Clinical Sciences, Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia.
Children's Cancer Centre, The Royal Children's Hospital, Parkville, Victoria, Australia.
JAMA Netw Open. 2020 Jul 1;3(7):e208507. doi: 10.1001/jamanetworkopen.2020.8507.
A substantial proportion of parents whose child is diagnosed with a life-threatening illness experience high levels of distress that can lead to long-term mental health difficulties. This can affect the child's recovery.
To evaluate the efficacy of an acceptance and commitment therapy-based group intervention, delivered using videoconferencing, in reducing posttraumatic stress symptoms (PTSS) in these parents.
DESIGN, SETTING, AND PARTICIPANTS: This study was a randomized clinical trial of an intervention for parents with elevated acute stress symptoms. It was a single-site study conducted in a tertiary pediatric hospital in Australia. Parents of children aged 0 to 18 years admitted for a life-threatening illness or injury to the oncology, cardiology, or pediatric intensive care departments were eligible. Participants were screened for eligibility within the first month after diagnosis or admission and then were randomized to the intervention group or the waiting list control group 4 to 10 months after diagnosis or admission. Recruitment commenced January 2014, and final postintervention follow-up was completed in February 2018. Data analysis was performed from July to September 2018.
Treatment was a psychological acceptance and commitment therapy-based group therapy program called Take a Breath, which consisted of a 6-session parent-mediated psychological intervention delivered via online videoconferences over the course of 8 weeks. Waiting list control participants received treatment as usual and were offered the intervention 3 months after randomization.
The primary outcome was PTSS, as measured by the Posttraumatic Stress Disorder Checklist-Version 5 (total score range, 0-80, with higher scores indicating greater symptom severity). The PTSS was measured both before and immediately after the intervention. Changes in psychological skills taught within the intervention were also evaluated, including acceptance, mindfulness, values-based living, and psychological flexibility.
Of 1232 parents who were assessed for eligibility, 313 were randomized; 161 were allocated to the waiting list control group, and 152 were allocated to the intervention group. Of those allocated, 44 parents in the waiting list group and 37 in the intervention group completed the postintervention questionnaire and were analyzed (81 participants total; mean [SD] age, 37.17 [6.43] years). Sixty-five participants (80.2%) were women, 48 participants (59.3%) were married, and 40 participants (49.4%) lived in rural or regional areas, or in a different state. In addition, 24 parents (29.6%) were in the cardiology illness group, 32 parents (39.5%) were in the oncology group, and 25 parents (30.9%) were in the pediatric intensive care unit group. The intervention group demonstrated significantly greater improvements in PTSS compared with the waiting list group (Cohen d = 1.10; 95% CI, 0.61-1.59; P = .03). The mean Posttraumatic Stress Disorder Checklist-Version 5 scores decreased from 31.7 (95% CI, 27.0-36.4) to 26.2 (95% CI, 21.8-30.7) in the waiting list control group and from 23.3 (95% CI, 18.6-28.1) to 17.8 (95% CI, 13.8-21.8) in the intervention group.
The findings of this study support the use of acceptance and commitment therapy to reduce PTSS in parents of very ill children, regardless of diagnosis. These findings also suggest that a brief, group format using a videoconferencing platform can be used effectively to access hard-to-reach populations, particularly fathers and caregivers living in nonmetropolitan areas.
Australian New Zealand Clinical Trials Registry Identifier: ACTRN12611000090910.
相当一部分孩子被诊断患有危及生命的疾病的父母会经历高度的困扰，这可能导致长期的心理健康问题。这会影响孩子的康复。
评估基于接受和承诺疗法的小组干预在降低这些父母的创伤后应激症状（PTSS）方面的疗效。
设计、地点和参与者：这是一项针对急性应激症状升高的父母的干预措施的随机临床试验。这是在澳大利亚一家三级儿科医院进行的单站点研究。患有危及生命的疾病或因癌症、心脏病或儿科重症监护病房入院的 0 至 18 岁儿童的父母符合条件。在诊断或入院后的第一个月内对符合条件的父母进行筛查，然后在诊断或入院后 4 至 10 个月时将其随机分配到干预组或候补名单对照组。招募工作于 2014 年 1 月开始，最终的干预后随访于 2018 年 2 月完成。数据分析于 2018 年 7 月至 9 月进行。
治疗是一种基于接受和承诺疗法的心理小组治疗方案，称为“深呼吸”，由 6 节家长介导的心理干预组成，通过在线视频会议在 8 周内完成。候补名单对照组的参与者接受常规治疗，并在随机分组后 3 个月接受治疗。
主要结果是创伤后应激障碍检查表第 5 版（总分范围为 0-80，得分越高表示症状越严重）的 PTSS。在干预前后都测量了 PTSS。还评估了干预中所教授的心理技能的变化，包括接受、正念、基于价值观的生活和心理灵活性。
在 1232 名符合条件的父母中，有 313 名接受了评估，其中 161 名被分配到候补名单对照组，152 名被分配到干预组。在被分配的参与者中，候补名单组有 44 名父母和干预组有 37 名父母完成了干预后的问卷调查并进行了分析（共 81 名参与者；平均[SD]年龄为 37.17[6.43]岁）。65 名参与者（80.2%）为女性，48 名参与者（59.3%）已婚，40 名参与者（49.4%）居住在农村或地区或不同的州。此外，24 名父母（29.6%）患有心脏病，32 名父母（39.5%）患有癌症，25 名父母（30.9%）患有儿科重症监护病房。与候补名单组相比，干预组的创伤后应激障碍检查表第 5 版评分显著改善（Cohen d=1.10；95%CI，0.61-1.59；P=0.03）。候补名单对照组的创伤后应激障碍检查表第 5 版评分从 31.7（95%CI，27.0-36.4）降至 26.2（95%CI，21.8-30.7），干预组从 23.3（95%CI，18.6-28.1）降至 17.8（95%CI，13.8-21.8）。
这项研究的结果支持使用接受和承诺疗法来降低重病儿童父母的创伤后应激症状，无论诊断如何。这些发现还表明，一种简短的、基于视频会议平台的小组形式可以有效地用于接触难以到达的人群，特别是居住在非城市地区的父亲和照顾者。
澳大利亚和新西兰临床试验注册中心标识符：ACTRN12611000090910。
