Pediatric Medical Traumatic Stress And Influencing Factors In Parents Of Children Undergoing Pediatric Surgery:A Longitudinal Study

ObjectiveTo explore the level and development trajectory of pediatric medical traumatic stress in parents of children undergoing pediatric surgery from preoperative period(T0),postoperative recovery period(T1),after discharge(T2)to 3 months after discharge(T3),and to explore the influencing factors of parents’pediatric medical traumatic stress and different development trajectories in different periods,so as to provide a direction for nurses to implement dynamic assessment of psychological traumatic stress and intervention for parents of children undergoing pediatric surgery.MethodsFrom January 2022 to October 2022,convenience sampling was used to select 206parents of children who met the inclusion and exclusion criteria in the Pediatric surgery Ward of a three tertiary hospital in Anhui Province as the research objects.General and clinical information questionnaire,The PTSD Checklist for DSM-5(PCL-5),Parents’Perception of Uncertainty in Illness Scale(PPUS),Hospital Anxiety and Depression Scale(HADS),Simplified Coping Style Questionnaire(SCSQ)and Perceived Social Support Scale(PSSS)were used in the day before surgery(T0),the recovery period after surgery(T1),and the follow-up period(T1).The parents’medical traumatic stress symptoms and its influencing factors were followed up after the return visit(T2)and 3months after discharge(T3).SPSS26.0 and Mplus8.3 statistical software were used for data management and model verification.Statistical methods included descriptive statistics,repeated measures analysis of variance,independent sample nonparametric test,Spearman correlation coefficient analysis,generalized linear Model analysis,Latent Growth Mixture Model(LGMM)and binary Logistic regression analysis.The level of testing was two-sidedα=0.05.Results(1)The preoperative pediatric medical traumatic stress score of the parents was12.50(6.00,23.00),and the incidence was 12.62%(26/206).The score of postoperative recovery period was 10.00(3.75,19.00),the incidence was 10.68%(22/206),the score after discharge was 7.00(3.00,19.00),the incidence was 7.43%(15/202),and the score at 3 months after discharge was 6.00(1.00,15.75).The incidence was 6.77%(13/192).Repeated measures analysis of variance showed that PMTS levels of parents gradually decreased over time(χ~2=88.139,P<0.001).(2)The results of generalized linear model analysis of influencing factors showed that:Before operation(T0),postoperative complications of children,parents’negative coping style and parents’anxiety were the independent influencing factors of pediatric medical traumatic stress of children’s parents.The influence of each factor on PMTS of children’s parents from large to small was no postoperative complications of children(6.653),parents’anxiety(1.577)and parents’negative coping style(0.480).During the postoperative recovery period(T1),parents’illness uncertainty,parents’negative coping style and parents’anxiety were the independent influencing factors of parents’pediatric medical traumatic stress.The influence of each factor on parents’PMTS from large to small was parents’anxiety(1.828),parents’negative coping style(0.343)and parents’illness uncertainty(0.125).After discharge(T2),postoperative complications of children,parents’disease uncertainty,parents’negative coping style and parents’anxiety were independent influencing factors of pediatric medical traumatic stress of parents of children.The influence of each factor on PMTS of parents of children from large to small was children without postoperative complications(7.382),parents’anxiety(1.379),parents’negative coping(0.508),parents’uncertainty about the disease(0.131).At 3 months after discharge(T3),postoperative complications of children,negative parental coping,parental anxiety and parental depression were independent influencing factors of pediatric medical traumatic stress of children’s parents.The influence of each factor on PMTS of parents of children from large to small was no postoperative complications of children(8.329),parental anxiety(1.388),parental depression(0.877),and parental negative coping(0.504).(3)The results of the mixed model of latent variable growth showed that the medical traumatic stress symptoms trajectory of parents of surgical children had group heterogeneity,which was mainly manifested in two categories:the first was low-level decline(91.3%)and the second was high-level stability(8.7%).(4)Binary Logistic regression analysis showed that postoperative complications and type of surgery were the influencing factors of medical traumatic stress symptoms trajectory category in parents of surgical children.Conclusions(1)The pediatric medical traumatic stress levels of parents of children undergoing pediatric surgery from preoperative,postoperative recovery period,after discharge to 3months after discharge showed a dynamic change trend,and the incidence gradually decreased over time.(2)The main influencing factors of pediatric medical traumatic stress in parents of children undergoing pediatric surgery included postoperative complications of children,parents’uncertainty about the disease,parents’negative coping style,parents’anxiety and depression,and the differences were changed with time.(3)There is population heterogeneity in the pediatric medical traumatic stress trajectory of parents of children undergoing pediatric surgery,and there are two latent categories,the first was low-level decline and the second was high-level stability.(4)Postoperative complications and type of surgery are the main influencing factors of pediatric medical traumatic stress trajectory in parents of surgical children.