The relationship between post-traumatic stress in children and adolescents who underwent liver transplantation and post-traumatic stress in their mothers

The relationship between post-traumatic stress in children and adolescents who underwent liver transplantation and post-traumatic stress in their mothers | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The relationship between post-traumatic stress in children and adolescents who underwent liver transplantation and post-traumatic stress in their mothers özge gizli çoban, Arzu Aras, Arif Önder, Sema Öznur Tek, Aslı Sürer Adanır, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4322432/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Liver transplantation(LT) has become the standard treatment protocol for end-stage liver disease, metabolic disorders and, some types of liver tumors. In the present study, we aimed to investigate the quality of life and post-traumatic stress disorder in pediatric LT recipients and in their mothers. Methods Sixty-one children and adolescents who had undergone LT aged 1–18 years took part in this study. The control group consisted of 25 healthy children and adolescents. Participants fulfilled the Child Depression Inventory, Child Post-Traumatic Stress Disorder-Reaction Index, The Pediatric Quality of Life Inventory. Mothers fulfilled the Family Assessment Device and PTSD Checklist-Civilian. Results The physical, psychosocial, and total health scores in the patient group were significantly lower than in the control group. Child-traumatic stress scores were significantly higher in the patient group than in the control group. However, there were no significant differences between groups in terms of child depression scores and maternal traumatic stress scores. There was a negative correlation between maternal traumatic stress scores and child-psychosocial health scores. Maternal traumatic stress scores also correlated positively with child traumatic stress scores. Conclusion Mothers of the LT recipients can benefit from psychoeducation about the symptoms of post-transplant traumatic stress and providing psychological support to caregivers may help with the stress of caring for a child with LT. Liver transplantation quality of life post-traumatic stress disorder family functioning 1. Introduction Liver transplantation(LT) has become the standard treatment protocol for end-stage liver disease, metabolic disorders and, some types of liver tumors. The most common indication for LT in children is still biliary atresia [1]. As a result of new advancements, survival rates of recipients are now quite good and are associated with improved quality of life (QoL) [2]. The 5-year survival rates are now approaching 76% for adults and 90% for children [3]. These successes are due to the enhancement of surgical skills, better organ preservation techniques, the accessibility of newer immunosuppressants, and above all, all to an enormous accumulated global experience [2]. The long-term well-being of the recipients often depends on many pre- and post-transplant determinants, including compliance, QoL, and psychosocial adjustment [4]. After the transplant procedure, numerous children and adolescents report tiredness and may show traces of depression and anxiety [5, 6]. Higher post-traumatic stress disorder(PTSD) rates were also shown in pediatric LT recipients [7, 8]. A review examining the health-related quality of life(HRQoL) in pediatric LT recipients indicated an advancement in HRQoL compared to pre-transplant status; there was a trend towards a worse HRQoL compared to the healthy people and a better HRQoL than for other chronic diseases [9]. In a study, patients under 4 years of age described a good HRQoL in all categories. All school-age patients had poor or extremely poor psychosocial HRQOL[10]. The functioning of the family is related to the extent to which the needs of the members of the family are met [11]. Family functioning refers to families' ability to deal with stressful situations. Through cooperation and following the family's rules and principles, family members can resolve conflicts. The functioning of the family is suggested to be one of the indicators of the mental health and QoL of the family. [12]. In the present study, we aimed to investigate QoL, PTSD in pediatric LT recipients and in their mothers. This was of high interest and therefore the secondary aim of the study was to assess their relationship with family functioning. 2. Methods 2.1. Participants: Sixty-one children and adolescents who had undergone LT aged 1–18 years took part in this study. The patients were enrolled in the study during their clinical follow-up at the outpatient clinic of …. University Faculty of Medicine, Department of Pediatric Gastroenterology, between October 2019 and July 2021. Only one family was excluded from the study for refusing to participate in the study. The control group was made up of relatives of the hospital staff members and consisted of 25 healthy children and adolescents. Subjects and their parents who agreed to participate signed informed consent and then fill out the questionnaires. The study protocol was approved by the Institutional Ethics Committee (protocol number:787). 2.2. Measures: Sociodemographic data form created by researchers includes patient’s age, sex, educational level of mothers and fathers, patient/parent-reported treatment adherence, and who is responsible for taking medication (parent or patient). The Child Depression Inventory (CDI) The CDI has been applied to measure depressive symptoms [13]. It consists of 27 items. For each statement, the child is asked to choose the answer that best describes their emotions over the past two weeks. Each item is rated 0, 1, or 2 depending on the severity of the symptoms. The increment in the total score indicates the severity of the depression. The reliability and validity of the CDI have been confirmed for the Turkish population[14]. In this study, only children who could read and write fulfilled this questionnaire. Child Post-Traumatic Stress Disorder-Reaction Index(CPTSD-RI) In children, post-traumatic stress symptoms were assessed using the CPTSD-RI. It consists of 20 Likert-type questions. CPTSD-RI was developed by Pynoos et al.[15] and its reliability and validity in the Turkish language were demonstrated by Erden et al.[16]. In this study, only children who could read and write fulfilled this scale. The Pediatric Quality of Life Inventory (PedsQL) The PedsQL was carried out to assess performed to evaluate HRQoL in physical and psychosocial areas [17]. Only child-report PedsQL was used in this study. Higher values reflect greater HRQoL. The reliability and validity studies of the Turkish version were carried out for 5–7, 8–12, 13–18 –year-old children [18–20]. In this study, only children who could read and write fulfilled this inventory. Family Assessment Device(FAD) FAD is a 60 item questionnaire used to assess family functioning. The FAD consists of seven scales that measure problem-solving, communication, roles, affective responsiveness, affective involvement, behavior control, and general functioning [21]. The statements were rated on a 4-point Likert scale and a mean value was calculated; higher values indicate poorer family functioning. The validity and reliability of the FAD in Turkish families were confirmed by Bulut [22]. PTSD Checklist-Civilian(PCL-C) PTSD was assessed with the PCL-C in mothers in this study. The PCL-C is a 17-item self-report questionnaire [23]. Its reliability and validity in the Turkish language were demonstrated by Kocabaşoğlu et al. [24]. 