Publications by authors named "Erin A Brown"

10 Publications

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Topical Review: Medical Trauma During Early Childhood.

J Pediatr Psychol 2021 Aug;46(7):739-746

Department of Counseling and Clinical Psychology, Columbia University Teachers College.

Objective: Early childhood is a high-risk period for exposure to traumatic medical events due to injury/illness. It is also one of the most important and vulnerable periods due to rapid development in neurobiological systems, attachment relationships, cognitive and linguistic capacities, and emotion regulation. The aim of this topical review is to evaluate empirical literature on the psychological impact of medical trauma during early childhood (0-6 years) to inform models of clinical care for assessing, preventing, and treating traumatic stress following injury/illness.

Methods: Topical review of empirical and theoretical literature on pediatric medical traumatic stress (PMTS) during early childhood.

Results: There are important developmental factors that influence how infants and young children perceive and respond to medical events. The emerging literature indicates that up to 30% of young children experience PMTS within the first month of an acute illness/injury and between 3% and 10% develop posttraumatic stress disorder. However, significant knowledge gaps remain in our understanding of psychological outcomes for infants and young children, identification of risk-factors and availability of evidence-based interventions for medical trauma following illness.

Conclusions: This topical review on medical trauma during early childhood provides: (a) definitions of key medical trauma terminology, (b) discussion of important developmental considerations, (c) summary of the empirical literature on psychological outcomes, risk factors, and interventions, (d) introduction to a stepped-model-of-care framework to guide clinical practice, and (e) summary of limitations and directions for future research.
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August 2021

Parent and Clinician Communication During Paediatric Burn Wound Care: A Qualitative Study.

J Pediatr Nurs 2020 Nov - Dec;55:147-154. Epub 2020 Sep 17.

School of Psychology, University of Queensland, The University of Queensland, QLD, Australia. Electronic address:

Purpose: To thematically describe parent-clinician communication during a child's first burn dressing change following emergency department presentation.

Design And Methods: An observational study of parent-clinician communication during the first burn dressing change at a tertiary children's hospital. Verbal communication between those present at the dressing change for 87 families, was audio recorded. The recordings were transcribed verbatim and transcripts were analysed within NVivo11 qualitative data analysis software using qualitative content analysis.

Findings: Three themes, underpinned by parent-clinician rapport-building, were identified. Firstly, knowledge sharing was demonstrated: Clinicians frequently informed the parent about the state of the child's wound, what the procedure will involve, and need for future treatment. Comparatively, parents informed the clinician about their child's temperament and coping since the accident. Secondly, child procedural distress management was discussed: Clinicians and parents had expectations about the likelihood of procedural distress, which was also related to communication about how to prevent and interpret procedural distress (i.e., pain/fear). Finally, parents communicated to clinicians about their own distress, worry and uncertainty, from the accident and wound care. Parents also communicated guilt and blame in relation to injury responsibility.

Conclusions: This study provides a description of parent-clinician communication during paediatric burn wound care.

Practical Implications: The results can assist healthcare professionals to be prepared for a range of conversations with parents during potentially distressing paediatric medical procedures.
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April 2021

The role of parental acute psychological distress in paediatric burn re-epithelialization.

Br J Health Psychol 2019 11 6;24(4):876-895. Epub 2019 Aug 6.

School of Psychology, The University of Queensland, St Lucia, Qld, Australia.

Objectives: Following a paediatric burn, parents commonly experience high levels of acute psychological distress, which has been shown to increase child psychological distress as well as child procedural distress. The influence of psychological stress and perceived pain on wound healing has been demonstrated in several laboratory and medical populations. This paper investigates the influence of parental acute psychological distress and procedural behaviour on the child's rate of re-epithelialization, after controlling for child procedural distress.

Design: A prospective observational study with longitudinal outcome.

Methods: Eighty-three parents of children 1-6 years old reported acute psychological distress (post-traumatic stress symptoms [PTSS], guilt, pre-procedural fear, general anxiety/depression symptoms) in relation to their child's burn. A researcher observed parent-child behaviour at the first dressing change, and parents and nurses reported child procedural distress (pre-, peak-, and post-procedural pain and fear). These variables, along with demographic and injury information, were tested for predicting time to re-epithelialization. Date of re-epithelialization was determined by the treating consultant.

Results: Days to re-epithelialization ranged from 3 to 35 days post-injury. A hierarchical multiple regression analysis found wound depth and size significantly accounted for 28% of the variance in time to re-epithelialization. In Block 2, child peak-procedural pain significantly accounted for 6% additional variance. In Block 3, parental PTSS significantly accounted for 5% additional variance.

Conclusions: Parental PTSS appears to be an important but under-recognized factor that may influence their child's burn re-epithelialization. Further investigation is required to understand the mechanisms contributing to this association. Statement of contribution What is already known on this subject? Psychological stress delays wound healing, and this relationship has been found in paediatric burn populations with procedural pain. Parental psychological stress is often present after a child's burn and is related to the child's procedural coping and distress. What does this study add? Parental post-traumatic stress is related to delayed child burn re-epithelialization. This association is in addition to procedural pain delaying re-epithelialization.
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November 2019

Impact of Parental Acute Psychological Distress on Young Child Pain-Related Behavior Through Differences in Parenting Behavior During Pediatric Burn Wound Care.

