Women with Ovarian Cancer: Examining the Role of Social Support and Rumination in Posttraumatic Growth, Psychological Distress, and Psychological Well-being

Predicting psychological distress in advanced ovarian cancer patients during the COVID-19 pandemic

PURPOSE

This longitudinal study investigated distress rates in patients with advanced ovarian cancer during the COVID-19 pandemic and examined whether time, illness representations, and coping strategies predicted distress levels.

METHODS

UK patients with stage 3 or 4 ovarian cancer were recruited between September 2020 and March 2021. Data were collected at baseline (T0), 2 months (T1), and 4 months (T2) post-enrolment. Validated questionnaires assessed distress (anxiety, depression, PTSD, fear of progression) and predictors (coping strategies and illness perceptions), analysed via multilevel modelling.

RESULTS

Seventy-two participants returned a questionnaire at T0, decreasing to 49 by T2. High distress was observed, with over 50% of participants experiencing anxiety and depression consistently. Nearly 60% reported clinical levels of fear of progression at some point. PTSD rates resembled the general population. Although distress levels remained stable over time, some individual variability was observed. Time had minimal effect on distress. Coping strategies and illness perceptions remained stable. Threatening illness perceptions consistently predicted distress, while specific coping strategies such as active coping, acceptance, self-blame, and humour predicted various aspects of distress. Together, these factors explained up to half of the distress variance.

CONCLUSION

The findings have implications for routine screening for distress and the inclusion of psychological treatment pathways in advanced ovarian cancer care. Addressing illness representations is crucial, with attention to informational support. Future research should explore the long-term effects of heightened distress and the effectiveness of interventions targeting illness perceptions. This study informs current clinical practice and future pandemic preparedness in cancer care.

Post-traumatic growth in cancer survivors: What is its extent and what are important determinants?

Background/Objective

The aim was to investigate the extent and longitudinal determinants of post-traumatic growth (PTG) in cancer survivors.

Methods

A sample of 1316 cancer survivors with various cancer types was examined using the EORTC QLQ-FA12 to assess fatigue, the EORTC QLQ-C30 pain items to assess pain and the Patient Health Questionnaire (PHQ-4) to assess emotional distress two years after diagnosis (t0). Additionally, patients rated how well they felt informed about fatigue at t0. PTG was assessed with the 21-item PTG-Inventory four years after diagnosis (t1) comprising the five subdimensions appreciation of life, relation to others, personal strengths, new possibilities and spiritual change.

Results

Regarding the extent of PTG, most positive developments were experienced in the PTG subdimension appreciation of life whereas the subdimension spiritual change was the least pronounced domain. Fatigue, pain and emotional distress were longitudinal but non-linear predictors of long-term PTG. Additionally, poor informedness about fatigue was associated with less PTG.

Conclusions

PTG can be perceived even years after a traumatic cancer event and is longitudinally associated with common cancer side effects like fatigue, emotional distress and pain. Further research into the role of individuals' informedness contributing to PTG is needed.

Post-traumatic growth in oncological patients during the COVID-19 pandemic

BACKGROUND

Post-traumatic growth (PTG) is defined as "positive psychological change experienced as a result of the struggle with highly challenging life circumstances". Diagnosis of cancer leads to many psychological challenges. The recent pandemic forced oncological patients to face other multiple stressors. Resilience is a target of interest for PTG. The aim of this study is to analyze relationships between cancer trauma, COVID-19 pandemic stress, PTG and resilience over time.

PARTICIPANTS AND PROCEDURE

One hundred forty-six patients (124 females, 22 males) in active oncological treatment were enrolled from September 2020: 45.2% (n = 66) diagnosed with gynecological cancer, 23.3% (n = 34) with breast cancer, 15.1% (n = 22) with lung cancer, 16.5% (n = 24) with other cancers. We conducted a prospective longitudinal study on oncological patients evaluated at: diagnosis (T0), 6 (T1) and 12 months (T2) by means of the following self-administered tests: Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale Revised (IES-R), Post-traumatic Growth Inventory (PTGI), Perceived Stress Scale (PSS), Connor-Davidson Resilience Scale (CD-RISC).

RESULTS

DT decreased over time (T0 vs. T2, p < .001). HADS decreased from T0 to T2 (p < .001). The PTG subscales regarding new possibilities and appreciating life improved comparing T0 vs. T2 (p = .029; p = .013), as well as the total index of PTG (p = .027). The IES avoidance subscale score decreased over time (T0 vs. T1, p = .035).

