High stress during admission predicts the impact of a PICU follow-up clinic on parents' psychological outcome

Introduction

There are no formal reports of follow-up services in pediatric intensive care settings despite mounting evidence that parents report negative psychological symptoms for many months after a child's admission to the pediatric intensive care unit (PICU). The aim of this study was to establish the impact of a PICU follow-up clinic on parents' distress.

Methods

In this prospective, randomised controlled trial, parents of 133 children admitted to an eight-bed PICU for >12 hours were randomly allocated to either the intervention (follow-up clinic appointment offered 2 months after discharge) or control (no appointment) condition. Parents' baseline stress was assessed at discharge using the Parental Stressor Scale: PICU [1]. Five months later, post-traumatic stress, anxiety and depression were assessed by postal questionnaires (Impact of Event Scale [2] and Hospital Anxiety and Depression Scale [3]).

Results

Outcome data were obtained for 105 parents. Whole group analyses revealed no significant differences in psychological outcome between the control and intervention groups. However, post hoc analyses revealed effects in favour of the intervention, for a sub-group of parents (n = 55) who had reported baseline stress scores above median during their child's hospitalisation. Within this sub-group, parents who received the intervention were less likely to report clinically significant levels of post-traumatic stress symptoms (25% vs 56%, P = 0.018) or depression (19% vs 52%, P = 0.009) than controls.

Conclusions

Whilst these results do not justify routine provision of PICU follow-up clinic appointments for all parents, they do suggest that rates of long-term distress in those who find the admission particularly traumatic could be reduced by a simple one-off intervention, which was feasible in a clinical setting.