A longitudinal investigation of posttraumatic growth in adult patients undergoing treatment for acute leukemia

Post-traumatic growth correlates among parents of children with chronic illnesses: A systematic review and meta-analysis

Parenting a child with a chronic illness presents a complex journey marked by various challenges, along with possible personal growth following these challenges. In this systematic review we present three meta-analyses, in order to examine the associations of post-traumatic growth (PTG) among parents of children with diverse chronic illnesses, and psychological distress, social support, and resilience. Analyzing 34 studies encompassing a total of 5328 parents, the results reveal several key findings. First, PTG was found to be prevalent among the parents. Second, there was no significant correlation between PTG and psychological distress, suggesting that these two processes may exist independently. Third, a positive correlation was observed between PTG and both social support and resilience-related factors, underscoring the role of these factors in fostering growth among parents of children with chronic illnesses. Additionally, illness type emerged as a moderator, affecting the strength of the above-mentioned correlations with PTG. Specifically, in the case of psychiatric illnesses, correlations of PTG with social support and resilience were stronger than in the context of other illnesses. Overall, this review emphasizes the significance of recognizing and addressing PTG correlates among parents of children with chronic illnesses, offering insights for clinical practice.

Role of Peer Support in Posttraumatic Growth Among Adolescent and Young Adult Cancer Patients and Survivors

Purpose: Adolescents and young adults (AYA) who undergo cancer treatment sometimes report posttraumatic growth (PTG). Although the importance of peer support has been suggested, its association with PTG, especially its five distinct domains, needs to be investigated further in AYA cancer survivors. The present study examined the role of demographics and peer support in PTG among AYA cancer patients and survivors. Methods: The present, multicenter, cross-sectional, web-based study enrolled AYA cancer patients and survivors (median age: 28 years). Of 549 AYA patients recruited, 212 from 11 cancer centers and 12 cancer patient communities agreed to participate by completing a self-reported measure of PTG (Extended Version of the Posttraumatic Growth Inventory-Japanese) and providing information about their diagnosis, treatment, peer support (affiliation with an AYA patient community or friendship with other AYA patients), and social status. Multiple regression analysis was used to identify significant correlations overall and in the five PTG domains. Results: PTG was positively associated with male sex, having a confidant, and friendship with other AYA patients, and negatively associated with cranial radiation. Friendship with other AYA patients was positively associated with four of the five PTG subscales. For the five subscale scores, "cranial radiation" was negatively associated with "relating to others"; "belonging to a religion" was positively associated with "spiritual change"; and "having a confidant" was positively associated with "relating to others" and "new possibility." Conclusion: "Having a confidant" and "friendship with other AYA patients" were positively associated with PTG. Psychosocial interventions mobilizing peer support may contribute to promoting PTG in AYA patients. UMIN000035439.

Reliability and Validity of the Japanese Version of the Short Form of the Expanded Version of the Posttraumatic Growth Inventory (PTGI-X-SF-J): A Cross-Sectional Study

A Japanese version of the short form of the expanded Posttraumatic Growth Inventory (PTGI-X-SF-J) was developed in this study, as the extended version captures broader, more diverse personal growth perspectives, such as existential spiritual growth. We collected cross-sectional data from 408 (first sample) and 284 (second sample) Japanese university students using the expanded version of the Posttraumatic Growth Inventory (PTGI-X-J). Exploratory factor analysis (EFA) was performed with the first sample and confirmatory factor analysis (CFA) with the second; reliability and validity were examined. The short-form version resulting from the EFA and CFA comprised 10 items and five factors. Cronbach's alpha for the PTGI-X-SF-J total and subscale scores ranged from 0.671 to 0.875. The intraclass correlation coefficient for the total and subscale scores between the PTGI-X-J and PTGI-X-SF-J ranged from 0.699 to 0.821. Regarding external validity, no significant correlation was found between posttraumatic growth and posttraumatic stress disorder checklists. Due to its brevity, the PTGI-X-SF-J can help assess diverse spiritual and existential personal growth experiences among clients, patients, and trauma survivors while reducing physical and psychological burdens.

Resilience in older adults with cancer: A scoping literature review

INTRODUCTION

Resilience, the ability to respond to stressors by maintaining or rapidly returning to normal homeostasis, serves as a new paradigm to improve the care of older adults. However, resilience research in oncology is nascent. We aimed to describe the current research landscape on physical, cognitive, and psychosocial resilience in older cancer patients.

MATERIALS AND METHODS

We searched PubMed/MEDLINE from inception to January 28, 2022 for records with the terms "resilient OR resilience OR resiliency." We included studies that focused on persons over age 65 with cancer and assessed physical, cognitive, or psychological resilience. We excluded studies that did not report original data; did not have the full text available; assessed resilience on fewer than three time points; and published in non-English languages. Definitions and measures of resilience were extracted and categorized using qualitative analysis.

RESULTS

Of 473 articles screened, we found 29 articles that met criteria for inclusion in our review. There was a high degree of heterogeneity in the definitions and measures of resilience. Resilience was defined as robustness/resistance to decline (n = 11), recovery from trauma/stressor (n = 7), and adaptive and proactive coping behaviors (n = 6). Ten papers did not define resilience. 21 studies utilized longitudinal analysis, five studies used randomized and nonrandomized control trials, and four studies assessed pre-post analysis. Stressors included cancer diagnosis (n = 18), chemotherapy (n = 3), radiation (n = 3), acute illness (n = 3), surgery (n = 2), and hematopoietic cell transplant (n = 1).

DISCUSSION

Evidence for predictors and determinants of resilience in older adults with cancer is limited by the absence of standardized definitions and measurements. There is a fundamental need for a more precise definition, measures, and understanding of the physiologic mechanisms underlying the response to the physical, cognitive, and psychosocial stressors of cancer and its treatments.