CONCLUSIONS

For some patients, the cancer experience is characterized not only by psychological distress but also by the presence and growth of positive aspects, such as the tendency to positively reconsider the value and importance of life, health and social relationships.

The effect of logotherapy-based, nurse-guided meaning attribution conversations on women diagnosed with gynecologic cancer: A Turkish pilot study

Although gynecological cancers are among the most common cancers worldwide, these diagnoses are among the most traumatic experiences in women's lives. This study aimed to examine the effects of logotherapy-based, nurse-guided meaning attribution conversations (MACs) on traumatic stress symptoms, post-traumatic growth, spiritual well-being, and life meaning attribution in gynecological cancer patients. This single-blind, randomized controlled trial consisted of face-to-face interviews with 68 women with gynecological cancer who received chemotherapy at Karadeniz Technical University Health Application And Research Center Farabi Hospital in 2019. Women in the intervention group underwent seven MAC sessions, whereas women in the control group only received routine nursing care. Data were collected using the Personal Information Form (PIF), the Traumatic Stress Symptom Scale (TSSS), the Post-Traumatic Growth Inventory (PTGI), the Meaning in Life Questionnaire (MLQ), and the Spiritual Well-Being Scale (SWBS). Descriptive statistics and parametric and nonparametric tests (Mann - Whitney U-test, Friedman test, Chi-squared test, and Fisher's exact test) were used to analyze the data. The study was registered at ClinicalTrials.gov (NCT05246462). We observed statistically significant differences in the post-intervention and follow-up mean TSSS, PTGI, and MLQ scores (p = .000) between groups. However, mean total SWBS scores were not significantly different between groups (p = .145). This study demonstrated that MACs decreased the traumatic stress symptoms of women with gynecological cancer and increased their post-traumatic growth and ability to attribute meaning to life, but did not affect their spiritual well-being.

The role of uncertainty intolerance in adjusting to long-term physical health conditions: A systematic review

Long-term physical health conditions (LTPHCs) are associated with poorer psychological well-being, quality of life, and longevity. Additionally, individuals with LTPHCs report uncertainty in terms of condition aetiology, course, treatment, and ability to engage in life. An individual's dispositional ability to tolerate uncertainty-or difficulty to endure the unknown-is termed intolerance of uncertainty (IU), and may play a pivotal role in their adjustment to a LTPHC. Consequently, the current review sought to investigate the relationship between IU and health-related outcomes, including physical symptoms, psychological ramifications, self-management, and treatment adherence in individuals with LTPHCs. A systematic search was conducted for papers published from inception until 27 May 2022 using the databases PsycINFO, PubMed (MEDLINE), CINAHL Plus, PsycARTICLES, and Web of Science. Thirty-one studies (N = 6,201) met the inclusion criteria. Results indicated that higher levels of IU were associated with worse psychological well-being outcomes and poorer quality of life, though impacts on self-management were less clear. With the exception of one study (which looked at IU in children), no differences in IU were observed between patients and healthy controls. Although findings highlight the importance of investigating IU related to LTPHCs, the heterogeneity and limitations of the existing literature preclude definite conclusions. Future longitudinal and experimental research is required to investigate how IU interacts with additional psychological constructs and disease variables to predict individuals' adjustment to living with a LTPHC.

Relationship between perceived social support and post-traumatic growth in coronavirus disease 2019 patients discharged from the hospital

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has affected mental health and physical health negatively in some individuals. Examining perceived social support and post-traumatic growth (PTG) in COVID-19 patients could facilitate our understanding of how patients maintain their mental health.

AIM

To examine the relationship between the level of perceived social support and PTG in COVID-19 patients discharged from the hospital.

METHODS

This descriptive study was carried out between August and September 2022 with patients who were hospitalized due to COVID-19 in a university hospital in Erzurum and who were discharged at least 3 mo prior to the beginning of the study. The study was completed by 196 patients. Study data were collected face-to-face using a personal information form, multidimensional scale of perceived social support and PTG inventory.

RESULTS

The total mean score of the multidimensional scale of perceived social support was 63.82 ± 15.72. The PTG inventory total mean score was 47.77 ± 19.85. In addition, a direct significant correlation was found between perceived social support in COVID-19 patients and PTG.