2.3. Statistics: All statistical analyses were performed using Statistical Package for the Social Sciences version 20.0 (IBM Corp) software package. The categorical variables are reported using frequency and percentage, and numerical variables with mean and standard deviation or median values. To determine the normality of the distribution of continuous variables, the Kolmogorov Smirnov test was used. For the comparison of the parameters between the groups, the independent samples t-test was used for normally distributed variables and the Mann- Whitney U test was used for those with non-normal distribution. The chi-square test was used to analyze the relationship between categorical variables. Spearman correlation analysis was used to analyze the relationship between numerical variables. P values of 0.05 were considered statistically significant. 3. Results The socio-demographic characteristics of the participants are shown in Table 1 . There was no significant difference between the groups in terms of age and sex. Table 1 Sociodemographic characteristics of the participants Patient group(n = 61) Control group(n = 25) P Value Age (Mean ± SD) 9.34 ± 4.85 9.44 ± 4.38 0.862 Sex a Girls, n(%) Boys, n(%) 31(50%) 31(50%) 13(52%) 12(48%) 0.866 Level of income a Low High 31(54.4%) 26(45.6%) 4(16%) 21(84%) 0.001 Marital status a Married Divorced 57(93.4%) 4(6.6%) 23(92%) 2(8%) 1.00 a : chi-square test. Bold values denote statistically significance According to PedsQL, the physical, psychosocial, and total health scores in the patient group were significantly lower than in the control group(p < 0.001 for both). Child-traumatic stress scores were significantly higher in the patient group than in the control group. However, there were no significant differences between groups in terms of child depression scores and maternal traumatic stress scores. According to FAD subscales, only ‘’communication’’ scores were significantly higher in the patient group which reflects communication problems in families with pediatric liver transplantation. Comparison of scale scores was shown in Table 2 . Table 2 Comparison of scale scores of the groups Patient group(n = 61) Control group(n = 25) P Value Physical-PedsQL 62.85 ± 23.02 87.84 ± 9.94 0.0001 Psychosocial-PedsQL 70.73 ± 17.83 87.85 ± 9.49 0.0001 Total-PedsQL 68.34 ± 17.32 87.85 ± 8.72 0.0001 CDI 10.08 ± 7.66 11.83 ± 9.13 0.665 Child-post traumatic stress scores 22.91 ± 11.94 11.94 ± 5.16 0.0001 Maternal post-traumatic stress scores 18.57 ± 13.00 17.96 ± 9.49 0.838 Family Assessment Device problem-solving communication roles affective responsiveness affective involvement behavior control general functioning 10.67 ± 3.77 15.20 ± 4.55 21.24 ± 4.98 9.98 ± 3.91 15.94 ± 3.02 17.92 ± 2.66 19.52 ± 6.50 9.90 ± 2.95 12.68 ± 2.91 20.81 ± 5.07 8.59 ± 2.97 15.90 ± 2.55 18.04 ± 3.21 18.81 ± 6.15 0.490 0.027 0.907 0.184 0.431 0.898 0.377 Bold values denote statistically significance. When asked who is responsible for taking medication in the transplant group, it was the patient's responsibility in only 4 families. When we asked the parents whether their children were adapting to the treatment, 44% said that they did not comply with the medication. Correlational analysis : In the patient group, a negative correlation was found between child depression scores and physical health scores, a positive correlation between child depression scores and child traumatic stress scores. There was also a negative correlation between physical health scores and child traumatic stress scores. Maternal traumatic stress scores also had a positive correlation with the some of subscales of FAD such as communication, roles, affective responsiveness, and general functioning that reflect negative family functioning. There was a negative correlation between maternal traumatic stress scores and child-psychosocial health scores. Maternal traumatic stress scores also correlated positively with child traumatic stress scores. Correlational analysis was shown in Table 3 . Table 3 Spearman correlational analysis of the CDI, PedsQL, CPTSD-RI and PCL-C scale scores in the patient group. CDI Physical-PedsQL Psychosocial –PedsQL CPTSD-RI PCL-C CDI -0.469** -0.287 0.437** 0.134 Physical-PedsQL 0.425** -0.470** -0.128 Psychosocial –PedsQL -0.397* -0.368* CPTSD-RI 0.490** PCL-C * P < 0.05 ** P < 0.01 *** P < 0.001 4. Discussion According to our study, the physical, psychosocial, and total health quality of life were worse in the patient group than in the control group. Child-traumatic stress scores were significantly higher in patient group than in the control group. ‘’Communication’’problems were much more common in family of the patient group than in the control group. Chronic childhood illnesses and their treatment represent a major source of chronic stress for patients and their parents, which can lead to emotional and behavioral problems and non-adherence to treatment [25]. Although it was initially believed to be solely related to wars and natural disasters, a variety of stressors including life-threatening diseases, was suggested to lead to PTSD (28). Studies have shown a high prevalence of self-reported PTSD in children who survive with a solid organ transplant, and these trauma symptoms are significantly linked to the children's self-assessed QoL [26]. Higher PTSD rates were also shown in pediatric LT recipients [7, 8, 27]. In line with these results, in our study, child-traumatic stress scores were significantly higher in liver transplant recipients. A review showed that PTSD rates are also high among parents of candidates and recipients of solid organ transplants. Studies were conducted primarily on caregivers of kidney and heart transplant recipients [28]. In one study, caregivers of pediatric recipients of solid organ transplants did not report increased levels of depression or anxiety but reported increased PTSD symptoms [29]. In another study, caregivers of pediatric solid organ recipients reported lower rates of clinical PTSD (11.3%) and this study found a low association between child and caregiver PTSD [30]. Our study is one of the few studies investigating the post-traumatic stress in mothers of pediatric liver transplant recipients. In our study, however, there were no significant differences between groups in terms of maternal traumatic stress scores. On the other hand, maternal traumatic stress scores also had a positive correlation with child traumatic stress scores and a negative correlation with child-psychosocial health scores. These results mean