O3230: Evaluating PsySTART-R for Healthcare Providers Caring for Critically Ill and Injured Children: Identifying Mental Health Risk Factors for PTSD and Depression

Background: Pediatric prehospital, emergency and critical care providers are on the frontlines of daily emergencies and disaster response, facing elevated risks of PTSD and depression due to frequent exposure to critically ill and injured children, grieving families, and morally distressing situations. While the general healthcare workforce has been studied in the context of emergency and disaster mental health, less is known about providers who care for children, who encounter unique emotional and operational challenges. PsySTART-R (Psychological Simple Triage and Rapid Treatment - Responder) is a self-triage tool previously empirically supported among adult healthcare responders in settings such as Typhoon Haiyan and the COVID-19 pandemic, where it demonstrated strong predictive validity for sub-syndromal PTSD and depression. However, it has yet to be adapted or evaluated for healthcare providers caring for children specifically. This study aimed to assess the feasibility and predictive value of PsySTART-R in this patient population, while identifying pediatric-specific factors that could enhance its sensitivity.

Methods: Healthcare providers caring for children in pre-hospital, emergency, and critical care settings completed the PsySTART-R tool, alongside the PTSD Checklist for DSM-5 (PCL-5) and the Patient Health Questionnaire-8 (PHQ-8). The association between PsySTART-R risk factors and clinically significant PTSD (PCL-5 ≥ 38) and depression (PHQ-8 ≥ 10) was examined. Descriptive statistics were used to assess the prevalence and distribution of risk factors, with attention to providers scoring above established clinical cut-off thresholds. Risk factor associations with PTSD and depression were evaluated using chi-squared or Fisher’s exact test as appropriate, while associations with the overall PsySTART score were evaluated using two-sample t-tests.

Results: PsySTART-R scores were significantly associated with both PTSD (p = 0.007) and depression (p = 0.015). Specific PsySTART risk factors, including witnessing unusually high numbers of deaths (p = 0.002) and concerns about toxic exposure (p = 0.022), were predictive of PTSD. Specific PsySTART risk factors, such as exposed to patients with prolonged screaming (p=0.018), being forced to abandon a patient (p = 0.044), insufficient support from others (p = 0.012), were significantly associated with depression. However, other factors such as hazardous working conditions, witnessing deaths or other severe injuries, and contact with grieving families did not show reach statistical significance.

Conclusion: PsySTART-R is a feasible and effective screening tool to identify pediatric healthcare providers at risk for PTSD and depression. Adapting the tool to include pediatric-specific stressors—such as non-accidental trauma, end-of-life care in children, and moral distress related to young patients—could increase its relevance and accuracy, improving early detection and enabling targeted interventions to support mental health and resilience among healthcare providers caring for children in everyday trauma and larger scale disasters and public health emergencies.