J Clin Psychol Med Settings 2019 12;26(4):516-529

School of Psychology, University of Queensland, St Lucia, Australia.

Pediatric burn injuries and subsequent wound care can be painful and distressing for children and their parents. This study tested parenting behavior as a mediator for the relationship between parental acute psychological distress and child behavior during burn wound care. Eighty-seven parents of children (1-6-years-old) self-reported accident-related posttraumatic stress symptoms (PTSS), pre-procedural anxiety, general anxiety/depression symptoms, and guilt before the first dressing change. Parent-child behavior was observed during the first dressing change. Mediation analyses identified three indirect effects. Parental PTSS predicted more child distress, mediated through parental distress-promoting behavior. Parental guilt predicted more child distress, mediated through parental distress-promoting behavior. Parental general anxiety/depression symptoms predicted less child coping, mediated through less parental coping-promoting behavior. Parents with accident-related psychological distress have difficulty supporting their child through subsequent medical care. Nature of parental symptomology differentially influenced behavior. Increased acute psychological support for parents may reduce young child procedural pain-related distress.
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December 2019

Changing patterns in the prevalence of posttraumatic stress disorder, major depressive episode and generalized anxiety disorder over 24 months following a road traffic crash: Results from the UQ SuPPORT study.

J Affect Disord 2018 08 21;236:172-179. Epub 2018 Apr 21.

School of Psychology, Australian Catholic University, Brisbane, Queensland, Australia.

Objective: To examine the prevalence and changing patterns of PTSD, major depressive episode (MDE), and generalized anxiety disorder (GAD) in adult claimants who sustained a non-catastrophic injury in a road traffic crash (RTC) in Queensland, Australia.

Method: Participants (N = 284) were assessed at approximately 6, 12, and 24 months post-RTC using the composite international diagnostic interview (CIDI) modules for PTSD, and CIDI-short form for MDE, and GAD.

Results: The prevalence of at least one of these disorders was 48.2%, 52.5%, and 49.3%, at 6, 12, and 24 months, respectively. Comorbidity was common (20.8% at 6 months, 27.1% at 12 months, and 21.1% at 24 months) and only 33.1% of participants never met PTSD, GAD, or MDE criteria. A substantial proportion of participants (42.3%) had an unstable diagnostic pattern over time. Participants with multiple diagnoses at 6 months were more likely to continue to meet diagnostic criteria for any disorder at 12 and 24 months than participants with a single diagnosis. Participants with PTSD (with or without MDE/GAD) were more likely to meet criteria for any disorder at 24 months than participants with another diagnosis. Preinjury psychiatric history increased the likelihood of any disorder at 24 months post-injury, but did not significantly increase the likelihood of PTSD.

Conclusions: People injured in a RTC are at risk of having complex psychological presentations over time. Interventions to prevent mental disorders, especially PTSD, in the early post-injury period are needed to prevent chronic psychological injury, including consideration of comorbidity and dynamic course.
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August 2018

Review of a Parent's Influence on Pediatric Procedural Distress and Recovery.

Clin Child Fam Psychol Rev 2018 06;21(2):224-245

School of Psychology, University of Queensland, St Lucia, QLD, Australia.

Understanding how parents influence their child's medical procedures can inform future work to reduce pediatric procedural distress and improve recovery outcomes. Following a pediatric injury or illness diagnosis, the associated medical procedures can be potentially traumatic events that are often painful and distressing and can lead to the child experiencing long-term physical and psychological problems. Children under 6 years old are particularly at risk of illness or injury, yet their pain-related distress during medical procedures is often difficult to manage because of their young developmental level. Parents can also experience ongoing psychological distress following a child's injury or illness diagnosis. The parent and parenting behavior is one of many risk factors for increased pediatric procedural distress. The impact of parents on pediatric procedural distress is an important yet not well-understood phenomenon. There is some evidence to indicate parents influence their child through their own psychological distress and through parenting behavior. This paper has three purposes: (1) review current empirical research on parent-related risk factors for distressing pediatric medical procedures, and longer-term recovery outcomes; (2) consider and develop existing theories to present a new model for understanding the parent-child distress relationship during medical procedures; and (3) review and make recommendations regarding current assessment tools and developing parenting behavior interventions for reducing pediatric procedural distress.
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June 2018

Early Maternal Reflective Functioning and Infant Emotional Regulation in a Preterm Infant Sample at 6 Months Corrected Age.

J Pediatr Psychol 2016 Sep 24;41(8):906-14. Epub 2016 Jan 24.

School of Nursing, Midwifery and Paramedicine, Australian Catholic University.

Objective: This study investigated the influence of maternal reflective functioning (RF) on 6-month-old infants' emotional self-regulating abilities in preterm infant-mother dyads.

Methods: 25 preterm (gestational age 28-34.5 weeks) infants' affect, gaze toward mother, and self-soothing behaviors (thumb-sucking and playing with clothing) were measured during the still-face procedure at 6 months corrected age. Maternal RF was measured at 7-15 days post-delivery using the Parent Development Interview.