Personality Traits and Coping Strategies Relevant to Posttraumatic Growth in Patients with Cancer and Survivors: A Systematic Literature Review

The possibility of positive psychological changes after cancer, namely, posttraumatic growth, is a growing field of research. Identifying personality traits and coping strategies related to posttraumatic growth may help find vulnerable individuals as well as promote helpful coping strategies to help more patients make positive changes at an early stage. The aim of this systematic literature review is to provide an overview of the quantitative data on coping strategies and personality traits associated with posttraumatic growth in patients with cancer and cancer survivors as well as the methods used in included studies. A systematic literature search was conducted using five databases (PubMed, PubPsych, PsycInfo, Web of Science, and PSYNDEXplus). The 70 reports of included studies assessed posttraumatic growth using questionnaires in a sample of patients with cancer or survivors. In addition, associations with a personality trait or coping strategy had to be examined cross-sectionally or longitudinally. All 1698 articles were screened for titles and abstracts by two authors, after which disputed articles were reviewed by a third author. Afterwards, articles were screened for full texts. Most studies had a cross-sectional design and used a sample of patients with breast cancer. Coping strategies have been researched more than personality factors. The personality traits of resilience, hardiness, dispositional positive affectivity, and dispositional gratitude seem to be related to posttraumatic growth, while the Big Five personality traits (openness to experience, conscientiousness, extraversion, agreeableness, neuroticism) have been less researched and/or seem to be unrelated. The use of social support, religious coping, positive reframing, and reflection during illness as coping strategies seems to be related to posttraumatic growth. The findings can be used for the development of interventions. Future studies should investigate associations longitudinally.

Examining the protective influence of posttraumatic growth on interpersonal suicide risk factors in a 6-week longitudinal study

Research has found an inverse relationship between posttraumatic growth (PTG) and suicidal ideation in military and community samples that holds when controlling for other suicide risk factors. However, further research is needed into the underlying mechanisms to clarify how PTG protects against the formation of suicidal ideation. The current two-wave longitudinal study examined whether perceiving PTG from recent adverse circumstances while in a national lockdown during the COVID-19 pandemic attenuated the positive relationship of two interpersonal suicide risk factors – perceived burdensomeness (PB) and thwarted belonginess (TB)–over 6 weeks. Participants (n = 170) were recruited online from Prolific from income-deprived areas in the United Kingdom (mean age = 37.65; SD = 12.50; 53.5% female). Post-hoc power analyses indicated we had insufficient power to examine the hypothesised mediation for TB. We examined whether PTG mediated the relationship between PB at wave 1 and wave 2 while controlling for depression and anxiety in a sample of individuals at-risk for suicidal ideation. PTG did significantly and partially mediate the positive relationship between PB at wave 1 and 2. We discuss the theoretical and clinical implications that could result if future research successfully replicates these initial exploratory findings.

Posttraumatic growth inventory: challenges with its validation among French cancer patients

Background

The Posttraumatic growth inventory (PTGI) aims to assess the positive psychological changes that individuals can perceive after a traumatic life event such as a cancer diagnosis. Several French translations of the PTGI have been proposed, but comprehensive data on their psychometric properties are lacking. This study aimed to provide a more complete assessment of the psychometric properties of one of the most used PTGI translations in early-stage breast cancer and melanoma patients.

Methods

A sample of 379 patients completed the PTGI two years after their cancer diagnosis. A confirmatory analysis was first performed to determine whether the initial five-factor structure of the PTGI was adequate for this French version. As issues were identified in the translation and in the questionnaire structure, we performed an exploratory analysis to determine the most suitable structure for this questionnaire. Validity and reliability of the evidenced structured were then assessed.

Results

The exploratory analysis evidenced a four-factor structure close to the initial structure: four of the five initial domains were recovered, and items from the unrecovered domain were split into the other domains. This new structure showed good internal consistency and acceptable validity.

Conclusions

This study highlights that the process of translation and cross-cultural validation of questionnaires is crucial to obtain valid and reliable psychometric instruments. We advise French psycho-oncology researchers and psychotherapists to (i) use the revised translation of Lelorain et al. (2010) proposed in this manuscript and (ii) use the four scores newly evidenced with a grouping of two response categories.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-022-01722-6.

Post-Traumatic Growth and Quality of Life among World Trade Center Health Registry Enrollees 16 Years after 9/11

A recent study of World Trade Center Health Registry enrollees found that about one-third experienced post-traumatic growth (PTG) in the wake of the 9/11 attacks and that PTG was associated with social support and social integration. However, the implications of PTG for the enrollees' overall quality of life are unknown. The present study investigated the prevalence of PTG and its association with the SF-12 physical and mental functioning quality of life scales in a sample of 4760 enrollees from the Registry's Health and Quality of Life Study (HQoL) who completed the first four surveys, were older than 18 on 9/11, reported English as their primary spoken language, and provided consistent self-report of 9/11 physical injury at the Registry's baseline and HQoL surveys. We employed multivariable linear regression to evaluate the association between PTG and the SF-12 physical and mental scales, controlling for sociodemographic and other variables. We found that 31% of the sample enrollees experienced PTG and that PTG exhibited a clinically and statistically significant association with the SF-12 mental scale but not the physical scale (physical: b = 0.15 (-0.45, 0.75), mental: b = 3.61 (2.85, 4.37)). Those who were physically injured during 9/11 showed larger improvements in mental functioning than those who were not. PTG has implications for the overall mental quality of life that should be further investigated.

Posttraumatic Growth and Psychological Distress among Female Breast Cancer Survivors in India: A Cross-Sectional Study

Introduction Breast cancer survivors (BCS) may experience a cascade of negative reactions during the entire treatment process in the form of psychiatric morbidity. However, exposure to a traumatic event also has the fertile ground for the potential to catalyze a host of positive changes, including development in personal, interpersonal, and spiritual levels, commonly referred to as posttraumatic growth (PTG). PTG is defined as “positive psychological change experienced due to a struggle with highly challenging life circumstances.”

Objective This study aims to measure the prevalence and correlates of PTG among BCS.

Materials and Methods It was a cross-sectional study carried in a tertiary care center of North India from January 2021 to April 2021. Total 700 BCS were approached and screened using the purposive sampling technique. Data were analyzed using the Statistical Package for Social Sciences, version 20.

Results The mean age (standard deviation [SD]) of the patients was 43.14 (8.53) years. The mean (SD) PTG score was 37 (13.66). Among the subdomain of PTG, most respondents showed growth in personal strength, relating to others, followed by an appreciation of life, spiritual change, and less growth in new possibilities. PTG was found to be significantly positively correlated with treatment completion time (r = 2.260, p = 0.02) and negatively correlated with depression, anxiety, and stress (r = –0.152, p = 0.04; r = –0.145, p = 0.05; r = –0.162, p = 0.02).

Conclusion Psychological morbidities must be addressed along with medical treatment of breast cancer so that growth post trauma can be further facilitated.

