Post-traumatic growth in breast cancer survivors: new insights into its relationships with well-being and distress

Altruistic kidney donation following the death of a loved one-a coincidence or a post-traumatic growth?

The aim of this study was to examine the case of altruistic kidney donation (AKD) following loss, in light of PTG theory. Loss may facilitate trauma alongside post-traumatic growth (PTG). Although much is known about the motivation for AKD in general, less is known about the motives of bereaved individuals who chose to altruistically donate their kidney post-loss. Employing a narrative approach, 10 bereaved individuals who altruistically donated a kidney were interviewed about their perceptions of the connection between the loss and their decision to donate a kidney post-loss. Content analysis revealed three types of bereaved AKD's perceived connection between the loss and the donation: explicitly direct, indirect, and implicit. Donation post-loss was characterized by aspects of PTG in three domains: self, other and worldviews. The findings are discussed in light of PTG theory and highlight the possible role of AKD in processes of coping and growth following grief.

Functional significance of posttraumatic growth in U.S. military veterans

BACKGROUND

Although many studies indicate that individuals who have experienced a traumatic event can experience posttraumatic growth (PTG), some researchers have questioned the significance of PTG in associations with functioning. The role of PTG in functioning following trauma may be better elucidated by accounting for its joint effects with posttraumatic stress disorder (PTSD) symptoms.

METHODS

Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 3847 trauma-exposed U.S. veterans. Participants completed assessments of potentially traumatic events, PTSD symptoms, and PTG, as well as a broad range of sociodemographic, military, trauma, health, personality, and psychosocial characteristics.

RESULTS

PTG was independently and moderately associated with higher mental, cognitive, and psychosocial functioning, but not physical functioning. Results showed a similar pattern of findings when examining relations between subdomains of PTG and these aspects of functioning. Additionally, among veterans who screened positive for PTSD, those who endorsed PTG reported higher levels of mental, cognitive, and/or psychosocial functioning than those who did not endorse PTG.

LIMITATIONS

Findings may be limited by the use of a cross-sectional design, retrospective self-reports of PTG, and a predominantly older white male veteran sample.

CONCLUSION

Results provide support for the functional significance of PTG and highlight the importance of considering PTSD symptoms to better understand the role of PTG in functioning. Clinical interventions to foster PTG may help promote post-trauma functioning.

The Role of Coping and Posttraumatic Stress in Fostering Posttraumatic Growth and Quality of Life Among Women with Breast Cancer

Tedeschi & Calhoun's model of posttraumatic growth (PTG) suggests that intrusive thoughts about a traumatic event, in combination with helpful coping strategies, facilitates PTG. This manuscript applies this model to a sample of breast cancer survivors, augments it to conceptualize coping strategies as "active" or "avoidant," and extends it to include health-related quality of life (HRQOL). This is a secondary analysis of a subset of breast cancer patients (N = 123) in a randomized clinical trial of Tibetan yoga, which examines the associations of coping at study entry with PTG, PTSS (i.e., intrusive thoughts and avoidance), and HRQOL (physical (PCS) and mental (MCS) component scales) reported 9 and 15 months later. Mediation analyses revealed that higher baseline active coping predicted higher 9-month PTG, which in turn predicted higher 15-month PCS [effect = .46, 95% CI (.06, 1.07)]. Exploratory moderated mediation analyses revealed that higher baseline intrusive thoughts about cancer predicted lower 9-month PTG, which in turn predicted lower 15-month PCS, but only for those reporting low active coping [effect = - .06, 95% CI (- .16, - .003)]. Active coping may play a critical role of fostering PTG and improving subsequent HRQOL in the presence of rumination about cancer.

Subjective well-being among Chinese breast cancer patients: The unique contributions of death anxiety, self-esteem, and social support

Previous studies have indicated that cancer patients may have a lower level of subjective well-being (SWB); nevertheless, the underlying factors for this phenomenon remain insufficiently investigated. Based on the characteristics of Chinese breast cancer patients and the unique culture, this study explored the independent contributions of death anxiety, self-esteem, and social support to SWB from the protective and risk perspectives. A cross-sectional survey recruited 514 females with breast cancer and collected participants' demographic and the above variables. The results found that death anxiety independently predicted SWB in a negative direction (β = -0.36, p < 0.001). In addition, self-esteem (β = 0.38, p < 0.001) and social support (β = 0.14, p < 0.001) also had the unique positive effects on SWB. These findings offer new insights into strengthening breast cancer patients' SWB, for instance, using relevant interventions to reduce death anxiety and improve self-esteem and social support.

"Is My Brain Ever Going to Work Fully Again?": Challenges and Needs of Cancer Survivors with Persistent Cancer-Related Cognitive Impairment

Many cancer survivors experience cognitive impairments that impact memory, concentration, speed of information processing, and decision making. These impairments, collectively known as cancer-related cognitive impairments (CRCIs), are a key domain of unmet needs and can significantly impact a cancer survivor's identity and quality of life. However, there are no purpose-built, multi-domain, needs assessment tools specifically for CRCI. The development of such tools requires an in-depth understanding of cancer survivors' CRCI-specific challenges and associated needs. This study explored the challenges and associated needs of cancer survivors with persistent CRCI. An in-depth qualitative design using semi-structured interviews with (a) cancer survivors with perceived CRCI (n = 32) and (b) oncology health professionals (n = 19) was utilised. A reflexive thematic analysis of the interviews resulted in five overarching themes: (1) executing regular activities, (2) relational difficulties, (3) occupational functioning, (4) psychological distress, and (5) social functioning, as well as an additional informational needs domain. Ultimately, CRCI was found to directly produce a range of challenges that negatively, and persistently, impact cancer survivors' quality of life. Cancer survivors were also found to have a range of needs associated with these challenges. This research should be used to inform future challenges and needs assessment tools as well as treatment and supportive care priority areas directly relating to CRCI.

