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Risk factors of post-traumatic stress disorder after hospitalization in a pediatric intensive care unit: a systematic literature review

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Abstract

The number of studies on post-traumatic stress disorder after hospitalization in a pediatric intensive care unit raised since 2004. The objective of this systematic review was to summarize and critically examine the literature about risk factors for these children to develop post-traumatic stress disorder following admission to an intensive care unit. The data sources were PubMed, Cochrane, Web of Science, PsycInfo, SUDOC, Scopus, and ScienceDirect. Studies were selected if they were in English or French and published between 01/01/2004 and 31/01/2022. Studies were excluded if patients were less than 1 month old and if no post-traumatic stress disorder was found. The internal validity and risk of bias were assessed using the National Institutes of Health Study Quality Assessment Tools for observational studies and the Ottawa Scale was used for the interventional study. The search yielded 523 results and 22 articles met inclusion criteria. Three common risk factors were identified from the data: parental post-traumatic stress disorder (especially in mothers), severity of illness and delusional memories. Internalizing behavior in children, acute parent and child stress, emergency admission and sepsis are also potential risk factors that require further investigation. The prevalence of this pathology is substantial (between 14 and 36%) and increasing awareness among pediatricians and psychologists seems necessary. Prevention programs are being studied to reduce the incidence of post-traumatic stress disorder in this population. Child and adolescent psychiatry liaison should collaborate with pediatric teams to support this objective.

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References

  1. Association, Pull-Erpelding M-C (2015) A psychiatric. DSM-5®. Elsevier Masson, Issy-les-Moulineaux

    Google Scholar 

  2. Stuber ML, Shemesh E (2006) Post-traumatic stress response to life-threatening illnesses in children and their parents. Child Adolesc Psychiatr Clin N Am Juill 15:597–609

    Article  Google Scholar 

  3. Walker AM, Harris G, Baker A et al (1999) Post-traumatic stress responses following liver transplantation in older children. J Child Psychol Psychiatry 40:363–374

    Article  CAS  Google Scholar 

  4. Association, Crocq M-A, Guelfi J-D (2004) A psychiatric. DSM-IV-TR. Masson, Issy-les-Moulineaux

    Google Scholar 

  5. Davydow DS, Gifford JM, Desai SV et al (2008) Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry 30:421–434. https://doi.org/10.1016/j.genhosppsych.2008.05.006

    Article  Google Scholar 

  6. Rees G, Gledhill J, Garralda ME, Nadel S (2004) Psychiatric outcome following paediatric intensive care unit (PICU) admission: a cohort study. Intensive Care Med 30:1607–1614

    Article  Google Scholar 

  7. Camisasca E (2011) Post-traumatic stress related to pediatric illness and injury. Post-traumatic syndromes in childhood and adolescence. John Wiley & Sons Ltd, Hoboken, pp 91–110

    Chapter  Google Scholar 

  8. Prince E, Gerstenblith TA, Davydow D, Bienvenu OJ (2018) Psychiatric morbidity after critical illness. Crit Care Clin 34:599–608. https://doi.org/10.1016/j.ccc.2018.06.006

    Article  Google Scholar 

  9. Parker AM, Sricharoenchai T, Raparla S et al (2015) Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med 43:1121–1129. https://doi.org/10.1097/CCM.0000000000000882

    Article  Google Scholar 

  10. National Institute for Health and care Excellence. Rehabilitation after critical illness in adults | Guidance and guidelines | NICE Internet. 25 March 2009. National Institute for, London

  11. Ziegler MF (2005) Posttraumatic stress responses in children: Awareness and practice among a sample of pediatric emergency care providers. Pediatrics 115:1261–1267

    Article  Google Scholar 

  12. Bolton D, O’Ryan D, Udwin O et al (2000) The long-term psychological effects of a disaster experienced in adolescence: II: general psychopathology. J Child Psychol Psychiatry 41:513–523. https://doi.org/10.1111/1469-7610.00636