Impact of the COVID-19 pandemic on cancer patients and psycho-oncology providers: Perspectives, observations, and experiences of the American Psychosocial Oncology Society (APOS) membership

OBJECTIVE

To understand: (1) psycho-oncology providersX2019; perspectives on and observations of the psychological responses of their cancer patients during the pandemic, and (2) psycho-oncology providersX2019; own experiences delivering care.

METHODS

In this concurrent mixed methods study, a survey was distributed to psychosocial providers who were members of the American Psychosocial Oncology Society (APOS). Survey respondents were invited to participate in a one-on-one audio-recorded interview via phone or secure ZoomX00AE;.

RESULTS

76 self-identified psycho-oncology providers responded to the survey and 11 participated in a one-on-one interview. Approximately half reported that patients responded in unique ways to COVID-19 stress relative to other populations. Three themes emerged from qualitative analyses: (1) unique burden on patients, (2) cancer patientsX2019; pandemic response and its relationship to their cancer experience, and (3) unexpected positive changes. Providers emphasized that the cancer experience may have prepared patients for the existential distress of the pandemic and described patientsX2019; resiliency. Two themes emerged regarding delivery of care: (1) new professional and personal challenges and (2) provider resiliency.

CONCLUSIONS

Although providers observed that the pandemic placed new burdens on patients, they emphasized that the cancer experience may have prepared patients for the existential distress of the pandemic and described patientsX2019; resiliency. To overcome challenges, psycho-oncology providers used innovative strategies to support patients and foster their own mental health. This article is protected by copyright. All rights reserved.

Grief and growth among Chinese parents who lost their only child: the role of positive and negative experiences of social support from different sources

BACKGROUND

In China, bereaved parents who have lost their only child are known as Shidu parents, and they tend to present high levels of prolonged grief reactions. To date, a widespread focus has been placed on positive social support, while potential negative experiences have been relatively neglected. Additionally, the role of social support from different sources (i.e. close family members [partner, siblings, grandchildren], peers, and others [relatives, friends, colleagues]) has not been examined thoroughly.

OBJECTIVE

The present study investigated whether social support from different sources has a differential impact on postloss adaptation (i.e. prolonged grief and growth). The loss-orientated and restoration-orientated coping strategies of the dual process model were also tested for their mediating roles.

METHODS

A total of 277 Chinese Shidu parents were recruited to complete a series of questionnaires including social support from different sources, prolonged grief symptoms, posttraumatic growth, and dual process coping strategies. Correlation analyses, paired sample t tests and structural equation modelling were conducted.

RESULTS

More positive support were related to less prolonged grief symptoms and more posttraumatic growth, while more negative support was only related to more prolonged grief. Positive support from close family members and others was significantly related to prolonged grief/growth, and negative support from these sources was significantly positively associated with prolonged grief. Positive or negative support from people who shared a similar experience was unrelated to prolonged grief/growth. Positive and negative support were related to prolonged grief and growth through loss-oriented coping strategies.

CONCLUSION

Overall, the present study indicated that positive and negative support experiences from different sources functioned differently in the recovery of Chinese Shidu parents and that loss-oriented coping played a mediating role. These findings highlight the importance of differentiating social support by traits in coping with grief and the crucial mediating role of loss-oriented coping.

HIGHLIGHTS

More positive support correlated with less prolonged grief and more growth, while more negative support correlated with more prolonged grief.Support from family members and friends was more potent than that from peers.Social Support correlated with prolonged grief/growth through loss-oriented coping.

Posttraumatic Growth and Coping Strategies Among Patients With Head and Neck Cancer: Do Approach Coping and Avoidant Coping Predict Posttraumatic Growth Over Time?

Despite an enormous number of studies addressing the importance of posttraumatic growth (PTG) among cancer patients, the literature lacks data regarding how different coping strategies affect PTG among head and neck cancer (HNC) patients over time. This longitudinal study investigated the PTG trend and coping over 5-7months among a cohort of HNC patients within the first year after their diagnosis. It determined an association between coping strategies and PTG over time. The study's HNC respondents were administered a socio-demographic and clinical characteristics questionnaire during their baseline assessments. Additionally, the Malay versions of the "PTG Inventory-Short Form" (PTGI-SF) and the "Brief Coping Orientation to Problems Experienced Inventory" (Brief COPE) were administered during respondents' baseline assessments and follow-up assessments (5-7months after the baseline assessments). In total, 200 respondents reported an increasing PTG trend and approach coping (active coping, planning, positive reframing, acceptance, emotional support, and instrumental support) and a decreasing trend of avoidant coping (self-distraction and denial) over time. Two approach coping strategies (acceptance and planning) significantly increased PTG while denial was the only avoidant coping strategy that significantly lowered PTG, after controlling for socio-demographic and clinical characteristics, over time. Our study's findings identified the need to incorporate psychosocial interventions that enhance approach coping and reduce avoidant coping into HNC patients' treatment regimes.

Examining Associations Between Major Negative Life Events, Changes in Weekly Reports of Post-Traumatic Growth and Global Reports of Eudaimonic Well-Being

Research on post-traumatic growth (PTG) has been compromised by methodological limitations. Recent process-oriented accounts of personality suggest, however, that positive changes may occur through short-term (i.e., state-level) changes in PTG. In the current year-long study, 1,247 participants provided weekly reports of significant negative events as well as state manifestations of PTG (up to 44 assessments per individual; 34,205 total). Trait assessments of eudaimonic well-being (EWB) were administered at intake and Weeks 45 and 52. Experiencing negative life events predicted increases in state PTG, which in turn predicted increases in EWB. However, stability was observed when modeling prospective changes in overall state PTG before and after the initial negative life event or across all negative life events occurring during the study time frame. These findings highlight the importance of studying PTG-related processes using appropriate research designs, analytic strategies, and time frames.

Online Mindfulness May Target Psychological Distress and Mental Health during COVID-19

Background

The COVID-19 pandemic has dramatically affected mental health, creating an urgent need for convenient and safe interventions to improve well-being. Online mindfulness interventions show promise for improving depression, anxiety, and general well-being.

Objective

To assess: 1) the impact of online mindfulness on psychological distress, 2) altruistic efforts, and 3) the quantity, quality, and availability of online mindfulness resources during the COVID-19 pandemic.

