Divergence in post-traumatic stress disorder status between children receiving hematopoietic stem cell transplantation and their primary caregivers

Abstract Background and Aims: Hematopoietic Stem Cell Transplantation(HSCT) has become a cornerstone therapy for pediatric hematological disorders‌. However, graft-versus-host disease may impose substantial physical and psychosocial burdens, constituting a severe traumatic event‌. Notably, the correlation and divergence in post-traumatic stress disorder(PTSD) between children and their primary caregivers remain inadequately characterized in HSCT children‌. This research aimed to explore the trend of PTSD status in children receiving HSCT and primary caregivers , and to provide a reference for targeted intervention. Methods: This prospective longitudinal study enrolled 64 child-caregiver dyads undergoing HSCT, including 39 boys and 25 girls, with an age of 10.22±2.13 years. Dyads were surveyed using the PTSD Check List-Civilian Version(PCL-C) across 4 critical phases: before conditioning regimen(T1), 1-2 weeks after HSCT(T2), discharge from the hospital after HSCT(T3), and 3 months after HSCT(T4). The difference between children and primary caregivers of PTSD status were probed. Results: The rate of PTSD among children receiving HSCT was 14.1%, 10.9%, 7.8%, and 9.5% at T1, T2, T3 and T4, respectively, and among primary caregivers was 26.6%, 25.0%, 21.9%, and 26.2% respectively. There were significant differences between children and caregivers on total PTSD score and re-experiencing score at 4 phases, and numbness score at T1, T3, and T4. There was a statistically significant change over time in the scores of the re-experience of primary caregivers, with the highest scores at T1. Conclusion: This prospective study mapping the developmental trajectories of dyadic PTSD in HSCT reveals caregiver distress predominance during pre-HSCT versus child-centered trauma emergence post-HSCT. Medical staff should prioritize alleviating anxiety in primary caregivers during the early phase‌, while progressively addressing the child's transplant-related stress in later stages.‌ This tiered intervention strategy enables mutual psychological support between both parties throughout this critical medical event‌.