CONCLUSION

The study results showed that perceived social support variables affected PTG significantly. Therefore, it is recommended for healthcare professionals to implement interventions to promote social support from healthcare professionals and the patient’s family and friends. Considering the negative effects of the ongoing COVID-19 pandemic, it is very important and necessary to implement effective public health interventions to promote PTG to reduce mental health problems.

Rates and correlates of psychological distress and PTSD among persons with physical disabilities in Cambodia

BACKGROUND

Compared to the general population, persons with disabilities are at increased risk of poor mental health. The aim of this study was to determine the rates and correlates of psychological distress and post-traumatic stress disorder (PTSD) among persons with physical disabilities in Cambodia.

METHODS

From July to December 2021 data were collected as part of a mental health screening programme for persons with physical disabilities who access prosthetic and orthotic services. Psychological distress was measured using the Kessler-10 (K-10) and PTSD using the PC-PTSD-5. Bivariate and multiple linear regression analyses were conducted to identify factors associated with levels of psychological distress and PTSD among this population.

RESULTS

Our study found a high prevalence of psychological distress and PTSD in this patient cohort. Of the 213 participants, 31.5% were likely to be experiencing mild to moderate psychological distress indicative of a mental health disorder, with 13.6% likely to have a severe mental health disorder. Sixty-five percent of patients reported experiencing PTSD symptoms, with forty-six percent meeting the criteria for probable PTSD. Psychological distress was associated with pathological worry, rumination, and facets of mindfulness. Rumination and pathological worry were found to be significant predictors of psychological distress. PTSD symptoms were associated with pathological worry but not facets of mindfulness or rumination. Facets of mindfulness and pathological worry were found to be significant predictors of PTSD.

CONCLUSION

Integration of mental health services within the disability sector is required to address psychological distress and PTSD symptoms among people with physical disabilities in Cambodia. Health system interventions, such as screening, referral, and the training of health providers, need to be strengthened. Further studies focussing on the psychosocial determinants of mental health of persons with disabilities in Cambodia are required.

Social support on Reddit for antiretroviral therapy

Purpose

Social media platforms such as Reddit can be used as a place for people with shared health problems to share knowledge and support. Previous studies have focused on the overall picture of how much social support people who live with HIV/AIDS (PLWHA) receive from online interactions. Yet, only few studies have examined the impact of social support from social media platforms on antiretroviral therapy (ART), which is a necessary lifelong therapy for PLWHA. This study used social support theory to examine related Reddit posts.

Design/methodology/approach

This study used content analysis to analyze ART-related Reddit posts. Each Reddit post was manually coded by two coders for social support type. A computational text analysis tool, Linguistic Inquiry and Word Count, was used to generate linguistic features. ANOVA analyses were conducted to compare differences in user engagement and well-being across the types of social support.

Findings

Results suggest that most of the posts were informational support posts, followed by emotional support posts and instrumental support posts. Results indicate that there are no significant differences within user engagement variables, but there are significant differences within several well-being variables including analytic score, clout score, health words usage and negative emotional words usage among social support types.

Originality/value

This study contributes to further understanding of social support theory in an online context used predominantly by a younger generation. Practical advice for public health researchers and practitioners is discussed.

Is rumination associated with psychological distress after a cancer diagnosis? A systematic review

Objective: The aim of this work was to review evidence on the association between psychological rumination and distress in those diagnosed with cancer. Methods: Six databases were searched for studies exploring rumination alongside overall assessments of psychological distress, depression, anxiety, or stress. Results: Sixteen studies were identified. Rumination was associated with distress cross-sectionally and longitudinally. However, once baseline depression was controlled for, the association was no longer seen. The emotional valence of ruminative thoughts and the style in which they were processed, rather than their topic, was associated with distress. Brooding and intrusive rumination were associated with increased distress, deliberate rumination had no association, and reflection/instrumentality had mixed findings. Conclusions: This review highlights that it is not necessarily the topic of content, but the style and valence of rumination that is important when considering its association with distress. The style of rumination should be the target of clinical intervention, including brooding and intrusion.

Social support and posttraumatic growth: A meta-analysis

BACKGROUND

The beneficial role of social support on posttraumatic growth (PTG) has been assumed by theoretical models and established in some studies. However, there are inconsistent findings and little knowledge on moderators. The present study aims to investigate the overall effect size of the relationship and identify factors affecting the association.