Methods

233 participants (203 U.S.; 20 international; 10 unknown) participated in this prospective, single-arm, non-randomized clinical trial of a single online mindfulness meditation session with pre- and post-surveys.

Main Outcome Measures

(a) Mindfulness session helpfulness, online platform effectiveness, and immediate pre- to post-session changes in momentary stress, anxiety, and COVID-19 concern; (b) qualitative themes representing how people are helping others during the pandemic; (c) absolute changes in quantity of mindfulness-oriented web content and free online mindfulness resource availability from May to August 2020.

Results

Most participants felt the online mindfulness session was helpful and the electronic platform effective for practicing mindfulness (89%, 95% CI: [82 to 93%]), with decreased momentary anxiety (76%; 95% CI: [69 to 83%]), stress (80%; [72 to 86%]), and COVID-19 concern (55%; [46 to 63%]), (p < 0.001 for each measure). Participants reported helping others in a variety of ways during the pandemic, including following public health guidelines, conducting acts of service and connection, and helping oneself in hopes of helping others. "Mindfulness + COVID" search results increased by 52% from May to August 2020. Most (73%) Academic Consortium for Integrative Medicine and Health member websites offer free online mindfulness resources.

Conclusions

Virtual mindfulness is an increasingly accessible intervention available world-wide that may reduce psychological distress during this isolating public health crisis. Kindness and altruism are being demonstrated during the pandemic. The consolidated online mindfulness resources provided may help guide clinicians and patients.

Roles of Reexamination of Core Beliefs and Rumination in Posttraumatic Growth Among Parents of Children With Cancer: Comparisons With Parents of Children With Chronic Disease

BACKGROUND

Studies have indicated that the impact of a traumatic experience can be negative and can provide the opportunity to experience psychological growth, known as posttraumatic growth (PTG).

OBJECTIVE

To evaluate the role of cognitive processing in PTG among parents of childhood cancer survivors (CCSs) based on the PTG theoretical model. We compared the model between parents of SCC and parents of children with chronic disease (CCDs) to determine how the role of cognitive processing in PTG is different depending on the children's illness.

METHODS

Final sample consisted of 78 parents of CCSs and 44 parents of CCDs. The survey included standardized measurements assessing reexamination of core beliefs, intrusive and deliberate rumination, posttraumatic stress symptoms, and PTG. The hypothetical relationships among the variables were tested by covariance structure analysis.

RESULTS

Posttraumatic growth among parents of CCSs had significantly strong association with reexamination of core beliefs, but not with deliberate rumination. Reexamination of core beliefs was significantly more likely to foster PTG among parents of CCSs, whereas deliberate rumination was significantly more likely to be associated with PTG among parents of CCDs.

CONCLUSIONS

For parents of CCSs, reexamination of core beliefs had a greater impact on PTG than deliberate rumination. Our results suggest that support should focus on the process of reexamining core beliefs in facilitating PTG among parents of CCSs.

IMPLICATIONS FOR PRACTICE

Nurses should provide parents of CCSs with reassurance regarding their experiences of the reexamination of core beliefs, which will likely lead to PTG.

The association between psychological functioning and social support and social constraint after cancer diagnosis: a 30-day daily diary study

This study evaluated one positive and one negative aspect of social functioning (social support and social constraint, respectively) to increase understanding of its relation to psychological functioning (distress and wellbeing) after cancer diagnosis. Participants in this longitudinal study were recently diagnosed, predominately late stage, first primary cancer survivors (n = 48). Data collection involved a 30-day period of daily assessment. Data were analyzed using multilevel linear models. As in prior studies, none of the variables changed significantly over time (ps = .07 to .99). Based on the intraclass correlation coefficient, 51 to 75% of the variance in the daily assessment data are attributable to between-person differences. There was a positive relationship between social constraint and both general and cancer-specific distress (ps < .05) and between social support and cancer-specific wellbeing (ps < .001). In prospective models, higher than average general distress predicted higher social support the next day (p = .004) and higher than average cancer-specific wellbeing predicted more social constraint the next day (p = .01). The findings lend some support to the interdependence of social functioning and psychological functioning after cancer diagnosis.

Cancer coping, healthcare professionals' support and posttraumatic growth in brain-tumor patients

The purpose of this study was to explore the influence of cancer coping and healthcare professionals' support on posttraumatic growth in patients with brain tumors. A cross-sectional, correlational design was used, in which a structured questionnaire was administered to 114 patients at a tertiary university hospital. Data were analyzed using descriptive statistics, independent t-test or one-way ANOVA, Pearson correlation, and hierarchical multiple regression analysis. Cancer coping (r = .33, p < .001) and healthcare professionals' support (r = .28, p = .002) correlated with posttraumatic growth. Among predictors, primary caregivers (brothers and sisters; β = .28), interpersonal coping (β = .26), and healthcare professionals' support (β = .20) had statistically significant influences on posttraumatic growth. The regression model explained approximately 22.0% of posttraumatic growth. These results contribute to cancer coping and healthcare professionals' support to significantly influence posttraumatic growth.

World Trade Center Exposure and Posttraumatic Growth: Assessing Positive Psychological Change 15 Years after 9/11

We evaluated the presence of posttraumatic growth (PTG) among survivors of the 9/11 terrorist attack and how indicators of psychosocial well-being, direct 9/11-related exposure, and posttraumatic stress symptoms (PTSS) relate to PTG. PTG was examined among 4934 participants using the Posttraumatic Growth Inventory (PTGI). A confirmatory factor analysis (CFA) was conducted to determine if the original factor structure of the PTGI fits our data and principal component analysis (PCA) to identify the appropriate factor structure. Multivariable linear regression models were used to examine the association between PTG and indicators of psychosocial well-being, 9/11-related exposure, and PTSS, controlling for covariates. CFA identified a two-factor structure of the PTGI as a better fit than the original five-factor model. Participants who experienced very high 9/11-related exposure level (ß = 7.72; 95% CI: 5.75-9.70), higher PTSS at waves 1 (ß = 0.13; 95% CI: 0.08-0.18) and 2 (ß = 0.09; 95% CI: 0.05-0.14), high social integration (ß = 5.71; 95% CI: 4.47, 6.96), greater social support (ß = 0.49; 95% CI: 0.37, 0.61), and higher self-efficacy (ß = 1.26; 95% CI: 1.04, 1.48) had higher PTGI scores. Our findings suggest PTG is present, 15 years following the 9/11 terrorist attack. Very high-level 9/11 exposure, PTSS, and indicators of psychosocial well-being were associated with PTG.