Predictors of post traumatic growth in allogeneic hematopoietic stem cell transplantation survivors: a cross-sectional survey

AIMS

Given the increasing number of Hematopoietic Stem Cell Transplantations (HSCT) performed world-wide, the increasing likelihood of survival following HSCT, and the profound physical, psychosocial, and emotional impact of HSCT on survivors, their carers and families, it is important to identify factors that may contribute to or support post-traumatic growth (PTG) after transplant. In this study, we aimed to investigate the prevalence of PTG in an Australian cohort of long-term allogeneic HSCT survivors and describe associations between PTG and relevant clinical, sociodemographic and psychological variables.

METHODS

This was a large, multi-centre, cross sectional survey of Australian HSCT-survivors inviting all those transplanted in New South Wales between 2000 and 2012. Respondents completed the PTG Inventory (PTGI), the Sydney Post-BMT Survey, FACT-BMT, DASS 21, The Chronic Graft versus Host Disease (GVHD) Activity Assessment-Patient Self-Report (Form B), the Lee Chronic GVHD Symptom Scale, and the Fear of Cancer Recurrence Scale. Data was analysed using independent t-tests, one-way analysis of variance, and pearson's correlations, and hierarchical multiple regression adjusted for potential confounders and to ascertain independent associations of explanatory variables with PTG.

RESULTS

Of 441 respondents, 99% reported some level of PTG with 67% reporting moderate to high levels of PTG. Female gender, younger age, complementary therapy use, anxiety, psychological distress and psychosocial care, and higher quality of life were associated with higher levels of PTG. Importantly, we also found that PTG was not associated with either chronic GVHD or post-HSCT morbidity.

CONCLUSIONS

In this study - the largest study of PTG in long-term allogeneic HSCT survivors - we found that growth appears ubiquitous, with 99% of survivors reporting some degree of PTG and 67% reporting moderate-high levels of PTG. Importantly, we found no association with GVHD or chronic physical post-HSCT morbidity, or adverse financial, occupational or sexual impacts. This suggests that it is the necessity for and experience of, HSCT itself that foments personal growth. Accordingly, healthcare professionals should be alert to the profound and wide-ranging impact of HSCT - and the degree to which survivor's may experience PTG. Identifying interventions that may assist HSCT survivors cope and building their resilience is of utmost importance.

Posttraumatic Growth and Subjective Well-Being in Men and Women after Divorce: The Mediating and Moderating Roles of Self-Esteem

Prior research has mainly examined non-adaptive responses to divorce, with less attention being paid to positive changes following the adversity of marital dissolution, especially posttraumatic growth and its consequences. The aim of this paper was to analyse the relationship between posttraumatic growth and subjective well-being, as well as the mediating and moderating role of self-esteem in this relationship among divorced men and women. The sample consisted of 209 divorcees (143 females, 66 males) aged 23-80 (M = 41.97, SD = 10.72). The Posttraumatic Growth Inventory (PTGI), the Oxford Happiness Questionnaire (OHQ) and the Rosenberg Self-Esteem Scale (SES) were used in the study. Positive associations between overall posttraumatic growth, specific growth dimensions, subjective well-being and self-esteem were found. Self-esteem was confirmed as a mediator in the relationships between changes in perception of self and subjective well-being (SWB), between changes in relating to others and SWB and between appreciation for life and SWB. Self-esteem moderated the association between spiritual changes and subjective well-being; namely, changes in spirituality were positively related to happiness in individuals with lower and average self-esteem but not with high self-esteem. We found no differences between women and men in the obtained results. Self-esteem might be considered a possible psychological (mediating rather than moderating) mechanism in the transmission of PTG onto SWB in divorcees, regardless of their gender.

Relationships between satisfaction with life, posttraumatic growth, coping strategies, and resilience in cancer survivors: A network analysis approach

OBJECTIVE

Cancer survivors' satisfaction with life should be seen through the psychological factors related to a person's capabilities to face and handle the situation. This study aimed to (1) examine the relationships of satisfaction with life, posttraumatic growth, resilience and coping strategies in a global network model, (2) find the bridge indicators between satisfaction with life and the other constructs, and (3) test for the invariance of the network structures across several moderating variables.

METHODS

In a heterogeneous sample of 696 cancer survivors (69% female; mean age = 53.1 ± 15.44 years; median time from being diagnosed = 4 years; breast cancer was the most frequent type of cancer) their satisfaction with life, resilience, coping strategies and posttraumatic growth was measured. In order to account for their complexity, the relationships between the constructs were explored using a network analysis approach.

