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Impact of ethnicity on parental health outcomes and experiences after paediatric intensive care unit discharge: a mixed-methods systematic review

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Abstract

The impact of ethnicity on parental health outcome after paediatric intensive care unit (PICU) discharge remains unclear. Thirteen medical and healthcare databases, unpublished studies and grey literature were searched up to November 5, 2021. We performed a mixed-method systematic review to understand the impact of ethnicity on parental outcomes after PICU discharge, including eight quantitative and eight qualitative studies. Among 1529 parents included, 1064 (72%) were White. Higher prevalence of post-traumatic stress disorder was seen in Black parents (17% White vs 36% Black, p = .03). Latino ethnicity was found to have protective effect against anxiety as compared to White parents (coefficient − 4.27, p < .001). A total of 91 findings were aggregated into 14 categories, and the five synthesized themes from the eight qualitative studies were long-term psychological impact after PICU, use of coping strategies, challenges of re-integration, changes in relationships and the utilization of formal support services and resources. Mixed-method synthesis found that parents of ethnic minority group were underrepresented (18%) and had higher attrition rates in a longitudinal study as compared to White parents following childhood critical illness.

   Conclusion: There are significant gaps in evidence related to the impact of ethnicity on long-term parental health outcomes after PICU discharge. Ethnic diversity and inclusiveness in long-term PICU research may aid understanding of the parental experiences and outcomes to close the gap in health disparity.

What is Known:

• Survival rates of paediatric critical illness have improved.

• Families of paediatric intensive care unit survivors continue to experience mental health issues, with 30% experiencing symptoms of post-traumatic stress 6 months after discharge.

What is New:

• Parents from different ethnic backgrounds are underrepresented in paediatric critical care research.

• Minorities experience worse short-term outcomes after intensive care discharge.

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Abbreviations

ASD:

Acute stress disorder

CINAHL:

Cumulated Index to Nursing and Allied Health Literature

CKNI:

China National Knowledge Infrastructure

COPE:

Creating opportunities for parent empowerment

EBP:

Evidence-based practice

EDI:

Equity, diversity and inclusion

EMBASE:

The Cochrane Library, Excerpta Medica dataBASE

EThOS:

E-These Online Service

JBI:

Joanne Briggs Institute

LILACS:

Literatura Latino-Americana em Ciências da Saúde – Latin American and Caribbean Health Sciences Literature

MEDLINE:

Medical Literature Analysis and Retrieval System Online

PICU:

Paediatric intensive care unit

PISC-p:

Post-intensive Care Syndrome-paediatrics

PTS:

Post-traumatic stress

PTSD:

Post-traumatic stress disorder

PubMed:

ProQuest, Public/Publisher MEDLINE

SciELO:

Scientific Electronic Library Online

T:

Time-point

TBI :

Traumatic brain injury

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Funding

This research is supported through the KK Women’s and Children’s Hospital (KKH) Academic Medicine Start-up Fund (Ref: KRDUK20AR100, October 2020) and SingHealth FY2019 Talent Development Fund (TDF) Award-Research (December 2018).

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Authors and Affiliations

  1. School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK

    Pei-Fen Poh, Matthew C. Carey & Jos M. Latour

  2. Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Pei-Fen Poh & Jan Hau Lee

  3. Faculty of Health, The University of Plymouth Centre for Innovations in Health and Social Care: a Joanna Briggs Institute Centre of Excellence, University of Plymouth, Plymouth, UK

    Matthew C. Carey & Jos M. Latour

  4. Duke-NUS Medical School, Singapore, Singapore

    Jan Hau Lee

  5. Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK

    Joseph C. Manning

  6. Centre for Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK

    Joseph C. Manning

  7. School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Australia

    Jos M. Latour

  8. Department of Nursing, Hunan Children’s Hospital, Changsha, China

    Jos M. Latour

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  1. Pei-Fen Poh
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  4. Joseph C. Manning
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Contributions

PFP, MCC, JHL, JCM and JML conceptualized and designed the systematic review. PFP and MC performed the data collection. PFP, MCC, JCM and JML conducted the data synthesis. PFP drafted the first manuscript and MCC, JHL, JCM and JML critically reviewed the manuscript drafts. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Pei-Fen Poh.

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Conflict of interest

Pei-Fen Poh and Dr Jan Hau Lee are related to KK Women’s and Children’s Hospital by employment. Dr Joseph Manning, Dr Matthew Carey and Professor Jos Latour do not have any financial relationship with KK Women’s and Children’s Hospital, Singapore. Pei-Fen Poh received funding from the KK Women’s and Children’s Hospital. Dr Jan Hau Lee received funding from the National Medical Research Council, Singapore. Dr Joseph Manning is currently funded through NIHR HEE ICA Clinical Lectureship and therefore the views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care, UK.

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Communicated by Piet Leroy

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Poh, PF., Carey, M.C., Lee, J.H. et al. Impact of ethnicity on parental health outcomes and experiences after paediatric intensive care unit discharge: a mixed-methods systematic review. Eur J Pediatr 181, 3817–3829 (2022). https://doi.org/10.1007/s00431-022-04595-5

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