Uncertainty and primary appraisal as predictors of acute stress disorder in parents of critically ill children: A mediational model

This study examined illness-related uncertainty and primary appraisals of threat, centrality, and challenge as predictors of acute stress disorder (ASD) symptoms in parents of children hospitalized in a pediatric intensive care unit (PICU). Ultimately, a mediational pathway was tested to determine if primary appraisal was a mechanism that accounted for the impact of uncertainty on ASD symptoms. Ancillary study aims were to assess the degree to which parents perceived uncertainty in the PICU environment, and to determine the prevalence of ASD among parents in this setting. Self-report data was collected from 77 parents (57 mothers, 19 fathers) of children hospitalized in a PICU for a minimum of 48 hours. Descriptive analyses showed that parents perceived a high degree of uncertainty and 57% of parents met diagnostic criteria for ASD. Unexpected admission was the only objective medical status variable significantly related to uncertainty, threat appraisal, and ASD symptoms. Consistent with hypotheses, results from hierarchical regression analyses showed that perceived uncertainty and primary appraisals of threat accounted for significant variance in parents' ASD symptoms; however, neither centrality nor challenge appraisals were related to parents' ASD symptoms. Because threat was the only appraisal dimension found to be directly related to ASD symptoms, it was the only dimension tested in the mediational model. Consistent with the hypothesis, threat appraisals fully mediated the effect of uncertainty on ASD symptoms; results from a Sobel test confirmed the significance of full mediation. This study is the first to examine uncertainty, primary appraisal, and ASD symptoms in this population. Results clarify that it is not the mere perception of uncertainty that adversely impacts parental adjustment, but rather how it is appraised, and therefore, point to a practical area for in-hospital interventions targeting parents' pediatric medical traumatic stress symptoms. Although a substantial body of empirical research supports a relation between uncertainty and maladaptive outcomes, studies also link uncertainty to positive outcomes. Future research should include positive indicators of adjustment and examine how appraisals vary according to sources of uncertainty.