RESULTS

The network analysis shows that satisfaction with life is strongly connected to resilience, moderately connected to coping strategies, and has a weak connection with posttraumatic growth. In the separate networks, the relationships between the psychological constructs were examined in greater detail. Besides some exceptions observed in the degree of disability, the networks were invariant across gender, age, years since being diagnosed, cancer type and treatment type.

CONCLUSION

The findings suggest that interventions focused on cancer survivors' coping strategies and resilience could help increase their satisfaction with life. However, further replication of the proposed and/or modified model is needed.

The nature and content of rumination for head and neck cancer survivors

Introduction

Head and neck cancer (HNC) diagnosis and treatment can be a significant life trauma. Some HNC survivors experience post-traumatic growth (PTG), which has been linked with better health-related quality-of-life. Empirical research on PTG, and theoretical models, point to the importance of being able to purposely make sense of the traumatic experience. Intrusive rumination, by contrast, is linked to poorer outcomes. This study explored HNC survivors' experiences of rumination.

Methods

Twenty HNC survivors between 9 months and 5 years post-diagnosis were recruited (11 male, 9 female, age range 46-83). They had a range of HNC sub-types and cancer treatments. Participants underwent a semi-structured interview about their cancer diagnosis and treatment. Reflexive thematic analysis identified themes and sub-themes around rumination.

Results

Four themes with linked subthemes on the content and process of rumination were identified. Theme 1 was rumination and worry related to diagnosis. Here, survivors discussed how the HNC diagnosis and plans for treatment had dominated their initial thoughts. Theme 2 was processing the trauma of HNC. This theme reflected rumination on the traumatic experience of diagnosis and treatment and how the participant was reacting to it. Theme 3 was considering the impact. This theme encompassed retrospective thinking (e.g., on treatment decisions made) and comparisons between the participant now versus the early days after diagnosis. Theme 4 was continued rumination. This theme included ongoing intrusive and distressing rumination about the trauma and impact of cancer. Those who expressed ongoing rumination revisited fears (e.g., concerns about their future) or returned to negative experiences (e.g., distressing exchanges with healthcare professionals or what they perceived as poor care).

Conclusion

This study uniquely describes the nature and content of rumination following HNC. Early intrusive rumination is common and may reflect perceptions of cancer as an existential threat. Over time, rumination can become more reflective and move towards deliberate meaning-making. Some HNC survivors may benefit from interventions to reduce barriers to this transition. The content of distressing and difficult to control rumination (commonly focused on ongoing fears or inability to resolve difficult experiences) helps to identify those who may benefit from more directed psychological support.

Post-traumatic Growth: Longitudinal Study on Battered Women in Close Relationships after Both They and Their Partners Undergo Therapy

Violence in intimate relationships is a major problem worldwide. Many women, despite having experienced violence from a partner, decide to remain in a relationship with the perpetrator. A special premise for such a decision is that the abusive partner undertakes therapy that serves to build security in the family. An important indicator of dealing with violence is post-traumatic growth (PTG), a concept introduced by Calhoun and Tedeschi (1998) to describe positive changes as a result of traumatic experiences. The purpose of the research was to assess PTG changes in the course of relationships in which the woman had experienced violence from her partner, but both her partner and she had undertaken therapy and changed their behavior (N = 48). The conducted research used a demographic survey and two questionnaires: The Polish version of the Impact Event Scale-Revised (IES-R, Weiss, Marmara prepared by Juczyński and Ogińska-Bulik [2009]) examining three dimensions of trauma (intrusion, hyperarousal, and avoidance) and the Post-traumatic Growth Inventory (Tedeschi & Calhoun [2004]; Polish version prepared by Ogińska-Bulik & Juczyński [2010]). The studies showed that over a period of one and half years, significant changes in PTG had taken place. Reportedly, changes in self-perception and changes in relating to others have decreased, while appreciation of life increased but spiritual life remained the same. The research also allowed us to distinguish several groups of corelates in changes in individual PTG categories. The studies also indicate that building a close relationship with the person who caused the harm can limit the victim's PTG.

The effects of trait resilience and rumination on psychological adaptation to breast cancer

This cross-sectional study examined the effect of trait resilience and specific types of rumination on positive psychological adaptation post-diagnosis among 201 breast cancer patients. They completed self-reported measures describing trait resilience, rumination, posttraumatic growth, and health-related quality of life. Hierarchical analysis showed that trait resilience significantly predicted higher quality of life and posttraumatic growth after controlling for demographic and clinical variables. Additionally, “intrusion” and “brooding” subtypes of rumination negatively predicted quality of life, with “instrumentality” positively predicting quality of life and posttraumatic growth, suggesting the importance of trait resilience and multidimensional rumination for positive psychological changes among breast cancer survivors.

Acceptance and commitment therapy versus mindfulness-based stress reduction for newly diagnosed head and neck cancer patients: A randomized controlled trial assessing efficacy for positive psychology, depression, anxiety, and quality of life

Background and aim

Head and neck cancer patients are vulnerable to various psychological complications due to the effects of both cancer itself and cancer treatment on patients’ appearance and physical well-being. Nevertheless, few data have been obtained on effective psychosocial interventions that could protect this group of cancer patients’ psychological well-being. Therefore, this three-armed, parallel-group, double-blind, randomized control trial (RCT) aims to evaluate and compare the effects of acceptance and commitment therapy (ACT) and mindfulness-based stress reduction (MBSR) on positive psychology (such as posttraumatic growth [PTG], hope, and optimism), quality of life (QoL), and psychological complications (depression, anxiety, and experiential avoidance) among newly diagnosed head and neck cancer patients.

