[How children experience a parent being chronically ill: a qualitative analysis of interviews with children of hemodialysis patients]. / Kindliches Erleben der chronischen körperlichen Erkrankung eines Elternteils: Eine qualitative Analyse von Interviews mit Kindern dialysepflichtiger Eltern.

Children's subjective experience of growing up with a somatically ill parent was studied by a qualitative analysis of individual interviews with children having a parent on hemodialysis. Transcripts of semi-structured interviews with 8 children and adolescents between 6 and 17 years and with one ill mother, whose father had had the same disease, were evaluated through structuring content analysis and psychoanalytical text interpretation. All individuals showed a strong sense of responsibility for their parents. In some cases this conflicted with their strives for autonomy. Almost all children tried to avoid conflicts with their parents. Younger children suffered from diffuse sadness, whereas children up from 11 years had concrete fears of medical complications or their parents' possible decease. In case parents spoke frankly about their illness, children felt relieved. Results suggest that growing-up with a chronically ill parent means a sustaining experience for a child, which requires enormous efforts of psychological adaptation. In preventive counselling concepts, parents should be strengthened in their competence as emotionally available attachment figures.

Posttraumatic syndromes in children and adolescents after road traffic accidents--a prospective cohort study.

BACKGROUND: The impact of road traffic accidents (RTAs) on the physical health of children is well recognized, but their psychological consequences have only recently become a topic of research. While other traumatic experiences in childhood are well studied, this kind of trauma has been poorly investigated to date. SAMPLING AND METHODS: A prospective cohort study was conducted of 8- to 18-year-old children and adolescents who were involved in RTAs in a large urban area during a 6-month period. The children and adolescents were interviewed within 1 week after the accident and, again, 3 months later. In total, 72 children and adolescents took part in the study. Symptoms of posttraumatic stress, depression and anxiety were assessed by a structured clinical interview and standardized questionnaires. RESULTS: One week after the accident, 11% of the children met the diagnostic criteria for posttraumatic stress disorder (PTSD) according to ICD-10 and a further 13% met the criteria for 'subsyndromal PTSD'. Complex syndromes consisting of subsyndromal posttraumatic stress, (separation) anxiety and depression were common among those children. Isolated cases of anxiety and depression symptoms were also observed but rarely reached an impairing level. Three months after the accident, 25% of the children reported persistence of the PTSD symptoms (measured by the Impact of Event Scale - Revised). The strongest predictor of the extent of posttraumatic stress after 3 months was proven to be the initial level of PTSD symptoms. This predictor alone accounted for 38% of its variance. CONCLUSIONS: Our results provide evidence that even after 'everyday' RTAs, psychological consequences are common. Special attention should be paid to the common occurrence of subsyndromal psychological disturbances and more complex syndromes. The results further indicate the limitations of the PTSD concept in the assessment of posttraumatic disturbances in childhood and adolescence.