Els van Meijel

83 Parental posttraumatic stress | Chapter 5 Measures Factors associated with parental PTSS The multiple points of data collection are summarized in Figure 5.1. Within two weeks after the accident the parents were asked the following closed questions (yes/no) on trauma history and acute stress: ‘Before the accident, did you ever experience anything frightening or horrible yourself?’ (Trauma history); ‘Have you felt very stressed or irritable since your child was injured or since your child has been in the hospital?’ (Acute stress); ‘If you now think about your injured child, do you perspire, shake or does your heart beat faster?’ (Acute stress). These questions were used in cooperation with the authors of the STEPP (Winston et al., 2003). From the STEPP assessment we used the question: ‘Did you see the accident in which your child got hurt?’ Within two weeks after the accident we also asked children to rate the worst pain since the accident (van Meijel et al., 2019). For this purpose, we used the Visual Analogue Scale (VAS), a small ruler with a 10-centimeter line, marked with “no pain” on the left, and “the worst possible pain” on the right. The children used a sliding gauge to mark the location corresponding to the amount of pain they had experienced. The reverse side of the instrument shows the corresponding values from 0 to 100 mm. This instrument was used according to internal hospital guidelines (Baas & Kramer, 2008). Scores can be rounded to the nearest integer and categorized as no or mild pain (0-3), moderate pain (4-7) and severe pain (8-10). We used the category children with severe pain to examine the association with severity of posttraumatic stress of parents. Data on child hospitalization were derived from the medical records and checked with the parents at the 3-month assessment (T1). We divided the variable “length of hospitalization” into two categories: hospitalization 1 day or less and hospitalization more than 1 day. The follow-up interviews (T2) started with the following open-ended questions, first regarding the child, and then regarding the parent him or herself: ‘How are things going?’ and ‘What has happened since we last met?’ With this initial part of the interview we aimed to become informed about the parents’ perception of the course of posttraumatic stress over time and about any other relevant health or mental health related information. Details on long-term consequences of the injury, specifically permanent physical impairment of children, were obtained from children and/or parents in this part of the follow-up assessment. In our study, permanent physical impairment was defined as loss or abnormality of parts of the body, resulting in