Methods and analysis

This RCT will target newly diagnosed head and neck cancer patients who have been treated only with surgery or who have not yet received any treatment. In total, 120 patients who meet all of the study’s inclusion criteria and none of its exclusion criteria will be randomly assigned into three groups—an ACT group, an MBSR group, and a treatment-as-usual control group—at a 1:1:1 allocation ratio. Participants in the two intervention groups (the ACT and MBSR groups) will undergo an eight-week group intervention program. During this program, each intervention will comprise eight modules based on ACT and MBSR, respectively. Outcome assessments will be performed across a three-point timeline, including before the intervention (t₀), immediately after the psychosocial intervention at eight weeks (t₁), and six months after the intervention (t₂). The primary outcome that will be assessed during this RCT is PTG. Meanwhile, the secondary outcomes that will be evaluated in this study are such as QoL, hope, optimism, depression, anxiety, and experiential avoidance.

Trial registration number

NCT04800419 (ClinicalTrials.gov). Registered on March 16, 2021.

Life After Facing Cancer: Posttraumatic Growth, Meaning in Life and Life Satisfaction

Although it is known that facing cancer may be accompanied by a range of chronic and acute stress reactions, it can also contribute to positive psychological changes and influence one's life perception. The aim of this cross-sectional study was to investigate relationship between posttraumatic growth (PTG), meaning in life and life satisfaction to determine whether the presence of meaning or the search for meaning mediated the relationship between PTG and life satisfaction. The study was conducted with 149 cancer survivors who were at least one-month post-completion of all medical cancer therapy. The results indicate positive associations between PTG, the presence of meaning in life, the search for meaning and life satisfaction. Moreover, the relationship between PTG and life satisfaction could be explained by the mediating effect of the presence of meaning in life. Thus, it is important for clinicians to systematically facilitate PTG, meaning in life and life satisfaction as protective factors to one's daily functioning.

Kellner's Symptom Questionnaire, a Highly Sensitive Patient-Reported Outcome Measure: Systematic Review of Clinimetric Properties

INTRODUCTION

Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric approach provides a viable framework for their assessment.

OBJECTIVE

The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being).

METHODS

The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included.

RESULTS

A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo.

CONCLUSIONS

The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.

The well-being and burden of caregiving for patients with Parkinson's disease

OBJECTIVES

Well-being and positive psychological functioning may protect caregivers from experiencing burden. Despite this, research has scarcely explored these variables among caregivers of patients with Parkinson's disease (PD). This research endeavoured (1) to measure differences in distress and well-being between caregivers of PD patients and caregivers assisting individuals suffering from non-neurodegenerative age-related health problems (controls); and (2) to evaluate the predictors of well-being, distress and caregiver burden in the total sample of caregivers.

METHODS

The study has a cross-sectional design. 100 caregivers were recruited from centres for ageing individuals. 50 caregivers assisted patients with PD, while the other 50 were considered as controls. Participants completed self-report questionnaires concerning psychological well-being, life satisfaction, post-traumatic growth, distress and symptomatology. Multiple regression analysis was performed on the dataset of the total sample (N = 100), exploring the possible predictors and correlates of caregiver burden.

RESULTS

Caregivers who assisted patients with PD significantly experienced more depression, more distress and less well-being when compared to controls. The main significant correlates of caregiver burden were older age, less psychological well-being and more depression.

CONCLUSIONS

Parkinson's disease caregivers reported more impairment in psychological well-being and higher rates of distress. In the total sample of caregivers (of patients with PD and of healthy individuals), depression and specific areas of well-being (environmental mastery, personal growth) correlated to the burden of caregiving. Psychosocial interventions focused on these dimensions may help caregivers to better cope with the possible burden of the assistance.

Post-traumatic growth and its predictors among Syrian refugees in Istanbul: A mental health population survey

AIMS

The negative mental health effects of exposure to trauma are well-documented. However, some individuals are theorized to undergo post-traumatic growth (PTG) after exposure to trauma, potentially experiencing positive psychological change across five domains: appreciation for life, relationships with others, new possibilities in life, personal strength, and spiritual change. PTG is less studied in forcibly displaced populations in low- and middle-income countries. This study aimed to explore levels of PTG and associated factors among Syrian refugee adults living in Istanbul, Turkey.

METHODS

A cross-sectional survey was conducted with 1678 respondents. This study analyzed PTG data from 768 individuals as measured by the Post-Traumatic Growth Inventory (PTGI). Descriptive analysis and univariate and multivariate least squares linear regression modeling were used. Factor analysis and Cronbach's alpha tests assessed the psychometric properties of the PTGI.

RESULTS

The sample exhibited a moderate level of PTG at 55.94 (SD=22.91, range 0-105). Factor analysis of PTGI revealed only four factors instead of five, and the PTGI yielded high internal reliability (Cronbach's α=0.90). PTG and post-traumatic stress disorder (PTSD) had a curvilinear relationship, with the highest PTG levels experienced by those with moderate PTSD levels. Five other variables were significantly associated with PTG: older age, less education, somatic distress, and history of an overnight stay at a health facility for mental health care were associated with lower PTG, while more years of education were associated with higher PTG.