that the mother’s traumatic stress adversely affected the child’s psychological status. Liver transplantation in childhood was suggested to have a negative impact on various domains of HRQoL[9]. A number of studies included within a review suggest that HRQoL is lower in pediatric LT recipients than healthy children, but similar to children with chronic diseases or other pediatric solid organ transplant recipients [31]. In our previous study, we investigated depression, anxiety, PTSD, and QoL in LT recipients and compared those variables with LT candidates and healthy controls. We had found that the child report-QoL scores were significantly lower in both the pre-transplant and post-transplant groups as compared with the healthy controls [8]. In line with these results, in the present study, we found that physical, psychosocial, and total health scores were significantly lower in the patient group than in the control group. And also, there was a negative correlation between physical health scores and child traumatic stress scores, suggesting that traumatic stress negatively affects the physical QoL of the patients. Parents of children with LT need to be able to perform numerous roles and adapt to alterations in their child’s care. They go through the process of learning how to manage the disease, from living with someone with existing liver disease, to how to care for their child with LT [32]. Pediatric solid organ transplantation is also related with heightened family stress and burden throughout the transplant procedure that are associated with poorer adherence to post-transplant immunosuppressant medications [28]. In the present study, communication problems were much more shown in the patient group than in the control group which reflects communication problems in families with pediatric LT. Maternal traumatic stress scores also had a positive correlation with the some of subscales of FAD such as communication, roles, affective responsiveness, and general functioning suggesting that maternal traumatic stress adversely affected family functioning. Families who exhibit deficiencies in communication and sharing responsibility for family duties may have difficulty coping with stressful times [33]. One of the strengths of this study is that a relatively large sample size of pediatric liver transplant recipients and includes a healthy control group. Besides evaluating the psychological status of the child, we also investigated the mothers and family functioning. There are also some limitations of this study. First, we did not have a control group including other chronic illnesses. Second, we did not assess other psychiatric diagnoses beyond depression and PTSD, and the presence of those disorders was based on self-report measures. Additionally, the study was limited to one center. Multi-center studies would be better to further validate the findings obtained. 5. Conclusion In the present study, HRQoL was worse and post-traumatic stress was higher in patient group than in the control group. ‘’Communication’’problems were much more shown in the family of the patient group than in the control group. In addition, maternal post-traumatic stress is associated with child psychosocial-QoL and post-traumatic stress in pediatric liver transplant recipients. It is vital to evaluate family functioning to identify the family’s strengths, weaknesses, and concerns during the transplant period and re-evaluate at regular intervals post-transplant. Additionally, mothers of the LT recipients can benefit from psychoeducation about the symptoms of post-transplant traumatic stress and providing psychological support to caregivers may help with the stress of caring for a child with LT. Young adults who have had a liver transplant in childhood face various and specific challenges compared to their peers who have never had a transplant or who have had a transplant later in life (33) that highlights the importance of the follow up these patients in terms of psychological status. Future longitudinal studies will help follow patients and their families over time for a more in-depth assessment of PTSD. Abbreviations CDI The Child Depression Inventory CPTSD-RI Child Post-Traumatic Stress Disorder-Reaction Index FAD Family Assessment Device HRQoL Health-Related Quality of Life LT Liver Transplantation QoL Quality of Life PedsQL The Pediatric Quality of Life Inventory PCL-C PTSD Checklist-Civilian PTSD Post-traumatic Stress Disorder Declarations Author contributions : Ö.G.Ç and AA. involved in concept/design. A.A. and S.Ö.T collected the data. A.Ö., A.S.A and A.A. involved in data analysis/interpretation and statistics. Ö.G.Ç. wrote the manuscript. R.A. critically revised the manuscript. Conflict of interest: None Funding: None Data availability: The data used to support the fndings of this study are available from the corresponding author upon request. Consent for publication: Not applicable. References Pham YH, Miloh T. Liver Transplantation in Children. Clinics in liver disease. 2018;22(4):807 − 21. Kohli R, Cortes M, Heaton N, Dhawan A. Liver transplantation in children: state of the art and future perspectives. Archives of disease in childhood. 2018;103(2):192-8. Lai JC, Ufere NN, Bucuvalas JC. Liver transplant survivorship. Liver transplantation. 2020;26(8):1030-3. Rook M, Rand E. Predictors of long-term outcome after liver transplant. Current opinion in organ transplantation. 2011;16(5):499–504. Fredericks E, Lopez M, Magee J, Shieck V, Opipari-Arrigan L. Psychological functioning, nonadherence and health outcomes after pediatric liver transplantation. American Journal of Transplantation. 2007;7(8):1974-83. 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Transplantation proceedings; 2013: Elsevier. Ryan C, Epstein NB, Keitner GI, Miller IW, Bishop DS. Evaluating and treating families: The McMaster approach: Routledge; 2012. Modanloo S, Rohani C, Farahani AS, Vasli P, Pourhosseingholi A. General family functioning as a predictor of quality of life in parents of children with cancer. Journal of pediatric nursing. 2019;44:e2-e8. Kovacs M. Children's depression inventory (CDI): Multi-Health System Toronto; 2003. Öy B. Children’s Depression Inventory: a study of reliability and validity. Turk Psikiyatri Dergisi. 1991;2:132-6. Pynoos RS, Frederick C, Nader K, Arroyo W, Steinberg A, Eth S, et al. Life threat and posttraumatic stress in school-age children. Archives of general psychiatry. 1987;44(12):1057-63. Erden G, Kiliç E, Uslu R, Kerimoglu E. Çocuklar için travma sonrasi stres tepki ölçegi: Türkçe geçerlik, güvenirlik çalismasi. Çocuk ve Gençlik Ruh Sagligi Dergisi. 1999;6(3):143-9. Varni JW, Seid M, Kurtin PS. 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Weathers FW, Litz BT, Herman D, Huska J, Keane T. The PTSD checklist-civilian version (PCL-C). Boston, MA: National Center for PTSD. 1994;10. Kocabasoglu N, Çorapçioglu Özdemir A, Yargiç I, Geyran PT, editors. PTSD checklist-civilian version. PCL-C) Ölçeginin geçerlilik ve güvenilirligi Yeni Symposium; 2005. Compas BE, Jaser SS, Dunn MJ, Rodriguez EM. Coping with chronic illness in childhood and adolescence. Annual review of clinical psychology. 