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      Emotional reactions in parents of the youth who experienced the Utøya shooting on 22 July 2011; results from a cohort study


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          Objective and setting

          The objective of this study was to provide knowledge about the emotional reactions in parents whose offspring experienced a mass shooting on Utøya island in Norway in 2011. The research questions included whether parents’ reactions were influenced by their offspring’s symptom level, age, living situation and parental gender.


          The study was designed as an open cohort study. The data were collected at two time points; 4–5 months and 14–15 months after the shooting.


          The participants were 531 parents of youth exposed to the Utøya island attack.

          Outcome measures

          The Parental Emotional Reaction Questionnaire measured parents’ reactions, and University of California, Los Angeles Post-traumatic Stress Disorder Reaction Index measured youths' post-traumatic stress symptoms.


          Parental emotional reactions were positively related to post-traumatic stress reactions in offspring at wave 1: Est.=0.20, 95% CI 0.10 to 0.30, p<0.001, over time (wave 1and wave 2 nested within individuals): Est.=0.23, CI 0.13 to 0.32, p<0.001, and at wave 2: Est.=0.26, CI 0.12 to 0.39, p<0.001. Youths’ age was not significantly related to parental emotional reactions, neither at wave 1: Est.=0.19, CI −0.40 to 0.77, p=0.531, over time: Est.=0.26, CI −0.27 to 0.79, p=328, nor at wave 2: Est.=0.32, CI −0.41 to 1.05, p=0.389. Mothers were more emotionally upset than fathers both at wave 1: Est.=−5.66, CI −7.63 to −3.69, p<0.001, over time: Est.=−5.36, CI −7.18 to −3.55, p<0.001, and at wave 2: Est.=−5.33, CI −7.72 to −2.53, p<0.001.


          The findings suggest that parenting after trauma should be addressed in outreach programmes and in planning of healthcare services.

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          Most cited references33

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          Traumatic stress in parents of children admitted to the pediatric intensive care unit.

          To measure the prevalence of parental acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) and to examine the relationship between ASD symptoms and PTSD symptoms in parents of infants and children admitted to the pediatric intensive care unit (PICU). To examine the correlation between parental perceptions of illness severity and objective measures. To assess the association among demographic, situational, and illness factors and the severity of ASD and PTSD. Prospective cohort study. Thirty-eight bed PICU at an urban children's hospital. The parents of 272 children admitted to the PICU for >48 hrs. ASD symptoms were assessed using the Acute Stress Disorder Scale during the child's admission. PTSD symptoms were assessed using the PTSD Checklist at least 2 months after discharge. The severity of illness was measured using the Pediatric Risk of Mortality (PRISM III) score. Of the 272 parents completing the initial assessment, 87 (32%) met symptom criteria for ASD. Of the 161 parents completing follow-up, 33 (21%) met symptom criteria for PTSD. PTSD symptoms at follow-up were associated with ASD symptoms assessed in the PICU, unexpected admission, parent's degree of worry that the child might die, and the occurrence of another hospital admission or other traumatic event subsequent to the index admission. Neither ASD nor PTSD responses were associated with objective measures of a child's severity of illness (PRISM III score). Traumatic stress symptoms are common among parents in the PICU and may persist long after discharge. There is strong support from these data for continued attention to supporting parents both during and after a child's PICU admission.
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            Impact of pediatric critical illness and injury on families: a systematic literature review.

            We sought to inform decision-making for children and families by describing what is known and remains unknown about the impact of childhood critical illness and injury on families. This report also was designed as a tool for research planning and design so that meaningful studies are performed and duplication is avoided. After a national scholarship competition and the identification of 3 medical student summer scholars, a literature search was conducted by using the National Library of Medicine and a PubMed keyword search system at the National Institutes of Health. A total of 115 reports were reviewed and assigned to the 5 following categories characterizing the impact of pediatric critical illness/injury on families: stressors, needs, specific domains (psychological, physical, social), coping, and interventions. The reports reviewed indicate that pediatric critical illness and injury is stressful for the entire family. The effects on parents, siblings, and marital cohesion were variably described. Needs of family members (eg, rest, nutrition, communication) were identified as being unmet in many studies. Permanent impact on siblings and marital relationships has been considered detrimental, but these conclusions are not adequately quantified in presently available studies. Reviewed reports minimally investigated cultural diversity, effects on fathers versus mothers, siblings, socioeconomic status, and financial burden. Studies were often anecdotal and included small sample sizes. Methodologic limitations were numerous and varied and seriously narrowed the significance of the studies we reviewed. The reports that we evaluated were largely limited to those of English-speaking families, white people, and married mothers. Future research should use more rigorous methods in the measurement of impact of childhood critical illness and injury on families. Families of critically ill and injured children would benefit from the practitioners of pediatric critical care acquiring enhanced knowledge and sensitivity about family communication and dynamics.
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              The mutual prospective influence of child and parental post-traumatic stress symptoms in pediatric patients.

                Previous studies found notable rates of post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) in pediatric patients and their parents and suggest a significant association between child and parent PTSS. However, little is known about mutual influences between child and parental PTSS over time. This study prospectively examined the presence of PTSS and PTSD and the mutual influence of child and parental PTSS in a large sample of pediatric patients with different medical conditions.   A total of 287 children (aged 6.5-16 years) and their mothers (n = 239) and fathers (n = 221) were assessed at 5-6 weeks and 1 year after an accident or a new diagnosis of cancer or diabetes mellitus type 1 in the child.   At the first assessment 11.1% and at the second assessment 10.2% of the children had moderate to severe PTSS. At 5-6 weeks 29.3% of mothers and 18.6% of fathers met criteria for PTSD. At 1 year the rates were 14.6% for mothers and 7.9% for fathers. There were considerable differences of PTSS among different medical diagnostic groups in children and parents. Mothers were more vulnerable than fathers. Structural equation analysis revealed that initially high PTSS in mothers and fathers were longitudinally related to poorer recovery from PTSS in the child. Cross-lagged effects from the child to the parents and from one parent to the other were not significant.   This study highlights the long-term influence of parental PTSS on the child's recovery after trauma and calls for a family systems approach and for early interventions in the treatment of traumatized pediatric patients. © 2011 The Authors. Journal of Child Psychology and Psychiatry © 2011 Association for Child and Adolescent Mental Health.

                Author and article information

                BMJ Open
                BMJ Open
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                16 October 2017
                : 7
                : 10
                [1 ]Mental & Physical health, Norwegian Institute of Public Health and Norwegian Centre for Violence and Traumatic Stress Studies , Oslo, Norway
                [2 ]departmentDepartment of Psychology , University of Oslo , Oslo, Norway
                [3 ]Norwegian Centre for Violence and Traumatic Stress Studies , Oslo, Norway
                [4 ]departmentFaculty of medicine , University of Oslo , Oslo, Norway
                [5 ]Center for Child and Adolescent Mental Health, Eastern and Southern Norway , Oslo, Norway
                Author notes
                [Correspondence to ] Dr Tonje Holt; tonje.holt@ 123456fhi.no
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                Funded by: the Norwegian Research Council and the Norwegian Directorate of Health;
                Mental Health
                Custom metadata

                psychological trauma,post-traumatic stress,parental emotional reactions
                psychological trauma, post-traumatic stress, parental emotional reactions


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