.jpg "Patrice Pryce, BS, MD photo")
Jeffrey Edwards, MD, MA, MAS
Associate Professor of Pediatrics
New York-Presbyterian/Columbia University Irving Medical Center, United States
Disclosure information not submitted.
Title: Parental Adverse Childhood Experiences and Stress in Families and Children Following PICU Admission
INTRODUCTION/HYPOTHESIS: Pediatric intensive care unit (PICU) admission is stressful and can cause post-traumatic stress disorder (PTSD) in patients and parents. Adverse childhood experiences (ACEs)—abuse, neglect, and household dysfunction occurring under age 18—may worsen stress and lead to unfavorable biopsychosocial outcomes for parents and children. We explored associations between parental ACEs and post-ICU PTSD symptoms in them and their children.
Methods: Prospective, observational study of English-speaking parents of PICU patients admitted for >2 days. Parents completed a ACE questionnaire and weekly Abbreviated Parental Stressor Scale for PICU (A-PSS) during their child's PICU stay and PTSD checklist for DSM-5 (PCL-5) and Child Stress Disorder Checklist-Short Form (CSDC), a PTSD screening tool, 30 days post-discharge. Correlations between ACEs and PCL-5 and CSDC, as well as between PCL-5 and CSDC, were derived using Spearman’s coefficients. Associations between ACEs and PCL-5 and CSDC were explored with logistic regression; various clinical and demographic variables were adjusted for in separate models due to small sample/outcome size.
Results: Over 6 months, 100 of 126 parents approached enrolled. 82% were female; 48% identified as white, 17% as black, and 16% as Hispanic/Latino. A majority (70%) had >1 ACE; 16% had >3 ACEs. Of the 74 parents whose children were 30 days post-discharge, 51 (69%) completed follow-up. Five (10%) were high risk for PTSD. 51% of children screened at risk for PTSD. Parental ACEs were weakly correlated with PTSD in parents (rho=0.34, p=0.015) but not in children (p=0.59). PTSD screening in parents and children was weakly correlated (rho=0.33, p=0.023). For each additional ACE, parents had 86% greater odds of high PTSD risk (OR=1.86, p=0.01). After separately adjusting for race, education, past PICU stays, admission illness severity, PICU length of stay, and average A-PSS, ACEs remained positively associated with high PTSD risk (all ORs 1.78-2.95, p< 0.043). ACEs were not associated with CSDC after adjusting for the same variables.
Conclusions: Many PICU parents reported ACEs, and some were at high risk for PTSD. More parental ACEs were associated with greater odds of parental PTSD. Understanding how parental ACEs impact post-ICU stress may be essential in trauma-informed care.