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Background: various emotions are implicated in posttraumatic stress disorder (PTSD). Longitudinal studies examining temporal associations between emotions and posttraumatic stress may reveal who is at risk of chronic psychological problems. This study examined the longitudinal relationships of mothers’ trauma-related emotions with posttraumatic stress and depressive symptoms after pediatric burn injury.Methods: data from two cohort studies were used (n = 296). Mothers reported the intensity of burn-related emotions within the first month (T1) and 12 months postburn (T2). The Impact of Event Scale (IES) and the Hospital and Anxiety Depression Scale (HADS-D; depression subscale) were administered at T1 and 18 months postburn (T3).Results: based on two exploratory factor analyses, emotion variables were combined into acute and long-term basic emotions (fear, sadness, horror, anger) and self-conscious emotions (guilt, shame). The path model showed a positive relationship between acute and long-term basic emotions. Higher long-term basic emotions were related to persistence of posttraumatic stress and depressive symptoms. Acute self-conscious emotions showed associations with posttraumatic stress and depressive symptoms at T1 and were longitudinally related to depressive, but not posttraumatic stress, symptoms.Limitations: the posttraumatic stress measure was not based on DSM-5 PTSD criteria and results require replication using these criteria.Conclusions: this study suggests that mothers’ acute self-conscious and long-term basic emotions in relation to their child's burn injury are involved in the development of posttraumatic stress and depressive symptoms. Clinically, assessing and monitoring parents’ early posttraumatic stress, depressive symptoms and burn-related emotions may be useful to identify parents at risk.

Background: It is well established that a paediatric burn injury can lead to parental post-traumatic stress symptoms. The content of parents’ memories and appraisals may reveal the traumatic experiences that need attention. Objective: To inform clinical practice, the aim of this study was to qualitatively examine parents’ (intrusive) memories and appraisals, and associated emotions, concerning the injury, the hospitalisation, and its consequences. Method: Approximately three to six months after the burn event, semi-structured interviews were conducted with parents of 18 children (0–16 years old) that had been hospitalised for a burn injury. Thematic analysis was carried out to obtain themes. Results: A central element in parents’ memories and appraisals was a sense of external or internal threat. Intrusive memories were predominantly related to the accident and first aid (i.e. threat of the injury), whereas parents’ memories about the child’s suffering were emotional but not experienced as intrusive. Later appraisals of the burn injury and its consequences included negative appraisals of the child’s increased vulnerability, responsibility of self or other, the child’s prolonged suffering and (risk of) permanent change, as well as appraisals of positive outcome and recovery. Emotions commonly reported in the context of memories and appraisals were fear, sadness, guilt, and relief. Conclusions: This study offers insight into the traumatic nature of paediatric burn injury from the parent’s perspective and provides directions for the delivery of trauma-informed (after)care.

Background: It is well established that a paediatric burn injury can lead to parental post-traumatic stress symptoms. The content of parents’ memories and appraisals may reveal the traumatic experiences that need attention. Objective: To inform clinical practice, the aim of this study was to qualitatively examine parents’ (intrusive) memories and appraisals, and associated emotions, concerning the injury, the hospitalisation, and its consequences. Method: Approximately three to six months after the burn event, semi-structured interviews were conducted with parents of 18 children (0–16 years old) that had been hospitalised for a burn injury. Thematic analysis was carried out to obtain themes. Results: A central element in parents’ memories and appraisals was a sense of external or internal threat. Intrusive memories were predominantly related to the accident and first aid (i.e. threat of the injury), whereas parents’ memories about the child’s suffering were emotional but not experienced as intrusive. Later appraisals of the burn injury and its consequences included negative appraisals of the child’s increased vulnerability, responsibility of self or other, the child’s prolonged suffering and (risk of) permanent change, as well as appraisals of positive outcome and recovery. Emotions commonly reported in the context of memories and appraisals were fear, sadness, guilt, and relief. Conclusions: This study offers insight into the traumatic nature of paediatric burn injury from the parent’s perspective and provides directions for the delivery of trauma-informed (after)care.

Aim Differing views on benefits and disadvantages of parental presence during their child’s wound care after burn injury leave the topic surrounded by controversies. This study aimed to describe and explain parents’ experiences of their presence or absence during wound care. Methods Shortly after the burn event, 22 semi-structured interviews were conducted with parents of children (0–16 years old) that underwent hospitalization in one of the three Dutch burn centers. Eighteen of these parents also participated in follow-up interviews three to six months after discharge. Interviews were analyzed using grounded theory methodology. Results Analyses resulted in themes that were integrated into a model, summarizing key aspects of parental presence during wound care. These aspects include parental cognitions and emotions (e.g., shared distress during wound care), parental abilities and needs (e.g., controlling own emotions, being responsive, and gaining overall control) and the role of burn care professionals. Conclusion Findings emphasize the distressing nature of wound care procedures. Despite the distress, parents expressed their preference to be present. The abilities to control their own emotions and to be responsive to the child’s needs were considered beneficial for both the child and the parent. Importantly, being present increased a sense of control in parents that helped them to cope with the situation. For parents not present, the professional was the intermediary to provide information about the healing process that helped parents to deal with the situation. In sum, the proposed model provides avenues for professionals to assess parents’ abilities and needs on a daily basis and to adequately support the child and parent during wound care.

A burn injury event and subsequent hospitalization are potentially distressing for children. To elucidate the child’s experience of pediatric burn injury, children’s reflections on the burn event and its aftermath were examined. Semi-structured interviews were conducted with eight children (12–17 years old). Using thematic analysis, interview transcripts were coded and codes were combined into overarching categories. Three categories were identified: vivid memories; the importance of parental support; psychosocial impact and coping. Implications for care are discussed in terms of assessing children’s appraisals, paying attention to the parent’s role, and preparing families for potential psychological barriers after discharge.

