Predicting posttraumatic stress disorder in children and parents following accidental child injury: evaluation of the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP)

BMC Psychiatry

Ramón JL Lindauer⁵  Martha A Grootenhuis⁸  Frits Boer¹  Jan SK Luitse³  Frank W Bloemers⁴  J Carel Goslings⁶  Hugo A Heij²  Brent C Opmeer⁷  Eva Verlinden⁵  Maj R Gigengack⁵  Els PM van Meijel⁵ 

[1] Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;Pediatric Surgical Center of Amsterdam, Academic Medical Center, University of Amsterdam and VU University medical center, Amsterdam, the Netherlands;Emergency Department, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;Department of Surgery, VU University medical center, Amsterdam, the Netherlands;de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands;Trauma Unit Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;Pediatric Psychology Department of the Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

关键词: STEPP;    Screening;    Adolescents;    Children;    Accident;    Posttraumatic stress disorder;   

Others  :  1210183
DOI  :  10.1186/s12888-015-0492-z

 received in 2014-11-13, accepted in 2015-04-29,  发布年份 2015

【 摘 要 】

Background

Children and their parents are at risk of posttraumatic stress disorder (PTSD) following injury due to pediatric accidental trauma. Screening could help predict those at greatest risk and provide an opportunity for monitoring so that early intervention may be provided. The purpose of this study was to evaluate the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP) in a mixed-trauma sample in a non-English speaking country (the Netherlands).

Methods

Children aged 8-18 and one of their parents were recruited in two academic level I trauma centers. The STEPP was assessed in 161 children (mean age 13.9 years) and 156 parents within one week of the accident. Three months later, clinical diagnoses and symptoms of PTSD were assessed in 147 children and 135 parents. We used the Anxiety Disorders Interview Schedule for DSM-IV - Child and Parent version, the Children’s Revised Impact of Event Scale and the Impact of Event Scale-Revised. Receiver Operating Characteristic analyses were performed to estimate the Areas Under the Curve as a measure of performance and to determine the optimal cut-off score in our sample. Sensitivity, specificity, positive and negative predictive values were calculated. The aim was to maximize both sensitivity and negative predictive values.

Results

PTSD was diagnosed in 12% of the children; 10% of their parents scored above the cut-off point for PTSD. At the originally recommended cut-off scores (4 for children, 3 for parents), the sensitivity in our sample was 41% for children and 54% for parents. Negative predictive values were 92% for both groups. Adjusting the cut-off scores to 2 improved sensitivity to 82% for children and 92% for parents, with negative predictive values of 92% and 96%, respectively.

Conclusions

With adjusted cut-off scores, the STEPP performed well: 82% of the children and 92% of the parents with a subsequent positive diagnosis were identified correctly. Special attention in the screening procedure is required because of a high rate of false positives. The STEPP appears to be a valid and useful instrument that can be used in the Netherlands as a first screening method in stepped psychotrauma care following accidents.