CONCLUSIONS

This study identified the role of the sociodemographic and psychological determinants that influence post-traumatic growth among Syrian refugees in Istanbul. These findings could be used to inform future research and programs seeking to understand PTG in refugees.

Relationship among symptoms, resilience, post-traumatic growth, and quality of life in patients with glioma

PURPOSE

The aims of this study were to explore the relationship among symptoms, resilience, post-traumatic growth, and quality of life, and to identify the influence of these variables on quality of life in patients with glioma.

METHODS

A correlational, cross-sectional research design was used. A convenience sample of 120 patients was recruited from an outpatient neurosurgery clinic. Data analyses included descriptive statistics, independent t-test, one-way ANOVA, Pearson's correlation coefficient, and hierarchical regression analysis and were performed with the SPSS WIN 25.0 program.

RESULTS

Quality of life positively correlated with the duration of disease diagnosis and resilience and negatively correlated with age, age at onset, severity of symptoms, and interference in symptoms. Resilience was negatively correlated with severity of symptoms and interference with symptoms, and was positively correlated with post-traumatic growth. Hierarchical regression analysis showed that demographic and clinical factors explained 39.3% of the variance in quality of life in glioma patients. The explanatory power increased by 22.1% and 15.1%, respectively, when interference in symptoms and resilience were considered.

CONCLUSIONS

Assessment of quality of life in patients with glioma should consider symptoms and resilience, along with demographic and clinical factors. Interventions developed to improve quality of life in glioma patients must also consider these factors.

[Post-traumatic growth: Some conceptual considerations]

OBJECTIVE

Post-traumatic growth (PTG) is a quite new concept of positive psychology proposed in the mid-1990s which is still rather confidential in France. This article aims to propose a full description of this concept from an historical view to epidemiological data through underlying mechanisms and evaluation.

METHODS

A literature search identifying relevant results was performed through the Pubmed database.

RESULTS

PTG refers to positive psychological changes experienced as a result of a traumatic life event in order to rise to a higher level of functioning. That is to say that people experiencing psychological struggle following adversity may often see positive outcomes in the aftermath of trauma. Domains of PTG include appreciation of life, relationships with others, new possibilities in life, personal strength and spiritual change. A self-report scale, the Post-Traumatic Growth Inventory (PTGI), has been developed. PTG has been demonstrated after various traumatic events such as transport accidents, natural disasters, interpersonal violence or medical problems, with a prevalence ranging from 3 to 98 % depending on the type of trauma.

DISCUSSION

The concept of resilience and some evaluation bias may have been deleterious for the development of the PTG concept in the French-speaking world. There is a need to consolidate data to understand the pathway leading to PTG, noticeably to identify factors contributing to PTG that can help to promote the growth as a new therapy for trauma.

Exploring Post-traumatic Growth in Parkinson's Disease: A Mixed Method Study

Post-traumatic growth (PTG) may favor the psychological adaptation to chronic illnesses. However, few studies investigated PTG in Parkinson's Disease (PD). This study aims to investigate PTG in patients with PD, by exploring disease-specific features and assessing its impact on distress, well-being, and quality of life. A mixed methodology with a convergent parallel design was used. 54 patients were classified according to their level of PTG (low PTG, medium PTG, and high PTG). PD patients with high PTG showed a more positive psychological adaptation and less distress when compared to patients with less PTG. Forty-nine patients were interviewed and their transcripts were analyzed using Thematic Analysis. The emerged themes confirmed the traditional dimensions of PTG model, but a specific theme connected to a new body awareness was identified. Patients with high PTG were more likely to report positive statements following PD diagnosis, particularly concerning spirituality and maintaining a good physical functioning. PTG presents peculiar characteristics in PD and it may favor a better psychological adjustment following the diagnosis.

Well-being and distress of patients with Parkinson's disease: a comparative investigation

ABSTRACTBackground:Psychological resources, such as psychological well-being (PWB) and life satisfaction (LS) can aid individuals suffering from chronic illnesses to cope with their illness. The aim of this study was to investigate PWB, LS, quality of life (QoL), and distress in patients with Parkinson's disease (PD) and to compare them with healthy controls.

METHODS

One hundred and thirteen individuals were recruited. Fifty of the participants suffered from PD, while 53 individuals reported other non-neurological diseases. PD patients were assessed through medical routine examinations. All participants had to be devoid of severe cognitive impairment. They were administered self-report questionnaires to measure PWB, LS, QoL, and distress. A cross-sectional comparative design was applied.

RESULTS

PD patients reported higher general PWB than controls with the exception of the autonomy subscale where the PD patients scored lower. However, they also reported higher distress (anxiety, depression, somatic symptoms, and hostility-irritability), lower LS, and poorer QoL compared to controls. In regressive models, general PWB and LS were significantly correlated to the presence of PD, to its functional impairments, and not to other socio-demographic variables.

CONCLUSIONS

Findings confirmed previous literature on other neurological conditions, showing that PD may be associated with greater psychological distress, lower levels of LS and QoL. At the same time, PD patients may preserve their PWB, which is a protective factor for mental and physical health. The presence of these psychological resources is inversely related to functional impairments. Future studies should better investigate the pattern of PWB in PD.

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.

