家庭功能对儿童和其父母入住 PICU 后创伤后应激发展的影响。
The Effects of Family Functioning on the Development of Posttraumatic Stress in Children and Their Parents Following Admission to the PICU.
机构信息
University of Southern California Keck School of Medicine, Los Angeles, CA.
Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
出版信息
Pediatr Crit Care Med. 2019 Apr;20(4):e208-e215. doi: 10.1097/PCC.0000000000001894.
OBJECTIVES
To report the rate of acute stress and posttraumatic stress among children and parents following PICU admission and the relation between family function and posttraumatic stress.
DESIGN
Prospective, longitudinal, multi-informant observational study. Pediatric patients (n = 69) and parents were recruited in the ICU. They completed measures evaluating acute stress and posttraumatic stress during their hospitalization and at 3-month follow-up. Parents completed measures of family functioning during the hospitalization. Pearson correlations and multiple regression models were used to examine the relations between family functioning and acute stress and posttraumatic stress.
SETTING
An academic, urban, pediatric hospital in California.
PATIENTS
Children, 8-17 years old, admitted to the PICU for greater than 24 hours and their English- or Spanish-speaking parents.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
All children endorsed acute stress during their PICU admission, with 51% meeting criteria for acute stress disorder. At 3-month follow-up, 53% of the children continued to endorse posttraumatic stress with 13% meeting criteria for posttraumatic stress disorder. Among parents, 78% endorsed acute stress during admission with 30% meeting criteria for acute stress disorder, and at follow-up, 35% endorsed posttraumatic stress with 10% meeting criteria for posttraumatic stress disorder. In multiple linear regression modeling, child acute stress significantly predicted child posttraumatic stress (β = 0.36; p < 0.01). In the parent model, parent acute stress (β = 0.29; p < 0.01) and parent education (β = 0.59; p < 0.00) positively predicted parent's posttraumatic stress. Family function was not a predictor of either's posttraumatic stress.
CONCLUSIONS
Both children and parents have alarmingly high rates of acute stress and posttraumatic stress following the child's PICU admission. Although family function did not emerge as a predictor in this study, further understanding of the influence of the family and the interplay between child and parent posttraumatic stress is needed to improve our understanding of the model of development of posttraumatic stress in this population to inform the intervention strategies.
目的
报告儿童和父母在 PICU 入院后急性应激和创伤后应激的发生率，以及家庭功能与创伤后应激的关系。
设计
前瞻性、纵向、多信息观察研究。在 ICU 招募儿科患者（n = 69）和父母。他们在住院期间和 3 个月随访时完成评估急性应激和创伤后应激的测量。住院期间，父母完成了家庭功能的测量。使用 Pearson 相关和多元回归模型来检验家庭功能与急性应激和创伤后应激之间的关系。
地点
加利福尼亚州的一家学术性、城市性儿科医院。
患者
8-17 岁，因 PICU 住院时间超过 24 小时的儿童及其讲英语或西班牙语的父母。
干预措施
无。
测量和主要结果
所有儿童在 PICU 住院期间均出现急性应激，51%符合急性应激障碍标准。在 3 个月随访时，53%的儿童继续出现创伤后应激，13%符合创伤后应激障碍标准。在父母中，78%在入院时出现急性应激，30%符合急性应激障碍标准，在随访时，35%出现创伤后应激，10%符合创伤后应激障碍标准。在多元线性回归模型中，儿童的急性应激显著预测儿童的创伤后应激（β=0.36；p<0.01）。在父母模型中，父母的急性应激（β=0.29；p<0.01）和父母的教育（β=0.59；p<0.00）正预测父母的创伤后应激。家庭功能不是两者创伤后应激的预测因素。
结论
儿童和父母在儿童 PICU 入院后都出现了令人震惊的高急性应激和创伤后应激发生率。尽管家庭功能在本研究中没有成为预测因素，但需要进一步了解家庭的影响以及儿童和父母创伤后应激之间的相互作用，以增进我们对这一人群创伤后应激发展模式的理解，为干预策略提供信息。
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