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The role of parental acute psychological distress in paediatric burn re‐epithelialization
Author(s) -
Brown Erin A.,
De Young Alexandra,
Kimble Roy,
Kenardy Justin
Publication year - 2019
Publication title -
british journal of health psychology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.05
H-Index - 88
eISSN - 2044-8287
pISSN - 1359-107X
DOI - 10.1111/bjhp.12384
Subject(s) - distress , anxiety , depression (economics) , pediatric burn , medicine , clinical psychology , observational study , multilevel model , longitudinal study , psychology , psychiatry , surgery , pathology , machine learning , computer science , economics , macroeconomics
Objectives Following a paediatric burn, parents commonly experience high levels of acute psychological distress, which has been shown to increase child psychological distress as well as child procedural distress. The influence of psychological stress and perceived pain on wound healing has been demonstrated in several laboratory and medical populations. This paper investigates the influence of parental acute psychological distress and procedural behaviour on the child's rate of re‐epithelialization, after controlling for child procedural distress. Design A prospective observational study with longitudinal outcome. Methods Eighty‐three parents of children 1–6 years old reported acute psychological distress (post‐traumatic stress symptoms [ PTSS ], guilt, pre‐procedural fear, general anxiety/depression symptoms) in relation to their child's burn. A researcher observed parent–child behaviour at the first dressing change, and parents and nurses reported child procedural distress (pre‐, peak‐, and post‐procedural pain and fear). These variables, along with demographic and injury information, were tested for predicting time to re‐epithelialization. Date of re‐epithelialization was determined by the treating consultant. Results Days to re‐epithelialization ranged from 3 to 35 days post‐injury. A hierarchical multiple regression analysis found wound depth and size significantly accounted for 28% of the variance in time to re‐epithelialization. In Block 2, child peak‐procedural pain significantly accounted for 6% additional variance. In Block 3, parental PTSS significantly accounted for 5% additional variance. Conclusions Parental PTSS appears to be an important but under‐recognized factor that may influence their child's burn re‐epithelialization. Further investigation is required to understand the mechanisms contributing to this association.Statement of contribution What is already known on this subject? Psychological stress delays wound healing, and this relationship has been found in paediatric burn populations with procedural pain. Parental psychological stress is often present after a child's burn and is related to the child's procedural coping and distress. What does this study add?Parental post‐traumatic stress is related to delayed child burn re‐epithelialization. This association is in addition to procedural pain delaying re‐epithelialization.