Els van Meijel

13 General introduction | Chapter 1 was one year. The prevalence decreased from 21% in the acute phase to 11% after one year (Hiller et al., 2016). Posttraumatic stress in parents Accidental injury in children also affects the parents and puts them at risk for developing substantial posttraumatic stress symptoms (PTSS) (Kassam-Adams, Fleisher, & Winston, 2009; Le Brocque, Hendrikz, & Kenardy, 2010). The prevalence of PTSS in parents 3-6 months after their child’s accidental trauma is 10% to 17%. Kassam- Adams and colleagues found partial or full posttraumatic stress disorder (PTSD) in 15% of the parents (Kassam-Adams et al., 2009) approximately six months following traffic- related pediatric injury. Parents’ well-being has an effect on the child’s functioning (Alisic, Jongmans, vanWesel, & Kleber, 2011). PTSS in parents is longitudinally related to poorer recovery of PTSS in the child (Landolt, Ystrom, Sennhauser, Gnehm, & Vollrath, 2012). Parental PTSS increases the risk of child PTSD (Kolaitis et al., 2011) and parents’ early symptoms are a risk factor for persistent posttraumatic stress in injured children (Kassam-Adams et al., 2013). A meta-analysis reported significant effect sizes for the relationship between parent and child PTSS, suggesting that parental PTSS, especially maternal, may be a risk factor for child PTSS (Morris, Gabert-Quillen, & Delahanty, 2012). Although parental PTSS clearly has adverse effects and previous research supports the occurrence of long-term PTSS and related impairment in parents (Kazak et al., 2006), there is a lack of long-term follow-up studies. We found only one study with a 1-year and 11-year follow-up period (Bakker, Van Loey, Van Son, & Van der Heijden, 2010) in 48 mothers of children with burns. PTSS was assessed by self-report. At 1 year and 11 years after their child’s burn event, 17% of the mothers reported clinically significant PTSS. Risk factors for PTSD and PTSS Given the probable adverse consequences for the children and parents, identifying persons at risk for PTSD is important. Screening instruments such as the Screening Tool for Early Predictors of PTSD (STEPP) are suitable for this purpose (Winston, Kassam- Adams, Garcia-Espana, Ittenbach, & Cnaan, 2003). See also the subsection ‘Screening for risk of PTSD’ below. However, if the setting does not allow for the use of a screening instrument or if no screening method is available, other methods to identify children and parents at risk can be advisable. Therefore, insight into factors possibly associated with PTSD is necessary. Moreover, there are possible individual risk factors that can be