Facilitating Posttraumatic Growth After Critical Illness

The theory of posttraumatic growth arose from accounts of various trauma survivors experiencing not only distress but also growth and change. An intensive care unit admission is an unplanned, sudden, and traumatic experience, and many survivors have posttraumatic stress that can lead to posttraumatic stress disorder. Survivors leave the intensive care unit with new functional impairments that drive depression, and they frequently experience anxiety. Amidst the stress of understanding the trauma of an intensive care unit admission, survivors can grow in their world views, relationships, and sense of self. Understanding posttraumatic growth in intensive care unit survivors will inform health care providers on how to help survivors understand their new difficulties after an intensive care unit stay and facilitate growth. This article is a conceptual review of posttraumatic growth, identifiers of posttraumatic growth, and how the tenets of the posttraumatic growth theory apply to intensive care unit survivors. Health care professionals, specifically nurses, can incorporate practices into their care during and after the intensive care unit stay that encourage understanding and positive accommodation of new difficulties brought on by the intensive care unit hospitalization to support survivor growth. Opportunities for research include incorporating posttraumatic growth assessments into post-intensive care unit clinics, self-help materials, and various programs or therapies. Outcomes associated with posttraumatic growth are listed to suggest directions for research questions concerning posttraumatic growth in intensive care unit survivors.

Exploring narratives on PTG in cancer patients in active vs remission phases of disease: what about a peritraumatic growth?

OBJECTIVE

The present study aims to explore post-traumatic growth in cancer patients comparing the active phase, when patients undergo different treatments, and the remission phase, characterised by periodic follow-ups and gradually return to lives outside the hospital world.

METHODS

69 cancer patients (36 in active phase and 33 in remission phase) completed an online survey narrating their growth experience related to cancer disease. A modelling emergent theme analysis was implemented for narratives of both group by means of T-Lab software.

RESULTS

Four themes emerged for narratives of active phase group: 'the time of illness and the time of life (saturating the 46% of words)', 'the meaning-seeking' (21%), 'to find oneself in a battle (21%)' and 'to learn by battling' (12%). Remission phase group themes concerned 'the time of life' (40%), 'the seismic experience' (31%), 'to care for the Self and for others' (15%) and 'strength from vulnerability' (14%).

CONCLUSIONS

Remission group narratives are close to PTG as defined in scientific literature, while patients in the active phase of disease narrated PTG as the attempt of including illness in their life trajectory and learning from the battle against cancer. Author suggests the definition of peritraumatic growth as a transformation process parallel to treatment phase.

Fertility Preservation in Young Adults: Prevalence, Correlates, and Relationship with Post-Traumatic Growth

Purpose: This study describes the prevalence of fertility preservation (FP) knowledge, discussions, and engagement in a heterogeneous sample of Canadians diagnosed with cancer in young adulthood and tests the relationship of these variables with later post-traumatic growth (PTG). Methods: Data were taken from the Young Adults with Cancer in their Prime (YACPRIME) study, a national cross-sectional survey of Canadians diagnosed with cancer as young adults. This subanalysis included 463 individuals, ages 20-39 years (mean = 30.28, standard deviation = 4.68, 88% female), diagnosed after 2006. Participants self-reported demographics, responded to questions regarding their experience with FP, and completed the PTG inventory. Results: In total, 81% reported awareness of risk, 52% discussed FP, and 13% pursued FP. PTG was higher for those with knowledge of fertility risk [F (3, 455) = 3.26, p = 0.021], when controlling for sex and on treatment status, but did not differ between those who discussed FP versus not, or made arrangements versus not. Those who reported not engaging in FP because of their own choice [F(3, 402) = 5.98; p = 0.001] or their doctor's recommendation not to delay treatment [F(3, 402) = 3.25; p = 0.022] reported significantly higher PTG, when controlling for sex and on-treatment status. Financial reasons, lack of knowledge about FP, and age were not related to PTG. Conclusions: This study demonstrates that FP discussions and uptake remain low, highlighting the need for continued education and efforts to improve access to intervention. Knowledge of risk, along with making the choice to prioritize treatment over FP, was related to higher PTG, suggesting informed decisions made early in treatment may support positive psychosocial outcomes.

Psychosocial Experiences of Young Adults Diagnosed With Acute Leukemia During Hospitalization for Induction Chemotherapy Treatment

The diagnosis of cancer for anyone is a time of fear and uncertainty. For young adults (YAs) diagnosed with acute leukemia (AL), there are the additional challenges related to lengthy aggressive in-hospital treatment, multiple concurrent symptoms, and decreased well-being. The purpose of this study was to explore the experiences of YAs with AL undergoing induction chemotherapy. This study used a nested qualitative longitudinal design with a convenience sample. Qualitative data were collected using semistructured interviews, and participants were invited to maintain journals. The semistructured interviews were audiotaped, transcribed, and loaded into Atlas.ti for analysis. Common themes and categories were verified and used to disseminate the findings. Seven YAs, mean age 32 (SD, 4) years, participated in this study. Three thematic classifications emerged: getting through, supported yet isolated, and information exchange preferences, which detail how these YAs processed and coped during treatment. The findings from this study provide important insights for nurses regarding coping mechanisms that YAs apply, which included relying on technology and social media platforms. Additionally, the YAs in this study discussed their need for information. The findings from this study may provide insights for clinicians currently caring for YAs with AL, while also directing future palliative care research endeavors.

Cognitive factors related to distress in patients recently diagnosed with cancer

OBJECTIVE

This study aims to analyse the association between rumination and thought suppression and the intensity of psychological distress in a sample of patients with recently diagnosed cancer.

METHODS

A total of 131 patients with a recent diagnosis of cancer were assessed within 4 months of diagnosis. All participants completed standardized questionnaires to assess psychological distress, rumination, and thought suppression. Multiple regression and logistic regression models were conducted to determine the associations between these variables.

RESULTS

The multiple regression model explained 50% of variance in psychological distress, with rumination independently explaining more than 16% of the variance. Thought suppression, however, was not significantly associated with distress. The logistic model for caseness of depression and anxiety explained, respectively, 33% and 48% of the variance. Anxiety caseness was also associated with social support and self-efficacy.

