Els van Meijel

92 Chapter 5 | Parental posttraumatic stress This study had several limitations. First, almost half of the parents were lost to follow- up. Among those, 9 of 13 reported PTSS at 3 months. This precludes generalization and conclusions about the change of parental PTSS over time, as the estimated prevalence of PTSS at long-term follow-up may be biased. Second, the time between the first and follow-up assessment ranged from 2 to 4 years, resulting in variability in children’s development and transitions in life (van Meijel et al., 2019). This could preclude generalization of the findings to other populations, specifically on the association between parental and child PTSS. Third, posttraumatic stress was assessed by questionnaire and not by clinical interview. Therefore, the prevalence of parental PTSS should be interpreted with caution. Fourth, acute stress (irritability), acute stress (physical), and trauma history were measured with only one question. Due to a lack of comprehensiveness, acute stress and trauma history may not have been adequately measured. The present study adds to the knowledge of parental PTSS. The identification of factors associatedwith severity of later parental PTSS can support decisions about assessments and interventions in the various medical phases. In the peritrauma and acute phase, special attention is required for the stress experienced by the parents, whether or not this is visible to the medical staff. Circumstances surrounding acute treatment of accidentally injured children are often unclear and therefore stressful for many parents. Medical staff should be trained to increase their awareness of acute parental stress, to prevent parental stress as much as possible, to ask about it systematically, to inform parents about it, and, if necessary, refer parents to a psychologist for intervention. To prevent interaction with the child’s response, parents can be helped in dealing with the circumstances and coping with their stress. Supporting parents to adequately address the child’s needs would facilitate child adjustment and recovery. Furthermore, to avoid persistent posttraumatic stress, we recommend timely screening for risk. Later on, systematic monitoring of parents of injured children is indicated, including screening for traumatic stress and treatment of significant traumatic stress. Overall, our results illustrate the importance of attention for parental posttraumatic stress to prevent adverse long-term psychological consequences for the parent and indirectly for the child. Further research is necessary to determine the prevalence of long-term PTSS in parents after accidental injury of their child and to confirm the role of factors associated with parental PTSS severity and their possible interaction.