After the Psychoeducational Intervention: Turkish Breast Cancer Survivors' Experiences

OBJECTIVE

To explore breast cancer survivors' life experiences and perceptions about participating in a psychoeducational intervention that aimed at reducing psychological distress and in improvement of the quality of life.

MATERIALS AND METHODS

This study was a post-trial qualitative descriptive study. Data were collected at semi-structured interviews three months after the psychoeducational intervention. Interviews were conducted with 32 Turkish breast cancer survivors. Obtained data were analyzed with inductive content analysis.

RESULTS

The data were categorized into three themes: personal growth, unmet needs and recommendations about the quality of the psychoeducation. Survivors explained that they had positive changes in their self-concept, view of life and relationships after the psychoeducational intervention. In addition, they mentioned the unmet needs to join support groups and raise public awareness to decrease stigma over breast cancer patients in the society.

CONCLUSION

The results of the present study provide new insights into experiences of breast cancer survivors who participated a psychoeducational intervention and provide guidance for attempts to improve survivorship care via psychoeducation to professionals. Psychoeducational interventions should be continuously offered to provide psychosocial support for breast cancer survivors. Future research into psychoeducation for breast cancer survivors should be restructured to involve social support.

The Duality of Human Experience: Perspectives From Psychosocial Adaptation to Chronic Illness and Disability—Empirical Observations and Conceptual Issues

The authors examine the current views on the duality of the human experience as portrayed within the process of coping with traumatic life events. Emphasis is placed on those views associated with the onset or diagnosis of chronic illnesses and disabilities (CID). In a companion article, the authors reviewed experiential dualities focusing on (a) modes of psychosocial adaptation to CID, such as coping versus succumbing, disabled and nondisabled selves; (b) models of denial; and (c) models of personal growth following adversity and traumatic events, such as the onset or diagnosis of CID. Discussion then focused on the dualities espoused by the latter models, which typically dichotomize human functioning following traumatic experiences. In the present article, the authors discuss (a) the main factors, considered by the various theoretical models, that have been found to exert influence on the genuineness of personal growth, with a special emphasis on post-CID psychological growth; (b) pertinent empirical findings that, directly and indirectly, address the perceived dualities of personal growth in the context of psychosocial adaptation to CID; and (c) theoretical and research implications associated with the study of the dual nature of post-CID growth, including recommendations for investigating the veracity of this reported personal growth.

Positive mental health among cancer survivors: overlap in psychological well-being, personal meaning, and posttraumatic growth

Purpose

Positive mental health involves theoretical constructs like psychological well-being, personal meaning, and posttraumatic growth. This study aims to provide empirical insight into possible overlap between these constructs in cancer survivors.

Methods

Within the context of a randomized controlled trial, 170 cancer survivors completed the patient-reported outcome measures (PROMs) Ryff’s Scales of Psychological Well-Being (SPWB), Personal Meaning Profile (PMP), and Posttraumatic Growth Inventory (PTGI). Exploratory factor analysis (EFA) on the subscales of these PROMs, as well as structural equation modeling (SEM), was used to explore overlap in these three constructs.

Results

The EFA resulted in a three-factor solution with an insufficient model fit. SEM led to a model with a high estimated correlation (0.87) between SPWB and PMP and lower estimated correlations with PTGI (respectively 0.38 and 0.47). Furthermore, the estimated correlation between the subscales relation with God (PMP) and spiritual change (PTGI) was high (0.92). This model had adequate fit indices (χ²(93) = 144, p = .001, RMSEA = 0.059, CFI = 0.965, TLI = 0.955, SRMR = 0.061).

Conclusions

The constructs psychological well-being and personal meaning overlap to a large extent in cancer survivors. Posttraumatic growth can be seen as a separate construct, as well as religiosity. These findings facilitate researchers to select the appropriate PROM(s) when testing the effect of a psychosocial intervention on positive mental health in cancer survivors.

Relevance

An increasing number of psychosocial intervention trials for cancer survivors use positive mental health outcomes. These constructs are often multifaceted and overlapping. Knowledge of this overlap is important in designing trials, in order to avoid the pitfalls of multiple testing and finding artificially strengthened associations.

Netherlands Trial Register

NTR3571

Electronic supplementary material

The online version of this article (10.1007/s00520-018-4325-8) contains supplementary material, which is available to authorized users.

Posttraumatic growth in head and neck cancer survivors: Is it possible and what are the correlates?

OBJECTIVES

Posttraumatic growth (PTG) is a possible positive consequence of a traumatic event, such as cancer. Head and neck cancer (HNC) may be particularly traumatic, given its adverse effects on functional, psychological, and social wellbeing. We investigated the extent of PTG, factors associated with PTG, and associations between PTG and health-related quality-of-life (HRQoL) in HNC survivors.

METHODS

HNC survivors (ICD10 C00-C14, C32), identified from the population-based National Cancer Registry Ireland, completed a postal survey. PTG was assessed using the Posttraumatic Growth Inventory (PTG-I) and HRQoL with FACT-G and FACT-H&N. Associations between socio-economic characteristics, social support, and clinical variables and PTG were examined using multivariable linear regression. Total HRQoL scores were compared in those with none-low PTG vs moderate-high PTG.

