To Determine Level of Post Traumatic Stress Faced By Adolescent Children with Chronic Illness

Background : Chronic Illness is disorders or diseases that compromise well-being, either temporarily or chronically. Identifying related risk factors is of theoretical and practical relevance. It helps to understand psychosocial consequences of chronic diseases and provide valuable information for clinicians regarding who should be screened for what kind of problems. These children undergo a silent development of stress which occur Post Trauma. Post Traumatic Stress (intrusive memories, avoidance, and distress) is a condition of persistent mental and emotional stress occurring as a result of injury or severe psychological shock. Aim and Objective: To determine level of post traumatic stress faced by adolescent children with chronic illness . Samples and Methods : The study was carried out in 75 samples under treatment for Chronic illness in MMM hospital between age group 1 to 20 years. The samples were selected through convenient sampling technique. The Tool used for data collection and assessment of Post traumatic stress level is a Semi structured questionnaire which includes: Demographic details-: Socio demographic profile (age, gender, place of residence, religion, education, occupation, type of family etc) and .Post traumatic stress scale-Manual for the Administration and Scoring of the PTSD(Post Traumatic stress disorder) Symptom Scale – Interview for DSM-5 (PSS-I-5) Result: PTSD (Post Traumatic stress disorder) was significantly observed in all the respondents’ with chronic illness. Conclusion: The preliminary study concludes the presence of post traumatic stress disorder among adolescence with chronic illness. This particularly emphasizes on multidimensional assessment and treatment.

Epidemiological studies have shown that about 35% of children and adolescents, on average, suffering from chronic health condition likely to suffer from Post Traumatic Stress. Post traumatic stress disorder (intrusive memories, avoidance, distress) is a condition of persistent mental and emotional stress occurring as a result of injury or severe psychological shock, typically involving disturbance of sleep and constant vivid recall of the experience, with dulled responses to others and to the outside world.
The consequences of chronic illness leading Post traumatic Stress may affect the well being of the person in turn affecting the family as a whole. This study involves to the determine level of post traumatic stress faced by adolescences suffering from chronic illness. The Key contributors of chronic illness are Poor lifestyle choices, such as smoking, overuse of alcohol, poor diet, lack of physical activity and inadequate relief of chronic stress and progression of preventable chronic diseases. These children face various health problems affecting the Physical and mental well being.

Post Traumatic Stress
Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events such as assault, disaster or severe accidents. The symptoms include repeated and unwanted re-experiencing of the event, hyper arousal, emotional numbing and avoidance of stimuli (including thoughts) which could serve as reminders for the event. A sizeable proportion recover in the next few weeks or months, but in a significant group these symptoms persist, often for years. It is largely the group of people with persistent PTSD who seek treatment. For these people social and occupational functioning is often severely impaired. There are four core in PTSD which are considerably stable in all types of traumas. Such as, 1. Experiencing or witnessing a stressful event; 2. Re-experiencing symptoms of the event that include nightmares and (or) flashbacks; 3. Efforts to avoid situations, places, and people that are reminders of the traumatic event; and 4. Hyper-arousal symptoms, such as irritability, concentration problems, and sleep disturbances.

Symptoms of Post Traumatic Stress
1. Intrusive memories-Recurrent, unwanted distressing memories of the event, 2. Avoidance-Trying to avoid thinking or talking about the event, 3. Negative changes in thinking and mood, 4. Changes in emotional reactions, 5. The intensity of symptoms can vary in intensity over time.

RISK FACTORS FOR DEVELOPMENT OF POST TRAUMATIC STRESS DISORDER (PTSD)
Aim: 1. This study is to determine level of post traumatic stress faced by adolescent children with chronic illness.
Objectivity of the Study 1. To assess the level of Post Traumatic Stress faced by chronic illness adolescence 2. To identify the various factors leading to Post traumatic stress.

Procedure
Children educated about the nature and procedure of the study. The children were enrolled in the study after obtaining parental consent (11-18years) / consent (18-20years). The study was conducted among 75 adolescence suffering from chronic illness. The chronic illness conditions included cardiac, neurological, diabetes and genetic condition. The tool used for data collection was segregated into two sections Section A: Socio demographic profile (age, gender, place of residence, ordinal position of child in the family, number of siblings, religion, education of parents, occupation, type of family, family monthly income) and Section B: Post traumatic stress scale-Manual for the Administration and Scoring of the PTSD Symptom Scale -Interview for DSM-5 (PSS-I-5

RESEARCH METHODOLOGY The Population, Sample and Sampling
The population of this research is adolescence with Chronic illness (Cardiac, Neurology, Genetic, diabetic) of age group 11 and 20. For sampling the sample size was selected by convenient sampling.

Research Tools
The questionnaire used in this study are Section A: Socio demographic profile (age, gender, , place of residence, ordinal position of child in the family, number of siblings, religion, education of parents, occupation, type of family, family monthly income) and Section B: Post traumatic stress scale-Manual for the Administration and Scoring of the PTSD Symptom Scale -Interview for DSM-5 (PSS-I-5) 1. Re-experiencing symptoms 2. Avoidance 3. Changes in cognition and mood 4. Increased arousal and reactivity

Analysis
The data was analyzed using Statistical Package for Social Sciences (SPSS) and percentage analysis. Table 1 reveals the post traumatic stress level of the respondent. The mean value of the category changes in cognition and mood is relatively high than others with 18.64. Followed by the category increased arousal and reactivity with mean value of 16.83. the category of reexperiencing symptoms showed the mean value of 13.61 and the category of avoidance showed the least stress level 6.04.In re-experiencing symptoms nightmares were found to be high among the respondents with the mean of 3.16, avoiding thoughts were high in the avoidance category with the mean of 3.04, the respondents were feeling highly detached according to the changes in cognition and mood with the mean of 3.16 and finally respondents had difficulty in staying asleep with the mean of 3.89 in increased arousal and reactivity.  Table 1 shows the distribution of post traumatic stress level of the respondents. Nearly half of the respondents(49.3%) were falling under severe post traumatic stress, whereas (42.7%) of the respondents were found to be under moderate post traumatic stress and finally only (8%) of the respondents were found to be in mild post traumatic stress level. Stress in respondents was observed more because of the increase in their anxiety and fear after trauma.

DISCUSSION
Adolescence (from Latin adolescere, meaning "to grow up") is a transitional stage of physical and psychological development that generally occurs during the period from puberty to legal adulthood. Identity development is a stage in the adolescent life cycle. For most, the search for identity begins in the adolescent years. During these years, adolescents are more open to 'trying on' different behaviors and appearances to discover who they are. In an attempt to find their identity and discover who they are, adolescents are likely to cycle through a number of identities to find one that suits them best. Developing and maintaining identity (in adolescent years) is a difficult task due to multiple factors such as family life, environment, and social status. In this stage an adolescence suffering from chronic illness tends to undergo a lot of psychological trauma which leads miserable disturbances in Normal adolescence of similar age. Adolescences are more likely to show symptoms similar to those seen in adults. They develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. Since many chronic diseases cannot be cured, the main goal is to reduce the consequences of the diseases on the lives of adolescents. Identifying the associated variables influencing post traumatic stress among adolescence as early as possible can help to turn down the consequences into positive aspect through multi variation dimensional approach .Among the 75 samples analyzed in this study Majority ( 49.3% ) of the respondents were found to be in severe Post traumatic stress disorder .(42.7) were in moderate . This percentage becomes the target respondents to develop Post traumatic Stress in mere future if multivariate approach is failed to be provided. Only 8 % were in mild category which reflects around only 5% of sample is able to cope up voluntarily.