Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. Amy Damashek

Second Advisor

Dr. Galen Alessi

Third Advisor

Dr. Amy Naugle

Fourth Advisor

Dr. J. Lia Gaggino


Unintentional injuries, PTSD, behavioral modeling, children, parenting, negative mental health outcomes


Unintentional injuries are the leading cause of death for children ages 0-19 and account for 9.2 million emergency room visits in the United States each year (Borse et al., 2008). Research shows that approximately 20% of children meet criteria for PTSD following an unintentional injury (Ostrowski et al., 2011). There are several factors that may contribute to the development of PTSD including caregivers’ posttraumatic stress symptoms after the injury event. Research has not explained the association between caregivers’ PTSD and children’s risk for PTSD symptoms, but it is possible that caregivers with PTSD may be modeling anxious behaviors to their children who are then adopting those anxious behaviors. Examining these behaviors may help to develop effective interventions to prevent child PTSD. The present study examined whether or not caregiver modeling of anxious behaviors or anxious coping affects children’s development of PTSD symptoms or other psychological symptoms (e.g., disruptive behavior) after an unintentional injury. We recruited caregivers and their children from a pediatrics office following an Emergency Department visit for an unintentional injury. Caregivers and their children attended two sessions 6 weeks apart. During the first session, caregivers completed several measures regarding their and their child’s coping, anxiety, and PTSD symptoms, and answered questions regarding their child’s injury. Children also answered several questions about their injury. In the second session, caregivers completed measures regarding their child’s PTSD symptoms and internalizing and externalizing behaviors. We utilized multiple regression analyses to examine our hypotheses and to determine which predictor variables predict PTSD symptoms as well as child internalizing and externalizing symptoms. Results showed that caregiver anxiety and PTSD symptoms along with child internalizing and externalizing behaviors were related to higher levels of PTSD symptoms following a child’s unintentional injury. These results suggest that caregivers’ anxiety levels regarding children’s injuries are important predictors of children’s PTSD symptoms. It is possible that caregivers’ symptoms of anxiety alter their interactions with their children, and this may lead to negative outcomes for children. We were unable to make conclusions regarding caregivers modeling anxious behaviors since we were not able to make direction observations. However, these findings highlight the importance of assessing for pre-existing child and caregiver symptoms in order to better understand which children are at a higher risk for the development of PTSD or other psychopathology following an injury. By doing this, it may be possible to intervene early to reduce the likelihood of children developing negative outcomes following an injury.

Access Setting

Dissertation-Open Access