Parental Levels of Anxiety Predict Child Adjustment after Illness and Injury

by John Koutras, MD

The risk factors for children developing post-traumatic stress symptoms (PTSS) or post-traumatic stress disorder (PTSD) following a medical trauma are complex and include medical and family factors, among others.  A concept of “relational PTSD” has been proposed which suggests that parent and child symptoms mutually influence each other.  A new study is the first to include independent assessments of mothers, fathers and children while controlling for the severity of the child’s medical condition. 

John Koutras, MD

Families from four German children’s hospitals were recruited within 2 weeks of the child’s admission for either a new diagnosis of cancer or type I diabetes mellitus (n=149), or occurrence of an unintentional injury (n=138).  Child PTSS were assessed by the Child PTSD Reaction Index (RI).  Parental PTSS was assessed by the Post-traumatic Diagnostic Scale (PDS).  The authors used a proxy variable of number of days of the child’s hospital stay, in an attempt to operationalize the severity of medical stressors. 

The incidence of moderate to severe PTSS in children was between 4 % and 17 % at 5-6 weeks, and between 2% and 17% at 1 year.  At both time points, children with diabetes showed the lowest rates and children with injuries had the highest rates.  At 5-6 weeks, PTSS rates among parents were higher than children.  Specifically, parents of children with cancer and diabetes were affected significantly more than their children.  Although parental symptoms decreased over time, PTSD in the cancer group was still remarkably high at 1 year (mothers 25 %; fathers 18%).  In contrast, only 5% of the children with cancer had clinically relevant PTSS.  PTSS were found to be quite stable over time in both adults and children, i.e. levels of PTSS at 5-6 weeks were found to be highly predictive of levels at 1 year.  Initially high levels of PTSS in mothers and fathers were longitudinally related to poorer recovery of PTSS in the child.

Thus, there appears to be a longitudinal influence of parental PTSS on child PTSS in injured children.  One postulated mechanism for this relationship is that parents’ own symptoms prevent them from adequately addressing the child’s needs following the trauma.  Therefore, the child does not receive the psychological buffering of an optimal caregiving relationship. 

When working with hurt and hospitalized children, some focus on the parents’ well-being and their own reaction to the event may pay dividends for the entire family down the road.


Markus A,Ystrom E et al.  The mutual prospective influence of child and parental post-truamatic stress symptoms in pediatric patients.  J Child Psychology Psychiatry 2012: 53 July: 767-774.


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