Els van Meijel

84 Chapter 5 | Parental posttraumatic stress restrictions or lack of ability to perform activities that were considered normal before the accident and are normal for children of that age. According to this definition, answers were coded dichotomously: the presence of permanent physical impairment ‘yes’ or ‘no’. Examples of permanent physical impairment are chronic or frequent pain, walking with a limp, partial deafness and chronic fatigue. Furthermore, a specific question was included regarding new traumatic events: ‘Since the accident, did other stressful things happen to you?’ DSM-IV-TR criteria for a traumatic event (APA, 2000) were decisive for a positive or negative score on this item. Non-traumatic events were classified as life events. If the parent reported one or more new traumatic events, we asked how the parent felt about the consequences of the event and, if applicable, if help in any form was needed. Parents that reported PTSS at T1 or between T1 and T2, and parents that reported new traumatic or life events between T1 and T2, were asked if they had had any form of psychotherapy and if yes, we asked for more details about the therapy and the result of it. Parental posttraumatic stress symptoms (PTSS) The parents completed a self-report instrument, the Dutch version of the Impact of Event Scale-Revised (IES-R; Horowitz et al., 1979; Weiss, 2007). The IES-R consists of 22 questions and contains the subscales re-experiencing, avoidance and hyperarousal (APA, 2000). An example of an item is: “I found myself acting or feeling like I was back at that time.” Scoring is on a 5-point scale. Items are rated according to the frequency of their occurrence during the past week (Not at all=0, A little bit=1, Moderately=2, Quite a bit=3, Extremely=4; range 0-88). The focus is on the child’s accident. A total score of 23 or above indicates the likely presence of PTSD according to DSM-IV-TR criteria (APA, 2000; Mouthaan et al., 2014); in our study this was reported as PTSS, clinically significant posttraumatic stress. We used the total IES-R score to compare means between parents with and without PTSS and to test for associations with parental PTSS severity. A higher score indicates higher severity (Mouthaan et al., 2014). The Dutch IES-R showed adequate similarity with the total score of the Clinician- administered PTSD scale (CAPS; r = 0.75, p < .001) (Hovens et al., 1994; Mouthaan et al., 2014; Weathers et al., 2001). The internal consistency reliability (Cronbach’s alpha) of the current sample was 0.93.