Els van Meijel

121 General discussion | Chapter 7 Despite these limitations, this thesis has provided new insights into posttraumatic stress following child accidental injury, specifically on prevalence and possibly related factors such as acute pain. Furthermore, a validated instrument for screening for risk of PTSD in the Netherlands is now available. A major strength of our studies is that we used a diagnostic semi-structured clinical interview for parents and children to assess child PTSD at 3 months and at long-term follow-up. Besides this interview, we used the child’s self-report of posttraumatic stress symptoms. This is a time-consuming method, but it generates highly reliable results. In addition, our study of algorithms for young children has contributed to the understanding of PTSS in this age group and the development of age-appropriate assessment tools. Another important strength of our studies is the long-term follow-up period for children and parents. Although the follow-up sample was small, a 61% response rate is positive for a long-term study. The inclusion of physical recovery and choices regarding therapy in the longer term studies provided important new insights into the relationship between these factors and posttraumatic stress. Future research This thesis provided new insights into the psychological consequences of accidents and accidental injury in children and their parents. However, the individual studies also raised new questions and topics. First, the STEPP screening tool can be refined and further improved to decrease the percentage of false positives. The tool can be tested with DSM-5 criteria. New ways of screening, e.g., via telephone or apps, can be examined and can increase cost-effectiveness of screening. Second, further research on strategies to implement the STEPP can be useful. To implement screening for risk in hospital settings, it will probably be necessary to provide additional results from research and demonstrate the financial benefit of early identification of PTSD. Future research will then be needed before screening for risk becomes financially attractive to health insurance companies and hospital management. Third, the role of pain in the development of PTSD can be further specified in future research, including the interaction between pain and other factors, and the usefulness of acute pain in screening tools such as STEPP. With regard to long-term PTSD in children as well as in parents, research in a larger sample with a fixed follow-up period can further clarify the role of the various factors possibly associated with PTSD. Fourth, since diagnostic