Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: a systematic review

Finding benefit in stressful uncertain circumstances: relations to social support and stigma among women with unexplained illnesses

Living with a chronic illness can be challenging, but the ability to derive benefits and grow from this experience may enhance well-being. However, the possibility of obtaining such benefits may be dependent on the levels of stigmatization and lack of social support experienced by an individual as a result of the illness. Chronic fatigue syndrome (CFS) and fibromyalgia are chronic conditions that remain largely unexplained and those with these conditions must often contend with stigma and skepticism from others. Individuals with CFS/fibromyalgia often display stress-related biological alterations and the experience of stressful life events has been associated with illness development. The present study demonstrated that women with CFS/fibromyalgia (n = 40) as well as community participants who were depressed/anxious (n = 37), reported higher stigma levels than healthy women (n = 33). Moreover, women with CFS/fibromyalgia and those with depression/anxiety also reported greater levels of stigma than women with a chronic yet more widely accepted condition (n = 35; rheumatoid arthritis, osteoarthritis and multiple sclerosis). Secrecy related to stigma among those with CFS/fibromyalgia declined with increased social support, but this was not apparent among those with other chronic conditions. In addition, posttraumatic growth was lower among women with CFS/fibromyalgia compared to those with other chronic conditions. Qualitative analysis examining both negative impacts and positive changes stemming from illness experience revealed many similarities between women with CFS/fibromyalgia and those with other chronic conditions, including elevated appreciation for life, personal growth and compassion for others. However, women with CFS/fibromyalgia tended to report less positive change regarding interpersonal relationships compared to women with other chronic conditions. In general, unexplained illnesses were also accompanied by stigmatization which might ultimately contribute to women's lower ability to derive positive growth from their illness experience.

Post-traumatic growth in survivors of allogeneic hematopoietic stem cell transplantation

OBJECTIVE

This study aimed to understand factors related to post-traumatic growth (PTG) in patients who received allogeneic hematopoietic stem cell transplantation (HSCT), building baseline data for developing intervention programs to enhance PTG in HSCT survivors.

METHODS

A self-report survey was administered to 100 patients who received HSCT within the last 5 years. The Post-traumatic Growth Inventory, Impact of Event Scale-Revised, Perceived Social Support Scale, and Healthcare Professional's Support Scale were used, as well as items on demographic and clinical characteristics. Standard deviations of frequency and percentage, Chi-squared test between genders, independent t-test, correlation analysis between independent variables and extent of PTG, and regression analysis were conducted.

RESULTS

The PTG levels of HSCT survivors were statistically significantly higher when participants were women, carried out more religious activities, had higher educational levels, or utilized nurse counseling. The 'intrusive thinking' traumatic impact subcategory, as well as social support and support from healthcare professionals, were found to be highly related to PTG scores. Upon multiple regression analysis, factors with greatest influence on PTG in HSCT survivors were support from healthcare professionals, followed in order, by social support, utilization of nurse counseling, intrusive thinking, and frequency of religious activities.

CONCLUSIONS

We suggest implementing programs for HSCT patients to enhance support from healthcare professionals and to increase post-traumatic growth through greater utilization of nurse counseling, self-help meetings, and writing.

Personality change associated with chronic diseases: pooled analysis of four prospective cohort studies

BACKGROUND

Common chronic conditions, such as heart disease and cancer, are associated with increased psychological distress, functional limitations and shortened life expectancy, but whether these diseases alter aspects of personality remains unclear.

METHOD

To examine whether the onset of heart disease, stroke, diabetes, cancer, hypertension, arthritis and respiratory disease is associated with subsequent changes in personality traits of the five-factor model, we pooled data from the Health and Retirement Study, the Midlife in the United States Survey, and the graduate and sibling samples of the Wisconsin Longitudinal Study for an individual-participant meta-analysis (total n=17,493; mean age at baseline 55.8 years).

RESULTS

After adjustment for age, we observed consistent decreases in extraversion [-0.25 T-scores per one disease; 95% confidence interval (CI) -0.40 to -0.10], emotional stability (-0.40, 95% CI -0.61 to -0.19), conscientiousness (-0.44, 95% CI -0.57 to -0.30) and openness to experience (-0.25, 95% CI -0.37 to -0.13) but not in agreeableness (-0.05, 95% CI -0.19 to 0.08) after the onset of chronic diseases. The onset of each additional chronic disease accelerated the average age-related personality change by 2.5 years in decreasing extraversion, 5.5 years in decreasing conscientiousness, and 1.6 years in decreasing openness to experience, and attenuated the increasing levels of emotional stability by 1.9 years. Co-morbid conditions were associated with larger changes than single diseases, suggesting a dose-response association between morbidity and personality change.

CONCLUSIONS

These results support the hypothesis that chronic diseases influence personality development in adulthood.

