Els van Meijel

91 Parental posttraumatic stress | Chapter 5 follow-up assessment, it is likely that the prevalence at follow-up would have been higher and in agreement with assumptions based on previous studies (Bakker et al., 2010; Bronner et al., 2010; Kazak et al., 2006). In our study, parental and child posttraumatic stress were significantly associated 3 months after the accident, which is in line with the outcomes of other studies included in the meta-analysis of Morris et al. (2012). The association between child and parental PTSS, and the adverse effect of parental stress on the child’s PTSS and recovery, illustrate the important role of parental posttraumatic stress and the importance of adequate psychotherapy. In our sample, although it was very small, the majority of the parents reported no need for therapy. Our findings on the association between child and parent PTSS and the effects on children can be supportive in developing strategies to convince parents to accept adequate treatment. In the univariable models, both acute stress items were significantly associated with the severity of parental PTSS at T1 and T2. In the multivariable models, this was the case at T1 but not at T2. At T2, one of the acute stress items did not contribute to the multivariable model. The differences between the multivariable models at T1 and T2 may result from the small sample size at T2 (n = 69). Our results show that acute parental stress is significantly associated with parental PTSS severity at 3 months and at 2–4 years post-injury. These results are in line with those of other studies (Allenou et al., 2010; Bronner et al., 2010). Furthermore, our results show that hospitalization longer than one day is associated with short and long-term parental PTSS severity. These findings are in line with those of Landolt et al. (2012) but differ from those of Bronner et al. (2010). Our results also show that long-term permanent impairment of the child is associated with parental PTSS severity at follow-up. In future research, it might be useful to examine whether the length of hospitalization and later permanent impairment are related to the characteristics of the injury. If so, it might be possible to determine, at an early stage, what type of injury and/or what injury severity will probably lead to permanent impairment. Although injury severity itself is not a predictor for PTSS, research in children with burns indicates that there is an indirect relationship between burn extent and parental PTSS, through factors such as anxiety or guilt (Bakker et al., 2010; Hall et al., 2006).