Posttraumatic stress in children and mothers after renal transplantation

Abstract

The study extended the model of posttraumatic stress to children with a kidney transplant and their mothers in an attempt to capture aspects of their experience living with a transplant that might otherwise elude general screening measures used in past research. Is the ongoing life threat associated with possible rejection and/or other aspects of their daily treatment regimen contributing to a pattern of intrusive thoughts, avoidance and hyperarousal characteristic of posttraumatic stress disorder? Thirty-two children who had undergone kidney transplant (KT) and 25 children with chronic renal insufficiency/failure (CRF) between 8 and 17 years old were administered self-report measures of posttraumatic stress symptoms (PTS), general behavioral/emotional problems and family functioning during a regularly scheduled clinic visit. At the same time, mothers completed a similar battery reporting on their PTS symptoms, their child's PTS symptoms and overall emotional/behavioral wellbeing. MANOVA indicated that KT children did not differ from CRF children on PTS, dissociation or general behavioral/emotional problems. MANOVA similarly indicated that RT mothers did not differ from CRF mothers on their personal PTS, their child's general emotional/behavioral or family functioning. Thirty-nine percent of the RT children and 48% of the CRF children labeled their illness as the most distressing event in their lives; 9% of the RT and 4% of the CRF met criteria for "Full PTSD." Three percent of RT mothers and 8% of CRF mothers exhibited full constellation of PTS. Concordance between mother and child on child's PTS was only moderate with highest agreement on the reexperiencing criteria. Significant correlations were found between the child's trauma history, their PTS symptoms and clinical maladjustment. The child's PTS symptoms were significantly correlated with the mother's PTS symptoms, but only marginally associated with the mothers' report of their PTS symptoms. Months since diagnosis was marginally associated with PTS and in the negative direction. More attention needs to be directed to the progressive nature of kidney disease, and to the assessment of the longitudinal course of PTSD, which may shift with the advancement of disease. Early intervention is warranted for children with a history of other traumas to minimize further potential traumatization.