Journal of Traumatic Stress, Vol. 24, No. 4, August 2011, pp. 414–421 ( C  2011) CE ARTICLE Predicting Pediatric Posttraumatic Stress Disorder After Road Traffic Accidents: The Role of Parental Psychopathology Gerasimos Kolaitis, George Giannakopoulos, Magda Liakopoulou, Panagiota Pervanidou, Stella Charitaki, Constantinos Mihas, and Spyros Ferentinos Athens University Medical School Ioannis Papassotiriou “Aghia Sophia” Children’s Hospital, Athens George P. Chrousos and John Tsiantis Athens University Medical School This study examined prospectively the role of parental psychopathology among other predictors in the development and persistence of posttraumatic stress disorder (PTSD) in 57 hospitalized youths aged 7–18 years immediately after a road traffic accident and 1 and 6 months later. Self report questionnaires and semistructured diagnostic interviews were used in all 3 assessments. Neuroendocrine evaluation was performed at the initial assessment. Maternal PTSD symptomatology predicted the development of children’s PTSD 1 month after the event, OR = 6.99, 95% CI [1.049, 45.725]; the persistence of PTSD 6 months later was predicted by the child’s increased evening salivary cortisol concentrations within 24 hours of the accident, OR = 1.006, 95% CI [1.001, 1.011]. Evaluation of both biological and psychosocial predictors that increase the risk for later development and maintenance of PTSD is important for appropriate early prevention and treatment. Road traffic accidents (RTAs) are the leading cause of morbid- ity and mortality among children and adolescents in industrialized countries, with 9,000 individuals under the age of 19 dying and 355,000 being injured annually in Europe (European Child Safety Alliance, 2007; Peden et al., 2004). A major role of public health in the prevention of RTAs is to collect data on the psychological con- sequences of RTAs to guide the treatment of injured children and adolescents (Peden et al., 2004). There is now sound evidence that children and adolescents may suffer significant and long-lasting psychological distress following RTAs (Caffo & Belaise, 2003). Previous studies indicate that the prevalence of posttraumatic stress disorder (PTSD) among children and adolescents was about 27% (18–34%) between the first and second month following an RTA (Mirza, Bhadrinath, Goodyer, & Gilmour, 1998; Olofsson, Gerasimos Kolaitis, George Giannakopoulos, Magda Liakopoulou, Stella Charitaki, Constanti- nos Mihas, Spyros Ferentinos, and John Tsiantis, Department of Child Psychiatry, Athens Uni- versity Medical School; Panagiota Pervanidou and George P. Chrousos, First Department of Paediatrics, Athens University Medical School; Ioannis Papassotiriou, Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, Athens. Correspondence concerning this article should be addressed to Gerasimos Kolaitis, Department of Child Psychiatry, Athens University Medical School, “Aghia Sophia” Children’s Hospital, 115 27 Athens, Greece. E-mail: gkolaitis@med.uoa.gr C  2011 International Society for Traumatic Stress Studies. View this article online at wileyonlinelibrary.com DOI: 10.1002/jts.20667 Bunketorp, & Andersson, 2009; Stallard, Salter, & Velleman, 2004; Stallard, Velleman, & Baldwin, 1998; Zink & McCain, 2003) and decreased to approximately 13% (6–23%) 3 to 6 months later (Bryant, Mayou, Wiggs, Ehlers, & Stores, 2004; Di Gallo, Barton, & Parry-Jones, 1997; Kassam-Adams & Win- ston, 2004; McDermott & Cvitanovich, 2000; Mirza et al., 1998; Olofsson et al., 2009; Zink & McCain, 2003). Although PTSD may significantly impede children’s and adolescents’ de- velopment causing substantial subjective distress and resulting in impaired functioning, medical services often ignore or underes- timate the likelihood of PTSD development and they are un- aware of risk factors that predict PTSD development and its fu- ture persistence (Cohen et al., 2010; Lonigan, Phillips, & Richey, 2003). Age is found not to be related to PTSD among children and adolescents following RTAs. Some studies suggest that girls show greater risk for developing PTSD than male victims of RTAs (Kassam-Adams & Winston, 2004; Mirza et al., 1998; Stallard et al., 1998, 2004). Findings regarding type of accident as a risk factor have been inconsistent (Bryant et al., 2004; de Vries et al., 1999; Keppel-Benson, Ollendick, & Benson, 2002; Landolt, Voll- rath, Timm, Gnehm, & Sennhauser, 2005; Mirza et al., 1998; Stallard et al., 2004; Zink & McCain, 2003). The severity of body injury has been found to be unrelated to pediatric PTSD after 414