Preventing Posttraumatic Stress in Children following Injury

Transcription

1 Preventing Posttraumatic Stress in Children following Injury Presenter: Cristal Lopez Mentors: Meghan Marsac Ph.D., Nancy Kassam-Adams Ph.D., and Kristen Kohser MSW, LSW

2 Overview Define/describe PTSD Background on trauma Introduce the Coping Coach Interven=on Modules Coping Coach study design Objec=ves Design My role in Coping Coach Introduce my own study Ques=on Methodologies Results Discussion

3 What is PTSD? Posttraumatic stress disorder (PTSD) requires exposure to a potentially traumatic event. i.e. death or serious injury to individual/others. Symptoms can include re-experiencing, avoidance, arousal, changes in mood or cognitions, and impaired daily functioning. 1,2 Poorer health outcomes and impaired quality of life. 15

4 Why should we care? Injuries, acute medical illnesses, and medical treatments are among the most common traumatic experiences of children worldwide. Children facing acute pediatric medical events frequently exhibit significant PTSS. 3,12,20,23 20 million U.S. children suffer unintentional injuries annually % significant persistent PTSD 11, 15

5 Why should we care? Prevalence rates of PTSS among children exposed to trauma range widely, from 12 19% of children with injuries or illnesses to 20 63% of children exposed to violence. 16 High prevalence/impact of PTSD Research is needed As of now, preventive PTSS interventions for pediatric medical populations have produced mixed results. 4, 6, 13, 15, 20, 24

6 Internet 83% of U.S. children aged 3-17 have a computer in their home. 8 Low cost, accessible method for delivery of psychological, health information, and interventions. Cognitive Behavioral Therapy shown to be very effective. Missing evidence to be translated into widely accessible interventions

7 Intervention

8 Modules min each (can be repeated) Feelings Appraisals Avoidance Promotion of Social Support

9 Objectives Assess/maximize the feasibility of the Coping Coach intervention for children who experience acute, potentially traumatic medical events due to violence.

10 Design Target sample size: 20 children and their parents Pilot study to examine feasibility, usability, acceptability, and child engagement/ comprehension of the Coping Coach Intervention. Baseline Measures & Interven=on 6 Week Follow up 12 Week Follow up

11 Measures Children will complete: How I Coped Under the Pressure Scale (HICUPS) Child Post-Traumatic Cognitions Inventory (CPTCI) Adaptive Appraisals Questionnaire (AAQ) Child PTSD Symptom Scale (CPSS) Parent will complete: Demographic Questionnaire Traumatic Events Screening Inventory-Parent Report (TESI-P)* Parent Socialization of Coping Questionnaire (PSCQ) Pediatric Quality of Life Inventory (PedsQL) PTSD Checklist (PCL)

12 Eligibility Inclusion Criteria: Children aged 8-12 years of age Child experienced a potential traumatic experience in past 2 weeks Child perceived event as traumatic (determined by screening) English Consent/Assent Child s Glasgow Coma Score >12 Injury had to be due to non familial violence or violent injury (e.g. fight at school) Exclusion Criteria: Child s medical status precludes completing assessments. No parent/guardian available Child s injury involved family violence/abuse Child or parent has been arrested or is subject to legal proceedings related to the injury

13 My role Completed Coping Coach training Screened CHOP s healthcare software (EPIC) for eligibility Enrolled children into study Conducted follow up calls Tested Coping Coach for bugs/updates

14 Psycho-social factors Psychosocial factors potential mechanisms. Low vs. high socioeconomic localities and PTSS levels. 5 Significant effects of social support on PTSS. 14, 21 Parents role 15

15 Question Could parent encouragement to seek social support mediate the relationship between socioeconomic status and PTSS in children following injury? Parental encouragement to seek social support SES PTSS

16 Methodologies 98 Children (aged 8-13 years) Demographic Questionnaire Income Education

17 Methodologies cont. Parent Socialization of Coping Questionnaire (PSCQ): 17 Assesses parents suggestions regarding children s coping strategies with regard to a specific stressor. Subscales include: Distraction Strategies Avoidance Strategies Support Seeking Coping Strategies

18 Methodologies cont. Child PTSD Symptom Scale (CPSS) 9 : 24-item self-report measure yields PTSD severity score and PTSD diagnostic status.

19 SES Results SES Categorization Income $0-29,999 Low SES $30,000-$74,999 Middle SES $75,000+ High SES Education Some High School, High School Diploma, GED Some College Low SES Middle SES Completed College, Graduate/Professional Degree Dennis, E. F., Webb, D. A., Lorch, S. A., Mathew, L., Bloch, J. R., & Culhane, J. F. (2012) United States Census Bureau (2013) Oaks, M. (n.d.). Measuring Socioeconomic Status. High SES Table 1. Cross-Tabulation of SES Categories Low Education Middle Education High Education Low Income 12% 8.7% 0% Middle Income 8.7% 13% 7.6% High Income 6.5% 8.7% 34.8% χ 2 (4, N = 92) = 32.99, p <.001.

