Invisible injuries

Accidents are a major cause of injury in children and can have great impact on the lives of children and their parents. The aims of this research project were (1) to evaluate the utility in the Netherlands of the STEPP, a screening instrument to identify children (aged 8-18) and parents at risk for Posttraumatic Stress Disorder (PTSD) following child accidental injury, and (2) to examine short (3 months) and long-term (2–4 years) posttraumatic stress in children and parents following child accidental injury, including possible associated factors. An exploratory study directed at children below the age of 8 was also included. The prevalence of PTSD in children was 11.6% at 3 months, and 11.4% 2–4 years after the accident. In parents, this was 9.6% and 5.8%, respectively. With adjusted cut-off scores, the STEPP correctly identified 82% of the children and 92% of the parents with a subsequent positive diagnosis. In children, severe acute pain was associated with short-term PTSD and the presence of permanent physical impairment was associated with long-term PTSD. In parents, acute stress was significantly associated with severity of posttraumatic stress symptoms (short and long-term), as was the child’s permanent physical impairment (long-term). At 3 months, parental and child posttraumatic stress were significantly associated. The findings in this thesis support an active approach to prevent PTSD and promote resilience. Findings on associated factors such as severe acute pain and permanent physical impairment provide an opportunity to improve the care for accidentally injured children and their parents.