CONCLUSIONS

The findings of this study indicate that rumination is an important explanatory variable of psychological distress in patients with recently diagnosed cancer. Statistical models that include rumination could explain a significant proportion of variance of clinical caseness for both anxiety and depression. These findings suggest that assessing rumination in recently diagnosed patients could improve clinical practice by detecting individuals at greater risk of developing more severe psychological distress. These findings suggest that treating rumination as a key component of the therapeutic objectives of psychological interventions could improve clinical outcomes.

Predictors of post-traumatic stress symptoms following occupational accidents: A longitudinal study

OBJECTIVE

Occupational accidents are highly stressful events that frequently occur and impact both the physical and mental health of workers. The aim of this study was to longitudinally assess a predictive model of posttraumatic stress symptoms (PTSS) in workers who have suffered a recent accident.

METHOD

Two hundred and forty-four workers (77.8% men), aged 18 to 73 years, who had experienced an accident during the last month that resulted in hospitalization and/or ten or more days of sick leave, were surveyed. A second survey was carried out six months later. Regression analyses included psychological predictors (i.e. subjective severity of event, brooding and positive and negative religious coping), along with objective predictors (i.e. hospitalization, sick leave days and unemployment).

RESULTS

It was found that the main predictors of PTSS were brooding, negative religious coping, days of sick leave and unemployment, with a large effect size (R² = .45).

CONCLUSIONS

The discussion is based on the usefulness of including selected psychological and objective predictors for detecting people more susceptible to developing psychopathology due to the stress following an accident. Identifying at-risk people for developing PTSS after an accident may help to introduce selective preventive strategies or early interventions in this population.

Resilience in Cancer Patients

Background: Being diagnosed with cancer and undergoing its treatment are associated with substantial distress that can cause long-lasting negative psychological outcomes. Resilience is an individual's ability to maintain or restore relatively stable psychological and physical functioning when confronted with stressful life events and adversities. Posttraumatic growth (PTG) can be defined as positive life changes that result from major life crises or stressful events. Objectives: The aims of this study were to 1) investigate which factors can strengthen or weaken resilience and PTG in cancer patients and survivors; 2) explore the relationship between resilience and PTG, and mental health outcomes; and 3) discuss the impact and clinical implications of resilience and PTG on the process of recovery from cancer. Methods: A literature search was conducted, restricted to PubMed from inception until May 2018, utilizing the following key words: cancer, cancer patients, cancer survivors, resilience, posttraumatic growth, coping, social support, and distress. Results: Biological, personal, and most importantly social factors contribute to cancer patients' resilience and, consequently, to favorable psychological and treatment-related outcomes. PTG is an important phenomenon in the adjustment to cancer. From the literature included in this review, a model of resilience and PTG in cancer patients and survivors was developed. Conclusions: The cancer experience is associated with positive and negative life changes. Resilience and PTG are quantifiable and can be modified through psychological and pharmacological interventions. Promoting resilience and PTG should be a critical component of cancer care.

An Item-Level Analysis of the Posttraumatic Stress Disorder Checklist and the Posttraumatic Growth Inventory and Its Associations With Challenge to Core Beliefs and Rumination

Background: Previous studies have found that rumination and challenge to core beliefs may have a predictive effect on Posttraumatic Stress Disorder (PTSD) and Posttraumatic Growth (PTG) among different samples. In addition, there is some evidence that these variables have different effects on PTSD and PTG, although the latter construct has been the target of a larger body of research and theoretical models. The main objective of the current study is to examine the effect of challenge to core beliefs, intrusive rumination, and deliberate rumination on PTSD and PTG, through an item-level analyses.

Methods: The sample was composed of 205 Portuguese women who had been given a breast cancer diagnosis (M = 54.32, SD = 10.05), and who completed the following self-administered questionnaires: the Posttraumatic Stress Disorder Checklist (PCL-C); the Posttraumatic Growth Inventory (PTGI); the Core Beliefs Inventory; and the Event Related Rumination Inventory. Two multivariate multiple regression analyses, using each item of the PCL-C and the PTGI as dependent variables, were conducted.

Results: The results demonstrated that challenges to core beliefs predict 17 of the 21 PTGI items and 12 of the 17 PCL-C items. All but one item of the PCL-C are predicted by intrusive rumination, while the variance of only 4 items of the PTGI are explained by deliberate rumination.

Conclusion: These findings indicate that women with breast cancer who tend to display higher levels of intrusive rumination are more likely to report PTSD symptoms, and that an examination of one’s core beliefs is predictor of both positive and negative outcomes. In spite of the proven effect of challenge to core beliefs on both variables, this study suggests that this effect has only a minor influence on PTSD, in addition to confirming its major impact on PTG.

Benefit finding in renal transplantation and its association with psychological and clinical correlates: A prospective study

Objectives

The identification of positive psychological changes, including benefit finding (BF), in chronic illness has gained substantial interest. However, less is known about BF in the context of a positive medical intervention. End‐stage renal disease (ESRD) can be regarded as a burdensome condition, but transplantation is expected to restore physical and psychological functioning to a large extent after a period of illness. The aim of this study was to examine (1) changes in BF from pre‐ to 12 months post‐transplantation, (2) the concurrent association of disease‐related characteristics and optimism to BF, and (3) the potential causal relations between BF and distress.

Methods

In this longitudinal study, 319 patients completed questionnaires before, 3 months, 6 months, and/or 12 months post‐transplantation. Multilevel models were used for the analyses. Measures included the Illness Cognitions Questionnaire to measure BF, the Life Orientation Test to measure optimism, and the General Health Questionnaire to measure distress.

Results

Benefit finding increased from pre‐ to post‐transplantation. Fewer symptoms and comorbidities, and more optimism, were related to more BF over all time‐points. The direction of the relation between BF and distress changed over time. Before transplantation, distress predicted an increase in BF, whereas post‐transplantation, distress predicted a decrease in BF. The causal relation between BF and distress post‐transplantation appeared to be reciprocal.

Conclusions

A positive medical intervention such as renal transplantation might facilitate the development of BF. This study indicates the need for longitudinal research on the relation between BF and psychological health in the face of positive events.

