Relationship between parental emotional states, family environment and the behavioural adjustment of pediatric burn survivors

doi:10.1016/S0305-4179(98)00038-2

Burns

Volume 24, Issue 5, August 1998, Pages 425-432

https://doi.org/10.1016/S0305-4179(98)00038-2 Get rights and content

Abstract

The purpose of this study was to examine the relationship between psychosocial adjustment of the burned child and characteristics of the child's family. It hypothesized that parents who perceived their children without major behavioural problems would possess supportive family values and would, themselves, be better adjusted psychologically than those parents who perceived their children as possessing multiple behavioural problems. A stratified random sampling technique was used to select 35 (29 boys, 6 girls) paediatric burn survivors, ages 9 to 18, 1–5 years post-burn, with burn sizes ranging from 3 to 92% burn. Subjects' parents were administered the Child Behaviour Checklist (CBCL), the Family Environment Scale (FES), the Impact of Events Scale (IES), and the Beck Depression Inventory (BDI). The subjects were divided into two groups on the basis of the total problem CBCL scores, i.e. troubled (T ≥ 60) or untroubled (T < 60). One-way ANOVA tests revealed no significant differences between the two groups in the way parents reacted to trauma (IES) and parental depression (BDI). Significant differences (p < 0.01) were revealed between the two groups on FES subscales. The parents of the untroubled group scored higher on ‘Cohesion’ and ‘Organization’ and lower on ‘Conflict’. These parents also scored higher (p ≤ 0.05) on ‘Achievement Orientation’. The results indicate that work with the family to promote cohesion, to decrease conflict, to enhance stability and to promote expectation of positive achievement must be a part of the rehabilitation of the burned child.

References (30)

MS Knudson-Cooper
Adjustment to visible stigma: the case of the severely burned
Soc Sci Med
(1981)
G Browne et al.
Psychosocial adjustment of burn survivors
Burns Incl Ther Inj
(1985)
FJ Stoddard et al.
Psychiatric outcome of burned children and adolescents
J Amer Acad Child Adoles Psychiat
(1989)
P Blakeney et al.
Social competence and behavioural problems of paediatric burn survivors
J Burn Care Rehabil
(1993)
WJ Meyer et al.
Inconsistencies in psychological assessment of children post major burn
J Burn Care Rehabil
(1995)
C Byrne et al.
The social competence of children following burn injury: a study of resilience
J Burn Care Rehabil
(1986)
P Blakeney et al.
Long-term psychosocial adjustment following burn injury
J Burn Care Rehabil
(1988)
P Blakeney et al.
Familial values as factors influencing long-term psychological adjustment of children after severe burn injury
J Burn Care Rehabil
(1990)
TM Achenbach
Manual for the child behavior checklist/4–18 and 1991 profile
(1991)
RH Moos et al.
Family environment scale manual
(1984)

TA Beck et al.

Beck depression inventory manual

(1987)

JM Oliver et al.

Depression as measured by the DSM-III and the Beck Depression Inventory in an unselected adult population

J Consult Clin Psychiat

(1984)

M Horowitz et al.

Impact of event scale: a measure of subjective stress

Psychosom Med

(1979)

MJ Horowitz

Stress response syndromes: a review of posttraumatic and adjustment disorders

Hosp Commun Psychiat

(1986)

HI McCubbin et al.

Bridging normative and catastrophic family stress

Cited by (56)