2012;8:455 − 80. Hind T, Lui S, Moon E, Broad K, Lang S, Schreiber RA, et al. Post-traumatic stress as a determinant of quality of life in pediatric solid-organ transplant recipients. Pediatric Transplantation. 2021:e14005. Walker AM, Harris G, Baker A, Kelly D, Houghton J. Post-traumatic stress responses following liver transplantation in older children. The Journal of Child Psychology and Psychiatry and Allied Disciplines. 1999;40(3):363 − 74. Cousino MK, Rea KE, Schumacher KR, Magee JC, Fredericks EM. A systematic review of parent and family functioning in pediatric solid organ transplant populations. Pediatric Transplantation. 2017;21(3):e12900. Young GS, Mintzer LL, Seacord D, Castaneda M, Mesrkhani V, Stuber ML. Symptoms of posttraumatic stress disorder in parents of transplant recipients: incidence, severity, and related factors. Pediatrics. 2003;111(6):e725-e31. Masood SS, Triplett KN, Killian M, Mayersohn GS, Desai DM. Examining the association of medical complications and posttraumatic stress symptoms in pediatric solid organ transplant patients and their caregivers. Pediatric Transplantation. 2021:e14030. Parmar A, Vandriel SM, Ng VL. Health-related quality of life after pediatric liver transplantation: a systematic review. Liver Transplantation. 2017;23(3):361 − 74. Kosmach-Park B. The impact of liver transplantation on family functioning in pediatric recipients: Can “healthy” families contribute to improved long-term survival? : Wiley Online Library; 2013. Fredericks EM. Family roles and routines after pediatric liver transplantation: Implications for quality of life and beyond. Pediatric transplantation. 2012;16(7):688. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4322432","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":297086252,"identity":"a462ffc6-0e6d-41d8-9a13-5f8f72364b9b","order_by":0,"name":"özge gizli çoban","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIie2RMYvCMBSAEwIvy8OuKa3nX3hQcNS/Igh1cRCc5EAFQZeC/yazItTFxU1wsfoHLCgod8OlnBw3pR0d8k3fkI+8lzDmcLwtxEKQy/xkFGtVEwRcRVQkUPUeZKrTVIWVJp633We3wRhruIpH934rBCay88GS+NPdMAoJEOQ0PdZ11wwGUdS3bbFO4kARml3W86OvhUkQAmuywd6XIoWgujD09aRCksqUX4lMEgPP9aY88RMUAaOOGWwnAq63CKJkF/NiWf74Hn80FgnPn/qz7clZdrEl5kdI4Et/RViPF8gTf7z0TxwOh8Pxnx8HgT235Q7gRgAAAABJRU5ErkJggg==","orcid":"","institution":"Akdeniz University","correspondingAuthor":true,"prefix":"","firstName":"özge","middleName":"gizli","lastName":"çoban","suffix":""},{"id":297086260,"identity":"c320d449-c133-4c16-8219-0a6f6331b860","order_by":1,"name":"Arzu Aras","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Arzu","middleName":"","lastName":"Aras","suffix":""},{"id":297086265,"identity":"df1871cc-8384-4c2f-b844-58daea950572","order_by":2,"name":"Arif Önder","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Arif","middleName":"","lastName":"Önder","suffix":""},{"id":297086269,"identity":"180a12e6-c110-42b2-a941-1dd16ea5ab45","order_by":3,"name":"Sema Öznur Tek","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Sema","middleName":"Öznur","lastName":"Tek","suffix":""},{"id":297086273,"identity":"7477f311-6f57-4f52-b0c9-c90fcf6a1897","order_by":4,"name":"Aslı Sürer Adanır","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Aslı","middleName":"Sürer","lastName":"Adanır","suffix":""},{"id":297086276,"identity":"b13c9770-9158-4a80-9123-ac568d16d753","order_by":5,"name":"Reha Artan","email":"","orcid":"","institution":"Akdeniz University","correspondingAuthor":false,"prefix":"","firstName":"Reha","middleName":"","lastName":"Artan","suffix":""}],"badges":[],"createdAt":"2024-04-25 07:47:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4322432/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4322432/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57995654,"identity":"bb61d494-be8c-41b8-abef-04831c7bbe3f","added_by":"auto","created_at":"2024-06-09 09:01:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":508222,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4322432/v1/3d138e9d-c872-462d-ab02-6136b5063295.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The relationship between post-traumatic stress in children and adolescents who underwent liver transplantation and post-traumatic stress in their mothers","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eLiver transplantation(LT) has become the standard treatment protocol for end-stage liver disease, metabolic disorders and, some types of liver tumors. The most common indication for LT in children is still biliary atresia [1]. As a result of new advancements, survival rates of recipients are now quite good and are associated with improved quality of life (QoL) [2]. The 5-year survival rates are now approaching 76% for adults and 90% for children [3]. These successes are due to the enhancement of surgical skills, better organ preservation techniques, the accessibility of newer immunosuppressants, and above all, all to an enormous accumulated global experience [2].\u003c/p\u003e \u003cp\u003eThe long-term well-being of the recipients often depends on many pre- and post-transplant determinants, including compliance, QoL, and psychosocial adjustment [4]. After the transplant procedure, numerous children and adolescents report tiredness and may show traces of depression and anxiety [5, 6]. Higher post-traumatic stress disorder(PTSD) rates were also shown in pediatric LT recipients [7, 8].\u003c/p\u003e \u003cp\u003e A review examining the health-related quality of life(HRQoL) in pediatric LT recipients indicated an advancement in HRQoL compared to pre-transplant status; there was a trend towards a worse HRQoL compared to the healthy people and a better HRQoL than for other chronic diseases [9]. In a study, patients under 4 years of age described a good HRQoL in all categories. All school-age patients had poor or extremely poor psychosocial HRQOL[10].\u003c/p\u003e \u003cp\u003eThe functioning of the family is related to the extent to which the needs of the members of the family are met [11]. Family functioning refers to families' ability to deal with stressful situations. Through cooperation and following the family's rules and principles, family members can resolve conflicts. The functioning of the family is suggested to be one of the indicators of the mental health and QoL of the family. [12].\u003c/p\u003e \u003cp\u003eIn the present study, we aimed to investigate QoL, PTSD in pediatric LT recipients and in their mothers. This was of high interest and therefore the secondary aim of the study was to assess their relationship with family functioning.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Participants:\u003c/h2\u003e \u003cp\u003eSixty-one children and adolescents who had undergone LT aged 1\u0026ndash;18 years took part in this study. The patients were enrolled in the study during their clinical follow-up at the outpatient clinic of \u0026hellip;. University Faculty of Medicine, Department of Pediatric Gastroenterology, between October 2019 and July 2021. Only one family was excluded from the study for refusing to participate in the study. The control group was made up of relatives of the hospital staff members and consisted of 25 healthy children and adolescents. Subjects and their parents who agreed to participate signed informed consent and then fill out the questionnaires. The study protocol was approved by the Institutional Ethics Committee (protocol number:787).