METHODS

Six electronic databases were searched. Newcastle-Ottawa Quality Assessment Scale (NOS) were used to evaluate the quality of studies. Study quality, study design, trauma type, PTG measure, social support measure, continent, publishing language, sample size, gender, religion, and age were analyzed as moderators. Meta-regression was conducted with the significant differential predictors in moderator analysis.

RESULTS

The meta-analysis included 217 samples and a total of 47,940 participants from both longitudinal and cross-sectional studies. There was a medium positive effect size between social support and PTG in random effect model, r = 0.418, p < .001. The meta-regression analysis indicated that the association between social support and PTG was stronger among caregivers (vs. other traumatized samples), Chinese, older individuals and studies with smaller sample size.

LIMITATIONS

Only survey results were included in the analysis. The retrospective self-report may limit a more objective assessment of the relations. In addition, 87 % of the studies were cross-sectional, which may influence the estimation of a valid effect size.

CONCLUSIONS

Regarding the medium positive association between social support and PTG, it is important to enhance social support for trauma survivors. It will be especially effective for caregivers, Chinese, and older people.

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.

Associations of body image with depressive symptoms and PTG among breast cancer patients: The mediating role of social support

Background

Cancer diagnosis and treatment usually trigger positive and negative psychological health outcomes. Social support is a coping resource for psychological health outcomes. However, little research is available on the relationships between social support, body image, and overall psychological health outcomes in breast cancer (BC) patients. This study aimed to estimate the prevalence of depressive symptoms and post-traumatic growth (PTG) and examine the mediating roles of social support between body image and depressive symptoms and PTG among BC patients, respectively.

Methods

A cross-sectional study was conducted in the Northeast China from December 2015 to August 2017. All the participants were diagnosed with BC and underwent surgery. This study was conducted with 405 BC patients from the First Affiliated Hospital of China Medical University. Participants completed the Center for Epidemiologic Studies Depression scale, Post Traumatic Growth Inventory, Body Image Scale, and Perceived Social Support Scale. The associations of social support, body image with depressive symptoms, and PTG were examined by hierarchical linear regression analysis. Asymptotic and resampling strategies were used to explore the mediating role of social support.

Results

The prevalence of depressive symptoms was 88.1%, and 67.2% of the patients had moderate-high PTG, 52.84% of the patients had body concerns, and 264 (65.19%) patients had high-level social support. Body image was positively associated with depressive symptoms (β = 0.445, P < 0.001) and social support was negatively associated with depressive symptoms (β = −0.219, P < 0.001). Body image was negatively associated with PTG (β = −0.095, P = 0.023), whereas social support was positively associated with PTG (β = 0.533, P < 0.001). Social support significantly mediated the associations among body image, depressive symptoms (effect size = 0.057), and PTG (effect size = −0.304), respectively.

Conclusions

Social support played mediating role in the relationships between body image and depressive symptoms and PTG. The interventions based on social support and body image should be included in psychological health prevention.

Posttraumatic growth and rumination among parents of children with autism spectrum disorder: The mediating role of social support

Although rumination and social support are regarded as essential predictors of posttraumatic growth (PTG), few studies have explored the associations among PTG, rumination, and social support in parents of children with autism spectrum disorder (ASD). This study examined whether social support mediates the relationship between rumination and PTG. Cross-sectional questionnaire data were collected from 385 parents of children with ASD from September 2019 to November 2020 by convenience sampling. Participants completed the Posttraumatic Growth Inventory, Event Related Rumination Inventory, and Social Support Rating Scale. Path analyses showed that subjective support partially mediates the relationship between deliberate rumination and PTG (β = 0.073, P &lt; 0.001), and indirect effects account for 15.30% of the total effects. In addition, a negative direct path was found between intrusive and PTG because of the suppression effect of subjective support (β = -0.110, P &lt; 0.01), and indirect effects accounted for 80% of the direct effects. For future studies, it underscores the essential role of subjective support and rumination in promoting PTG in parents of children with ASD.

Dyadic effects of rumination and self-disclosure on posttraumatic growth in newly diagnosed gynecological cancer couples: an actor-partner interdependence modeling approach

OBJECTIVE

To examine the dyadic effects of rumination and self-disclosure on posttraumatic growth among newly diagnosed gynecological cancer couples.

