137734-Els-van-Meijel

126 Chapter 8 | Summary General introduction Chapter 1 is an introductory chapter about posttraumatic stress after accidental injury in children and adolescents 4 and their parents and about the aims of this thesis. Accidents are a major cause of injury in children and can have great impact on the lives of children and their parents. In the Netherlands, approximately 123,000 children (aged 8-18 5 ; 43% girls, 57% boys) per year are injured in an accident and are subsequently treated in the emergency department of a hospital. In case of potentially life-threatening injury, children are treated in the trauma room of the emergency department, in which staff and equipment for treatment of severe traumatic injuries are available. The accident itself, being transported in the ambulance, the injury, the pain, medical procedures and hospitalization – all can be frightening and potentially traumatic. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the first criterion for PTSD is that the person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence in one or more of the following ways: direct exposure, witnessing the trauma, learning that a relative or close friend was exposed to a trauma, or indirect exposure to aversive details of the trauma. PTSD includes symptoms of re-experiencing, avoidance, negative alterations in cognitions and mood and increased arousal. PTSD can be diagnosed if symptoms persist for longer than one month and cause substantial distress or impairment in functioning. Since the studies in this thesis were performed with DSM- IV-TR criteria, the most important differences between DSM-IV-TR and DSM-5 were summarized in this chapter. PTSD negatively affects children’s functioning and physical recovery from injury. Parental posttraumatic stress has an effect on their own functioning and increases the risk of child PTSD. Given the adverse consequences for the children and the parents, identifying persons at risk for PTSD is important. Moreover, it is important to gain insight in risk factors for PTSD, specifically because there are potential risk factors that can be addressed after an accident. An example of such a factor is acute pain. Research 4 For reasons of readability, both groups are generally referred to as ‘children’ in this thesis. 5 Since the main focus of this thesis is on children aged 8-18, only information on children in this age category is presented here.