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Measures:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eSociodemographic data form created by researchers includes patient\u0026rsquo;s age, sex, educational level of mothers and fathers, patient/parent-reported treatment adherence, and who is responsible for taking medication (parent or patient).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eThe Child Depression Inventory (CDI)\u003c/strong\u003e \u003cp\u003eThe CDI has been applied to measure depressive symptoms [13]. It consists of 27 items. For each statement, the child is asked to choose the answer that best describes their emotions over the past two weeks. Each item is rated 0, 1, or 2 depending on the severity of the symptoms. The increment in the total score indicates the severity of the depression. The reliability and validity of the CDI have been confirmed for the Turkish population[14]. In this study, only children who could read and write fulfilled this questionnaire.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eChild Post-Traumatic Stress Disorder-Reaction Index(CPTSD-RI)\u003c/strong\u003e \u003cp\u003eIn children, post-traumatic stress symptoms were assessed using the CPTSD-RI. It consists of 20 Likert-type questions. CPTSD-RI was developed by Pynoos et al.[15] and its reliability and validity in the Turkish language were demonstrated by Erden et al.[16]. In this study, only children who could read and write fulfilled this scale.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eThe Pediatric Quality of Life Inventory (PedsQL)\u003c/strong\u003e \u003cp\u003eThe PedsQL was carried out to assess performed to evaluate HRQoL in physical and psychosocial areas [17]. Only child-report PedsQL was used in this study. Higher values reflect greater HRQoL. The reliability and validity studies of the Turkish version were carried out for 5\u0026ndash;7, 8\u0026ndash;12, 13\u0026ndash;18 \u0026ndash;year-old children [18\u0026ndash;20]. In this study, only children who could read and write fulfilled this inventory.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFamily Assessment Device(FAD)\u003c/strong\u003e \u003cp\u003eFAD is a 60 item questionnaire used to assess family functioning. The FAD consists of seven scales that measure problem-solving, communication, roles, affective responsiveness, affective involvement, behavior control, and general functioning [21]. The statements were rated on a 4-point Likert scale and a mean value was calculated; higher values indicate poorer family functioning. The validity and reliability of the FAD in Turkish families were confirmed by Bulut [22].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePTSD Checklist-Civilian(PCL-C)\u003c/strong\u003e \u003cp\u003ePTSD was assessed with the PCL-C in mothers in this study. The PCL-C is a 17-item self-report questionnaire [23]. Its reliability and validity in the Turkish language were demonstrated by Kocabaşoğlu et al. [24].\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Statistics:\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAll statistical analyses were performed using Statistical Package for the Social Sciences version 20.0 (IBM Corp) software package. The categorical variables are reported using frequency and percentage, and numerical variables with mean and standard deviation or median values. To determine the normality of the distribution of continuous variables, the Kolmogorov Smirnov test was used. For the comparison of the parameters between the groups, the independent samples t-test was used for normally distributed variables and the Mann- Whitney U test was used for those with non-normal distribution. The chi-square test was used to analyze the relationship between categorical variables. Spearman correlation analysis was used to analyze the relationship between numerical variables. P values of 0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe socio-demographic characteristics of the participants are shown \u003cb\u003ein\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There was no significant difference between the groups in terms of age and sex.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient group(n\u0026thinsp;=\u0026thinsp;61)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group(n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.44\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eGirls, n(%)\u003c/p\u003e \u003cp\u003eBoys, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(50%)\u003c/p\u003e \u003cp\u003e31(50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(52%)\u003c/p\u003e \u003cp\u003e12(48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLevel of income\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eLow\u003c/p\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(54.4%)\u003c/p\u003e \u003cp\u003e26(45.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(16%)\u003c/p\u003e \u003cp\u003e21(84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57(93.4%)\u003c/p\u003e \u003cp\u003e4(6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(92%)\u003c/p\u003e \u003cp\u003e2(8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e chi-square test. \u0026nbsp; \u0026nbsp;Bold values denote statistically significance\u003c/p\u003e\u003c/p\u003e \u003cp\u003eAccording to PedsQL, the physical, psychosocial, and total health scores in the patient group were significantly lower than in the control group(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for both). Child-traumatic stress scores were significantly higher in the patient group than in the control group. However, there were no significant differences between groups in terms of child depression scores and maternal traumatic stress scores.\u003c/p\u003e \u003cp\u003eAccording to FAD subscales, only \u0026lsquo;\u0026rsquo;communication\u0026rsquo;\u0026rsquo; scores were significantly higher in the patient group which reflects communication problems in families with pediatric liver transplantation. Comparison of scale scores was shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of scale scores of the groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient group(n\u0026thinsp;=\u0026thinsp;61)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group(n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical-PedsQL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e62.85\u0026thinsp;\u0026plusmn;\u0026thinsp;23.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e87.84\u0026thinsp;\u0026plusmn;\u0026thinsp;9.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsychosocial-PedsQL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e70.73\u0026thinsp;\u0026plusmn;\u0026thinsp;17.