Mediators of Initial Acute and Later Posttraumatic Stress in Youth in a PICU.

OBJECTIVES: Youth in a PICU and their parents may experience initial symptoms of acute stress disorder and later symptoms of posttraumatic stress disorder. The objective of this study was to examine potential mediators of these conditions, including youth anxiety, depression, negative affect, and hospital fear, as well as parent anxiety and depression DESIGN: This study involved a short longitudinal design that encompassed initial assessments in a PICU setting and later assessments 4-7 weeks after discharge. SETTING: Youth and their parents completed dependent measures in the hospital and at follow-up at the youth's home or an outpatient clinic setting. PATIENTS: Fifty youth aged 9-17 yrs were admitted to a PICU for respiratory illness/asthma (30.0%), trauma (26.0%), surgery and after surgery recovery (20.0%), infections/viral illness (8.0%), neurologic disorder (6.0%), or other (10.0%). Parents (n = 50) were also assessed. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Measures were utilized for youth anxiety, acute stress, depression, negative affect, posttraumatic stress, and hospital fear, as well as parent anxiety, acute stress, depression, and posttraumatic stress. Some youth (26%) and parents (24%) had substantial posttraumatic stress disorder symptoms develop. Youth acute stress disorder symptoms in the PICU predicted later youth posttraumatic stress disorder symptoms, parent acute stress disorder symptoms in the PICU predicted later parent posttraumatic stress disorder symptoms, and youth acute stress disorder symptoms in the PICU predicted later parent posttraumatic stress disorder symptoms. Youth anxiety, negative affect, and hospital fear mediated initial youth acute stress disorder symptoms and later youth posttraumatic stress disorder symptoms. CONCLUSIONS: Youth in a pediatric intensive care unit are at increased risk for posttraumatic stress disorder and should be screened for acute stress disorder.

What do clinicians expect? Comparing envisioned and reported violence for male and female patients.

Mental health professionals' (MHPs') accuracy in assessing the risk of violence in female patients is particularly limited. Based on assessments made by 205 MHPs of 605 patients in an emergency room, this study explored potential causes of MHPs' poorer accuracy in assessing women's potential for violence. The dimensions that underlie MHPs' envisioned violence in patients were identified and were compared with those that characterized patients' reported violence during a 6-month follow-up period. There were three key findings from their study. First, violence envisioned by MHPs differed depending on their professional role and varied in its congruence with patients' reported violence. Second, patients' violence was organized by dimensions of domesticity and substance relatedness; women's violent incidents were more domestic than were men's. Third, when MHPs envisioned violence that was highly conditional on psychiatric deterioration and medication noncompliance, violence often did not occur.

Gender and risk assessment accuracy: underestimating women's violence potential.

Understanding factors that contribute to mental health professionals' (MHPs') accuracy in assessing patients risk of violence can inform efforts to improve accuracy and to integrate risk assessment technology with practice. Based on a sample of 147 clinicians who assessed 680 patients in a psychiatric emergency room, this study investigates the influence of patient gender, MHP gender, and their potential interaction on MHPS' risk assessment accuracy. The results indicate that MHPs of both genders are particularly limited in their ability to assess female patients' risk of future violence. This finding was not limited to a particular professional group and was not attributable to gender-related differences in violence. Implications for future research on the judgment processes that may underlie MHPs' limited accuracy with women and for training programs in violence risk assessment are discussed.