Els van Meijel

117 General discussion | Chapter 7 a previous study showed that children and parents who perceive a high risk of life threat in medical events are at great risk of PMTS (Price et al., 2016). The STEPP also contains several questions that refer to the subjective reaction during or right after the event. Examples of such items are: “When your child was hurt (or when you first heard it had happened), did you feel really helpless, like you wanted to make it stop happening, but you couldn’t?” and “When you got hurt, or right afterwards, did you feel really afraid? Since the STEPP does not include posttraumatic stress symptoms, there is probably no need to adapt the questionnaire to DSM-5 criteria (see also our recommendations for future research). Due to the changes in the diagnostic criteria in DSM-5, a drop in prevalence by about 1% was expected (Kilpatrick et al., 2013). Although research that compares the prevalence rates of DSM-IV and DSM-5 in children and adolescents is scarce, the results have shown comparable prevalence rates for both diagnostic systems. In adolescents and young adults who survived the shooting at Utoya Island in Norway, a prevalence of 11.1%was found using DSM-IV criteria and 11.7% using DSM-5 criteria (Hafstad, Dyb, Jensen, Steinberg, & Pynoos, 2014). In a non-clinical sample of earthquake survivors, the authors found an overall high consistency (87.1%) between DSM-IV-TR and DSM-5 diagnoses and prevalence rates of 37.5% and 39.8%, respectively (Carmassi et al., 2013). However, both studies reported methodological limitations such as the use of a self- report instrument (Carmassi et al., 2013) and the lack of assessment of functional impairment (both studies), which precludes generalization to other samples. Clinical implications This research project evaluated several subjects and themes that are important to accidentally injured children and their parents. Since accidents are widespread, the general and specific findings of this thesis justify systematic clinical attention for the psychological consequences of accidents for children and their parents. Challenges for improvement in medical care Acute pain is an example of a modifiable factor in medical care associated with the development of traumatic stress. The identification of potentially modifiable factors makes it possible to intervene and to address these factors beginning with the acute