Applying the Cognitive Model of Post-Traumatic Stress to Examine the Role of Appraisals, Trauma Memory, and Coping Strategies Following Pediatric Injury: A Systematic Review.

UNLABELLED

Following a traumatic injury, 25-57% of children will develop clinically significant post-traumatic stress symptoms (PTSS). The cognitive model of post-traumatic stress disorder posits that PTSS develop based on the encoding of trauma memories and the individual's appraisals of the event and its sequelae. In addition, the behaviors and cognitive strategies used to cope with distress are proposed to serve as causal and maintaining factors for PTSS. The purpose of this study was to systematically review and summarize the role of psychological processing factors, including cognitive appraisals, trauma memory, and coping styles, on the development of PTSS in children following injury. Systematic searches were conducted in May 2024 for articles published at any time in PubMed, APA PsycInfo, and PTSDpubs databases. Included articles analyzed the association between cognitive appraisals, trauma memories, and/or coping strategies and PTSS in children (ages 5-18) who received medical treatment for a single-incident traumatic injury. Data were extracted related to study and sample characteristics, measures, and findings regarding the association between psychological processes and PTSS. The quality of included studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The titles and abstracts of 836 articles were screened, and 105 full text articles were reviewed, resulting in 34 eligible articles. Articles were rated as being of "good" (44%) or "fair" (56%) quality. Studies examined cognitive appraisals ( = 18), trauma memory characteristics ( = 15), and coping strategies ( = 13). Several factors were associated with PTSS, including maladaptive cognitive appraisals, guilt, avoidant coping, and decreased cohesion, accuracy, and context in the trauma narrative. This review provides support for the cognitive model of PTSS when applied to pediatric injury populations. Limitations of the current literature are noted, including lack of evidence of temporal associations and relationships between variables in the cognitive model. Findings can be used to identify cognitive-behavioral treatment targets and ascertain the ideal timing for screening and preventative interventions.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40653-025-00695-0.