Posttraumatic Growth in Patients with Malignant Bone Tumor: Relationships with Psychological Adjustment

Aim: Owing to the inadequate data to support the valid instrument for assessing the positive changes among patients with malignant bone tumor, the present study was designed to provide such valid evidence through examining the psychometric properties of a Chinese version of the Posttraumatic Growth Inventory (PTGI-C) among these patients, and to evaluate the effects of posttraumatic growth on positive and negative symptoms in malignant bone tumor patients. Methods: Potential patients with malignant bone tumor from five tertiary hospitals were admitted to the hospital during the period from January 2013 to October 2017. At the baseline assessment (T1), all patients completed a demographic form, PTGI-C, and Positive and Negative Affect Scale (PANAS). After 4 weeks later (T2), all the patients finished PANAS and PTGI-C again, and the PTGI-C was re-administered to patients who were simple randomly selected from the total sample. Results: The PTGI-C exhibited moderate reliability and validity. The Cronbach’s α coefficient of the total scale was 0.91. Confirmatory factor analysis supported the five-factor model and the convergent validity results obtained were distinct but correlated. The multiple linear regression analyses showed that posttraumatic growth had a significant prediction on positive affect (F=16.445, p<0.001), accounting for 69.4 % of the variance and as well as the negative affect (F=8.707, p<0.001), accounting for 48.3 % of the variance. Personal strength at T1 was positively associated with positive affect at T2, and more personal strength and spiritual change at T1 were associated with less negative affect at T2. Conclusions: PTGI-C has demonstrated sufficient psychometric properties which indicate that it is appropriate to measure posttraumatic growth in patients with malignant bone tumor. Relating to others, spiritual growth, personal strength and appreciate to life are important factors which contribute to predicting positive affect and negative affect.

Vicarious trauma and vicarious posttraumatic growth among substance abuse treatment providers

BACKGROUND

Practitioners working with clients who have experienced trauma are vulnerable to experiencing both vicarious trauma and vicarious posttraumatic growth (PTG). A survey was conducted in which treatment providers who work with adults seeking help for substance abuse were asked about their experience of vicarious trauma and vicarious PTG. It was hypothesized that vicarious trauma and vicarious PTG would be positively associated with each other, that personal history of trauma and years of working with clients who had experienced trauma would be positively associated with vicarious trauma, and that in addition to those variables, personal counseling, training, and supervision would be associated with vicarious PTG.

METHODS

Surveys were sent to the directors of 15 social service agencies in one county in central California. Surveys included questions about the respondent's history of substance use and trauma and experience with clients who had experienced trauma. In addition, the survey contained 3 scales: the Trauma History Screen, the Posttraumatic Growth Inventory, and the Impact of Event Scale-Revised.

RESULTS

Survey data were obtained from 51 counselors. There was a significant positive association between vicarious trauma and vicarious PTG, and both were significantly associated with respondents' history of trauma. Providers who were in recovery were more likely than others to report a history of trauma and to report higher levels of vicarious trauma and vicarious PTG.

CONCLUSION

Counselors working with clients in substance abuse treatment may experience vicarious trauma and vicarious PTG. Implications for preparing counselors to work with this population are discussed.

Symptom Management and Psychosocial Needs of Adults With Acute Myeloid Leukemia During Induction Treatment: A Pilot Study

BACKGROUND

Patients with a new diagnosis of acute myeloid leukemia (AML) are at risk of experiencing a high symptom burden due to the disease and its treatment, which includes a long period of hospitalization.

OBJECTIVE

The aim of this pilot work was to describe the multidimensional symptoms and health-related quality of life experienced by patients with a new diagnosis of AML across induction chemotherapy.

METHODS

A prospective, longitudinal descriptive study design was implemented to evaluate symptoms and health-related quality of life at the time of enrollment through 6 weeks postdiagnosis and identify who might be most at risk of experiencing high symptom burden.

RESULTS

A total of 19 participants were included in this analysis. Moderate to severe levels of distress were present in 25% to 50% of participants, depending on timing in treatment. Females and those with a previous history of a psychological disorder reported higher symptom burden during treatment.

CONCLUSIONS

Our findings indicate that adults with AML experience multiple distressing symptoms during the induction treatment.

IMPLICATIONS FOR PRACTICE

Timely routine multidimensional assessment of symptoms in individuals undergoing induction chemotherapy treatment for AML is critical as they may be experiencing multiple concurrent symptoms. Additional research to advance symptom assessment and amelioration of distressing symptoms to improve health-related quality of life is needed in this unique population.

Cancer-related loneliness mediates the relationships between social constraints and symptoms among cancer patients

Cancer patients have high rates of persistent and disabling symptoms. Evidence suggests that social constraints (e.g., avoidance and criticism) negatively impact symptoms, but pathways linking these variables have yet to be identified. This study examined whether cancer-related loneliness (i.e., feeling socially disconnected related to having cancer) mediated the relationships between social constraints and symptoms (i.e., pain interference, fatigue, sleep disturbance, and cognitive complaints) in patients with various cancers (N = 182). Patients (51% female, mean age = 59) were recruited from the Indiana Cancer Registry and completed questionnaires assessing social constraints, cancer-related loneliness, and symptoms. Structural equation modeling was used to evaluate the hypothesized relationships among variables. The model demonstrated good fit. Consistent with our hypothesis, cancer-related loneliness mediated the relationships between social constraints and each symptom. Findings suggest that addressing cancer-related loneliness in symptom management interventions may mitigate the negative impact of social constraints on outcomes.

Patient-reported outcomes in acute myeloid leukemia: Where are we now?

Outcomes for acute myeloid leukemia remain poor, and treatment decisions must consider not just quantity, but also quality of life (QOL). We conducted a systematic review of studies in patients with acute myeloid leukemia or high-risk myelodysplastic syndrome that incorporated patient-reported outcome (PRO) measures. PubMed and PsycINFO were searched for articles published from January 2000 through June 2016. Forty-one were relevant for our review with more published in recent years. There was considerable inter-study heterogeneity in which instruments were used, and many studies employed multiple (often overlapping) instruments. Longitudinal studies in particular suffered from both high attrition rates due to disease-related mortality as well as waning compliance with questionnaire completion. There remain significant challenges to incorporation of PROs into leukemia trials. Despite these limitations, however, well-implemented PROs can provide important information beyond objective response outcomes and highlight areas of focus for clinicians caring for patients and for future research endeavors.

Predictors of post-traumatic growth in stroke survivors

PURPOSE

The development of post-traumatic growth was studied longitudinally within 14 months poststroke. The predictions of two models of post-traumatic growth were examined.