20 SES on PTSS Results The effect of education on PTSS: (F(2,93) =.41, p =.67) The effect of income on PTSS: (F(2,96) = 2.82, p =.07)

21 SES on Social Support Results The effect of education on parental encouragement to seek social support: (F(2,91) =.51, p =.61) The effect of income on parental encouragement to seek social support: (F(2,94) = 2.31, p =.11)

22 Discussion Back to step 1: Categorization of SES varied based on parental income or education Future research should utilize a measure of SES that fully incorporates and captures the complexity of SES. Standardized Scale (e.g. Duncan SEI, Nam-Powers OSS, & Household prestige scale) Assessing partial mediation

23 References 1 American Psychiatric Associa=on. (1994). Diagnos=c and sta=s=cal manual of mental disorders, 4 th Edi=on (DSM- IV). Washington, DC: American Psychiatric Publishing. 2 American Psychiatric Associa=on. (2010). DSM- 5 Development: Pos\rauma=c Stress Disorder. 3 Balluffi, A., Kassam- Adams, N., Kazak, A., Tucker, M., Dominguez, T., & Helfaer, M. (2004). Trauma=c stress in parents of children admi\ed to the pediatric intensive care unit. Pediatric Cri=cal Care Medicine, 5, Berkowitz, S. J., Stover, C. S., & Marans, S. R. (2011). The child and family trauma=c stress interven=on: Secondary preven=on for youth at risk of developing PTSD. Journal of Child Psychology and Psychiatry and Allied Disciplines, 52(6), Bradley, R. H., & Corwyn, R. F. (2002). Socioeconomic status and child development. Annual Review Of Psychology, 53(1), Cox, C., & Kenardy, J. (2010). A randomised controlled trial of a web- based early interven=on for children and their parents following accidental injury. Journal of Pediatric Psychology, 35, Dennis, E. F., Webb, D. A., Lorch, S. A., Mathew, L., Bloch, J. R., & Culhane, J. F. (2012). Subjec=ve social status and maternal health in a low income urban popula=on. Maternal And Child Health Journal, 16(4), File, T. (2013). Computer and internet use in the United States. Current populaeon survey reports. Washington, DC: U.S. Census Bureau. 9 Foa E, Johnson K, Feeny N, Treadwell K. The Child PTSD Symptom Scale: A Preliminary Examina=on of its Psychometric Proper=es. Journal of Clinical Child Psychology 2001;30(3):

24 References 10 Grossman D. The history of injury control and the epidemiology of child and adolescent injuries. The Future of Children 2000;10(1): Kahana, S., Feeny, N., Youngstrom, E., & Drotar, D. (2006). Pos\rauma=c stress in youth experiencing illnesses and injuries: An exploratory meta- analysis. Traumatology, 12(2), Kean, E., Kelsay, K., Wamboldt, F., & Wamboldt, M. (2006). Pos\rauma=c stress in adolescents with asthma and their parents. Journal of the American Academy of Child and Adolescent Psychiatry, 45, Kramer, D. N., & Landolt, M. A. (2011). Characteris=cs and efficacy of early psychological interven=ons in children and adolescents aker single trauma: A meta- analysis. European Journal of Psychotraumatology, 2, Lauterbach, D., Koch, E. I., & Porter, K. (2007). The rela=onship between childhood support and later emergence of PTSD. Journal Of TraumaEc Stress, 20(5), Marsac, M. L., Kassam- Adams, N., Delahanty, D. L., Widaman, K., & Barakat, L. P. (2014). Pos\rauma=c stress following acute medical trauma in children: A proposed model of bio- psycho- social processes during the peri- trauma period. Clinical Child And Family Psychology Review, 17(4), Marsac, M. L., Winston, F. K., Hildenbrand, A. K., Kohser, K. L., March, S., Kenardy, J., & Kassam- Adams, N. (2015). Systema=c, theore=cally grounded development and feasibility tes=ng of an innova=ve, preven=ve web- based game for children exposed to acute trauma. Clinical PracEce In Pediatric Psychology, 3(1),

25 References 17 Miller P, Kliewer W, Hepworth J, Sandler I. Maternal socializa=on of children s postdivorce coping: Development of a measurement model. Journal of Applied Developmental Psychology 1994;15: Mintzer, L., Stuber, M., Seacord, D., Castaneda, M., Mesrkhani, V., & Glover, D. (2005). Trauma=c stress symptoms in adolescent organ transplant recipients. Pediatrics, 115(6), Oaks, M. (n.d.). Measuring Socioeconomic Status. Retrieved July 22, 2015, from h\p:// FullChapter.pdf 20 Stallard, P., & Smith, E. (2007). Appraisals and cogni=ve coping styles associated with chronic post- trauma=c symptoms in child road traffic accident survivors. Journal of Child Psychology and Psychiatry and Allied Disciplines, 48(2), Taylor, S. E., Welch, W. T., Kim, H. S., & Sherman, D. K. (2007). Cultural differences in the impact of social support on psychological and biological stress responses. Psychological Science, 18(9), United States Census Bureau (2013). Income and Poverty in the United States. Issued September Accessed July 21, Walker, A., Harris, G., Baker, A., Kelly, D., & Houghton, J. (1999). Pos\rauma=c stress responses following liver transplanta=on in older children. Journal of Child Psychology and Psychiatry, 40(3), Zehnder, D., Prchal, A., Vollrath, M., & Landolt, M. (2006).Prospec=ve study of the effec=veness of coping in pediatric pa=ents. Child Psychiatry and Human Development, 36(3),

26 Acknowledgments Meghan Marsac, Ph.D. Nancy Kassam-Adams, Ph.D. Kristen Kohser, LSW CARIT Team Center for Injury Research and Prevention (CIRP) Staff Children & Parent participants Joanne Levy Safa Browne SUMR Cohort 2015

27 Ques=ons?