METHODS

This cross-sectional study recruited 400 newly diagnosed gynecological cancer couples from a tertiary general hospital from July to December 2020. Questionnaires were administered to collect information on demographic and cancer-related characteristics, rumination, self-disclosure, and posttraumatic growth. The actor-partner interdependence model was used to explore the dyadic effects of rumination and self-disclosure on posttraumatic growth.

RESULTS

Gynecological cancer survivors reported more posttraumatic growth than their spouses. The patients' deliberate rumination and self-disclosure and spouses' self-disclosure had actor and partner effects on their own and their spouses' posttraumatic growth. Besides, the patients' intrusive rumination and spouses' deliberate rumination had actor effects on their own posttraumatic growth.

CONCLUSIONS

Spouses' posttraumatic growth was influenced by their own and their wives' deliberate rumination and self-disclosure, while survivors' posttraumatic growth was affected by their own deliberate rumination, intrusive rumination, self-disclosure, and their spouses' self-disclosure. Promoting deliberate rumination and self-disclosure could facilitate the couples' posttraumatic growth. Besides, reducing intrusive rumination may be useful for the survivors and indirectly contribute to spouses' posttraumatic growth. This study indicates that couple-centered interventions may be crucial and more effective in facilitating posttraumatic growth among newly diagnosed gynecological cancer couples.

Loneliness and Psychological Distress in Women Diagnosed with Ovarian Cancer: Examining the Role of Self-Perceived Burden, Social Support Seeking, and Social Network Diversity

The aim of the present study was to examine the role of self-perceived burden, social support seeking, and social network diversity in loneliness and psychological distress among women with ovarian cancer. A cross-sectional design was employed whereby 130 women diagnosed with ovarian cancer, recruited through various online sources (e.g., social media), completed the study via Qualtrics. Participants completed questionnaires that assessed self-perceived burden, social support seeking, social network diversity, loneliness, and psychological distress (anxiety, depressive symptoms). The models examined indicated that there were indirect effects of self-perceived burden and social network diversity on psychological distress via loneliness. Social support seeking was not significant in the models. Loneliness, self-perceived burden, and social network diversity should be of clinical concern among those working to support women with ovarian cancer. Future studies on longitudinal patterns or examining other factors associated with loneliness are needed to better understand the mental health of women with ovarian cancer.

Perceived social support associated with posttraumatic growth in liver transplant recipients: A cross-sectional study

INTRODUCTION

There is almost no information about the role of perceived social support, one of the main variables facilitating posttraumatic growth, in liver transplant. For this reason, the issue requires further clarity. The aim of this study was to investigate the relationship between perceived social support and posttraumatic growth in individuals receiving liver transplants.

METHOD

This cross-sectional study was carried out with liver transplant recipients at a hospital in eastern Turkey (N = 117). The data collection instruments included a Descriptive Characteristics Form, the Posttraumatic Growth Inventory and the Multidimensional Scale of Perceived Social Support. The data were analyzed using descriptive statistics, correlation analysis and hierarchical linear regression analysis.

RESULTS

It was revealed that the participants had high levels of posttraumatic growth (73.05 ± 16.82) and perceived social support (67.75 ± 14.33). A moderate and positive relationship was determined between the mean perceived social support total score and the mean posttraumatic growth total score of the participants (p < 00.01). Perceived social support explained 25.6% of the variance in posttraumatic growth (F = 39.600; p < 0.05; Adjusted R²=0.256), while perceived social support together with primary school-level education and low economic status explained 32.3% of the variance in posttraumatic growth (F = 17.954; p < 0.05; Adjusted R²=0.323).

CONCLUSION

The results on perceived social support revealed that liver transplant recipients had a subjective feeling of being understood, respected and supported by their families more than friends and significant other in a social environment. This study showed that high perceived social support contributes to posttraumatic growth in liver transplant recipients. Apart from perceived social support, other factors affecting posttraumatic growth included individuals' perceptions of their education level and economic situation.

Family support and posttraumatic growth among tourism workers during the COVID-19 shutdown: The role of positive stress mindset

The COVID-19 pandemic has taken a severe hit on the health of workers in the tourism industry. It is crucial to understand how to help the workforce in this service industry become resilient and adaptive through this crisis. The primary objective of this research is to examine how family support nurtures tourism workers' posttraumatic growth (PTG), an adaptation form in the resilience process. The valid data were collected from 384 tourism workers who were on unpaid leave or layoff during the COVID-19 crisis. The results demonstrated the positive relationship between family support and tourism workers' PTG, for which positive stress mindset was identified as a mediation mechanism. Deliberate and intrusive ruminative thinking styles moderated the effect of family support on positive stress mindset. Theoretical and practical implications of the mechanisms through which family support promotes tourism workers' PTG are discussed.

