The Value of Screening Parents for Their Risk of Developing Psychological Symptoms After PICU

Abstract

All parents completed Impact of Event Scale-Revised and Hospital Anxiety and Depression Scale at 6 months. Of the 209 parents of 145 children recruited to the study, 78 (37%) were identified, on the basis of their Posttraumatic Adjustment Scale score at baseline, as being at risk of developing posttraumatic stress disorder, and randomized to the control or intervention condition. Follow-up data were provided by 157 of 209 parents (75%). Logistic regression analyses controlling for parent gender and child length of stay showed that high-risk control parents (n = 32) were significantly more likely to score above the clinical cutoff for all three psychological outcomes than parents deemed low risk at baseline (n = 89) (posttraumatic stress: odds ratio = 3.39; 95% CI, 1.28-8.92; p = 0.014; anxiety: odds ratio = 6.34; 95% CI, 2.55-15.76; p < 0.001; depression: odds ratio = 4.13; 95% CI, 1.47-11.61; p = 0.007). Only 14 of 38 (37%) high-risk intervention parents attended the follow-up clinic appointment they were offered. At follow-up, there were no statistically significant differences between the intervention and control groups, but there were small effect sizes in favor of the intervention for anxiety scores (Cohen d = 0.209) and depression scores (Cohen d = 0.254) CONCLUSIONS:: Screening parents for psychological vulnerability using measures such as the Posttraumatic Adjustment Scale may enable more efficient targeting of support. However, further research is needed on how best to provide effective follow-up intervention for families.

A review of interventions supporting parent's psychological well‐being after a child's intensive care unit discharge

“…These interventions were, however, provided at different time points, ranging from PICU admission (Melnyk et al, ) to within 7 days of discharge (Als et al . ) and 6 weeks after discharge (Gledhill et al, ) up to 2 months after discharge (Colville et al, ; Samuel et al, ) (Table ).…”

“…Studies varied in design, but all reported quantitative data (Table ). They included one full‐scale randomized controlled trial (RCT) (Melnyk et al, ), an exploratory RCT (Colville et al, ), a feasibility and pilot RCT (Als et al, ) and a feasibility study using a RCT design (Samuel et al, ). The remaining two studies used a non‐randomized design.…”

International Survey of Critically Ill Children With Acute Neurologic Insults: The Prevalence of Acute Critical Neurological Disease in Children: A Global Epidemiological Assessment Study*

“…29,30,33,34 Few centers reported having ICU follow-up clinics, an innovative multidisciplinary effort to address recovery from critical illness. 35 …”

Family Burden After Out-of-Hospital Cardiac Arrest in Children

“…PICU follow-up clinics have been suggested as one type of intervention to support parents most vulnerable to psychological distress after their child’s critical illness. However, a recent study reported that only a minority of parents were able or willing to participate in a PICU follow-up clinic appointment (22). Follow-up meetings or other interventions to support caregivers of children after OH-CA would need to be developed or adapted for this population, and tested for feasibility, acceptability and impact on family burden.…”