Background The concept quality of life (QOL) refers to both health-related outcomes and one’s skills to reach these outcomes, which is not yet incorporated in the burn-related QOL conceptualisation. The aim of this study was to obtain a comprehensive overview of relevant burn-specific domains of QOL from the patient’s perspective and to determine its hierarchical structure. Methods Concept mapping was used comprising a focus group (n = 6), interviews (n = 25), and a card-sorting task (n = 24) in burn survivors. Participants sorted aspects of QOL based on content similarity after which hierarchical cluster analysis was used to determine the hierarchical structure of burn-related QOL. Results Ninety-nine aspects of burn-related QOL were selected from the interviews, written on cards, and sorted. The hierarchical structure of burn-related QOL showed a core distinction between resilience and vulnerability. Resilience comprised the domains positive coping and social sharing. Vulnerability included 5 domains subdivided in 13 subdomains: the psychological domain included trauma-related symptoms, cognitive symptoms, negative emotions, body perception and depressive mood; the economical domain comprised finance and work; the social domain included stigmatisation/invalidation; the physical domain comprised somatic symptoms, scars, and functional limitations; and the intimate/sexual domain comprised the relationship with partner, and anxiety/avoidance in sexual life. Conclusion From the patient’s perspective, QOL following burns includes a variety of vulnerability and resilience factors, which forms a fresh basis for the development of a screening instrument. Whereas some factors are well known, this study also revealed overlooked problem and resilience areas that could be considered in client-centred clinical practice in order to customize self-management support.

Background The concept quality of life (QOL) refers to both health-related outcomes and one’s skills to reach these outcomes, which is not yet incorporated in the burn-related QOL conceptualisation. The aim of this study was to obtain a comprehensive overview of relevant burn-specific domains of QOL from the patient’s perspective and to determine its hierarchical structure. Methods Concept mapping was used comprising a focus group ( n = 6), interviews ( n = 25), and a card-sorting task ( n = 24) in burn survivors. Participants sorted aspects of QOL based on content similarity after which hierarchical cluster analysis was used to determine the hierarchical structure of burn-related QOL. Results Ninety-nine aspects of burn-related QOL were selected from the interviews, written on cards, and sorted. The hierarchical structure of burn-related QOL showed a core distinction between resilience and vulnerability. Resilience comprised the domains positive coping and social sharing. Vulnerability included 5 domains subdivided in 13 subdomains: the psychological domain included trauma-related symptoms, cognitive symptoms, negative emotions, body perception and depressive mood; the economical domain comprised finance and work; the social domain included stigmatisation/invalidation; the physical domain comprised somatic symptoms, scars, and functional limitations; and the intimate/sexual domain comprised the relationship with partner, and anxiety/avoidance in sexual life. Conclusion From the patient’s perspective, QOL following burns includes a variety of vulnerability and resilience factors, which forms a fresh basis for the development of a screening instrument. Whereas some factors are well known, this study also revealed overlooked problem and resilience areas that could be considered in client-centred clinical practice in order to customize self-management support.

Adjustment after pediatric burn injury may be a challenge for children as well as their parents. This prospective study examined associations of internalizing and externalizing problems in children and adolescents 12 months postburn with preburn functioning, and parental acute and chronic posttraumatic stress symptoms (PTSS) from different perspectives. Child, mother, and father reports of 90 children (9–18 years), collected within the first month and 12 months postburn, were analyzed. Results indicated that overall, child and parental appraisals of pre- and postburn behavioral problems were not significantly different from reference data. Rates of (sub)clinical postburn behavioral problems ranged from 6 to 17 %, depending on the informant. Pre- and postburn behavioral problems were significantly related, but only from the parents’ perspective. Path models showed an association between parental PTSS 12 months postburn and parental reports of child internalizing problems, as well as a significant indirect relationship from parental acute stress symptoms via PTSS 12 months postburn. Notably, no associations between parental PTSS and child reports of postburn behavioral problems were found. In conclusion, parental observations of child externalizing problems appear to be influenced by their perspectives on the child’s preburn functioning, while parental observations of internalizing problems are also related to long-term parental PTSS. However, these factors seem of no great value in predicting behavioral problems from the child’s perspective, suggesting substantial informant deviations. To optimize adjustment, clinical burn practice is recommended to adopt a family perspective including parent perception of preburn functioning and parental PTSS in assessment and intervention.

Adjustment after pediatric burn injury may be a challenge for children as well as their parents. This prospective study examined associations of internalizing and externalizing problems in children and adolescents 12 months postburn with preburn functioning, and parental acute and chronic posttraumatic stress symptoms (PTSS) from different perspectives. Child, mother, and father reports of 90 children (9–18 years), collected within the first month and 12 months postburn, were analyzed. Results indicated that overall, child and parental appraisals of pre- and postburn behavioral problems were not significantly different from reference data. Rates of (sub)clinical postburn behavioral problems ranged from 6 to 17 %, depending on the informant. Pre- and postburn behavioral problems were significantly related, but only from the parents’ perspective. Path models showed an association between parental PTSS 12 months postburn and parental reports of child internalizing problems, as well as a significant indirect relationship from parental acute stress symptoms via PTSS 12 months postburn. Notably, no associations between parental PTSS and child reports of postburn behavioral problems were found. In conclusion, parental observations of child externalizing problems appear to be influenced by their perspectives on the child’s preburn functioning, while parental observations of internalizing problems are also related to long-term parental PTSS. However, these factors seem of no great value in predicting behavioral problems from the child’s perspective, suggesting substantial informant deviations. To optimize adjustment, clinical burn practice is recommended to adopt a family perspective including parent perception of preburn functioning and parental PTSS in assessment and intervention.