The efficacy of optimism: benefit finding in the treatment of diabetes in Iranian patients

The incidence of diabetes mellitus is on the rise around the world. Middle Eastern countries will be facing a vast increase in the number of diabetes mellitus cases by 2030. Diagnosis of a chronic disease such as diabetes mellitus can be a shocking and life-altering event. Conversely, a diagnosis of a chronic illness can also offer the patient opportunities to change unhealthy behaviors such as poor diet, smoking, and lack of exercise, making them healthier than before their diagnosis. This is referred to as “benefit finding”. This study reveals the many benefit findings of Iranian patients who have been diagnosed with diabetes mellitus and illustrates how benefit finding can be an integral part of long-term patient care.

Posttraumatic growth and associated socio-demographic and clinical factors in Chinese breast cancer survivors

PURPOSE

The factors that affect posttraumatic growth (PTG) in breast cancer survivors have been discussed for many years, but it remains unclear which are most influential. The purpose of this study was to determine the level of PTG and identify associated socio-demographic and clinical factors in Chinese breast cancer survivors.

METHODS AND SAMPLE

A descriptive research design with a convenience sampling method was employed to collect data using the simplified Chinese version of the Posttraumatic Growth Inventory (PTGI-SC). This questionnaire was administered to 1227 participants recruited from eight tertiary hospitals and cancer survivor groups in Beijing between April 2010 and April 2012.

KEY RESULTS

PTG is present in Chinese breast cancer survivors, with an average PTGI-SC score of 70.18 ± 15.85. There were five variables in the regression model: exercise, other chronic disease, income, education level, and work status. Exercise showed the strongest positive association with PTG after breast cancer. Household income and educational level also positively influenced PTG. Survivors with other accompanying chronic diseases had lower PTG. Retired survivors had the highest PTG, those working had moderate PTG, and those on sick leave had the lowest PTG.

CONCLUSIONS

PTG is common among Chinese breast cancer survivors. It is positively associated with exercise, income, education, and retirement, and negatively associated with the presence of other chronic diseases and working. The results may provide information on how to promote the development of PTG while nursing breast cancer survivors.

The relationship between posttraumatic stress and posttraumatic growth among adolescent and young adult (AYA) cancer patients

OBJECTIVE

Theories of posttraumatic growth suggest that some degree of distress is necessary to stimulate growth; yet, investigations of the relationship between stress and growth following trauma are mixed. This study aims to understand the relationship between posttraumatic stress symptoms and posttraumatic growth in adolescent and young adult (AYA) cancer patients.

METHOD

165 AYA patients aged 14-39 years at diagnosis completed standardized measures of posttraumatic stress and posttraumatic growth at 12 months following diagnosis. Locally weighted scatterplot smoothing and regression were used to examine linear and curvilinear relationships between posttraumatic stress and posttraumatic growth.

RESULTS

No significant relationships between overall posttraumatic stress severity and posttraumatic growth were observed at 12-month follow-up. However, curvilinear relationships between re-experiencing (a posttraumatic stress symptom) and two of five posttraumatic growth indicators (New Possibilities, Personal Strengths) were observed.

CONCLUSION

Findings suggest that re-experiencing is associated with some aspects of posttraumatic growth but not others. Although re-experiencing is considered a symptom of posttraumatic stress disorder, it also may represent a cognitive process necessary to achieve personal growth for AYAs. Findings call into question the supposed psychopathological nature of re-experiencing and suggest that re-experiencing, as a cognitive process, may be psychologically adaptive. Opportunities to engage family, friends, cancer survivors, or health care professionals in frank discussions about fears, worries, or concerns may help AYAs re-experience cancer in a way that enhances their understanding of what happened to them and contributes to positive adaptation to life after cancer.

Validation of interpersonal support evaluation list-12 (ISEL-12) scores among English- and Spanish-speaking Hispanics/Latinos from the HCHS/SOL Sociocultural Ancillary Study

The Interpersonal Support Evaluation List-12 (ISEL-12; Cohen, Mermelstein, Kamarck, & Hoberman, 1985) is broadly employed as a short-form measure of the traditional ISEL, which measures functional (i.e., perceived) social support. The ISEL-12 can be scored by summing the items to create an overall social support score; three subscale scores representing appraisal, belonging, and tangible social support have also been proposed. Despite extensive use, studies of the psychometric properties of ISEL-12 scores have been limited, particularly among Hispanics/Latinos, the largest and fastest growing ethnic group in the United States. The current study investigated the reliability and structural and convergent validity of ISEL-12 scores using data from 5,313 Hispanics/Latinos who participated in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Participants completed measures in English or Spanish and identified their ancestry as Dominican, Central American, Cuban, Mexican, Puerto Rican, or South American. Cronbach's alphas suggested adequate internal consistency for the total score for all languages and ancestry groups; coefficients for the subscale scores were not acceptable. Confirmatory factor analyses revealed that the one-factor and three-factor models fit the data equally well. Results from multigroup confirmatory factor analyses supported a similar one-factor structure with equivalent response patterns and variances between language groups and ancestry groups. Convergent validity analyses suggested that the total social support score related to scores of social network integration, life engagement, perceived stress, and negative affect (depression, anxiety) in the expected directions.

