Els van Meijel

61 Results of a 2–4-year follow-up study | Chapter 4 Zatzick and colleagues found an association between high levels of recurrent traumatic life events before the injury and PTSD in injured adolescents 12 months after the accident (Zatzick et al., 2008). Additionally, they suggested that traumatized adolescents are at risk for recurrent posttraumatic life events, including reinjury. PTSD and comorbid disorders (e.g., depression) have been shown to have a negative effect on social relationships, which can lead to social withdrawal, break up of significant relationships and problems in the family (Mehta & Ameratunga, 2012; NICE, 2005). In the general population of children, multiple trauma exposure results in posttraumatic stress symptoms after a next potentially traumatic event (Copeland et al., 2007). Natural recovery of posttraumatic stress symptoms in children can be promoted and facilitated by mechanisms such as post-trauma social support and family cohesiveness (Kazak et al., 2005). These mechanisms can be seen as protective factors and may reduce the risk of persistent PTSS. Furthermore, the resilience of parents appears to play a key role in their children’s emotional recovery; children of resilient parents were most likely to be resilient themselves (Le Brocque et al., 2010). Early screening to identify parents and families that are in need of support in the acute stage following a child’s accident can expedite the recovery of children (Muscara et al., 2018). As indicated above, evidence-based psychological treatments, including trauma- focused psychotherapy, have proven to be effective for children with significant symptoms or chronic PTSD. The association between the long-term consequences of accidental injury and whether or not children have received adequate trauma-focused psychotherapy is still unknown. If we could determine the long-termprevalence of PTSD in children following accidents and confirm identifying factors that are associated with the long-term occurrence of PTSD, this would provide valuable insight with regard to treatment efforts and prevention of long-term negative consequences for children injured in accidents. The aims of the present study were twofold: 1) to measure the prevalence of PTSD in children and adolescents, 2–4 years after accidental injury compared with 3 months after the accident; 2) to gain insight into individual factors that are associated with the occurrence of PTSD at follow-up: permanent physical impairment, acute pain, trauma history and new traumatic events and trauma-focused psychotherapy between the first and follow-up assessment.