Psychosocial Risk Screening for Parent Posttraumatic Stress Symptoms Post-PICU Discharge

Introduction: Up to 79% of parents have posttraumatic stress symptoms (PTSS) after a child’s PICU admission. A barrier to improving longterm PICU outcomes for families is the lack of tools to identify parents at-risk for PTSS. We hypothesize that parent psychosocial risk at PICU admission will predict parent PTSS post-discharge.


Methods: We conducted a prospective observational cohort study in parents (biological/other caregiver) of children with acute illness or injury admitted to PICU with expected stay of ≥3-days. Parents were recuited within 48 hrs of PICU admission. One parent per child completed the screening survey that contained the Psychosocial Assessment Tool (PAT), a validated tool that assesses parents’ psychosocial risk and resources in 6 areas, along with 10 secondary screening measures. Measures were chosen based on a conceptual model informed by stress-coping theory. Three months post-discharge, parents completed the Short PTSD Rating Interview, the primary outcome measure for PTSS. Multivariable linear regression assessed the association between the PAT and other screening measures with PTSS. Variables were included if associated (p < 0.05) with post-discharge PTSS in bivariate analysis.


Results: 133 parents completed the admission screening survey, with 96 completing the post-discharge survey. Parent median age was 33 years, with 59% mothers, and 58% non-white. Median child age was 3 years, with 46% female. Admission diagnoses included respiratory (41%) and neurologic (23%) conditions, with median PICU stay of 6 days. On the PAT, 47% had low psychosocial risk scores, 43% medium risk, and 10% high risk. In the multivariable model (n=87, R2=0.54), parents with high risk PAT scores (coef 6.4, p=0.002), PTSS and severe anxiety symptoms prior to PICU admission (coef 4.6, p=0.003; coef 5.9, p=0.017), and prior family member with ICU admission (coef 3.9, p=0.002) were associated with increased PTSS post-discharge.


Conclusions: Findings suggest that a short screening for distress (e.g., PTSS, anxiety) at PICU admission could identify parents who need immediate crisis intervention. A secondary assessment of psychosocial risk (e.g., PAT) could identify resources to help parents post-discharge. This two-tiered approach may decrease vulnerability to PTSS during and after their child’s PICU admission.