【 授权许可】

   
2015 van Meijel et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Winston FK, Kassam-Adams N, Garcia-Espana F, Ittenbach R, Cnaan A: Screening for risk of persistent posttraumatic stress in injured children and their parents. JAMA 2003, 290(5):643-9.
• [2]Kenardy JA, Spence SH, Macleod AC: Screening for posttraumatic stress disorder in children after accidental injury. Pediatrics 2006, 118(3):1002-9.
• [3]Kazak AE, Kassam-Adams N, Schneider S, Zelikovsky N, Alderfer MA, Rourke M: An integrative model of pediatric medical traumatic stress. J Pediatr Psychol 2006, 31(4):343.
• [4]National Institute of Mental Health: Post-Traumatic Sress Disorder [http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/index.shtml]
• [5]American Psychiatric Association: Diagnostic and statistical manual of mental disorders. 4th edition. American Psychiatric Association, Washington, DC; 2000.
• [6]Kahana SY, Feeny NC, Youngstrom EA, Drotar D: Posttraumatic stress in youth experiencing illnesses and injuries: An exploratory meta-analysis. Traumatol 2006, 12(2):148-61.
• [7]Alisic E, Zalta AK, van Wesel F, Larsen SE, Hafstad GS, Hassanpour K, et al.: Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Br J Psychiatry 2014, 204:335-40.
• [8]Stallard P, Salter E, Velleman R: Posttraumatic stress disorder following road traffic accidents - a second prospective study. Eur Child Adolesc Psychiatry 2004, 13(3):172-8.
• [9]VeiligheidNL: Factsheet ongevallen bij de jeugd [http://www.veiligheid.nl/cijfers/ongevallen-0-18-jaar]
• [10]Saxe GN, Miller A, Bartholomew D, Hall E, Lopez C, Kaplow J, et al.: Incidence of and risk factors for acute stress disorder in children with injuries. J Trauma 2005, 59(4):946-53.
• [11]Kolaitis G, Giannakopoulos G, Liakopoulou M, Pervanidou P, Charitaki S, Mihas C, et al.: Predicting pediatric posttraumatic stress disorder after road traffic accidents: the role of parental psychopathology. J Trauma Stress 2011, 24(4):414-21.
• [12]Trickey D, Siddaway AP, Meiser-Stedman R, Serpell L, Field AP: A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clin Psychol Rev 2012, 32(2):122-38.
• [13]Kassam-Adams N, Garcia-Espana JF, Miller VA, Winston F, Kassam-Adams N, Garcia-Espana JF, et al.: Parent-child agreement regarding children’s acute stress: the role of parent acute stress reactions. J Am Acad Child Adolesc Psychiatry 2006, 45(12):1485-93.
• [14]Sturms LM, van der Sluis CK, Stewart RE, Groothoff JW, ten Duis HJ, Eisma WH: A prospective study on paediatric traffic injuries: health-related quality of life and post-traumatic stress. Clin Rehabil 2005, 19(3):312-22.
• [15]Le Brocque RM, Hendrikz J, Kenardy JA: Parental response to child injury: examination of parental posttraumatic stress symptom trajectories following child accidental injury. J Pediatr Psychol 2010, 35(6):646-55.
• [16]Kassam-Adams N, Fleisher CL, Winston FK: Acute stress disorder and posttraumatic stress disorder in parents of injured children. J Trauma Stress 2009, 22(4):294-302.
• [17]Nixon RD, Ellis AA, Nehmy TJ, Ball SA: Screening and predicting posttraumatic stress and depression in children following single-incident trauma. J Clin Child Adolesc Psychol 2010, 39(4):588-96.
• [18]Baker SP, O’Neill B, Haddon W Jr, Long WB: The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974, 14(3):187-96.
• [19]Silverman WK, Albano AM: Anxiety Disorders Interview Schedule for DSM-IV: Child and parent interview schedule. The psychological Corporation, San Antonio, TX; 1996.
• [20]Siebelink BM, Treffers PDA: Dutch version of the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Version. Swets & Zeitlinger, Lisse, the Netherlands; 2001.
• [21]Lyneham HJ, Abbott MJ, Rapee RM: Interrater reliability of the Anxiety Disorders Interview Schedule for DSM-IV: child and parent version. J Am Acad Child Adolesc Psychiatry 2007, 46(6):731-6.
• [22]Silverman WK, Saavedra LM, Pina AA: Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry 2001, 40(8):937-44.
• [23]Olff M: Dutch version of the Children’s Revised Impact of Event Scale (CRIES-13) [http://www.childrenandwar.org/wp-content/uploads/2010/04/CRIES-13-inclusief-handleiding-maart-2013.pdf]
• [24]Perrin S, Meiser-Stedman R, Smith P: The Children’s Revised Impact of Event Scale (CRIES): Validity as a Screening Instrument for PTSD. Behav Cogn Psychother. 2005, 33:487-98.
• [25]Verlinden E, van Meijel EP, Opmeer BC, Beer R, de Roos C, Bicanic IA, et al.: Characteristics of the Children’s Revised Impact of Event Scale in a Clinically Referred Dutch Sample. J Trauma Stress 2014, 27(3):338-44.
• [26]Horowitz M, Wilner N, Alvarez W: Impact of Event Scale: a measure of subjective stress. Psychosom Med 1979, 41(3):209-18.
• [27]Weiss DS: The Impact of Event Scale: Revised. In Cross-cultural assessment of psychological trauma and PTSD. Edited by Wilson JP, Tang CS. Springer, New York; 2007:219-38.
• [28]Mouthaan J, Sijbrandij M, Reitsma JB, Gersons BP, Olff M: Comparing screening instruments to predict posttraumatic stress disorder. PLoS One 2014, 9(5):e97183.
• [29]Hovens JE, van der Ploeg HM, Klaarenbeek MT, Bramsen I, Schreuder JN, Rivero VV: The assessment of posttraumatic stress disorder: with the Clinician Administered PTSD Scale: Dutch results. J Clin Psychol 1994, 50(3):325-40.
• [30]Weathers FW, Keane TM, Davidson JR: Clinician-administered PTSD scale: a review of the first ten years of research. Depress Anxiety 2001, 13(3):132-56.