Perceived posttraumatic growth in cardiac patients: A systematic scoping review

The Content and Nature of Rumination in Chinese Young and Middle-Aged Patients with Acute Coronary Syndrome: A Qualitative Study

Individuals have different rumination patterns after experiencing traumatic events in different cultural backgrounds and situations. This study aimed to explore the experience of Chinese young and middle-aged patients with acute coronary syndrome (ACS) to understand the content and nature of their rumination. Sixteen participants were selected using the purposive sampling method in the First Affiliated Hospital of Soochow University from May 2023 to December 2023. Data were collected using semi-structured interviews and analyzed using Colaizzi's seven-step phenomenological method. The participants went through two successive stages: non-adaptive rumination and adaptive rumination. During the initial admission phase, all the participants experienced varying degrees of non-adaptive rumination. Non-adaptive rumination included four sub-themes: worry or anxiety of daily activities and medical therapy (37.50%), fear of unpredictable outcomes and death (37.50%), sadness of maladjustment (25.00%), and remorse of carelessness (12.50%). During the period of stable condition and pre-discharge, the participants received health education and gradually all transitioned to adaptive rumination. Adaptive rumination included four sub-themes: tracing of disease processes (100%), enhancement of disease cognition (81.25%), improvement of health awareness (62.50%), and adjustment of lifestyle cognition (100%). In conclusion, although the Chinese young and middle-aged patients with ACS experienced negative emotions after a traumatic cardiac event, they gradually made positive changes, and optimism and information support played important roles in this transition. The results of this study provide a fundamental understanding of rumination experiences in Chinese young and middle-aged patients with ACS and provide new data for healthcare providers when designing intervention programs to enhance post-traumatic growth in these patients.

Posttraumatic growth in palliative care settings: A scoping review of prevalence, characteristics and interventions

BACKGROUND

Posttraumatic growth refers to positive psychological change following trauma. However, there is a need to better understand the experience of posttraumatic growth in the palliative care setting as well as the availability and efficacy of interventions that target this phenomenon.

AIMS

To provide a review of the prevalence, characteristics and interventions involving posttraumatic growth in adults receiving palliative care and to collate recommendations for future development and utilisation of interventions promoting posttraumatic growth.

DESIGN

We performed a systematic scoping review of studies investigating posttraumatic growth in palliative care settings using the Arksey and O'Malley six-step scoping review criteria. We used the PRISMA guidelines for scoping reviews.

DATA SOURCES

Articles in all languages available on Ovid Medline [1946-2022], Embase [1947-2022], APA PsycINFO [1947-2022] and CINAHL [1981-2022] in November 2022.

RESULTS

Of 2167 articles located, 17 were included for review. These reported that most people report low to moderate levels of posttraumatic growth with a decline towards end-of-life as distress and symptom burden increase. Associations include a relationship between posttraumatic growth, acceptance and greater quality-of-life. A limited number of interventions have been evaluated and found to foster posttraumatic growth and promote significant psychological growth.

CONCLUSION

Posttraumatic growth is an emerging concept in palliative care where although the number of studies is small, early indications suggest that interventions fostering posttraumatic growth may contribute to improvements in psychological wellbeing in people receiving palliative care.

Effects of posttraumatic growth on psychosocial adjustment in young and middle-aged patients with acute myocardial infarction: The mediating role of rumination

BACKGROUND

Psychosocial adjustment is a core problem faced by young and middle-aged patients following a diagnosis of acute myocardial infarction (AMI), which seriously affects rehabilitation outcomes. However, the relationship and influencing mechanism between post-traumatic growth and psychosocial adjustment in young and middle-aged AMI patients have not been fully explored.

OBJECTIVES

This study aimed to determine the relationship between posttraumatic growth and psychosocial adjustment in young and middle-aged patients following AMI and to explore the mediating role of rumination.

METHODS

This cross-sectional study was conducted in Guangdong Province from January 2022 to August 2022. A total of 321 young to middle-aged patients with AMI participated in this study. Self-reported questionnaires were used to assess posttraumatic growth, rumination, and psychosocial adjustment. Pearson's correlation and path analyses were used to analyze the data.