RESULTS

A total of 583 survivors participated (response rate = 59%). The mean PTG score was 55.74 (95%CI 53.15-58.33); 60% had moderate-high PTG. Survivors scored highest in the PTG-I domain appreciation of life. In multivariable analysis, being female, being younger, having more social support, and having cancer-related financial stress were significantly associated with more PTG. HRQoL was significantly higher in those with moderate-high than no-little PTG (P < .01).

CONCLUSIONS

A notable proportion of HNC survivors report PTG but growth is, on average, lower than reported for other cancers. Nonetheless, higher PTG appears related to better HRQoL. Further research would be valuable to understand the pathways by which HNC may lead to PTG and inform development of strategies to support and encourage PTG in this survivor population.

Mixed Psychological Changes Following Mastectomy: Unique Predictors and Heterogeneity of Post-traumatic Growth and Post-traumatic Depreciation

Objectives: Post-traumatic growth (PTG) and its opposite-post-traumatic depreciation (PTD)-may be treated as important indicators of the patient quality of life. In the absence of studies on both, PTG and PTD in cancer patients, we investigated (1) coping strategies and support effectiveness as predictors of PTG and PTD in post-mastectomy women, (2) homogeneous classes with different intensity of PTG and PTD symptoms, and (3) correlates of class membership. Methods: Coping strategies (Brief COPE), support effectiveness (SSE-Q), PTG (PTGI), and PTD (negatively reworded items of PTGI) were measured in 84 post-mastectomy women (mean age = 62.27, SD = 8.38). Multiple regression, two-step cluster, and multinomial logistic regression were applied. Results: PTG and PTD had unique predictors: time since diagnosis and positive emotion-focused coping predicted PTG (R² = 0.24), while negative emotion-focused and avoidance-focused coping and low support effectiveness were linked to PTD (R² = 0.14). Four groups of PTG × PTD symptoms were identified: high PTG low PTD group (52.4%), low PTG low PTD group (17.9%), high PTG high PTD group (15.5%), and low PTG high PTD group (14.3%). Higher emotion- and avoidance-focused coping was characteristic for the high PTD low PTG group (R² = 0.41). Conclusion: Our findings shed light on the coexistence and unique predictors of PTG and PTD after mastectomy, indicating heterogeneity in PTG and PTD levels among post-mastectomy women.

Staring at My Body: The Experience of Body Reconstruction in Breast Cancer Long-term Survivors

BACKGROUND

Breast cancer takes time for its survivors after a mastectomy to adjust to their changed bodies. There are limited studies about the process of how those survivors accept the changes of their bodies and how they reestablish their new selves.

OBJECTIVE

The aim of this study was to understand the perception of body from women diagnosed with breast cancer more than 5 years previously and whose treatment included a mastectomy.

METHODS

A phenomenological method was applied to this study. Women who received a mastectomy at least 5 years previously were invited to participate. Eight participants were recruited from southern Taiwan.

RESULTS

Twenty transcripts were obtained and analyzed using Colaizzi's method. Three themes were obtained from the data analysis: "restoration of the body image," "abandonment of objectification," and "redefinition of self." Subthemes were also identified and described.

CONCLUSION

The results indicate that women with breast cancer have embodied the recovering experience to a new self and have adapted to identify their new bodies. They overcome being a female body with an absent breast(s) by discovering the value of their existence and being free from self-objectification.

IMPLICATIONS FOR PRACTICE

This study contributes to the understanding of the perception of body in long-term breast cancer survivors, which reflects the process of adjusting to the loss of a breast/breasts to reconstructing a new body experience. Health professionals could help and encourage women undergoing a mastectomy to engage in self-recovery by searching for and affirming self-value.

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.

Use of the Psychosocial Index: A Sensitive Tool in Research and Practice

BACKGROUND

The Psychosocial Index (PSI) is a self-rating scale based on clinimetric principles that is simple to use in a busy clinical setting. It can be integrated by observer-rated clinical judgment, providing a first-line, comprehensive assessment of stress, well-being, distress, illness behavior, and quality of life. By calculation of scores, it can be used for conventional psychological measurements. Its clinical applications and clinimetric properties are reviewed. The present version of the PSI has been slightly revised. In addition, a modified version for use in adolescents and young adults (PSI-Young; PSI-Y) is also included.

METHODS

Articles that involved the use of the PSI were identified by searching the Web of Science database from 1998 to February 2016 and by a manual search of the literature.

RESULTS

A total of 20 studies reporting results from the use of PSI were included. The PSI has been employed in various clinical populations in different countries and showed high sensitivity. It significantly discriminated varying degrees of psychosocial impairment in different populations. When subjects were identified by categorical criteria (presence of allostatic overload, psychosomatic syndromes, psychiatric disorders), the PSI scores were significantly different across subgroups.

CONCLUSIONS

In clinical practice, scanning the list of symptoms allows clinicians to assess rapidly which symptoms and problems are perceived as most troublesome. In research settings, the use of scores makes the PSI a valid and sensitive tool in differentiating levels of psychosocial variables among groups.

Evolution of post-traumatic growth during the first 12 months of dialysis: A longitudinal study

BACKGROUND

Initiating dialysis can produce psychological benefits. These positive changes, most frequently referred to as posttraumatic growth (PTG), have not previously been explored in these patients.