    Article  CAS  Google Scholar 

  13. Hiller RM, Meiser-Stedman R, Fearon P et al (2016) Research review: changes in the prevalence and symptom severity of child post-traumatic stress disorder in the year following trauma–a meta-analytic study. J Child Psychol Psychiatry 57:884–898. https://doi.org/10.1111/jcpp.12566

    Article  Google Scholar 

  14. Copeland WE, Keeler G, Angold A, Costello EJ (2007) Traumatic events and posttraumatic stress in childhood. Arch Gen Psychiatry 64:577–584. https://doi.org/10.1001/archpsyc.64.5.577

    Article  Google Scholar 

  15. Gedda M (2015) Traduction française des lignes directrices PRISMA pour l’écriture et la lecture des revues systématiques et des méta-analyses. Kinésithérapie Rev 15:39–44

    Article  Google Scholar 

  16. Cohen J (1960) A Coefficient of agreement for nominal scales. Educ Psychol Meas 20(37):46

    Google Scholar 

  17. Study Quality Assessment Tools | NHLBI, NIH. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed 20 Mar 2022.

  18. Gerlier J (2002) L’échelle de Jadad pour approcher la qualité d’un ECR. Acupuncture et moxibustion 1:66–67

    Google Scholar 

  19. Rennick JE, Morin I, Kim D et al (2004) Identifying children at high risk for psychological sequelae after pediatric intensive care unit hospitalization*. Pediatr Crit Care Med 5:358–363. https://doi.org/10.1097/01.PCC.0000128603.20501.0D

    Article  Google Scholar 

  20. Shears D, Nadel S, Gledhill J, Garralda ME (2005) Short-term psychiatric adjustment of children and their parents following meningococcal disease. Pediatr Crit Care Med 6:39–43. https://doi.org/10.1097/01.PCC.0000144705.81825.EE

    Article  Google Scholar 

  21. Bronner MB, Knoester H, Bos AP et al (2008) Posttraumatic stress disorder (PTSD) in children after paediatric intensive care treatment compared to children who survived a major fire disaster. Child Adolesc Psychiatry Ment Health 2:9. https://doi.org/10.1186/1753-2000-2-9

    Article  Google Scholar 

  22. Colville G, Pierce C (2012) Patterns of post-traumatic stress symptoms in families after paediatric intensive care. Intensive Care Med 38:1523–1531. https://doi.org/10.1007/s00134-012-2612-2

    Article  Google Scholar 

  23. Nelson LP, Lachman SE, Li SW, Gold JI (2019) The effects of family functioning on the development of posttraumatic stress in children and their parents following admission to the PICU. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc 20:e208–e215. https://doi.org/10.1097/PCC.0000000000001894

    Article  Google Scholar 

  24. Le Brocque RM, Dow BL, McMahon H et al (2020) The course of posttraumatic stress in children: examination of symptom trajectories and predictive factors following admission to pediatric intensive care. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc 21:e399–e406. https://doi.org/10.1097/PCC.0000000000002316

    Article  Google Scholar 

  25. Colville G, Kerry S, Pierce C (2008) Children’s factual and delusional memories of intensive care. Am J Respir Crit Care Med 177:976–982. https://doi.org/10.1164/rccm.200706-857OC

    Article  Google Scholar 

  26. Colville GA, Pierce CM (2013) Children’s self-reported quality of life after intensive care treatment. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc 14:e85-92. https://doi.org/10.1097/PCC.0b013e3182712997

    Article  Google Scholar 

  27. Caspani G, Corbet Burcher G, Garralda ME et al (2018) Inflammation and psychopathology in children following PICU admission: an exploratory study. Evid Based Ment Health 21:139–144. https://doi.org/10.1136/ebmental-2018-300027

    Article  Google Scholar 

  28. Dow BL, Kenardy JA, Le Brocque RM, Long DA (2012) The utility of the children’s revised impact of event scale in screening for concurrent PTSD following admission to intensive care. J Trauma Stress 25:602–605. https://doi.org/10.1002/jts.21742