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e87.85\u0026thinsp;\u0026plusmn;\u0026thinsp;9.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal-PedsQL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e68.34\u0026thinsp;\u0026plusmn;\u0026thinsp;17.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e87.85\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCDI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e10.08\u0026thinsp;\u0026plusmn;\u0026thinsp;7.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.83\u0026thinsp;\u0026plusmn;\u0026thinsp;9.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.665\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild-post traumatic stress scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e22.91\u0026thinsp;\u0026plusmn;\u0026thinsp;11.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.94\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal post-traumatic stress scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e18.57\u0026thinsp;\u0026plusmn;\u0026thinsp;13.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e17.96\u0026thinsp;\u0026plusmn;\u0026thinsp;9.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.838\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily Assessment Device\u003c/b\u003e\u003c/p\u003e \u003cp\u003eproblem-solving\u003c/p\u003e \u003cp\u003ecommunication\u003c/p\u003e \u003cp\u003eroles\u003c/p\u003e \u003cp\u003eaffective responsiveness\u003c/p\u003e \u003cp\u003eaffective involvement\u003c/p\u003e \u003cp\u003ebehavior control\u003c/p\u003e \u003cp\u003egeneral functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.77\u003c/p\u003e \u003cp\u003e15.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55\u003c/p\u003e \u003cp\u003e21.24\u0026thinsp;\u0026plusmn;\u0026thinsp;4.98\u003c/p\u003e \u003cp\u003e9.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.91\u003c/p\u003e \u003cp\u003e15.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02\u003c/p\u003e \u003cp\u003e17.92\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e \u003cp\u003e19.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e \u003cp\u003e12.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91\u003c/p\u003e \u003cp\u003e20.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.07\u003c/p\u003e \u003cp\u003e8.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e \u003cp\u003e15.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55\u003c/p\u003e \u003cp\u003e18.04\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e \u003cp\u003e18.81\u0026thinsp;\u0026plusmn;\u0026thinsp;6.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.490\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.907\u003c/p\u003e \u003cp\u003e0.184\u003c/p\u003e \u003cp\u003e0.431\u003c/p\u003e \u003cp\u003e0.898\u003c/p\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eBold values denote statistically significance.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen asked who is responsible for taking medication in the transplant group, it was the patient's responsibility in only 4 families. When we asked the parents whether their children were adapting to the treatment, 44% said that they did not comply with the medication.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCorrelational analysis\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eIn the patient group, a negative correlation was found between child depression scores and physical health scores, a positive correlation between child depression scores and child traumatic stress scores. There was also a negative correlation between physical health scores and child traumatic stress scores.\u003c/p\u003e \u003cp\u003eMaternal traumatic stress scores also had a positive correlation with the some of subscales of FAD such as communication, roles, affective responsiveness, and general functioning that reflect negative family functioning.\u003c/p\u003e \u003cp\u003eThere was a negative correlation between maternal traumatic stress scores and child-psychosocial health scores. Maternal traumatic stress scores also correlated positively with child traumatic stress scores. Correlational analysis was shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpearman correlational analysis of the CDI, PedsQL, CPTSD-RI and PCL-C scale scores in the patient group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCDI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysical-PedsQL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePsychosocial \u0026ndash;PedsQL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCPTSD-RI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePCL-C\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCDI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.469**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.437**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical-PedsQL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.425**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.470**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.128\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychosocial \u0026ndash;PedsQL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.397*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.368*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCPTSD-RI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.490**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCL-C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 \u003csup\u003e**\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01 \u003csup\u003e***\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAccording to our study, the physical, psychosocial, and total health quality of life were worse in the patient group than in the control group. Child-traumatic stress scores were significantly higher in patient group than in the control group. ‘’Communication’’problems were much more common in family of the patient group than in the control group.\u003c/p\u003e\u003cp\u003eChronic childhood illnesses and their treatment represent a major source of chronic stress for patients and their parents, which can lead to emotional and behavioral problems and non-adherence to treatment [25]. Although it was initially believed to be solely related to wars and natural disasters, a variety of stressors including life-threatening diseases, was suggested to lead to PTSD (28). Studies have shown a high prevalence of self-reported PTSD in children who survive with a solid organ transplant, and these trauma symptoms are significantly linked to the children's self-assessed QoL [26]. Higher PTSD rates were also shown in pediatric LT recipients [7, 8, 27]. In line with these results, in our study, child-traumatic stress scores were significantly higher in liver transplant recipients.