Kaplan Daniel, Nesfield Mekela Whyte, Eldridge Peter S, Cuddy WIlliam, Ansari Nadia, Siller Pamela, Li Simon
Department of Pediatrics, Division of Pediatric Critical Care, 554322Northwell Health Cohen Children's Medical Center, New Hyde Park, NY, USA.
Department of Pediatrics, Division of Pediatric Critical Care, Children's National Hospital, Washington, DC, USA.
J Intensive Care Med. 2023 Jan;38(1):11-20. doi: 10.1177/08850666221100482. Epub 2022 May 20.
To examine medical and psychosocial risk factors associated with the development of acute stress in parents of patients unexpectedly admitted to the PICU.
Cross-sectional observational study.
Two tertiary care children's hospitals with mixed medical/surgical/cardiac PICU.
Parents of patients unexpectedly admitted to the PICU.
None.
265 parents of 188 children were enrolled of whom 49 parents (18%) met ASD qualification and 108 (41%) parents developed ASD symptoms as determined by the ASDS-5 scale. Risk factors making parents likely to meet ASD qualification include parents from area served by Penn State (p < 0.001), prior psychiatric illness (p < 0.01), and female gender (p < 0.05), while graduating college was protective (p < 0.05). In the multivariate analysis, parents from area served by Penn State (OR 3.00 (1.49-6.05) p < 0.01) and parents with prior psychiatric illness (OR 2.16 (1.03-4.52) p < 0.05) were associated with ASD qualification. Parents who graduated college or had prior medical problems were not significant.Risk factors making parents more likely to develop ASD symptoms (significant symptoms that do not meet ASD qualification) include patients with higher PRISM-III scores (p < 0.01), patients receiving cardiovascular support (p < 0.05), parents with a history of prior physical/sexual abuse (p < 0.01), parental involvement in the past with a major disaster/accident (p < 0.01), a family member admitted to an ICU in the past (p < 0.05) and preexisting parental psychiatric/medical disorders (p < 0.001). In a multivariate analysis, prior parental psychiatric disorder (OR 4.11 (1.80-6.42) p < 0.001), history of parental abuse (OR 3.11 (1.14-5.08) p < 0.05), and parental prior medical problem (OR 2.03 (1.01-3.05) p < 0.05) were associated with the development of ASD symptoms. However, PRISM-III score and prior involvement in major disaster were not significant.
A combination of psychosocial parental risk factors and patient factors were associated with acute stress in parents. Further studies evaluating targeted hospital interventions towards parents most at-risk are needed.
研究儿科重症监护病房（PICU）意外收治患者的家长发生急性应激反应的医学和社会心理风险因素。
横断面观察性研究。
两家集医疗/外科/心脏科于一体的三级护理儿童医院的PICU。
PICU意外收治患者的家长。
无。
纳入了188名儿童的265名家长，其中49名家长（18%）符合急性应激障碍（ASD）的诊断标准，108名（41%）家长出现了ASD症状，这是根据ASDS - 5量表确定的。使家长可能符合ASD诊断标准的风险因素包括来自宾夕法尼亚州立大学服务地区的家长（p < 0.001）、既往有精神疾病（p < 0.01）以及女性（p < 0.05），而大学毕业则具有保护作用（p < 0.05）。在多变量分析中，来自宾夕法尼亚州立大学服务地区的家长（比值比[OR] 3.00[1.49 - 6.05]，p < 0.01）和既往有精神疾病的家长（OR 2.16[1.03 - 4.52]，p < 0.05）与符合ASD诊断标准相关。大学毕业或有既往医疗问题的家长则无显著关联。使家长更有可能出现ASD症状（不符合ASD诊断标准的显著症状）的风险因素包括PRISM - III评分较高的患者（p < 0.01）、接受心血管支持的患者（p < 0.05）、有既往身体/性虐待史的家长（p < 0.01）、家长过去曾经历重大灾难/事故（p < 0.01）、过去有家庭成员入住ICU（p < 0.05）以及家长既往存在精神/医疗障碍（p < 0.001）。在多变量分析中，家长既往精神障碍（OR 4.11[1.80 - 6.42]，p < 0.001）、家长虐待史（OR 3.11[1.14 - 5.08]，p < 0.05）以及家长既往医疗问题（OR 2.03[1.01 - 3.05]，p < 0.05）与ASD症状的发生相关。然而，PRISM - III评分以及过去参与重大灾难的情况并不显著。
家长的社会心理风险因素和患者因素共同与家长的急性应激反应相关。需要进一步开展研究，评估针对高危家长的有针对性的医院干预措施。