OBJECTIVE

To identify patterns in the temporal course of PTG in patients during their first 12 months of dialysis, and to relate to perceived stress.

DESIGN

A prospective, longitudinal, observational study.

SETTING AND METHODS

The sample included 98 patients, aged from 18 to 70 years, who commenced dialysis in the nine nephrology units of the Basque Country, Spain. Three assessments were carried out at 1, 6 and 12 months, using a PTG questionnaire and the Perceived Stress Scale. ANOVAs with post-hoc analysis were performed to identify significant differences between the groups.

RESULTS

Four groups were established based on the observed changes in PTG over time: high, increasing, decreasing and low PTG. Maintaining high PTG and decreasing PTG levels was associated with moderate levels of perceived stress.

CONCLUSION

Four different patterns of PTG have been identified, contributing to our understanding of the dynamics of the process of growth and enabling us to identify patients who may be more vulnerable.

Correlates of the positive psychological byproducts of cancer: Role of family caregivers and informational support

Objective:

Experiencing a life-threatening illness such as cancer can elicit both negative (e.g., distress) and positive (e.g., growth) psychological responses. The present study sought to determine the correlates of four positive psychological byproducts in cancer survivors: becoming a stronger person, coping better with life's challenges, making positive changes in life, and adopting healthier habits.

Method:

Data for this cross-sectional study were taken from the Medical Expenditures Panel Survey (MEPS) Experiences with Cancer Survivorship Supplement (Yabroff et al., 2012). Cancer survivors (N = 785) reported their sociodemographic and cancer-related characteristics. Descriptive statistics were utilized to summarize cancer survivor characteristics, including demographic factors, cancer factors, and stressors and resources related to cancer. Multivariable logistic regressions were employed to assess the independent association of the stressors and resources with each psychological response, controlling for covariates. All analyses were weighted to account for the complex sampling design of the MEPS.

Results:

In multivariable analyses, those with a family caregiver were 50% more likely to report better coping with challenges, and around 70% were more likely to report making positive changes in life or adopting healthier habits because of their cancer. Receiving informational support from healthcare providers was also consistently associated with positive byproducts (odds ratios ranging from 1.6 to 2.0). Few of the stressors were associated with positive byproducts: having insurance problems due to cancer was positively associated with becoming a stronger person, and work limitations were associated with making positive changes in life; those who reported high perceived chances of recurrence were less likely to report becoming a stronger person.

Significance of Results:

Having a family caregiver and receiving detailed informational support from healthcare providers were associated with reporting positive experiences with cancer. The hypotheses and future research stimulated by these findings may improve our understanding of the process by which positive byproducts develop and may ultimately help improve psychological well-being among cancer survivors.

The Role of Psychological Hardiness and Marital Satisfaction in Predicting Posttraumatic Growth in a Sample of Women With Breast Cancer in Isfahan

Background

Posttraumatic growth (PTG) refers to positive psychological change experienced as a result of the struggle with highly challenging life circumstances. PTG in cancer survivors is related to several psychosocial factors such as psychological hardiness and marital satisfaction.

Objectives

The purpose of this study was to examine the prediction of posttraumatic growth based on psychological hardiness and marital satisfaction.

Patients and Methods

A total of 120 women with breast cancer were recruited from several hospitals in Isfahan using convenience sampling. Participants completed the research questionnaires including the posttraumatic growth inventory (PTGI), the Ahvaz psychological hardiness scale and the Enrich’s marital satisfaction scale (EMS). Statistical analysis including means, standard deviation, Pearson’s correlation and multiple regression analysis were carried out using SPSS software (version 16).

Results

Results indicated that the majority of patients with cancer experienced posttraumatic growth. Findings also showed that psychological hardiness, marital satisfaction and longer time since diagnosis of cancer significantly predicted posttraumatic growth.

Conclusions

This study highlights the significant role of psychological hardiness and marital support in personal growth of breast cancer survivors.

Rumination, psychological distress and post-traumatic growth in women diagnosed with breast cancer

OBJECTIVE

Rumination, the repetitive and recursive rehearsal of cognitive content, has been linked to depression and anxiety in physically well populations, and to post-traumatic growth (PTG) in physical illness populations. Women diagnosed with breast cancer may experience both psychological distress and PTG. As rumination may influence outcomes through distinct pathways, this study investigated the association of intrusion, brooding and instrumental subcomponents of rumination with psychological distress and PTG in the breast cancer context.

METHODS

Women diagnosed with primary breast cancer (n = 185), mean age 55.98 years (SD = 9.26), completed an online survey including the Multi-dimensional Rumination in Illness Scale, Depression Anxiety and Stress Scales, Post-traumatic Growth Inventory, Medical Outcomes Social Support Survey, demographic and health-related questions.

RESULTS

As predicted, regression analyses indicated that brooding was positively related to depression, anxiety and stress, but was also negatively related to the PTG dimensions of new possibilities and spiritual growth. Partially supporting the study hypotheses, intrusion was positively associated with stress and the PTG of relating to others and new possibilities. As hypothesised, instrumental rumination was positively associated with all five dimensions of PTG.

CONCLUSIONS

Rumination is a key consideration in both positive and negative psychological responses of women diagnosed with breast cancer. Associations of specific components of rumination with varying psychological outcomes suggest differential paths by which the specific subcomponents of rumination exert this influence.