Posttraumatic stress and posttraumatic growth in children and their caregivers following pediatric SOT: A systematic review and meta-analysis

Abstract

A significant proportion of pediatric solid organ transplant (SOT) recipients and their caregivers experience psychosocial consequences that negatively impact clinical outcomes following SOT. As the SOT procedure involves traumatic elements, the present review aimed to identify rates of subthreshold posttraumatic stress (PTSS) symptoms and posttraumatic stress disorder (PTSD) in pediatric SOT recipients and in their caregivers in addition to analyzing correlates of these symptoms. Given prior work that has indicated potential realization of benefit in the aftermath of pediatric medical trauma, articles exploring posttraumatic growth (PTG) in pediatric SOT patients and their caregivers were systematically reviewed. A total of 22 independent studies were included in the meta-analyses of caregiver and patient posttraumatic stress (PTS) and seven independent studies were included in the systematic review of PTG. Results from meta-analytic reviews indicated an aggregated mean of 31.31% of patients and 43.47% of caregivers who met criteria for PTSS or PTSD. Findings showed large relationships between patient PTS symptoms and psychosocial outcomes, including depression, anxiety, and quality of life. Medium effects were obtained between patient PTS symptoms and demographic variables, including ethnicity and family income. Non-significant and small effects were obtained in relation to patient and caregiver PTS symptom severity, relevant medical characteristics, and time- and age-related outcomes. Related to overall PTG after pediatric SOT, findings provide clear evidence of elevated ratings in patients and their caregivers, particularly in the domain appreciation of life. Other domain-specific ratings warrant further investigation due to mixed findings. Future work should incorporate longitudinal data to establish predictive models of adaptation following pediatric SOT. Continued work examining patient PTG is recommended to guide interventions aimed at promoting positive coping following pediatric SOT.