Validation of the Psychosocial Assessment Tool 2.0 for paediatric burn patients
2023, Burns
The Psychosocial Assessment Tool 2.0 (PAT-B) is an adaptation of an existing screening tool with the aim of the present study to examine its effectiveness and suitability to identify children and families at risk of emotional, behavioral, and social maladjustment following paediatric burns.
Sixty-eight children aged between 6 months - 16 years (M = 4.40) admitted into hospital following paediatric burns, and their primary caregivers, were recruited. The PAT-B comprises several dimensions including family structure and resources, social support, as well as caregiver and child psychological difficulties. Caregivers completed the PAT-B and several standardized measures for validation purposes (e.g., caregiver reports of family functioning, child emotional and behavioural problems, caregiver distress). Children old enough to complete measures reported on their psychological functioning (e.g., posttraumatic stress and depression). Measures were completed within 3 weeks of child admission and then again at 3 months after burn.
The PAT-B demonstrated good construct validity, evidenced by moderate to strong correlations between the PAT-B Total and subscale scores and several criteria measures (family functioning, child behaviour and caregiver distress, child depressive symptoms, rs ranging from 0.33 −0.74). Preliminary support for criterion validity of the measure was observed when examined against the three tiers of the Paediatric Psychosocial Preventative Health Model. The proportion of families falling within these tiers of risk (Universal [low risk], 58.2%; Targeted, 31.3%; or Clinical range, 10.4%) was consistent with prior research. Sensitivity of the PAT-B to identify children and caregivers at high risk of psychological distress was 71% and 83%, respectively.
The PAT-B appears to be a reliable and valid instrument for indexing psychosocial risk across families who have sustained a paediatric burn. However, further testing and replication using a larger sample size is recommended before the tool is integrated into routine clinical care.
Below the surface: Parents’ views on the factors that influence treatment adherence in paediatric burn scar management — A qualitative study
2018, Burns
Parents have a crucial role to play in burn scar management for their children at a time that is extremely stressful for them and their child. Scar management treatments such as pressure garment therapy (PGT) require high levels of adherence. There has been a lack of research into the factors that may influence adherence in paediatric burn scar management. This qualitative research study has investigated parents’ experiences of scar management and their attempts to adhere to treatment at home. The aim of this paper is to outline parents’ views on the factors that influence adherence.
25 parents of paediatric and adolescent burn patients took part in semi-structured interviews. Participants were recruited from three UK burns services. Interviews were conducted in a participant-focussed manner and topics for discussion included parents’ accounts of treatment and their experience of PGT. A thematic analysis was undertaken.
Four overarching themes describe parents’ views and experiences of scar management and adherence. These are the transition from hospital to home; the practical realities of treatment; the emotional labour involved in treatment and; negotiating treatment and regime. The transition from hospital to home is a significant event for parents. They may be apprehensive about this at the same time as they desire that they and their child return to some sense of normality following the burn injury. Parents are required to adopt the role of therapeutic caregiver upon transition from hospital to home. Adherence to scar management is influenced by the practical realities of maintaining treatment (routine, division of care labour, hospital appointments) and the emotional labour involved in doing so. The latter demands that parents manage their own and their children’s emotions. Approaches to adherence were often described as flexible in response to these influences.
Some parents negotiate the realities and demands of scar management successfully, whereas others do not. The emotional labour experienced by parents and their ability to cope with this is often a strong influence on their views regarding adherence to scar management. Further research is needed to explore how burns services and staff manage this at present, and whether simple interventions can help with the key practical and emotional influences on treatment adherence.
Psychiatric Disorders Associated With Burn Injury
2017, Total Burn Care, Fifth Edition
Psychiatric problems frequently occur during burn treatment and can complicate recovery. In addition, preexisting psychiatric disorders are often present and sometimes will have contributed to the burn injury. Pain, itching, and stress during burn recovery can complicate treatment and recovery. It is therefore essential that members of the burn treatment team recognize, assess, and treat psychiatric problems in patients with burn injury. More severe psychiatric disorders in patients may result from the injury and treatment, such as posttraumatic stress disorder and depression. It is useful to have mental health professionals as part of the treatment team. Quick detection and treatment of psychiatric problems contribute to overall recovery and reduce complications.
Displaced Children: The psychological implications
2015, Child and Adolescent Psychiatric Clinics of North America
Socioeconomic impact of children's burns - A pilot study
2014, Burns
This pilot study aimed to gain empirical data on the social and economic impacts of child burns on children and parents, in the context of the outpatient setting.
A questionnaire was completed by 52 parents of paediatric patients attending the burns outpatient department at Queen Victoria Hospital (QVH), East Grinstead, for at least the third time. Children's medical notes were used to extract demographic and medical data. Quantitative data was analyzed statistically and qualitative data was analyzed manually using content analysis.
The financial burden related to the injury posed the greatest impact on parents, and was mainly associated with making the journey to the hospital, with lower income households being most affected. Self-employed parents and those who had to attend more than 6 hospital appointments also ran into difficulties. On the whole, there was not a considerable social impact on the burn-injured child, which may reflect the minor nature of burns in this study (mean depth partial thickness, median TBSA 1.0%).
Parents were shown to perceive a greater impact from their child's burn injury than their child. Certain groups of parents were identified as requiring additional support following the burn injury.
Parents' perceptions of adaptation and family life after burn injuries in children
2014, Journal of Pediatric Nursing
The aim of this study was to explore parents' experiences after their child's burn injury, focusing on how the burn had influenced family life and child adjustment. Six semi-structured interviews with parents of children treated at burn centers 2 to 7 years previously revealed the theme, “Feeling quite alone in striving to regain family wellbeing”. Identification of difficulties perceived by the parents during rehabilitation and up until the present is useful when developing pediatric burn care and support for parents of children with burns.

View all citing articles on Scopus

View full text

Scientific and clinical paperRelationship between parental emotional states, family environment and the behavioural adjustment of pediatric burn survivors

Abstract

Soc Sci Med

Burns Incl Ther Inj

J Amer Acad Child Adoles Psychiat

Social competence and behavioural problems of paediatric burn survivors

J Burn Care Rehabil

Inconsistencies in psychological assessment of children post major burn

J Burn Care Rehabil

The social competence of children following burn injury: a study of resilience

J Burn Care Rehabil

Long-term psychosocial adjustment following burn injury

J Burn Care Rehabil

Familial values as factors influencing long-term psychological adjustment of children after severe burn injury

J Burn Care Rehabil

Manual for the child behavior checklist/4–18 and 1991 profile

Family environment scale manual

Beck depression inventory manual

Depression as measured by the DSM-III and the Beck Depression Inventory in an unselected adult population

J Consult Clin Psychiat

Impact of event scale: a measure of subjective stress

Psychosom Med

Stress response syndromes: a review of posttraumatic and adjustment disorders

Hosp Commun Psychiat

Bridging normative and catastrophic family stress

Scientific and clinical paper
Relationship between parental emotional states, family environment and the behavioural adjustment of pediatric burn survivors