Resilience and Posttraumatic Growth of Patients With Breast Cancer During the COVID-19 Pandemic in China: The Mediating Effect of Recovery

Purpose

This study aims to examine the mediating role recovery plays in the relationship between resilience and posttraumatic growth (PTG) among breast cancer patients.

Methods

A cross-sectional study design was implemented between January 02, 2021 and April 29, 2021. A total of 789 breast cancer patients from eight hospitals in Liaoning province were selected for participation in this study. These participants completed questionnaires, which included the Post-Traumatic Growth Inventory, EGO Resilience Scale and the Questionnaire about the Process of Recovery. The associated factors of PTG were analyzed using hierarchical multiple regression (HMR). The proposed relationships among resilience, recovery, and PTG were checked by structural equation modeling (SEM) analyses.

Results

The average PTG score of breast cancer patients was 53.00 ± 28.30. PTG was positively correlated with both recovery and PTG (a*b = 0.1, BCa95% CI: 0.154 ∼ 0.054).

Conclusion

Breast cancer patients were found to exhibit a moderate degree of PTG. Resilience was positively associated with PTG and recovery mediated the positive effect of resilience on PTG. Resilience might serve as a crucial protective factor that could explain positive growth in life-threatening illnesses through the mediating path of recovery.

Social Support and Spiritual Well-Being of Patients With Esophageal Cancer Aged Over 50 Years: The Mediating Role of Rumination

BACKGROUND

Spiritual well-being plays an important role in helping patients cope with disease. Previous studies have investigated the association between social support and spiritual well-being, whereas few studies have explored the relationship in patients with esophageal cancer (EC), and the mechanisms behind this pathway have not been thoroughly examined.

OBJECTIVE

This study aimed to explore the relationship between social support and spiritual well-being of Chinese patients with EC aged over 50 years and to analyze whether the relationship was mediated by rumination.

METHODS

A cross-sectional survey was conducted with 197 EC patients. Participants completed the general information questionnaire, the Functional Assessment of Chronic Illness Therapy-Spiritual Scale, the Chinese Event Related Rumination Inventory, and the Perceived Social Support Scale (PSSS).

RESULTS

Results demonstrated that social support of patients with EC aged over 50 years was positively correlated with spiritual well-being and deliberate rumination and negatively correlated with intrusive rumination; spiritual well-being was positively associated with deliberate rumination and negatively correlated with intrusive rumination. The effect of social support on spiritual well-being was partially mediated by deliberate rumination and intrusive rumination.

CONCLUSIONS

The findings suggest that interventions directed toward enhancing social support and deliberate rumination and reducing the level of intrusive rumination may help patients with EC aged over 50 years improve spiritual well-being.

Correlates of posttraumatic growth among spouses of newly diagnosed gynecological cancer survivors: A cross-sectional study

PURPOSE

Despite increasing research on posttraumatic growth (PTG) of spouses of cancer patients, and the positive effects of spouses' PTG on both spouses and patients, there is little information on PTG and its correlates among husbands of gynecological cancer survivors, especially those of newly diagnosed survivors. We aimed to assess PTG among spouses of newly diagnosed gynecological cancer survivors and to examine its correlates.

METHODS

In a cross-sectional study, a total of 400 spouses of newly diagnosed gynecological cancer survivors were recruited and completed questionnaires with information on general characteristics, rumination, self-disclosure, locus of control, and PTG. Univariate analysis and multiple linear regression analysis were performed.

RESULTS

The mean score of PTG among the spouses was 57.77 (SD = 12.03). There were significant differences in PTG among spouses with different education levels, marriage duration, number of children, per capita monthly income, other traumatic events within 6 months, and time since diagnosis groups. Pearson's correlation analysis revealed that deliberate rumination, self-disclosure, and locus of control were significantly associated with PTG. The multiple regression model revealed that 53.6% of the variance in PTG was explained by marriage duration, time since diagnosis, self-disclosure, deliberate rumination, and internality locus of control.

