strategies work together potentially contribute to or prevent PTSS over time (e.g., Do more severe PTSS result in more coping attempts or a different type of coping?…”