Positive changes following cancer: posttraumatic growth in the context of other factors in patients with cancer

PURPOSE

The incidence of posttraumatic growth (PTG) has mostly been researched after typical traumatic events such as war, violence, bereavement, vehicle accidents, and so forth. This research has shown that PTG also occurs after cancer. This article presents the results of research which focused on PTG and what was related to its incidence, such as the specific reaction to trauma, among patients with hematological cancer (N = 72). The differences in the levels of PTG were analyzed from the perspective of demographic characteristics, characteristics of the disease, and treatment.

METHODS

PTG was measured using the Posttraumatic Growth Inventory-Czech version (PTGI-CZ). The associated variables were measured using instruments in measuring benefit findings [Benefit Finding Scale for Children-Czech version (BFSC-CZ)], distress tolerance [Distress Tolerance Scale (DTS)], hope [Adult Hope Trait Scale (AHTS)], and optimism [Revised Life Orientation Test (LOT-R)].

RESULTS

Regression analysis found that a higher perception of benefits of the disease (benefit findings) and a greater effort to regulate feelings of distress (distress regulation) explained 67.1% of the variance of PTG.

CONCLUSIONS

There were no significant differences in the level of PTG in terms of demographic indicators, type of cancer, current state of disease, or type of treatment. It was found that it was important for patients to perceive that their disease had been beneficial in a certain way. It was also important that patients made a great effort to regulate distress, which can occur when coping with the negative consequences of a disease, and at the same time, it is important for the process of PTG.

Posttraumatic Stress and Meaning Making in Mexico City

Mexico City, established in 1524, is Mexico’s most important educational, financial and cultural centre. As is typical of large metropolitan cities, Mexico City has its share of crime, violence and poverty. It also has a history of natural disasters, particularly large-scale earthquakes. There is a lack of research on the impacts and correlates of chronic exposure to trauma in developing societies such as Mexico City. Particularly, a dearth of research that examines the relationship between exposure to trauma and posttraumatic growth in these populations exists. Recently, the Association of Trauma Outreach and Prevention (ATOP) organised a humanitarian mission to Mexico City to assess posttraumatic symptomatology and identify factors that contributed to meaning making and posttraumatic growth, including socio-demographic variables. The results demonstrated that age and marital status were associated with traumatic stress symptomatology and the ability to find meaning in trauma and purpose in one’s life. Inconsistent with previous research, there were no differential associations in symptomatology or posttraumatic growth on the basis of gender. Of note, the results suggested that individuals who had offered support to others during a traumatic event were currently experiencing lower levels of posttraumatic stress and an increased ability to find meaning in the trauma.

Post-traumatic growth following spinal cord injury

CONTEXT/OBJECTIVE

Examine the relationship of post-traumatic psychological growth (PTG), depression, and personal and injury characteristics in persons with spinal cord injury (SCI).

DESIGN

Cross-sectional survey.

SETTING

Community.

PARTICIPANTS

Eight hundred and twenty-four adults with SCI.

INTERVENTIONS

None.

OUTCOME MEASURES

Five items from the Post-traumatic Growth Inventory, reflecting positive change after injury in life priorities, closeness to others, new opportunities being available, stronger faith, and personal strength.

RESULTS

Initial structural equation model testing of a conceptual model of personal and injury characteristics, violent etiology, depression, and PTG resulted in a poor fit. Model modifications resulted in an improved fit, but explained only 5% of the variance in PTG. Being female, younger, having less formal education, and less time since injury had significant relationships with PTG, whereas depression, violent etiology, and injury level/severity did not. In each PTG domain, between 54 and 79% of the sample reported at least some positive change after injury.

CONCLUSIONS

The results of this study, while promising, explained only a small portion of the variance in PTG. A majority of the sample experienced some positive change after injury, with the greatest change in discovering that they were stronger than they thought they were. Comparing means previously reported in a non-SCI sample of those who experienced trauma, positive change after injury was comparable for each PTG item except for new opportunities being available, which was significantly lower for those with SCI. Future directions of research include the development of theoretical models of PTG after SCI.

Is there a relationship between posttraumatic stress and growth after a lymphoma diagnosis?

OBJECTIVE

There are conflicting empirical data regarding the relationship between posttraumatic stress (PTS) and growth (PTG) observed in cancer survivors. Clarification of this association could inform evidence-based therapeutic recommendations to promote adjustment in survivors following a cancer diagnosis.