METHOD

Forty-three stroke survivors were investigated at two time points (i.e., time 1 and time 2), six months apart. Each completed the Post-traumatic Growth Inventory, Rumination Scale, Impact of Events Scale, Multidimensional Scale of Social Support, the Barthel Index and the COPE scale.

RESULTS

Post-traumatic growth was evident four to five months after stroke, increasing significantly over the next six months at which point levels resembled those reported in cross-sectional stroke studies. Active and denial coping and rumination at time 1 were positively associated, and age was negatively associated, with post-traumatic growth at time 2, but acceptance coping was not associated. Neither active coping nor rumination mediated the effect of social support on post-traumatic growth as predicted. As predicted, rumination mediated the relationship between post-traumatic stress and post-traumatic growth. Exploratory stepwise regression demonstrated rumination and active coping at time 1 accounted for 45% of variance in post-traumatic growth at time 2.

CONCLUSIONS

Post-traumatic growth can develop soon after stroke. Deliberate rumination is a key factor in post-traumatic growth. Both active coping and denial coping were associated with post-traumatic growth demonstrating the psychological complexity of poststroke adjustment. Implications for rehabilitation Therapists can expect stroke survivors to show post-traumatic growth in the first months after stroke. Therapists should look to promote post-traumatic growth and positive adjustment through working with survivors to increase active coping (attempts to deal effectively with the impact of stroke) and rumination (cognitive processing of the impact of the stroke). Since denial coping was also associated with posttraumatic growth, stroke survivors who maintain overly optimistic views about the severity and impact of their stroke are likely to benefit from therapists continually facilitating capacity for growth and well-being.

Psychological and clinical correlates of posttraumatic growth in cancer: A systematic and critical review

OBJECTIVE

The objective of this study is to describe major findings on posttraumatic growth (PTG) in cancer, by analyzing its various definitions, assessment tools, and examining its main psychological and clinical correlates.

METHODS

A search in relevant databases (PsycINFO, Pubmed, ProQuest, Scopus, and Web of Science) was performed using descriptors related to the positive reactions in cancer. Articles were screened by title, abstract, and full text.

RESULTS

Seventy-two met the inclusion criteria. Most articles (46%) focused on breast cancer, used the PTG inventory (76%), and had a cross-sectional design (68%). The PTG resulted inversely associated with depressive and anxious symptoms and directly related to hope, optimism, spirituality, and meaning. Illness-related variables have been poorly investigated compared to psychological ones. Articles found no relationship between cancer site, cancer surgery, cancer recurrence, and PTG. Some correlations emerged with the elapsed time since diagnosis, type of oncological treatment received, and cancer stage. Only few studies differentiated illness-related-life-threatening stressors from other forms of trauma, and the potentially different mechanisms connected with PTG outcome in cancer patients.

CONCLUSIONS

The evaluation of PTG in cancer patients is worthy, because it may promote a better adaption to the illness. However, many investigations do not explicitly refer to the medical nature of the trauma, and they may have not completely captured the full spectrum of positive reactions in cancer patients. Future research should better investigate issues such as health attitudes; the risks of future recurrences; and the type, quality, and efficacy of medical treatments received and their influence on PTG in cancer patients.

Exploring the Relationship Among Posttraumatic Growth, Life Satisfaction, and Happiness Among Korean Individuals With Physical Disabilities

A growing body of empirical evidence has demonstrated that individuals who experience traumatic and stressful life events can experience positive psychological changes as a result of their struggles with adversity, stress, and trauma. The purpose of the current study is to examine the relationship among five domains (e.g., as relating to others, recognition of new possibilities, a feeling of personal strength, and spiritual change) of posttraumatic growth, happiness, and life satisfaction among Korean individuals with physical disabilities. The results of this study show that three factors (i.e., recognition of new possibilities, experience of spiritual growth, and an appreciation of life) served as predictors of life satisfaction, and two factors (i.e., recognition of new possibilities and personal strength) predicted happiness. This result suggests that certain factors of posttraumatic growth can lead to particular health benefits and influence these benefits to varied extents.

Outpatient care of patients with acute myeloid leukemia: Benefits, barriers, and future considerations

Patients with acute myeloid leukemia (AML) who receive intensive induction or re-induction chemotherapy with curative intent typically experience prolonged cytopenias upon completion of treatment. Due to concerns regarding infection and bleeding risk as well as significant transfusion and supportive care requirements, patients have historically remained in the hospital until blood count recovery-a period of approximately 30 days. The rising cost of AML care has prompted physicians to reconsider this practice, and a number of small studies have suggested the safety and feasibility of providing outpatient supportive care to patients following intensive AML (re-) induction therapy. Potential benefits include a significant reduction of healthcare costs, improvement in quality of life, and decreased risk of hospital-acquired infections. In this article, we will review the currently available literature regarding this practice and discuss questions to be addressed in future studies. In addition, we will consider some of the barriers that must be overcome by institutions interested in implementing an "early discharge" policy. While outpatient management of selected AML patients appears safe, careful planning is required in order to provide the necessary support, education and rapid management of serious complications that occur among this very vulnerable patient population.

Posttraumatic Growth in Women Survivors of Breast Cancer

Aim:

The aim of the study was to understand the phenomenon of posttraumatic growth (PTG) in women survivors of breast cancer from an Indian perspective.

Settings and Design:

It was a mixed method, cross-sectional, and exploratory design wherein in-depth qualitative data covering a broader area of experiences were gathered from a sub-section of the larger quantitative sample (n = 50). The qualitative sample consisted of 15 Indian women from urban communities of Southern and Eastern India. Sampling method was purposive in nature.

Subjects and Methods:

Semi-structured interview schedule was developed by researchers based on a review of literature. In-depth interviews were audio recorded after their permissions were obtained and carried out at homes and offices of participants. All participants spoke English. Qualitative data were collected until no new phenomenological information emerged through the interviews.

Data Management and Analysis:

Descriptive phenomenological approach was utilized to analyze the interview data. It focuses on understanding one's life experience from the first person's point of view.

Results:

Consistent with other literature, PTG was evident in varying forms through positive changes in perspective toward life, better understanding of self, closer, and warmer relationships, and richer spiritual dimension of life.

Conclusions:

These findings have implications for promoting holistic cancer care and identifying ways to promote PTG through the initial stages of cancer care into survivorship trajectory.