CONCLUSIONS

This study was one of the early attempts in evaluating PTG among spouses of newly diagnosed gynecological cancer survivors and identified several significant, potentially modifiable factors (self-disclosure, deliberate rumination, and internality locus of control) associated with PTG, providing an important guide for the development of effective psychosocial interventions for this population.

Symptom Clusters in Patients With Gynecologic Cancer Receiving Chemotherapy

OBJECTIVES

To describe ratings of symptom occurrence, severity, and distress for 38 symptoms and to identify and compare the number and types of symptom clusters identified using these ratings. Although patients with gynecologic cancer experience multiple co-occurring symptoms, little is known about how these symptoms cluster together.

SAMPLE & SETTING

Eligible patients (N = 232) had gynecologic cancer and were receiving chemotherapy.

METHODS & VARIABLES

Symptoms were assessed using the Memorial Symptom Assessment Scale. Symptom clusters were identified through exploratory factor analysis. Geomin-rotated factor loadings with absolute values of 0.3 or greater were considered meaningful. Factor solutions (i.e., symptom clusters) were assessed for simple structure and clinical relevance.

RESULTS

Lack of energy, hair loss, and "I don't look like myself" were the most common, severe, and distressing symptoms. Hormonal, respiratory, and weight change clusters were identified across all three dimensions.

IMPLICATIONS FOR NURSING

Research that explores how symptom clusters change over time and their underlying mechanisms is warranted.

Post-traumatic growth and its influencing factors among Chinese women diagnosed with gynecological cancer: A cross-sectional study

PURPOSE

The experience of cancer could lead to positive psychological changes following the struggle with diagnosis and treatment. Understanding post-traumatic growth and its influencing factors in women affected by gynecological cancer is essential to enhance their possibility of achieving positive changes. The purpose of this study was to describe the post-traumatic growth level and explore the influencing factors of post-traumatic growth in Chinese women diagnosed with gynecological cancer.

METHOD

A cross-sectional survey with a convenience sampling method was employed to collect data using the Post-traumatic Growth Inventory (PTGI), Distress Disclosure Index (DDI), Medical Coping Modes Questionnaire (MCMQ), and Multidimensional Scale of Perceived Social Support (MSPSS). The questionnaires were administered to 344 participants recruited from two hospitals in Hefei City, the capital of Anhui Province in China, between March 2018 and March 2019. All statistical analyses were performed using nonparametric tests. The Mann-Whitney U Test was used to distinguish the intergroup differences. Correlations were evaluated with Spearman rank correlation coefficients.

RESULTS

Total score for PTGI was 56.5 (range 48.0-68.0). The subscale with the highest centesimal score in the PTGI was appreciation of life and the lowest was spiritual change. The top five items with the highest scores of PTGI belonged to appreciating life, personal strength, and relating to others. Self-disclosure, confrontation, avoidance, acceptance-resignation, perceived social support, education level, cancer type and the place they lived had significant influence on post-traumatic growth.

CONCLUSIONS

The findings indicate that women who have high levels of perceived social support, confrontation, avoidance, self-disclosure and education level tend to experience more post-traumatic growth, while, conversely, high levels of acceptance-resignation have a negative influence on promoting post-traumatic growth. These meaningful findings propose new perspectives for promoting post-traumatic growth in Chinese women diagnosed with gynecological cancer.

Social media recruitment for mental health research: A systematic review

BACKGROUND

Social media holds exciting promise for advancing mental health research recruitment, however, the extent and efficacy to which these platforms are currently in use are underexplored.

OBJECTIVE

A systematic review was conducted to characterize the current use and efficacy of social media in recruiting participants for mental health research.

METHOD

A literature review was performed using MEDLINE, EMBASE, and PsychINFO. Only non-duplicative manuscripts written in the English language and published between 1/1/2004-3/31/2019 were selected for further screening. Data extracted included study type and design, participant inclusion criteria, social media platform, advertising strategy, final recruited sample size, recruitment location, year, monetary incentives, comparison to other recruitment methods if performed, and final cost per participant.

RESULTS

A total of 176 unique studies that used social media for mental health research recruitment were reviewed. The majority of studies were cross-sectional (62.5%) in design and recruited adults. Facebook was overwhelmingly the recruitment platform of choice (92.6%), with the use of paid advertisements being the predominant strategy (60.8%). Of the reviewed studies, substance abuse (43.8%) and mood disorders (15.3%) were the primary subjects of investigation. In 68.3% of studies, social media recruitment performed as well as or better than traditional recruitment methods in the number and cost of final enrolled participants. The majority of studies used Facebook for recruitment at a median cost per final recruited study participant of $19.47. In 55.6% of the studies, social media recruitment was the more cost-effective recruitment method when compared to traditional methods (e.g., referrals, mailing).