\u003c/p\u003e\u003cp\u003eA review showed that PTSD rates are also high among parents of candidates and recipients of solid organ transplants. Studies were conducted primarily on caregivers of kidney and heart transplant recipients [28]. In one study, caregivers of pediatric recipients of solid organ transplants did not report increased levels of depression or anxiety but reported increased PTSD symptoms [29]. In another study, caregivers of pediatric solid organ recipients reported lower rates of clinical PTSD (11.3%) and this study found a low association between child and caregiver PTSD [30]. Our study is one of the few studies investigating the post-traumatic stress in mothers of pediatric liver transplant recipients. In our study, however, there were no significant differences between groups in terms of maternal traumatic stress scores. On the other hand, maternal traumatic stress scores also had a positive correlation with child traumatic stress scores and a negative correlation with child-psychosocial health scores. These results mean that the mother’s traumatic stress adversely affected the child’s psychological status.\u003c/p\u003e\u003cp\u003eLiver transplantation in childhood was suggested to have a negative impact on various domains of HRQoL[9]. A number of studies included within a review suggest that HRQoL is lower in pediatric LT recipients than healthy children, but similar to children with chronic diseases or other pediatric solid organ transplant recipients [31]. In our previous study, we investigated depression, anxiety, PTSD, and QoL in LT recipients and compared those variables with LT candidates and healthy controls. We had found that the child report-QoL scores were significantly lower in both the pre-transplant and post-transplant groups as compared with the healthy controls [8]. In line with these results, in the present study, we found that physical, psychosocial, and total health scores were significantly lower in the patient group than in the control group. And also, there was a negative correlation between physical health scores and child traumatic stress scores, suggesting that traumatic stress negatively affects the physical QoL of the patients.\u003c/p\u003e\u003cp\u003e Parents of children with LT need to be able to perform numerous roles and adapt to alterations in their child’s care. They go through the process of learning how to manage the disease, from living with someone with existing liver disease, to how to care for their child with LT [32]. Pediatric solid organ transplantation is also related with heightened family stress and burden throughout the transplant procedure that are associated with poorer adherence to post-transplant immunosuppressant medications [28]. In the present study, communication problems were much more shown in the patient group than in the control group which reflects communication problems in families with pediatric LT. Maternal traumatic stress scores also had a positive correlation with the some of subscales of FAD such as communication, roles, affective responsiveness, and general functioning suggesting that maternal traumatic stress adversely affected family functioning. Families who exhibit deficiencies in communication and sharing responsibility for family duties may have difficulty coping with stressful times [33].\u003c/p\u003e\u003cp\u003eOne of the strengths of this study is that a relatively large sample size of pediatric liver transplant recipients and includes a healthy control group. Besides evaluating the psychological status of the child, we also investigated the mothers and family functioning. There are also some limitations of this study. First, we did not have a control group including other chronic illnesses. Second, we did not assess other psychiatric diagnoses beyond depression and PTSD, and the presence of those disorders was based on self-report measures. Additionally, the study was limited to one center. Multi-center studies would be better to further validate the findings obtained.\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e "},{"header":"5. Conclusion","content":"\u003cp\u003eIn the present study, HRQoL was worse and post-traumatic stress was higher in patient group than in the control group. ‘’Communication’’problems were much more shown in the family of the patient group than in the control group. In addition, maternal post-traumatic stress is associated with child psychosocial-QoL and post-traumatic stress in pediatric liver transplant recipients. It is vital to evaluate family functioning to identify the family’s strengths, weaknesses, and concerns during the transplant period and re-evaluate at regular intervals post-transplant. Additionally, mothers of the LT recipients can benefit from psychoeducation about the symptoms of post-transplant traumatic stress and providing psychological support to caregivers may help with the stress of caring for a child with LT. Young adults who have had a liver transplant in childhood face various and specific challenges compared to their peers who have never had a transplant or who have had a transplant later in life (33) that highlights the importance of the follow up these patients in terms of psychological status. Future longitudinal studies will help follow patients and their families over time for a more in-depth assessment of PTSD.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCDI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe Child Depression Inventory\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCPTSD-RI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChild Post-Traumatic Stress Disorder-Reaction Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFamily Assessment Device\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHRQoL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth-Related Quality of Life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLiver Transplantation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eQoL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eQuality of Life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePedsQL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe Pediatric Quality of Life Inventory\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCL-C\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePTSD Checklist-Civilian\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePTSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePost-traumatic Stress Disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u0026Ouml;.G.\u0026Ccedil; and AA. involved in concept/design. A.A. and S.\u0026Ouml;.T collected the data. \u0026nbsp;A.\u0026Ouml;., A.S.A and A.A. involved in data analysis/interpretation and statistics. \u0026Ouml;.G.\u0026Ccedil;. wrote the manuscript. R.A. critically revised the manuscript. \u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e The data used to support the fndings of this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003ePham YH, Miloh T. Liver Transplantation in Children. Clinics in liver disease. 2018;22(4):807\u0026thinsp;\u0026minus;\u0026thinsp;21.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKohli R, Cortes M, Heaton N, Dhawan A. Liver transplantation in children: state of the art and future perspectives. Archives of disease in childhood. 