Els van Meijel

80 Chapter 5 | Parental posttraumatic stress 2016). The model is based on six assumptions. One of these is specifically relevant for understanding the role of parents: ‘a social ecological or contextual approach is optimal for intervention’. Their findings with that model suggest that parental PTSS increases risk for and maintenance of child PTSS. Parental PTSS not only affects the daily functioning of the parents themselves, but can also impact parenting practices and readiness to meet the demands of medical care for children (Price et al., 2016). The results of a qualitative study in parents following injury (Alisic, Boeije, Jongmans, & Kleber, 2012) suggest that a responsive parenting style supports child recovery. Parents report that their own distress interferes with the use of this parenting style (Alisic et al., 2012; Price et al., 2016). Given the probable adverse consequences for the parents as well as the children, it is important to identify parents at risk for high levels of posttraumatic stress as soon as possible after their child’s accident. Screening instruments such as the Screening Tool for Early Predictors of PTSD (STEPP) are suitable for this purpose (van Meijel et al., 2015; Winston et al., 2003). However, if the setting does not allow for the use of a screening instrument or if no screeningmethod is available, other methods to identify parents at risk can be advisable. Therefore, insight into factors possibly associated with parental PTSS is necessary. Risk factors for adult PTSS or PTSD after their own trauma are well studied, but less is known about factors associated with parental posttraumatic stress reactions following child accidental trauma or injury (Hiller et al., 2016). Furthermore, studies on risk factors for parental PTSD usually involve mixed populations of ill and injured children, and risk factors across these groups appear to vary (Price et al., 2016). Factors associated with parental posttraumatic stress can be parent-related or child- related. Prior trauma history is a consistent predictor of PTSD in adults following a subsequent trauma (Delahanty & Nugent, 2006) and is a predictor of PTSD severity in parents of children with traffic-related injuries (Kassam-Adams et al., 2009). Acute stress responses in parents of children treated in the pediatric intensive care unit were found to be related to parental PTSD (Bronner et al., 2010), and peritraumatic distress was found to be a predictor of PTSD in mothers of victims of motor vehicle accidents (Allenou et al., 2010). Witnessing the event was associated with parental PTSD (de Vries et al., 1999), but parents can be at risk for PTSD even if they are not directly involved in their child’s accident (Kassam-Adams et al., 2013). The number of initial days in hospital significantly predicted PTSS (short and long-term) in parents of a mixed population of accidentally injured children and children with diabetes and