METHODS

This cross-sectional study employed standardized measures to examine the association between PTS and PTG in a sample of long-term lymphoma survivors. In addition, associations between PTG and demographic, clinical and psychosocial variables were identified to inform clinical recommendations.

RESULTS

Long-term survivors of non-Hodgkin lymphoma provided informed consent (n = 886; 74% response rate). Subjects averaged 10.2 years post-diagnosis and 62.9 years of age. No significant association was found between the PTS and PTG summary scores. Several demographic and clinical variables (e.g., female gender and greater social support) were independently associated with greater PTG.

CONCLUSIONS

Clinicians are advised to be attentive to psychosocial needs throughout the post-cancer diagnosis adjustment period by screening for PTS symptomatology and recognizing that survivors who report growth may also be highly distressed.

Psychosocial impact of cancer

Diagnosis and treatment of malignant diseases affect in many ways the lives of patients, relatives and friends. In this chapter, we summarise the current knowledge concerning the psychosocial consequences of cancer.

Complementary and alternative medicine use and benefit finding among cancer patients

PURPOSE

An increasing number of cancer patients are choosing Complementary and Alternative Medicine (CAM) as an active way to manage the physical, psychological, and spiritual consequences of cancer. This trend parallels a movement to understand how a difficult experience, such as a cancer diagnosis, may help facilitate positive growth, also referred to as benefit finding. Little is known about the associations between the use of CAM and the ability to find benefit in the cancer experience.

METHODS

We conducted a cross-sectional survey of medical oncology outpatients in an urban academic cancer center. Patients completed measures of CAM use and benefit finding following a diagnosis of cancer. A hierarchical regression, adjusting for covariates, was performed to evaluate the unique contribution of CAM use on benefit finding. The relationship between specific CAM modalities and benefit finding was explored.

RESULTS

Among 316 participants, 193 (61.3%) reported CAM use following diagnosis. Factors associated with CAM use were female gender (p=0.005); college, or higher, education (p=0.09); breast cancer diagnosis (p=0.016); and being 12 to 36 months post-diagnosis (p=0.017). In the hierarchical regression, race contributed the greatest unique variance to benefit finding (23%), followed by time from diagnosis (18%), and age (14%). Adjusting for covariates, CAM use uniquely accounted for 13% of the variance in benefit finding. Individuals using energy healing and healing arts reported significantly more benefit than nonusers. Special diet, herbal remedies, vitamin use, and massage saw a smaller increase in benefit finding, while acupuncture, chiropractic, homeopathy, relaxation, yoga, and tai chi were not significantly associated with benefit finding.

CONCLUSIONS

Patients who used CAM following a cancer diagnosis reported higher levels of benefit finding than those who did not. More research is required to evaluate the causal relationship between CAM use, benefit finding, and better psychosocial well-being.

Routine depression screening in an HIV clinic cohort identifies patients with complex psychiatric co-morbidities who show significant response to treatment

This study described characteristics, psychiatric diagnoses and response to treatment among patients in an outpatient HIV clinic who screened positive for depression. Depressed (25 %) were less likely to have private insurance, less likely to have suppressed HIV viral loads, had more anxiety symptoms, and were more likely to report current substance abuse than not depressed. Among depressed, 81.2 % met diagnostic criteria for a depressive disorder; 78 % for an anxiety disorder; 61 % for a substance use disorder; and 30 % for co-morbid anxiety, depression, and substance use disorders. Depressed received significantly more treatment for depression and less HIV primary care than not depressed patients. PHQ-9 total depression scores decreased by 0.63 from baseline to 6-month follow-up for every additional attended depression treatment visit. HIV clinics can routinely screen and treat depressive symptoms, but should consider accurate psychiatric diagnosis as well as co-occurring mental disorders.

Prevalence and predictors of posttraumatic growth in accidentally injured patients

This study examined prevalence and predictors of posttraumatic growth in 180 accidentally injured patients of mainland China in their convalescence stage, investigating its relationships with demographic and accidental injury variables, personality, posttraumatic stress disorder (PTSD) symptoms, and coping styles. Our results showed that posttraumatic growth (PTG) presented mostly in the domain of Relating to Others and indicated that PTG was significantly related to marital status, educational level, personality, coping styles, and PTSD symptoms. Avoidance of PTSD symptoms, Openness to experience, and positive coping were significant predictors of PTG. The findings emphasize that when promoting PTG of accidentally injured patients, healthcare providers should facilitate patients utilizing personal resources, understand PTG coexists with PTSD symptoms, and adjust interventions based on the coping styles the patients have adopted.