2018;103(2):192-8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLai JC, Ufere NN, Bucuvalas JC. Liver transplant survivorship. Liver transplantation. 2020;26(8):1030-3.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRook M, Rand E. Predictors of long-term outcome after liver transplant. Current opinion in organ transplantation. 2011;16(5):499\u0026ndash;504.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFredericks E, Lopez M, Magee J, Shieck V, Opipari-Arrigan L. Psychological functioning, nonadherence and health outcomes after pediatric liver transplantation. American Journal of Transplantation. 2007;7(8):1974-83.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHames A, Matcham F, Joshi D, Heneghan MA, Dhawan A, Heaton N, Samyn M. Liver transplantation and adolescence: the role of mental health. Liver Transplantation. 2016;22(11):1544-53.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eShemesh E, Lurie S, Stuber ML, Emre S, Patel Y, Vohra P, et al. A pilot study of posttraumatic stress and nonadherence in pediatric liver transplant recipients. Pediatrics. 2000;105(2):e29-e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003e\u0026Uuml;nay M, \u0026Ouml;nder A, Gizli \u0026Ccedil;oban \u0026Ouml;, Atalay A, S\u0026uuml;rer Adanir A, Artan R, \u0026Ouml;zatalay E. Psychopathology, quality of life, and related factors in pediatric liver transplantation candidates and recipients. Pediatric transplantation. 2020;24(1):e13633.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eTaylor R, Franck LS, Gibson F, Dhawan A. A critical review of the health-related quality of life of children and adolescents after liver transplantation. Liver transplantation. 2005;11(1):51\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAlba A, Uribe M, Hunter B, Monz\u0026oacute;n P, Ferrada C, Heine C, Auad H, editors. Health-related quality of life after pediatric liver transplant: single-center experience in Chile. Transplantation proceedings; 2013: Elsevier.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRyan C, Epstein NB, Keitner GI, Miller IW, Bishop DS. Evaluating and treating families: The McMaster approach: Routledge; 2012.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eModanloo S, Rohani C, Farahani AS, Vasli P, Pourhosseingholi A. General family functioning as a predictor of quality of life in parents of children with cancer. Journal of pediatric nursing. 2019;44:e2-e8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKovacs M. Children\u0026apos;s depression inventory (CDI): Multi-Health System Toronto; 2003.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003e\u0026Ouml;y B. Children\u0026rsquo;s Depression Inventory: a study of reliability and validity. Turk Psikiyatri Dergisi. 1991;2:132-6.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePynoos RS, Frederick C, Nader K, Arroyo W, Steinberg A, Eth S, et al. Life threat and posttraumatic stress in school-age children. Archives of general psychiatry. 1987;44(12):1057-63.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eErden G, Kili\u0026ccedil; E, Uslu R, Kerimoglu E. \u0026Ccedil;ocuklar i\u0026ccedil;in travma sonrasi stres tepki \u0026ouml;l\u0026ccedil;egi: T\u0026uuml;rk\u0026ccedil;e ge\u0026ccedil;erlik, g\u0026uuml;venirlik \u0026ccedil;alismasi. \u0026Ccedil;ocuk ve Gen\u0026ccedil;lik Ruh Sagligi Dergisi. 1999;6(3):143-9.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eVarni JW, Seid M, Kurtin PS. PedsQL\u0026trade; 4.0: Reliability and validity of the Pediatric Quality of Life Inventory\u0026trade; Version 4.0 Generic Core Scales in healthy and patient populations. Medical care. 2001:800\u0026thinsp;\u0026minus;\u0026thinsp;12.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eUneri OS, Agaoglu B, Coskun A, Memik NC. Validity and reliability of Pediatric Quality of Life Inventory for 2-to 4-year-old and 5-to 7-year-old Turkish children. 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The impact of liver transplantation on family functioning in pediatric recipients: Can \u0026ldquo;healthy\u0026rdquo; families contribute to improved long-term survival? : Wiley Online Library; 2013.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFredericks EM. Family roles and routines after pediatric liver transplantation: Implications for quality of life and beyond. Pediatric transplantation. 2012;16(7):688.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Liver transplantation, quality of life, post-traumatic stress disorder, family functioning","lastPublishedDoi":"10.21203/rs.3.rs-4322432/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4322432/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eLiver transplantation(LT) has become the standard treatment protocol for end-stage liver disease, metabolic disorders and, some types of liver tumors. In the present study, we aimed to investigate the quality of life and post-traumatic stress disorder in pediatric LT recipients and in their mothers.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eSixty-one children and adolescents who had undergone LT aged 1\u0026ndash;18 years took part in this study. The control group consisted of 25 healthy children and adolescents. Participants fulfilled the Child Depression Inventory, Child Post-Traumatic Stress Disorder-Reaction Index, The Pediatric Quality of Life Inventory. Mothers fulfilled the Family Assessment Device and PTSD Checklist-Civilian.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe physical, psychosocial, and total health scores in the patient group were significantly lower than in the control group. Child-traumatic stress scores were significantly higher in the patient group than in the control group. However, there were no significant differences between groups in terms of child depression scores and maternal traumatic stress scores. There was a negative correlation between maternal traumatic stress scores and child-psychosocial health scores. Maternal traumatic stress scores also correlated positively with child traumatic stress scores.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMothers of the LT recipients can benefit from psychoeducation about the symptoms of post-transplant traumatic stress and providing psychological support to caregivers may help with the stress of caring for a child with LT.\u003c/p\u003e","manuscriptTitle":"The relationship between post-traumatic stress in children and adolescents who underwent liver transplantation and post-traumatic stress in their mothers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-02 05:47:03","doi":"10.21203/rs.3.rs-4322432/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7dcc8ff5-b07f-4a1b-aead-e6ad083aa0c6","owner":[],"postedDate":"May 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-09T08:53:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-02 05:47:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4322432","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4322432","identity":"rs-4322432","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}