Stress in a PICU could originate from the disease itself or from pain, disruptions of the child's routine or the ICU ambience and can be experienced at a physical, emotional or social level. There is insufficient data on the psychological well-being of children admitted to a PICU. Such information is vital to impart holistic care in PICU. This study was conceptualized to overcome this lacuna in knowledge.

Objectives:

To determine whether hospitalization in a PICU results in adverse psychological effects on a sick child and to identify factors contributing to the psychological stress.

Type of study:

Prospective cohort study.

Setting:

Level III PICU of a tertiary care hospital in Mumbai, India.

Patients & Method:

Consecutive patients admitted to PICU over 8 months and fulfilling inclusion criteria (age = 5 years, absence of neurological abnormalities precluding an interview, during of stay in PICU of at least 48 hours of conscious period) were enrolled. Age and sex matched controls were selected from the general pediatric wards. PRISM scores and level of therapeutic intervention (TISS 76 score) were assessed. Tools for psychological assessment were Temperament Measurement Schedule, Impact of Event Scale, Depression scale and the Self Esteem Scale. Statistical analysis was performed using SPSS version 11.5 for Windows.

Results:

Thirty patients (M: F ratio 1:2) and an equal number of age and sex matched controls were enrolled. Significantly higher proportion of patients in PICU had intrusive thoughts (43%) as compared to controls from the ward (6.7%) (p = 0.001). Development of intrusive thoughts correlated significantly with TISS score. Age, socioeconomic status, educational status, nature of the underlying disease, duration of the hospitalization and severity of disease as measured by PRISM score did not significantly correlate with the psychological outcome.

Conclusions:

Children in a PICU are at risk to develop psychological impairment manifest as experiencing intrusive thoughts related to the degree and type of therapeutic intervention.

Clinical Implications:

Impact of PICU hospitalization can be neutralized by measures such as pre-procedure counseling, analgesia and sedation for invasive procedures, recreational facilities and service of a psychologist.

NCPCC 2005 - Conference Abstracts.Pediatric Oncall [serial online] 2006 [cited 15 May 2006(Supplement 5)];3. Available from:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/
Psychological_consequences_PICU.asp