The relationship between internalised HIV-related stigma and posttraumatic growth

This study investigated the relationship between posttraumatic growth (PTG), an improvement in functioning as a trauma outcome, and internalised HIV-related stigma (IHRS), the acceptance of societal devaluation by a person living with HIV. Cross-sectional data were gathered from 56 males and 18 females infected with HIV, recruited though five HIV-support agencies in the Republic of Ireland and Northern Ireland. Multiple regression analyses revealed that (A) IHRS was associated with poorer outcomes in the PTG domains associated with veridical growth, (B) mode of transmission of HIV was associated with outcomes in all PTG domains, with the least stigmatised mode of transmission being associated with the greatest degree of growth, and (C) resilience was significantly and positively associated with outcomes in two domains of PTG. The results highlight the relevance of stigma for clinicians wishing to promote growth among those living with HIV. Clinical implications, limitations, and areas for future research are discussed.

Finding meaning after same-sex partner abuse: a content analysis of experiences of men with HIV

Given the high rates of partner abuse (PA) among sexual minority men with HIV, it is surprising that this phenomenon remains largely understudied in this group. The extant literature reveals little about the lived experiences of the men who experience abuse in their primary relationships. Furthermore, the role of meaning making in recovery from PA remains unclear for any demographic group. Knowledge of such appraisals may provide insight into the ways that sexual minority men with HIV understand or assign value to their abuse experiences. Here, we aim to qualitatively explore the ways in which such men (N = 28) find meaning following their experiences of PA. In general, most men reported a sense of personal strength from having endured and survived PA. Surprisingly, the men did not link their postabuse recovery experiences to their sexual minority identity nor to their HIV status. Some men mentioned an increased sense of agency and attention to their own needs in their postabuse lives. With the exception of positive relationships with providers, the men described little use of peer or family support and ongoing social isolation.

A non-randomised trial of an art therapy intervention for patients with haematological malignancies to support post-traumatic growth

The aim of this study was to determine the effect of art therapy on post-traumatic growth in patients with haematological malignancies in a non-randomised trial ( n = 36, intervention group; n = 129, control group). Art therapy was administered over a period of 22 weeks in small groups. Post-traumatic growth was measured with the Stress-Related Growth Scale. After controlling for the effect of potential confounders, no difference in post-traumatic growth was observed between the intervention and control groups after 22 weeks. There was no evidence for an effect of weekly group sessions with art therapy on post-traumatic growth in patients with haematological malignancies.

Posttraumatic growth, depressive symptoms, posttraumatic stress symptoms, post-migration stressors and quality of life in multi-traumatized psychiatric outpatients with a refugee background in Norway

Background

Psychiatric outpatients with a refugee background have often been exposed to a variety of potentially traumatizing events, with numerous negative consequences for their mental health and quality of life. However, some patients also report positive personal changes, posttraumatic growth, related to these potentially traumatic events. This study describes posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, post-migration stressors, and their association with quality of life in an outpatient psychiatric population with a refugee background in Norway.

Methods

Fifty five psychiatric outpatients with a refugee background participated in a cross-sectional study using clinical interviews to measure psychopathology (SCID-PTSD, MINI), and four self-report instruments measuring posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, and quality of life (PTGI-SF, IES-R, HSCL-25-depression scale, and WHOQOL-Bref) as well as measures of social integration, social network and employment status.

Results

All patients reported some degree of posttraumatic growth, while only 31% reported greater amounts of growth. Eighty percent of the patients had posttraumatic stress symptoms above the cut-off point, and 93% reported clinical levels of depressive symptoms. Quality of life in the four domains of the WHOQOL-Bref levels were low, well below the threshold for the’life satisfaction’ standard proposed by Cummins.

A hierarchic regression model including depressive symptoms, posttraumatic stress symptoms, posttraumatic growth, and unemployment explained 56% of the total variance found in the psychological health domain of the WHOQOL-Bref scale. Posttraumatic growth made the strongest contribution to the model, greater than posttraumatic stress symptoms or depressive symptoms. Post-migration stressors like unemployment, weak social network and poor social integration were moderately negatively correlated with posttraumatic growth and quality of life, and positively correlated with psychopathological symptoms. Sixty percent of the outpatients were unemployed.

Conclusions

Multi-traumatized refugees in outpatient clinics reported both symptoms of psychopathology and posttraumatic growth after exposure to multiple traumatic events. Symptoms of psychopathology were negatively related to the quality of life, and positively related to post-migration stressors such as unemployment, weak social network and poor social integration. Posttraumatic growth was positively associated with quality of life, and negatively associated with post-migration stressors. Hierarchical regression modeling showed that posttraumatic growth explained more of the variance in quality of life than did posttraumatic stress symptoms, depressive symptoms or unemployment. It may therefore be necessary to address both positive changes and psychopathological symptoms when assessing and treating multi-traumatized outpatients with a refugee background.

Longitudinal study of emerging mental health concerns in youth perinatally infected with HIV and peer comparisons

OBJECTIVE

Cross-sectional research indicates high rates of mental health concerns among youth with perinatal HIV infection (PHIV), but few studies have examined emerging psychiatric symptoms over time.

