Intensive Care Medicine

, Volume 38, Issue 9, pp 1523–1531 | Cite as

Patterns of post-traumatic stress symptoms in families after paediatric intensive care

  • Gillian ColvilleEmail author
  • Christine Pierce
Pediatric Original



To establish longitudinal rates of post-traumatic stress in a cohort of child–parent pairs; to determine associations with poorer outcome.


This was a prospective longitudinal cohort study set in a 21-bed unit. In total 66 consecutive admissions aged 7–17 years were screened with one parent at 3 and 12 months post-discharge. Measures used were the Children’s Revised Impact of Event Scale (CRIES-8) and the SPAN (short form of Davidson Trauma Scale).


In total 29 (44 %) child–parent pairs contained at least one member who scored above cut-off 12 months after discharge, with scores increasing over time for 18 parents and 26 children. At 3 months, 28 (42 %) parents and 20 (32 %) children scored above cut-off; at 12 months the rates were 18 (27 %) parents and 17 (26 %) children. Parents scoring above cut-off at 12 months were more likely to have had a child admitted non-electively (100 % vs. 77 %, p = 0.028); had higher 3-month anxiety scores (11.5 vs. 4.5, p = 0.001) and their children had higher post-traumatic stress scores at 3 months (14 vs. 8, p = 0.017). Children who scored above cut-off at 12 months had higher 3-month post-traumatic stress scores (18 vs. 7, p = 0.001) and higher Paediatric Index of Mortality (PIM) scores on admission (10 vs. 4, p = 0.037).


The findings that (a) nearly half of families were still experiencing significant symptoms of post-traumatic stress 12 months after discharge; (b) their distress was predicted more by subjective than by objective factors and (c) many experienced delayed reactions, indicate the need for longer-term monitoring and more support for families in this situation


Post-traumatic stress Paediatric intensive care Longitudinal Outcomes Parents 



We thank Sally Hall for her help in drafting the manuscript. This study was supported by a Leading Practice Through Research Award granted to the first author by The Health Foundation, UK.

Supplementary material

134_2012_2612_MOESM1_ESM.doc (47 kb)
Supplementary material 1 (DOC 47 kb)


