Many know the saying "the squeaky wheel gets the grease". While this may be true in many settings, when you’re a doctor or nurse trying to assess a patient or family's level of distress and ability to cope, it doesn't always fit. Sometimes the quiet patient, who follows all your instructions and never asks any questions, may be struggling the most to cope with their illness or injury. Research on medical traumatic stress has shown time and again that objective indicators of illness or injury severity do not predict who will go on to have lasting traumatic stress reactions. This means that it is not only the most ill or the most severely injured child who may need extra attention. Research studies also suggest a range of risk factors for long-lasting traumatic stress reactions, including: pre-existing vulnerabilities; prior behavioral or emotional concerns; traumatic aspects of the medical event; and the child’s or family’s early reactions to it.
So why does this matter if you're a doctor, nurse, or healthcare professional? JAMA Psychiatry released a study last week which found "children and teenagers with a psychiatric disorder had six times higher odds of having at health, legal, financial and social problems as adults" and "those with milder symptoms were three times more likely to have problems as adults". Helping these children and teens means referring to the appropriate mental health services. Screening all of your patients is one of the most effective ways to ensure those that need help, get help. Remember while the squeaky wheel will get the grease, the other wheels most likely need attention too.
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