METHODS

Youth with PHIV and peer comparisons who were HIV-exposed but uninfected or living in households with HIV-infected family members (HIV-affected) and primary caregivers participated in a prospective, multisite, longitudinal cohort study. Groups were compared for differences in the incidence of emerging psychiatric symptoms during 2 years of follow-up and for differences in psychotropic drug therapy. Logistic regression models were used to evaluate the association of emerging symptoms with HIV status and psychosocial risk factors.

RESULTS

Of 573 youth with study entry assessments, 92% attended at least 1 annual follow-up visit (PHIV: 296; comparisons: 229). A substantial percentage of youth who did not meet symptom criteria for a psychiatric disorder at study entry did so during follow-up (PHIV = 36%; comparisons = 42%). In addition, those who met criteria at study entry often met criteria during follow-up (PHIV = 41%; comparisons = 43%). Asymptomatic youth with PHIV were significantly more likely to receive psychotropic medication during follow-up than comparisons. Youth with greater HIV disease severity (entry CD4% <25% vs 25% or more) had higher probability of depression symptoms (19% vs 8%, respectively).

CONCLUSIONS

Many youth in families affected by HIV are at risk for development of psychiatric symptoms.

Quality of life after surgery for colon cancer in patients with Lynch syndrome: partial versus subtotal colectomy

BACKGROUND

Lynch syndrome is a disorder caused by mismatch repair gene mutations. Mutation carriers have a high risk of developing colorectal cancer. In patients with Lynch syndrome in whom colon cancer has been diagnosed, in general, subtotal colectomy instead of partial colectomy is recommended because of the substantial risk of metachronous colorectal cancer. However, the effect of more extensive surgery on quality of life and functional outcome is unknown.

OBJECTIVE

The aim of this study was to investigate quality of life and functional outcome in patients with Lynch syndrome after partial colectomy and subtotal colectomy.

DESIGN

This is a nationwide cross-sectional study in the Netherlands.

SETTINGS

Two quality-of-life questionnaires (Short Form-36 and The European Organization for Research and Treatment of Cancer Colorectal Cancer-specific Quality of Life Questionnaire Module) and a functional outcome questionnaire (Colorectal Functional Outcome) were used.

PATIENTS

Patients with Lynch syndrome who underwent surgery for colon cancer were included.

MAIN OUTCOME MEASURES

The primary outcomes measured were quality of life and functional outcome.

RESULTS

Questionnaires were sent to 192 patients with Lynch syndrome who underwent surgery for colorectal cancer. A total of 136 patients returned the questionnaire (response rate, 71%). Eighteen patients with rectal cancer, 9 patients with a permanent ileostomy, and 5 patients with an IPAA were excluded. Fifty-one patients underwent partial colectomy, and 53 underwent subtotal colectomy. None of the scales of the Short Form-36 survey showed a significant difference. Analysis of the Colorectal Functional Outcome questionnaire revealed that, after subtotal colectomy, patients have a significantly higher stool frequency (p ≤ 0.01) and a significantly higher score on stool-related aspects (p = 0.06) and social impact (p = 0.03). The European Organization for Research and Treatment of Cancer Colorectal Cancer-specific Quality of Life Questionnaire Module presented more problems with defecation after subtotal colectomy (p ≤ 0.01).

LIMITATIONS

Certain selection bias cannot be ruled out.

CONCLUSIONS

Although functional outcome is worse after subtotal colectomy than after partial colectomy, generic quality of life does not differ after the 2 types of surgery in Lynch syndrome. When discussing the options for surgery with the patient, all advantages and disadvantages of both surgical procedures, including quality of life and functional outcome, should be discussed.

Can positive thinking help? Positive automatic thoughts as moderators of the stress-meaning relationship

The purpose of this study was to test whether positive automatic cognitions moderated the relationship between event stressfulness and meaning in life. Measures of these constructs were administered to 232 students and community-dwelling adults. Supporting hypotheses and the literature, positive automatic cognitions moderated the relationship between event stressfulness and meaning in life. For persons with high levels of positive thinking, greater event stressfulness was associated with higher meaning in life. For persons with low levels of positive thinking, greater event stressfulness was associated with lower meaning in life. These results were obtained when controlling for positive affect, as well as the positive affect × event stressfulness interaction. The positive cognitions × event stressfulness interaction accounted for 2.9% of variance, and the overall model accounted for 47% of the variance in meaning in life.

Subjective experience and meaning of psychoses: the German Subjective Sense in Psychosis Questionnaire (SUSE)

BACKGROUND

Clinical research on subjective determinants of recovery and health has increased, but no instrument has been developed to assess the subjective experience and meaning of psychoses. We have therefore constructed and validated the Subjective Sense in Psychosis Questionnaire (SUSE) to measure sense making in psychotic disorders.

