Reactions in Parents of Children With Life Threatening Illness

This article review will look at a research study that was conducted to determine more precisely what were the effects on parents who were recently given a diagnosis relative to their child that was potentially life threatening. As one might imagine, this can be a stressful situation for any parent. While a reaction that was based on acute stress might seem to be common sense, the research set out to study the phenomena in a systematic way.

At four weeks following a child's diagnosis of a serious illness, 49 -- 54% of parents met DSM-IV criteria for acute stress disorder, across a number of illness groups, whereas 15 -- 27% of parents were in the moderate/severe range for depression and anxiety, and 25 -- 31% for stress. Results from this study demonstrate that rates and severity of these psychological reactions in parents of seriously ill children do not vary according to illness type (Muscara, et al., 2015).

The research outlines the situation which has led to the research aims of this study by briefly providing a background of the previous research that has been conducted in the field. There is no surprise that parents who have children that have a life threatening illness can experience psychological duress. Some studies have also shown that the psychological reactions are present regardless of the specific form of illness that was diagnosed in the child. Furthermore, previous studies have also found that the initial effects of the psychological trauma that was incurred can also be long-lasting and persist indefinitely. The researchers also identify a research model that has been used in previous efforts known as the Pediatric Medical Traumatic Stress Model (PMTSM) which is defined as (Muscara, et al., 2015):

"a useful framework in which to understand the development and trajectory of psychological disorders in parents associated with child medical trauma, and in identifying the optimal time for treatment."

Results using this model have indicated that the factors related to the early reaction that the parents have when learning about the diagnosis can be effective predictors of the long-term implications of the responses.

Based on the previous research, the researchers in this study frame their problem statement as (Muscara, et al., 2015):

"it remains unclear as to whether specific child illness types confer different risk on parents for developing clinically significant psychological reactions and longer-term mental health problems. Only a very small number of studies have examined psychological reactions in parents across different medical conditions simultaneously"

For example, the severity of the illness and the degree of the potential for mortality could differentiate different groups. For example, a parent who has learned of a child's cancer diagnosis may react (on average) statistically different from another individual with a slightly less threatening illness (such as a brain injury). So this particular study sets out to investigate these relationships, and whether illness-specific consequences exist for parent mental health following their child's diagnosis of serious illness/injury, will assist healthcare providers to identify and treat these mental health issues appropriately, and prevent the development of more serious and chronic mental health problems (Muscara, et al., 2015)". Having a better understanding between the factors and how they relate to each other could be used to help parents under duress and address many social problems related to these circumstances.

The studies formal hypothesis is also provided and reads as:

"We hypothesized that there would be no differences across childhood illness groups with respect to the levels of parent acute traumatic stress, depression, anxiety, and general stress symptoms, given that all illness types posed a threat of mortality and morbidity for the child. Our secondary aim was to investigate the relationship between symptoms of acute traumatic stress, and symptoms of depression, anxiety and general stress in this cohort of parents. We hypothesized that there would be a significant association between these symptoms within our cohort."

The IV is: Children's medical factors (illnesses or injuries)

The DV is: Parent's psychological reactions

The children's medical factors consist of the type of illness and the severity. The parents' psychological reactions will be recorded in terms of standard stress and depression tools that are available. Both variable seem to make sense in this case based off the literature review that is provided.

This paper reports the results from wave one of a prospective, longitudinal study; the Take a Breath study, which is being conducted at the Royal Children's Hospital (RCH), Melbourne, Australia; a state-wide, tertiary, pediatric hospital treating seriously ill children. Data were collected from participating parents within four weeks of child diagnosis or hospital admission between November 2010 and August 2012 (Muscara, et al., 2015).

• Participants included parents of children diagnosed and/or admitted to The RCH, where the illness or injury involved the threat of death or physical integrity to the child.

• Participants were recruited from consecutive first admissions to the RCH cardiology, oncology, and PICU departments

Other selection criteria included these requirements:

• parents with an active and current parenting role with the hospitalized child;

• child aged 0 -- 18 years;

• child diagnosed with or admitted due to a life threatening illness within the previous four weeks; child's first presentation of the illness

• exclusions for multiple traumas and previous health conditions

• exclusions for language barriers

With the sampling and the selection criteria, the resulting sample was comprised of parents from 145 eligible families agreed to participate, with a total of 134 mothers and 60 fathers participating and returning complete data (Muscara, et al., 2015). The sampling criterion are appropriate for this type of population given its unique circumstances. However, there may be cultural influences that could be present based on the entire sample consisting of Australian domestic citizens.

The data collection procedures consisted of:

"Research team members monitored daily admissions lists of the target inpatient wards, and liaised with clinical staff to identify eligible families. A member of the research team approached families on the ward in order to explain the study, and obtained written consent. Parents were provided study questionnaires and asked to return them within four weeks of their child's admission or surgery, via either mail or by leaving it with nursing staff (Muscara, et al., 2015)."

The two surveys used to collect psychological data included:

• Acute Stress Disorder Scale (ASDS) is a 19-item self-report measure which assesses acute stress disorders up to four weeks following a traumatic event, and identifies those who may be at risk for developing PTSD.

• Depression Anxiety Stress Scales -- Short-Form (DASS) is a 21-item self-report instrument designed to assess depressive, anxiety and general stress symptoms. Scores below nine, seven, and 14 respectively on the depression, anxiety and stress subscales are considered to be in the non-clinical range.

The medical related factors that data was collect for included:

• Length of stay

• Medical records to determine illness severity

There were no major issues identified in regards to the study and research design other than the fact that given only an Australian sample if the results would be generalizable to other populations. For example, there may be some cultural variability to be found in other samples. However, it is at least reasonable to suspect that the parent child bond would likely be largely independent of cultural influences; but further research would be need to confirm such relationships.