Predicting the unseen Pediatric Intensive Care Unit (PICU) outcome – PICU related parental Post Traumatic Stress

BY Mekela Whyte-Nesfield

Early in my career, my first concern in the Pediatric Intensive Care Unit had always been the survival of my patient. Until this question from a mother whose child I had been following forever changed my perception and my career. “Happy we are going home but how am I supposed to care for him? I’m a mess!”

The thought that this parent was experiencing anything other than joy that her child survived initially baffled me, but further conversations and a quick review of previously reported data brought clarity. I immediately wondered how many other PICU parents would struggle to perform the tasks needed of them and how could I begin to identify them.

The effects of a child’s admission to the pediatric intensive care unit (PICU) are far-reaching and pervasive. The social, emotional, cognitive and physical health of the child and family may be affected in various ways following the PICU experience. Collectively these potential sequelae are known as Post Intensive Care Syndrome – in pediatrics (PICS-p).

Parental mental health symptoms are well documented in previous studies. Some parents describe the PICU experience as being split between two worlds. Trying to balance life outside of the PICU (work, childcare, relationships) while also being there to support their sick child. Others report intense emotional distress and/or Acute Stress Disorder (ASD) symptoms during and following the admission. While some parents who report initial distress improve over time, displaying attributes of resilience and/or post traumatic growth. For some parents, these symptoms may continue for up to 30 months following the admission, developing into PICU associated Post traumatic stress disorder (PTSD). The percentages of parents who go on to develop PICU associated parental PTSD symptoms ranges broadly from 15-60% between studies.

As a community, our interest in PICU associated parental PTSD extends beyond the direct impact on the parent, to include the indirect impact of parent mental health within the household and greater society. This is important because functions such as parenting, maintaining financial stability, functioning in the workplace, and fostering the emotional, physical and cognitive recovery/wellbeing of the sick child and/or siblings, often deteriorates in parents affected by PTSD. Specifically, prior reports have noted significantly increased rates of parental alcoholism, decrease in income and increases in child mental health disorders including PTSD and behavioral disorders. Others have also questioned whether a parent suffering through PTSD symptoms may also impede the speed of physical and cognitive recovery in the sick child.

Thankfully from adult PTSD data we know that therapies can help these parents. Psychotherapies such as Cognitive Processing Therapy (CPT), Exposure therapy, Eye Movement Desensitization (EMDR) and yogic breathing as well as anti-anxiety and anti-depression medications have been utilized following PTSD diagnosis. Screening for PTSD post discharge may be helpful in prescribing treatment after parental PTSD has already developed. However, currently we are still unable to clearly identify prior to discharge, which parents will progress to have PTSD or significant PTSD symptoms after they leave the hospital. This major gap limits the ability of targeting diagnostic and treatment resources aimed at preventing parental PTSD.

This article is the first to investigate predicting the risk of developing PICU associated parental PTSD using machine learning techniques. We found that parents with a history of a mental health disorder prior to PICU admission has the highest predictive association with the development of PICU associated parental PTSD.

Determining in hospital risk of developing PICU associated parental PTSD is on the horizon. This will better enable us to pursue and evaluate the effectiveness of offering therapies targeting parental PTSD during the hospital stay or shortly after discharge. Potentially decreasing the risk of parents developing PTSD at all. This could be accomplished while avoiding the prohibitive cost of providing therapies to all parents, some of whom may not need them.

Machine learning and other artificial intelligence modalities may be the next step in identifying PICU parents that need our help and evaluating how we may help them. We look to the future with anticipation, striving to improve outcomes following PICU admission- mind, body and spirit.

Article details

Predicting Parental Post-Traumatic Stress Symptoms Following their Child's Stay in a Pediatric Intensive Care Unit, Prior to Discharge
Mekela M. Whyte-Nesfield, MD, Eduardo A. Trujillo Rivera, PhD, Daniel Kaplan, DO, Simon Li, MD, MPH, Pamela S. Hinds, RN, PhD, FAAN, and Murray M. Pollack, MD
First Published: September 30, 2024
DOI: 10.1177/08850666241287442
Journal of Intensive Care Medicine

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