UNLV Theses, Dissertations, Professional Papers, and Capstones 2009 Posttraumatic stress disorder and other consequences of a PICU admission Stephanie Ann Stowman University of Nevada Las Vegas Follow this and additional works at: https://digitalscholarship.unlv.edu/thesesdissertations Part of the Clinical Psychology Commons, and the Pediatrics Commons Repository Citation Stowman, Stephanie Ann, "Posttraumatic stress disorder and other consequences of a PICU admission" (2009). UNLV Theses, Dissertations, Professional Papers, and Capstones. 88. http://dx.doi.org/10.34917/1377513 This Dissertation is protected by copyright and/or related rights. It has been brought to you by Digital Scholarship@UNLV with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/or on the work itself. This Dissertation has been accepted for inclusion in UNLV Theses, Dissertations, Professional Papers, and Capstones by an authorized administrator of Digital Scholarship@UNLV. For more information, please contact [email protected]. POSTTRAUMATIC STRESS DISORDER AND OTHER CONSEQUENCES OF A PICU ADMISSION by Stephanie Ann Stowman Bachelor of Science Northern Arizona University 2002 Master of Arts University of Nevada, Las Vegas 2005 A dissertation submitted in partial fulfillment of the requirements for the Doctor of Philosophy Degree in Psychology Department of Psychology College of Liberal Arts Graduate College University of Nevada, Las Vegas December 2009 THE GRADUATE COLLEGE We recommend that the dissertation prepared under our supervision by Stephanie Ann Stowman entitled Posttraumatic Stress Disorder and Other Consequences of a PICU Admission be accepted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Psychology Christopher Kearney, Committee Chair Marta Meana, Committee Member Murray Millar, Committee Member Jennifer Keene, Graduate Faculty Representative Ronald Smith, Ph. D., Vice President for Research and Graduate Studies and Dean of the Graduate College December 2009 ii ABSTRACT Posttraumatic Stress Disorder and Other Consequences of a PICU Admission by Stephanie Ann Stowman Dr. Christopher Kearney, Examination Committee Chair Professor of Psychology University of Nevada, Las Vegas Currently, there is a paucity of literature regarding children’s experiences in a pediatric intensive care unit (PICU) relative to caregivers’ experiences. Children admitted to a PICU and their caregivers are at risk for various psychopathology. Disorders commonly identified in seriously ill children include depression, anxiety, acute stress disorder, and posttraumatic stress disorder. Caregivers of seriously ill children are at increased risk of depression, generalized anxiety disorder, acute stress disorder, and posttraumatic stress disorder. Researchers often fail to examine all relevant psychopathology and contributing factors and stressors, such as family environment, in seriously ill children and their caregivers. This study assessed 54 children admitted to a local PICU and their caregivers for relevant psychopathology. The mediating factors between the development of acute stress disorder and posttraumatic stress disorder were examined. The first hypotheses was parental psychopathology, specifically symptoms of anxiety, depression, and ASD, would mediate the relationship between (1) youth ASD symptoms iii during PICU admission and (2) the development of PTSD symptoms 4-7 weeks after discharge from the PICU. The second hypotheses was a child’s psychological functioning prior to admission, specifically symptoms of anxiety and depression, would mediate the relationship between (1) youth ASD symptoms during PICU admission and (2) the development of PTSD symptoms 4-7 weeks after discharge from the PICU. The third hypothesis was that parental psychopathology, specifically symptoms of anxiety and depression, will mediate the relationship between (1) parental ASD symptoms during their child’s PICU admission and (2) the development of PTSD symptoms 4-7 weeks after their child is discharged from the PICU. The fourth hypothesis was that family environment impacted symptoms of psychopathology in both the youth and the caregiver. Specifically, control and conflict were hypothesized to be positively correlated with symptoms of depression and anxiety. With respect to cohesion and expressiveness a negative relationship was hypothesized. A relationship between independence and the symptoms of depression and anxiety was also hypothesized. Analyses did not confirm hypotheses one or three. For hypothesis three, results supported a full mediation by youth anxiety as measured, however, a subsequent Sobel test for the model was not significant. ASD symptoms were a predictor for PTSD, replicating findings of previous research. Study findings also implicate subjective experience and anxiety in the development of ASD and PTSD. A discussion of study results indicate children admitted to a PICU and their parents are at increased risk for psychopathology and assessment should occur as well as intervention consideration. iv TABLE OF CONTENTS ABSTRACT ........................................................................................................................ ii CHAPTER 1 INTRODUCTION .................................................................................... 1 CHAPTER 2 LITERATURE REVIEW ....................................................................... 15 Psychopathology and Severely Ill Children .......................................................... 15 Depression............................................................................................................. 21 Anxiety…............... ............................................................................................... 39 Seriously Ill Children, Caregivers, and Psychopathology .................................... 71 Purpose of the Study ........................................................................................... 106 Hypotheses ......................................................................................................... 108 CHAPTER 3 METHODOLOGY ............................................................................... 112 Participants .......................................................................................................... 112 Measures ............................................................................................................. 112 Procedure ............................................................................................................ 129 Data Analyses ..................................................................................................... 131 CHAPTER 4 DATA ANALYSIS ............................................................................. 137 Hypothesis One ................................................................................................... 137 Hypothesis Two………………………………………………………………...139 Hypothesis Three ………………………………………………………………142 Hypothesis Four ………………………………………………………………. 146 Additional Analyses ……………………………………………………………146 CHAPTER 5 CONCLUSIONS AND RECOMMENDATIONS …………………...150 Clinical Implications ………………………………………………………….. 158 Conclusions and Recommendations for Further Study ………………………. 161 APPENDIX……………………………………………………………………………..164 Appendix I: Severity of Illness and Demographic/Information sheets ............. 164 Appendix II: Tables ............................................................................................ 169 REFERENCES…………………………………………………………………............178 VITA……………………………………………………………………………………217 v CHAPTER 1 INTRODUCTION Pediatric Intensive Care Unit Information In the United States, each year approximately 150,000 to 200,000 children are admitted to pediatric intensive care units (PICU) (Board & Ryan-Wenger, 2002). The largest regional hospital in Southern Nevada reports 600-800 admissions to their PICU each year (K. Daphtary, personal communication, June 15, 2007). A pediatric intensive care unit is a specialized unit of a hospital that provides concentrated care and monitoring of a child or adolescent. The age range of patients in a PICU is 0-16 years. However, admittance to a neonatal intensive care unit is standard for newborns in need of care (Colville, 2001). Children admitted to a PICU experience highly invasive technological interventions necessary to help their recovery from illness (Rennick, Johnston, Dougherty, Platt, & Ritchie, 2002). Children admitted to a PICU have needs met with more supervision and interventions not available in the general unit of a hospital. An example of therapy only provided under close supervision of medical staff on a PICU is a ventilator. Chronic conditions that may warrant admission to a PICU include pulmonary, endocrine, neurological, and oncologic disorders. These chronic conditions may include severe breathing difficulties such as asthma, heart defects, and complications of diabetes (Colville, 2001). Acute illnesses and conditions that typically warrant PICU admission 1 include post-operative recovery from major surgery, head trauma, and serious burns. The length of stay in a PICU depends on a child’s condition. The average length of stay in a PICU is under five days.