Risk versus resilience: an exploratory study of factors influencing the development of posttraumatic stress symptoms in pediatric burn patients Sarah Elizabeth Powers , University of Iowa Follow

[摘要] Children account for approximately 34% of the burn-injured population in the United States and are particularly at risk for developing posttraumatic stress disorder (PTSD) or other significant psychopathology (i.e., behavioral and attentional difficulties, acute stress, depression, anxiety, phobias, dissociative symptoms, and enuresis). There is a significant risk that quality of life (QOL) can have a negative impact on children who have sustained a burn injury, particularly within the domain of social functioning. Specifically, children who meet the criteria for PTSD following a burn injury are at an increased risk of experiencing impairment in overall QOL. However, there remains significant evidence that a substantial portion of children exhibit satisfactory QOL outcomes following a burn injury at a level comparable to their noninjured peers. This positive outcome may be attributed to the child"s level of resiliency--the protective factors that positively influence their ability to adjust and move forward following a traumatic event. Research on risk and resiliency of posttraumatic stress symptoms (PTSS) in pediatric burn survivors is limited. For psychological assessment and burn treatment to be successful, it is important to understand the resilient qualities that are present in children who experience positive post-burn-injury outcomes. By focusing on a child"s mental health strengths and by building his or her resilience, a health professional may prevent or lessen the child"s adjustment difficulty or psychopathological symptoms. Thus, the primary purpose of this study was to identify the relation between pediatric burn injury, demographic variables, resilience and QOL outcome with regard to PTSS. Demographic information (e.g, gender, age, household income, and diagnoses) and burn injury characteristics (e.g., age at time of burn, total body surface area injured, number or days spent in the hospital, and number of surgeries) were considered with regard to PTSS, resiliency, and QOL outcome. Further analysis efforts compared results from the Resiliency Scales for Children and Adolescents (RSCA) with scores obtained from the University of California at Los Angeles Posttraumatic Stress Reaction Index for Diagnostic and Statistical Manual--Fourth Edition (UCLA PTSD Reaction Index for DSM-IV; Reaction Index). Identical analyses were performed regarding the RSCA and the Pediatric Quality of Life Inventory, Version 4.0 (PedsQL 4.0). Analyses indicated a significant relation between PTSS severity and resilience, with positive resilience outcomes correlated to lower levels of PTSS severity. Further, a significant relation was found between QOL and PTSS, with positive QOL functioning related to lower levels of PTSS. Finally, a significant relation was found between resilience and QOL: Participants who endorse higher levels of resilience demonstrate better QOL outcomes. Overall, demographic information and burn injury characteristics did not significantly affect results regarding PTSS severity. Clinical implications and future areas of research are discussed.