Guilt is associated with acute stress symptoms in children after road traffic accidents

Although previous research has consistently found considerable rates of acute stress disorder (ASD) in children with accidental injuries, knowledge about determinants of ASD remains incomplete. Guilt is a common reaction among children after a traumatic event and has been shown to contribute to posttraumatic stress disorder. However, its relationship to ASD has never been examined. This study assessed the prevalence of ASD in children and adolescents following road traffic accidents (RTAs). Moreover, the association between peritraumatic guilt and ASD was investigated relying on current cognitive theories of posttraumatic stress and controlling for female sex, age, socioeconomic status (SES), injury severity, inpatient treatment, pretrauma psychopathology, and maternal posttraumatic stress symptoms (PTSS). One hundred and one children and adolescents (aged 7–16 years) were assessed by means of a clinical interview approximately 10 days after an RTA. Mothers were assessed by questionnaires. Three participants (3.0%) met diagnostic criteria for full ASD according to DSM-IV, and 17 (16.8%) for subsyndromal ASD. In a multivariate regression model, guilt was found to be a significant predictor of ASD severity. Female sex, outpatient treatment, and maternal PTSS also predicted ASD severity. Child age, SES, injury severity, and pretraumatic child psychopathology were not related to ASD severity. Future research should examine the association between peritraumatic guilt and acute stress symptoms in more detail. Moreover, guilt appraisals in the acute phase after an accident might be a relevant target for clinical attention.

尽管既往研究一致证实，意外受伤儿童群体的急性应激障碍（Acute Stress Disorder, ASD）患病率较高，但学界对该疾病发病相关影响因素的认知仍不全面。愧疚感是创伤事件后儿童常见的情绪反应，且已有研究表明其与创伤后应激障碍的发生密切相关，但目前尚无研究探讨其与ASD之间的关联。本研究旨在评估道路交通事故（Road Traffic Accidents, RTAs）后儿童与青少年群体的ASD患病率，并基于当前创伤后应激认知理论，控制女性性别、年龄、社会经济地位（Socioeconomic Status, SES）、损伤严重程度、住院治疗情况、创伤前精神病理状态以及母亲创伤后应激症状（Posttraumatic Stress Symptoms, PTSS）等混杂因素，探讨创伤期愧疚感与ASD之间的关联。本研究共纳入101名年龄7至16岁的儿童与青少年，在道路交通事故发生约10天后通过临床访谈完成评估，同时采用问卷对其母亲进行测评。结果显示，3名参与者（占比3.0%）符合《精神障碍诊断与统计手册第四版》（DSM-IV）中完全型ASD的诊断标准，另有17名参与者（占比16.8%）符合亚综合征型ASD的诊断标准。多变量回归分析结果表明，愧疚感是ASD症状严重程度的显著预测因子；女性性别、门诊治疗情况以及母亲PTSS同样可有效预测ASD症状严重程度。而儿童年龄、社会经济地位、损伤严重程度以及创伤前儿童精神病理状态与ASD症状严重程度无显著关联。未来研究应进一步深入探讨创伤期愧疚感与急性应激症状之间的关联，此外，事故发生后急性期内的愧疚感评估或许可作为临床干预的重要靶点。