METHOD

SUSE was based on an item pool generated by professionals and patients. For pre-testing, 90 psychosis patients completed the instrument. Psychometric properties were assessed using methods of classical test theory. In the main study, SUSE was administered to a representative sample of 400 patients. Factor structure, reliability and validity were assessed and confirmatory factor analyses (CFAs) were used for testing subscale coherence and adequacy of the hypothesized factor structure. Response effects due to clinical settings were tested using multilevel analyses.

RESULTS

The final version of SUSE comprises 34 items measuring distinct aspects of the experience and meaning of psychoses in a consistent overall model with six coherent subscales representing positive and negative meanings throughout the course of psychotic disorders. Multilevel analyses indicate independence from clinical context effects. Patients relating psychotic experiences to life events assessed their symptoms and prospects more positively. 76% of patients assumed a relationship between their biography and the emergence of psychosis, 42% reported positive experience of symptoms and 74% ascribed positive consequences to their psychosis.

CONCLUSIONS

SUSE features good psychometric qualities and offers an empirical acquisition to subjective assessment of psychosis. The results highlight the significance of subjective meaning making in psychoses and support a more biographical and in-depth psychological orientation for treatment.

Capturing the psychologic-personal perspective in spinal cord injury

OBJECTIVE

The overall objective of this study was to illustrate a systematic approach for capturing the psychologic-personal perspective in International Classification of Functioning, Disability and Health-based comprehensive research on spinal cord injury (SCI) in terms of what and how to measure. The specific aims were to identify (1) relevant areas of research for capturing the psychologic-personal factors in a study that is planned and conceptualized according to the comprehensive context of the International Classification of Functioning, Disability and Health, using SCI as a case in point; (2) a set of domains relevant for SCI research from a psychologic-personal perspective; and (3) suitable measurement instruments that can be considered for the assessment of those identified domains based on a set of predefined guiding principles.

DESIGN

The psychologic-personal factor structure was developed based on an item pool of 1246 entries from secondary analyses of available data from SCI studies. The domain set for psychologic-personal factors was identified through reviewing the scientific literature in PubMed and PsycInfo. The set of measurement instruments was collected using available measurement reviews, searches in the literature, instrument databases, and further sources and was selected using guiding principles.

RESULTS

Forty specific psychologic-personal factors, subdivided into seven areas of research, were identified: (1) sociodemographic personal characteristics, (2) the position in the immediate social and physical context, (3) personal history and biography, (4) feelings, (5) thoughts and beliefs, (6) motives, and (7) patterns of experience and behavior. The psychologic-personal factors domain set contains both cross-cutting outcome domains, namely quality-of-life, life satisfaction, subjective well-being, and sociodemographic personal characteristics, life events, positive and negative affect, perceived stress, locus of control, self-efficacy, purpose in life, coping, lifestyle, and personality. For each of the identified domains, a pool of measurement instruments was listed, and the application of predefined guiding principles for measurement instrument selection was exemplified for self-efficacy. It resulted in the selection of the General Self-Efficacy Scale by Schwarzer and Jerusalem (Measures in Health Psychology: A User's Portfolio. Causal and Control Beliefs. pp. 35-37; 1995).

CONCLUSIONS

The results of the current article contributed to creating a transparent protocol for the Swiss Spinal Cord Injury Cohort study, coordinated by the Swiss Paraplegic Research in Nottwil, Switzerland. This article also stresses the relevance of the comprehensive approach to SCI and the consideration of the psychologic-personal perspective in this approach. The study, therefore, hopes to encourage scientists to use the International Classification of Functioning, Disability and Health and the psychologic-personal perspective as a frame of reference for their research. Furthermore, the research reported in this article can inform the World Health Organization's future development of the personal factors classification in the International Classification of Functioning, Disability and Health.

Benefit finding and post-traumatic growth in long-term colorectal cancer survivors: prevalence, determinants, and associations with quality of life

BACKGROUND

As research on quality of life of colorectal cancer (CRC) survivors has mainly focused on downsides of cancer survivorship, the aim of this study is to investigate benefit finding (BF) and post-traumatic growth (PTG) in long-term CRC survivors.

METHODS

Benefit finding, PTG, and quality of life were assessed 5 years after diagnosis in a population-based cohort of 483 CRC patients using the benefit finding scale, the post-traumatic growth inventory, and the EORTC QLQ-C30. Prevalence of BF and PTG, determinants of moderate-to-high BF and PTG, and the association between BF, PTG, and quality of life were investigated.

RESULTS

Moderate to high levels of BF and PTG were experienced by 64% and 46% of the survivors, respectively. Survivors with the highest level of education and with higher depression scores reported less BF and PTG. The PTG increased with increasing stage and self-reported burden of diagnosis. Quality of life only correlated weakly with PTG (Pearson's r=0.1180, P=0.0112) and not with BF (r=0.0537, P=0.2456).