RESULTS

The total scores for posttraumatic growth, rumination, and psychosocial adjustment in young and middle-aged patients with AMI were 51.24±19.35, 35.18±8.72, and 43.55±26.04, respectively. All three were considered moderate. Posttraumatic growth was positively associated with rumination and negatively associated with psychosocial adjustment (p < 0.01). The relationship between posttraumatic growth and psychosocial adjustment was mediated by deliberate rumination.

CONCLUSIONS

Deliberate rumination mediated the relationship between posttraumatic growth and psychosocial adjustment. Healthcare providers should therefore guide patients to engage in deliberate rumination to help them grow following their AMI, thereby improving their psychosocial adaptability and prognosis.

Myokardinfarkt als Lebenschance

Einen Myokardinfarkt zu er- und überleben stellt für die Betroffenen häufig eine vital und emotional bedrohliche Situation dar. Copingmechanismen im Umgang mit der Herzerkrankung können z. B. eine komplette Verleugnung oder psychische Dekompensation bewirken. Dagegen kann ein Verständnis des Myokardinfarktes als Grenz- oder Kairós-Situation eine theoretische Bereicherung für Kliniker*innen darstellen und auf einen dritten Verarbeitungsweg hindeuten: Dieser wurde als „posttraumatisches Wachstum“ beschrieben und wird von Betroffenen selbst als ein Weckruf bezeichnet. Für Behandler*innen ist das Wissen bedeutsam, dass sich nach einem Myokardinfarkt nicht selten ein Zeitfenster öffnet, das eine Möglichkeit sowohl für Lebensstilveränderungen als auch persönliche und emotionale Wachstumschancen der Patient*innen bietet. Ein solches Zeitfenster entsteht, sobald das akute und lebensbedrohliche Herzereignis bewältigt wurde und ein Veränderungsspielraum durch die Infragestellung der bisherigen Lebensführung entsteht. Als „teachable moment“, der von der*dem Behandler*in erkannt werden sollte, ist diese Phase nicht quantifizierbar und unterliegt intra- und interindividuellen Schwankungen. Daher soll im Folgenden der Versuch unternommen werden, die Frage zu beantworten, inwiefern das Wissen um philosophische und ethische Konzepte (z. B. gutes Leben, Grenzsituation und Kairós-Situation) und ein deliberatives Gesprächsmodell der Behandler*in-Patient*in-Kommunikation dazu beitragen kann, die Patient*innen in dieser vulnerablen Zeit nach der akuten Bewältigung eines Myokardinfarkts zu begleiten und – im Sinne eines posttraumatischen Wachstums – zu neuen Sichtweisen auf ein für sie gutes Leben zu befähigen.

Health-related quality of life and psychological indicators of thriving 15-19 years after heart or lung transplantation

BACKGROUND

Survival into the second decade after cardiothoracic transplantation (CTX) is no longer uncommon. Few data exist on any health-related quality of life (HRQOL) impairments survivors face, or whether they may even experience positive psychological outcomes indicative of "thriving" (e.g., personal growth). We provide such data in a long-term survivor cohort.

METHODS

Among 304 patients prospectively studied across the first 2 years post-CTX, we re-interviewed patients ≥15 years post-CTX. We (a) examined levels of HRQOL and positive psychological outcomes (posttraumatic growth related to CTX, purpose in life, life satisfaction) at follow-up, (b) evaluated change since transplant with mixed-effects models, and (c) identified psychosocial and clinical correlates of study outcomes with multivariable regression.

RESULTS

Of 77 survivors, 64 (83%) were assessed (35 heart, 29 lung recipients; 15-19 years post-CTX). Physical HRQOL was poorer than the general population norm and earlier post-transplant levels (P's < .001). Mental HRQOL exceeded the norm (P < .001), with little temporal change (P = .070). Mean positive psychological outcome scores exceeded scales' midpoints at follow-up. Life satisfaction, assessed longitudinally, declined over time (P < .001) but remained similar to the norm at follow-up. Recent hospitalization and dyspnea increased patients' likelihood of poor physical HRQOL at follow-up (P's ≤ .022). Lower sense of mastery and poorer caregiver support lessened patients' likelihood of positive psychological outcomes (P's ≤ .049). Medical comorbidities and type of CTX were not associated with study outcomes at follow-up.

CONCLUSIONS

Despite physical HRQOL impairment, long-term CTX survivors otherwise showed favorable outcomes. Clinical attention to correlates of HRQOL and positive psychological outcomes may help maximize survivors' well-being.