    Article  Google Scholar 

  29. Vermunt LC, Buysse CMP, Joosten KFM et al (2008) Behavioural, emotional, and post-traumatic stress problems in children and adolescents, long term after septic shock caused by Neisseria meningitidis. Br J Clin Psychol 47:251–263

    Article  CAS  Google Scholar 

  30. Als LC, Picouto MD, Hau S-M et al (2015) Mental and physical well-being following admission to pediatric intensive care. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc 16:e141-149. https://doi.org/10.1097/PCC.0000000000000424

    Article  Google Scholar 

  31. Als LC, Picouto MD, O’Donnell KJ et al (2017) Stress hormones and posttraumatic stress symptoms following paediatric critical illness: an exploratory study. Eur Child Adolesc Psychiatry 26:511–519. https://doi.org/10.1007/s00787-016-0933-3

    Article  Google Scholar 

  32. Corbet Burcher G, Picouto MD, Als LC et al (2018) Post-traumatic stress after PICU and corticosteroid use. Arch Dis Child 103:887–889. https://doi.org/10.1136/archdischild-2017-314157

    Article  Google Scholar 

  33. Connolly D, McClowry S, Hayman L et al (2004) Posttraumatic stress disorder in children after cardiac surgery. J Pediatr 144:480–484. https://doi.org/10.1016/j.jpeds.2003.12.048

    Article  Google Scholar 

  34. Long D, Gibbons K, Le Brocque R et al (2021) Midazolam exposure in the paediatric intensive care unit predicts acute post-traumatic stress symptoms in children. Aust Crit Care. https://doi.org/10.1016/j.aucc.2021.06.004

    Article  Google Scholar 

  35. Stowman S, Kearney CA, Daphtary K (2015) Mediators of initial acute and later posttraumatic stress in youth in a PICU. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc 16:e113-118. https://doi.org/10.1097/PCC.0b013e31822f1916

    Article  Google Scholar 

  36. Dow BL, Kenardy JA, Long DA, Le Brocque RM (2019) Cognitive/affective factors are associated with children’s acute posttraumatic stress following pediatric intensive care. Psychol Trauma Theory Res Pract Policy 11:55–63. https://doi.org/10.1037/tra0000349

    Article  Google Scholar 

  37. Watson RS, Asaro LA, Hertzog JH et al (2018) Long-term outcomes after protocolized sedation versus usual care in ventilated pediatric patients. Am J Respir Crit Care Med 197:1457–1467

    Article  Google Scholar 

  38. Board R, Dai J (2011) Effects of five parent-and-child risk factors on salivary cortisol levels and symptoms of posttraumatic stress disorder in school-age, critically ill children: pilot study. Heart Lung J Crit Care 40:236–246. https://doi.org/10.1016/j.hrtlng.2010.05.051

    Article  Google Scholar 

  39. Rosenberg L, Rosenberg M, Sharp S et al (2018) Does Acute propranolol treatment prevent posttraumatic stress disorder, anxiety, and depression in children with burns? J Child Adolesc Psychopharmacol 28:117–123

    Article  CAS  Google Scholar 

  40. Lopes-Júnior LC, de Rosa MADRP, de Lima RAG (2018) Psychological and psychiatric outcomes following PICU admission: a systematic review of cohort studies. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc 19:e58–e67. https://doi.org/10.1097/PCC.0000000000001390

    Article  Google Scholar 

  41. Bowlby J (1988) A secure base: parent-child attachment and healthy human development. Basic Books, New York

    Google Scholar 

  42. Steele H, Steele M, Fonagy P (1996) Associations among attachment classifications of mothers, fathers, and their infants. Child Dev 67:541–555. https://doi.org/10.1111/j.1467-8624.1996.tb01750.x

    Article  CAS  Google Scholar 

  43. Steele H, Steele M (2005) Understanding and Resolving emotional conflict: The London parent-child project. Attachment from infancy to adulthood: the major longitudinal studies. Guilford Publications, New York, NY, US, pp 137–164