CONCLUSION

Many long-term CRC survivors experience BF and PTG. As these constructs were not strongly correlated with quality of life, focusing solely on quality of life after cancer misses an important aspect of survivorship.

Posttraumatic growth of injured patients after motor vehicle accidents: an interpretative phenomenological analysis

This study aimed to explore the process of posttraumatic growth of injured patients after a motor vehicle accident in China. Semi-structured interviews were conducted with six patients. Transcripts were analyzed using interpretative phenomenological analysis. Four main super-ordinate themes emerged: construction of meaning; perception of self; perception of connection; and perception of life philosophy. These themes describe growth and emotional distress which may well coexist. Posttraumatic growth can be seen as one outcome of a process of struggling with traumatic injuries. Some strategies for facilitating posttraumatic growth are discussed. Health-care providers may help the recovery of injured patients by facilitating posttraumatic growth.

Posttraumatic growth in breast cancer survivors: a comparison of volunteers and non-volunteers

BACKGROUND

The need to understand posttraumatic growth (PTG) in relation to actual changes in an individual's life has recently been raised. However, the relationship of volunteering, health, and PTG has not yet been assessed.

AIMS

To assess the relationship of volunteer work, health, and PTG, and to assess whether cognitive and emotional processing, emotional expressing, and social support differ in volunteer and non-volunteer breast cancer survivors.

METHODS

Participants were 84 breast cancer survivors who had volunteered to work with newly diagnosed breast cancer patients and 40 breast cancer survivors who did not participate in any volunteer work. Participants completed the PTG inventory, the emotional expression and processing scale, the cognitive processing scale, and the multidimensional scale of perceived social support.

RESULTS

Participants in both groups reported similar and relatively high levels of PTG (M = 70.22, SD = 17.38 in a possible range of 0-105). In the volunteer group, PTG levels were not related to self-reported health (r = 0.07, p>0.05), while in the non-volunteer group a high and significant correlation between self-reported health and PTG (r = 0.46, p<0.001), and a significant effect of group × self-reported health on PTG levels, were found. The study variables accounted for 31% of PTG variance, with cognitive and emotional processing and the interaction of group × health being significant predictors.

CONCLUSIONS

Although volunteers did not differ from non-volunteers in PTG levels, higher PTG was related to better health in the non-volunteers group only. These findings point to the complexity of PTG structure and its multifaceted relation to behavior.

Positive aspects of mental illness: a review in bipolar disorder

INTRODUCTION

There is growing interest to understand the role of positive psychological features on the outcomes of medical illnesses. Unfortunately this topic is less studied in relation to mental health, and almost completely neglected in relation to one of the most common severe psychiatric illnesses, bipolar disorder. Certain specific psychological characteristics, that are generally viewed as valuable and beneficial morally or socially, may grow out of the experience of having this affective disorder.

OBJECTIVE

We describe the sources, research and impact of these positive psychological traits in the lives of persons with bipolar disorder based on the few published literature available to date. These include, but are not limited to: spirituality, empathy, creativity, realism, and resilience.

METHODS

After an extensive search in the literature, we found 81 articles that involve descriptions of positive psychological characteristics of bipolar disorder.

RESULTS

We found evidence for enhancement of the five above positive psychological traits in persons with bipolar disorder.

CONCLUSIONS

Bipolar disorder is associated with the positive psychological traits of spirituality, empathy, creativity, realism, and resilience. Clinical and research attention to preserving and enhancing these traits may improve outcomes in bipolar disorder.

Link between personality and cancer

Personality refers to an individual's enduring and pervasive personal motivation, emotion, interpersonal style, attitudes and behavior that are stable over a long time after young adulthood. In relation to the cancer trajectory, three basic and one other personality traits have been studied with some frequency, namely neuroticism, extraversion, conscientiousness and optimism. The considerable stability of personality over time makes it a potential long-acting etiological factor for the development of cancer. However, the studies performed so far do not give much support to personality as a causative factor for cancer. Some studies of cancer survival have found significant associations between lower optimism and higher neuroticism with shorter survival. More mental distress and fatigue and poorer quality of life is significantly associated with higher neuroticism and lower optimism at cancer screening, diagnosis and primary treatment, short- and long-term follow-up and towards the end of life. Neuroticism is a strong predictor of post-traumatic stress disorder triggered by cancer as a life-threatening experience eventually leading to negative personality changes. To what extent cancer leads to positive personality changes (post-traumatic growth) is currently unsettled. Basic personality traits are strongly associated with lifestyle, which is considered an important etiological factor for the development of cancer. The methodological problems in the study of personality and cancer are considerable, and many research designs used so far may have been too simplistic. Studies of potential biomarkers for personality traits combined with inflammation markers of cellular carcinogenesis in longitudinal designs could be promising for the future. High neuroticism is important for the clinical management of cancer patients and should gain more attention from oncologists in the future.