Results: Infants with high RF mothers showed the most negative affect during the still-face episode (M = 21.33s, SE = 5.44), whereas infants with low RF mothers showed the most negative affect in the reunion episode (M = 18.14s, SE = 3.69). Infants with high RF mothers showed significantly more self-soothing behaviors when distressed (Ms > 14.5s) than infants with low RF mothers (Ms < 1s), p's < .01.

Conclusion: Maternal RF was associated with infants' self-regulating behavior, providing preliminary evidence for the regulatory role of maternal RF in preterm infants' emotion regulation capacity.
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September 2016

Parent-Reported Health-Related Quality of Life in Children With Traumatic Brain Injury: A Prospective Study.

J Pediatr Psychol 2016 Mar 22;41(2):244-55. Epub 2015 Sep 22.

Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland.

Objective: To identify which specific aspects of health-related quality of life (HRQL) are affected by traumatic brain injury (TBI) injury severity (Severity), time since injury (Time), and the interaction between Severity and Time, in a pediatric sample. It was hypothesized that Severity would decrease HRQL, Time would increase HRQL, and time to recover would be protracted for children with severe TBI.

Methods: This study followed a pediatric sample (n = 182, aged 6-14 years, recruited through three Australian hospitals) who sustained a mild or moderate-severe TBI across 3, 6, 12, and 18 months post-TBI. 12 specific HRQL outcomes were assessed via the Child Health Questionnaire-Parent Form 50 questionnaire.

Results: Dimensions of HRQL were differentially affected. Children with moderate-severe TBI generally experienced greater initial dysfunction than children with mild TBI; however, this difference disappeared by 18 months post-TBI.

Conclusions: Specific time points where HRQL outcomes may remediate are identified, and clinical recommendations regarding intervention strategies are discussed.
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March 2016

Effect of mental health on long-term disability after a road traffic crash: results from the UQ SuPPORT study.

Arch Phys Med Rehabil 2015 Mar 25;96(3):410-7. Epub 2014 Oct 25.

Centre of National Research on Disability and Rehabilitation Medicine, Faculty of Health and Behavioural Sciences, The University of Queensland, Queensland, Australia.

Objective: To investigate the relation between mental health and disability after a road traffic crash (RTC) up to 24 months for claimants with predominantly minor injuries in an Australian sample.

Design: Longitudinal cohort study with survey and telephone interview data collected at approximately 6, 12, and 24 months post-RTC.

Setting: Not applicable.

Participants: Claimants (N=382) within a common-law, fault-based compulsory third-party motor accident insurance scheme in Queensland, Australia, consented to participate when invited and were approached at each wave. Retention was high (65%) at 2-year follow-up. Disability scores from at least 1 wave were known for 363 participants, with the mean age of participants being 48.4 years and 62% being women.

Interventions: Not applicable.

Main Outcome Measure: Self-reported disability (via the World Health Organization Disability Assessment Schedule 2).

Results: Participants reported higher disability (mean, 10.9±9.3) compared with the Australian norms (mean, 3.1±5.3). A multilevel regression analysis found that predictors of disability included present diagnosis of posttraumatic stress disorder (PTSD), anxiety, or depression, mental health history, perceived threat to life, and pain. PTSD moderated the relation between age and disability such that older age predicted higher disability in the PTSD group only, whereas anxiety moderated the relation between expectation to return to work and disability such that those with low expectations and anxiety reported significantly higher disability.

Conclusions: Claimants with predominantly minor physical injuries report high disability, particularly when comorbid psychiatric disorders are present, pain is high, and expectations regarding return to work are low. Developing tools for detecting those at risk of poor recovery after an RTC is necessary for informing policy and practice in injury management and postinjury rehabilitation.
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March 2015

PTSD perpetuates pain in children with traumatic brain injury.

J Pediatr Psychol 2014 Jun 11;39(5):512-20. Epub 2014 Apr 11.

Centre of National Research on Disability and Rehabilitation Medicine (CONROD), School of Medicine, The University of Queensland, Brisbane, Australia.

Objective: This study tested theoretical models of the relationship between pain and posttraumatic stress disorder (PTSD) in children with traumatic brain injury (TBI).

Methods: Participants consisted of 195 children aged 6-15 years presenting to 1 of 3 Australian hospitals following a mild-severe TBI. Children were assessed at 3, 6, and 18 months after their accident for PTSD (via the Clinician-Administered PTSD Scale for Children and Adolescents [CAPS-CA] clinical interview) as well as physical pain (via the Child Health Questionnaire, 50-item version [CHQ-PF50]). Trained clinicians administered the CAPS-CA at home visits, and the CHQ-PF50 was collected through questionnaires.

Results: Structural equation modeling found the data supported the mutual maintenance model and also the nested perpetual avoidance model.

Conclusions: Both models indicate PTSD is driving the presence of pain, and not vice versa. A fourth model stating this was proposed. Therefore, it may be useful to address PTSD symptoms in treating child pain for expediting recovery.
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June 2014