College of Nursing University of Tennessee, Knoxville, Tennessee, USA.
School of Social Work Salem State University, Salem, Massachusetts, USA.
J Pain Symptom Manage. 2018 Sep;56(3):309-317. doi: 10.1016/j.jpainsymman.2018.06.001. Epub 2018 Jun 8.
Children in foster care suffer with serious illness at end of life. However, the relationship between prior trauma exposure and serious illness has received little empirical attention.
The objectives were to examine the prevalence and type of trauma exposure and investigate the relationship between prior trauma and serious illness among foster children at end of life.
We used national longitudinal foster care data. We included children who were younger than 18 years with residence in the U.S. Serious illness (i.e., physical health, mental/behavioral health, developmental disabilities) was measured via the foster care files. Three measures of prior trauma exposure (i.e., maltreatment, drug/alcohol exposure, psychosocial stressors) were created. Using multivariate logistic regressions, we evaluated the influence of prior trauma on serious illness at end of life, while controlling for demographic, geographic, and foster care support characteristics.
Sixty-eight percent of children experienced maltreatment, 28% exposure to parental drug/alcohol misuse, and 39% psychosocial stressors before entering foster care. Maltreatment was positively associated with physical health and developmental disabilities, whereas parental drug/alcohol exposure was inversely related to developmental disabilities. Psychosocial stressors contributed to the prediction of poor physical, mental, and developmental health.
These findings suggest that trauma-informed end-of-life care may be a critical need among children in foster care with serious illness. Future directions are discussed, including collaboration between end-of-life clinicians and social service workers and the importance of future research to understand and improve the quality of health at end of life for this underserved population.
寄养儿童在生命末期患有严重疾病。然而，先前的创伤暴露与严重疾病之间的关系很少受到实证关注。
本研究旨在检查创伤暴露的患病率和类型，并调查生命末期寄养儿童先前创伤与严重疾病之间的关系。
我们使用了全国性的纵向寄养数据。我们纳入了年龄小于 18 岁、居住在美国的儿童。严重疾病（即身体健康、精神/行为健康、发育障碍）通过寄养档案进行测量。创建了三种先前创伤暴露的测量方法（即虐待、药物/酒精暴露、心理社会压力源）。使用多变量逻辑回归，我们评估了先前创伤对生命末期严重疾病的影响，同时控制了人口统计学、地理位置和寄养支持特征。
68%的儿童在进入寄养前经历过虐待，28%的儿童暴露于父母的药物/酒精滥用，39%的儿童经历过心理社会压力源。虐待与身体健康和发育障碍呈正相关，而父母的药物/酒精暴露与发育障碍呈负相关。心理社会压力源与较差的身体、心理和发育健康有关。
这些发现表明，创伤知情的临终关怀可能是患有严重疾病的寄养儿童的重要需求。讨论了未来的方向，包括临终关怀临床医生和社会工作者之间的合作，以及未来研究的重要性，以了解和改善这一服务不足人群的临终健康质量。