    Google Scholar 

  44. Sagi A, van IJzendoorn M, Scharf M et al (1997) Ecological constraints for intergenerational transmission of attachment. Int J Behav Dev 20(2):287–299. https://doi.org/10.1080/016502597385342

    Article  Google Scholar 

  45. Traiter les psychotraumatismes, Gérard Lopez, Dunod, Les Ateliers Du Praticien, 16th July 2020

  46. Piva S, McCreadie VA, Latronico N (2015) Neuroinflammation in sepsis: sepsis associated delirium. Cardiovasc Hematol Disord Drug Targets 15:10–18

    Article  CAS  Google Scholar 

  47. Sheridan RL, Stoddard FJ, Kazis LE et al (2014) Long-term posttraumatic stress symptoms vary inversely with early opiate dosing in children recovering from serious burns: effects durable at 4 years. J Trauma Acute Care Surg 76:828–832. https://doi.org/10.1097/TA.0b013e3182ab111c

    Article  CAS  Google Scholar 

  48. Bokszczanin A (2007) PTSD symptoms in children and adolescents 28 months after a flood: age and gender differences. J Trauma Stress 20:347–351. https://doi.org/10.1002/jts.20220

    Article  Google Scholar 

  49. Baker SC, Gledhill JA (2017) Systematic review of interventions to reduce psychiatric morbidity in parents and children after Picu admissions*. Pediatr Crit Care Med 18:343–348. https://doi.org/10.1097/PCC.0000000000001096

    Article  Google Scholar 

  50. NCT04961697 (2021) Family and Patient Outcomes After Pediatric Intensive Care (FOREVER). https://clinicaltrials.gov/show/NCT04961697. https://doi.org/10.1002/central/CN-02290377. Accessed Jan 2022

  51. Hartman ME, Williams CN, Hall TA et al (2020) Post-intensive-care syndrome for the pediatric neurologist. Pediatr Neurol 108:47–53. https://doi.org/10.1016/j.pediatrneurol.2020.02.003

    Article  Google Scholar 

  52. Morina N, Koerssen R, Pollet TV (2016) Interventions for children and adolescents with posttraumatic stress disorder: a meta-analysis of comparative outcome studies. Clin Psychol Rev 47:41–54. https://doi.org/10.1016/j.cpr.2016.05.006

    Article  Google Scholar 

  53. Gillies D, Maiocchi L, Bhandari AP et al (2016) Psychological therapies for children and adolescents exposed to trauma. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD012371

    Article  Google Scholar 

  54. National Collaborating Centre for Mental Health (UK) (2005) Post-traumatic stress disorder: the management of PTSD in adults and children in primary and secondary care. Gaskell, Leicester (UK)

  55. National Institute for Health and care Excellence (2018) Post-traumatic stress disorder | Guidance and guidelines |. National Institute for Health and care Excellence, London

    Google Scholar 

  56. Schottelkorb AA, Doumas DM, Garcia R (2012) Treatment for childhood refugee trauma: a randomized, controlled trial. Int J Play Ther 21:57–73. https://doi.org/10.1037/a0027430

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Intensive Care, University Hospital of Angers, Angers, France

    Alice de Pellegars & Gérald Boussicault

  2. Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France

    Cindy Cariou, Marine Le Floch, Philippe Duverger & Elise Riquin

  3. Reference Center for Learning Disabilities, Nantes University Hospital, Nantes, France

    Philippe Duverger & Elise Riquin

  4. Laboratory of Psychology, LPPL EA4638, University of Angers, Angers, France

    Philippe Duverger & Elise Riquin

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  1. Alice de Pellegars
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de Pellegars, A., Cariou, C., Le Floch, M. et al. Risk factors of post-traumatic stress disorder after hospitalization in a pediatric intensive care unit: a systematic literature review. Eur Child Adolesc Psychiatry (2023). https://doi.org/10.1007/s00787-023-02141-8

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