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创伤性脑损伤后儿科重症监护后综合征的情感方面

Emotional Aspects of Pediatric Post-Intensive Care Syndrome Following Traumatic Brain Injury.

作者信息

Bradbury Kathryn R, Williams Cydni, Leonard Skyler, Holding Emily, Turner Elise, Wagner Amanda E, Piantino Juan, Luther Madison, Hall Trevor A

机构信息

Division of Pediatric Psychology, Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University and Doernbecher Children's Hospital, Portland, OR USA.

Children's Neuropsychological Services, 26 Chestnut Street, Suite 2E, Andover, MA USA.

出版信息

J Child Adolesc Trauma. 2021 Apr 6;14(2):177-187. doi: 10.1007/s40653-020-00332-y. eCollection 2021 Jun.

Abstract

Children with traumatic brain injury (TBI) requiring neurocritical care are at risk for neurocognitive, emotional, physical, and psychosocial difficulties, collectively known as Post-Intensive Care Syndrome. Our study assessed parent-reported emotional functioning and identified risk factors for emotional sequelae in the acute recovery phase. Fifty-three children between 5 and 18 years old hospitalized for TBI were assessed 1-month following discharge. Relevant injury-, child-, and family-specific variables were collected. Emotional functioning was assessed using PROMIS Parent Proxy Report Short Forms for Anxiety and Depressive Symptoms. We used Chi-square tests to evaluate differences between children with and without elevations in anxiety and depressive symptoms. Logistic regression determined predictors of elevations in symptoms among significant variables. Parents frequently endorsed moderate or worse anxiety (45.2%) and depressive (32.1%) symptoms among children. Mechanism of injury and elevated parent post-traumatic stress disorder (PTSD) symptoms were associated with elevated anxiety and depressive symptoms, while direct family involvement in the accident/injury was associated only with elevated anxiety symptoms. Results from logistic regression indicated that only elevated parent PTSD symptoms were a significant predictor for child anxiety and depressive symptoms. Anxiety and depressive symptoms are prevalent in the acute recovery phase of TBI. Consistent with previous research, elevations in anxiety and depressive symptoms were more related to psychosocial factors than injury severity. High levels of parent PTSD symptoms and their relationship with children's internalizing symptoms highlight the need for mental health treatment for TBI patients and their families.

摘要

需要神经重症监护的创伤性脑损伤(TBI)儿童面临神经认知、情绪、身体和心理社会方面的困难风险,这些统称为重症监护后综合征。我们的研究评估了家长报告的情绪功能,并确定了急性恢复期情绪后遗症的风险因素。对53名5至18岁因TBI住院的儿童在出院后1个月进行了评估。收集了相关的损伤、儿童和家庭特定变量。使用PROMIS家长代理报告焦虑和抑郁症状简表评估情绪功能。我们使用卡方检验来评估焦虑和抑郁症状有无升高的儿童之间的差异。逻辑回归确定了显著变量中症状升高的预测因素。家长们经常认可儿童中存在中度或更严重的焦虑(45.2%)和抑郁(32.1%)症状。损伤机制和家长创伤后应激障碍(PTSD)症状升高与焦虑和抑郁症状升高有关,而直系亲属直接参与事故/受伤仅与焦虑症状升高有关。逻辑回归结果表明,只有家长PTSD症状升高是儿童焦虑和抑郁症状的显著预测因素。焦虑和抑郁症状在TBI的急性恢复期很普遍。与先前的研究一致,焦虑和抑郁症状的升高与心理社会因素的关系比与损伤严重程度的关系更大。家长高水平的PTSD症状及其与儿童内化症状的关系凸显了对TBI患者及其家庭进行心理健康治疗的必要性。

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