  1. 1.
    National Institute for Health and Clinical Excellence (2005) Post-traumatic stress disorder: national clinical practice guideline no 26. Gaskell and the British Psychological Society, LondonGoogle Scholar
  2. 2.
    Brewin CR (2003) Posttraumatic stress disorder: malady or myth? Yale University Press, New HavenGoogle Scholar
  3. 3.
    Rees G, Gledhill J, Garralda ME, Nadel S (2004) Psychiatric outcome following paediatric intensive care unit (PICU) admission: a cohort study. Intensive Care Med 30:1607–1614PubMedCrossRefGoogle Scholar
  4. 4.
    Colville G, Kerry S, Pierce C (2008) Children’s factual and delusional memories of intensive care. Am J Respir Crit Care Med 177:976–998PubMedCrossRefGoogle Scholar
  5. 5.
    Balluffi A, Kassam-Adams N, Kazak A, Tucker M, Dominguez T, Helfaer M (2004) Traumatic stress in parents admitted to the pediatric intensive care unit. Pediatr Crit Care Med 5:547–553PubMedCrossRefGoogle Scholar
  6. 6.
    Bronner MB, Peek N, Knoester H, Bos AP, Last BF, Grootenhuis MA (2010) Course and predictors of posttraumatic stress disorder in parents after pediatric intensive care treatment of their child. J Pediatr Psychol 35:966–974PubMedCrossRefGoogle Scholar
  7. 7.
    Davydow DS, Richardson LP, Zatzick DF, Katon WJ (2010) Psychiatric morbidity in pediatric critical illness survivors: a comprehensive review of the literature. Arch Pediatr Adolesc 164:377–383CrossRefGoogle Scholar
  8. 8.
    National Institute for Health and Clinical Excellence (2009) Rehabilitation after critical illness: national clinical practice guideline no 83. NICE, LondonGoogle Scholar
  9. 9.
    Griffiths J, Fortune G, Barber V, Young JD (2007) The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Med 33:1506–1518PubMedCrossRefGoogle Scholar
  10. 10.
    Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Orgeas M, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larché J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B, FAMIREA Study Group (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 171:987–994PubMedCrossRefGoogle Scholar
  11. 11.
    Ward-Begnoche W (2007) Posttraumatic stress symptoms in the pediatric intensive care unit. J Spec Pediatr Nurs 12:84–92PubMedCrossRefGoogle Scholar
  12. 12.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52:1048–1060PubMedCrossRefGoogle Scholar
  13. 13.
    Bryant RA, Salmon K, Sinclair E, Davidson P (2007) The relationship between acute stress disorder and posttraumatic stress disorder in injured children. J Trauma Stress 20:1075–1079PubMedCrossRefGoogle Scholar
  14. 14.
    Chapman C, Mills K, Slade T, McFarlane AC, Bryant RA, Creamer M, Silove D, Teesson M (2011) Remission from post-traumatic stress disorder in the general population. Psychol Med 14:1–9Google Scholar
  15. 15.
    Pearson G, Stickley J, Shann F (2001) Calibration of the paediatric index of mortality in UK paediatric intensive care units. Arch Dis Child 84:125–128PubMedCrossRefGoogle Scholar
  16. 16.
    Townsend P, Phillimore P, Beattie A (1988) Health and deprivation: inequality and the North. Croom Helm, AndoverGoogle Scholar
  17. 17.
    Yule W (1997) Anxiety, depression and post-traumatic stress in childhood. In: Sclare I (ed) Child psychology portfolio. NFER-Nelson, Windsor, pp 35–38Google Scholar
  18. 18.
    Perrin S, Meiser-Stedman R, Smith P (2005) The children’s revised impact of event scale (CRIES): validity of a screening instrument for PTSD. Behav Cogn Psychother 33:487–498CrossRefGoogle Scholar
  19. 19.
    Davidson JR, Book SW, Colket JT, Tupler LA, Roth S, David D, Hertzberg M, Mellman T, Beckham JC, Smith RD, Davison RM, Katz R, Feldman ME (1997) Assessment of a new self-rating scale for post-traumatic stress disorder. Psychol Med 27:153–160PubMedCrossRefGoogle Scholar
  20. 20.
    Brewin CR (2005) Systematic review of screening instruments for adults at risk of PTSD. J Trauma Stress 18:53–62PubMedCrossRefGoogle Scholar
  21. 21.
    Meltzer-Brody S, Churchill E, Davidson JRT (1999) Derivation of the SPAN, a brief diagnostic screening test for post-traumatic stress disorder. Psychiatry Res 8:63–70CrossRefGoogle Scholar
  22. 22.
    Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the hospital anxiety and depression scale: an updated literature review. J Psychosom Res 52:69–77PubMedCrossRefGoogle Scholar
  23. 23.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370PubMedCrossRefGoogle Scholar
  24. 24.
    Gillies ML, Barton J, DiGallo A (2003) Follow-up of young road accident victims. J Trauma Stress 16:523–526PubMedCrossRefGoogle Scholar
  25. 25.
    Landolt MA, Vollrath M, Timm K, Gnehm HE, Sennhauser FH (2005) Predicting posttraumatic stress symptoms in children after road traffic accidents. J Am Acad Child Adolesc Psychiatry 44:1276–1283PubMedCrossRefGoogle Scholar
  26. 26.
    Andrews B, Brewin CR, Philpott R, Stewart L (2007) Delayed onset post-traumatic stress disorder: a systematic review of the evidence. Am J Psychiatry 164:1236–1319Google Scholar
  27. 27.
    Carty J, O’Donnell ML, Creamer M (2006) Delayed-onset PTSD: a prospective study of injury survivors. J Affect Disord 90:257–261PubMedCrossRefGoogle Scholar
  28. 28.
    Jurbergs N, Long A, Ticona L, Phipps S (2009) Symptoms of posttraumatic stress in parents of children with cancer: are they elevated relative to parents of healthy children? J Pediatr Psychol 34:4–13PubMedCrossRefGoogle Scholar
  29. 29.
    Currier JM, Jobe-Shields LE, Phipps S (2009) Stressful life events and posttraumatic stress symptoms in children with cancer. J Trauma Stress 22:28–35PubMedCrossRefGoogle Scholar
  30. 30.
    McFarlane AC (1987) Family functioning and over-protection following a natural disaster: the longitudinal effects of post-traumatic morbidity. Aust N Z J Psychiatry 21:210–218PubMedCrossRefGoogle Scholar
  31. 31.
    Melnyk BM, Alpert-Gillis L, Feinstein NF, Crean HF, Johnson J, Fairbanks E, Small L, Rubenstein J, Slota M, Corbo-Richert B (2004) Creating opportunities for parent empowerment: program effects on the mental health/coping outcomes of critically ill young children and their mothers. Pediatrics 113:597–607CrossRefGoogle Scholar
  32. 32.
    Meiser-Stedman R, Yule W, Smith P, Glucksman E, Dalgleish T (2005) Acute stress disorder and posttraumatic stress disorder in children and adolescents involved in assaults or motor vehicle accidents. Am J Psychiatry 162:1381–1383PubMedCrossRefGoogle Scholar
  33. 33.
    O’Donnell ML, Creamer M, Holmes AC, Ellen S, McFarlane AC, Judson R, Silove D, Bryant RA (2010) Posttraumatic stress disorder: does admission to intensive care unit increase risk? J Trauma 69:627–632PubMedCrossRefGoogle Scholar
  34. 34.
    Colville GA, Cream PR, Kerry SM (2010) Do parents benefit form the offer of a follow-up appointment after their child’s admission to intensive care? An exploratory randomised controlled trial. Intensive Crit Care Nurs 26:146–153PubMedCrossRefGoogle Scholar
  35. 35.
    Griffiths JA, Barber VS, Cuthbertson BH, Young JD (2006) A national survey of intensive care follow-up clinics. Anaesthesia 61:950–955PubMedCrossRefGoogle Scholar
  36. 36.
    Brewin CR, Scragg P, Robertson M, Thompson M, d’Ardenne P, Ehlers A, Psychosocial Steering Group, London Bombings Trauma Response Programme (2008) Promoting mental health following the London bombings: a screen and treat approach. J Trauma Stress 21:3–8PubMedCrossRefGoogle Scholar
  37. 37.
    Colville G (2012) Paediatric intensive Care. The Psychologist 25:206–209Google Scholar
  38. 38.
    Knowles RE, Tarrier N (2009) Evaluation of the effect of prospective patient diaries on emotional well-being in intensive care unit survivors: a randomized controlled trial. Crit Care Med 37:184–191PubMedCrossRefGoogle Scholar
  39. 39.
    Jones C, Bäckman C, Capuzzo M, Egerod I, Flaatten H, Granja C, Rylander C, Griffiths RD, RACHEL group (2010) Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomized, controlled trial. Crit Care 14:R168PubMedCrossRefGoogle Scholar
  40. 40.
    Crawford JR, Henry JD, Crombie C, Taylor EP (2001) Brief report: normative data for the HADS from a large non-clinical sample. Br J Clin Psychol 40:429–434PubMedCrossRefGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  1. 1.Paediatric Psychology ServiceSt George’s HospitalLondonUK
  2. 2.PICUGreat Ormond St Hospital for ChildrenLondonUK

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