CONCLUSION

Social media appears to be an effective and economical recruitment tool for mental health research. The platform raises methodological and privacy concerns not covered in current research regulations that warrant additional consideration.

Growth from adversity in trans and gender diverse people of color

BACKGROUND

Trans-negativity and gender-based discrimination negatively impact on the wellbeing and mental health in transgender (trans) and gender diverse people (TGD). There is limited research on TGD people thriving under adversity, and no research to date has considered TGD people of color in this context.

METHOD

We used the Post-Traumatic Growth Inventory (PTGI-X) to survey 125 TGD people of color and 625 white TGD adults (18 to 68 years old, M = 26.0, SD = 9.2) about their experiences of growth from adversity. Confirmatory factor analysis (CFA), using sub-sampling to compensate for our unequal sample sizes, supported a five-factor structure of the PTGI-X consisting of growth in relating to others, finding new possibilities, personal strength, greater appreciation of life, and spiritual/existential change. Measurement invariance tests confirmed configural, metric, and scalar invariance of this structure across the two TGD subgroups.

RESULTS

A MANOVA revealed that growth from adversity in TGD participants was generally greater than that reported by people who have recently been exposed to a traumatic event. T-tests revealed that TGD people of color experienced more growth in terms of relating to others and more personal strength than white TGD participants. Subsequent hierarchical regressions revealed that race moderated associations between PTGI-X scores and personal well-being, with TGD people of color reporting more benefits (more well-being) at high levels of growth but also more deficits (less well-being) at low levels of growth than the white TGD subgroup.

CONCLUSION

The results support the use of the PTGI-X with TGD populations and across racial TGD subgroups and indicate that growth from adversity is not only prevalent in TGD people but also relevant to positive outcomes, particularly in TGD people of color.

Death-related distress in adult primary brain tumor patients

Background

A diagnosis of cancer may increase mortality salience and provoke death-related distress. Primary brain tumor (PBT) patients may be at particular risk for such distress given the certainty of tumor progression, lack of curative treatments, and poor survival rates. This study is the first to examine the prevalence of death-related distress and its correlates in PBT patients.

Methods

Adult PBT patients (N = 105) enrolled in this cross-sectional study and completed the Death Distress Scale (subscales: Death Depression, Death Anxiety, Death Obsession), Generalized Anxiety Disorder-7, and Patient Health Questionnaire-9. Prevalence and predictors of death-related distress, and the relationships of demographic variables to clusters of distress, were explored.

Results

The majority of PBT patients endorsed clinically significant death-related distress in at least one domain. Death anxiety was endorsed by 81%, death depression by 12.5%, and death obsession by 10.5%. Generalized anxiety was the only factor associated with global death-related distress. Cluster analysis yielded 4 profiles: global distress, emotional distress, resilience, and existential distress. Participants in the resilience cluster were significantly further out from diagnosis than those in the existential distress cluster. There were no differences in cluster membership based on age, sex, or tumor grade.

Conclusions

PBT patients appear to have a high prevalence of death-related distress, particularly death anxiety. Further, 4 distinct profiles of distress were identified, supporting the need for tailored approaches to addressing death-related distress. A shift in clusters of distress based on time since diagnosis also suggest the need for future longitudinal assessment.

Activation of β2-Adrenergic Receptor Promotes Growth and Angiogenesis in Breast Cancer by Down-regulating PPARγ

Purpose

Chronic stress and related hormones are key in cancer progression. Peroxisome proliferator-activated receptor γ (PPARγ) and its agonists was reported that inducing anti-tumor effect. However, the function of PPARγ in pro-tumorigenic effects induced by chronic stress in breast cancer remains unknown. Herein, we have characterized a novel role of PPARγ and vascular endothelial growth factor (VEGF)/fibroblast growth factor 2 (FGF2) signals in breast cancer promoted by chronic stress.

Materials and Methods

We performed experiments in vivo and in vitro and used bioinformatics data to evaluate the therapeutic potential of PPARγ in breast cancer promoted by stress.

Results

Chronic stress significantly inhibited the PPARγ expression and promoted breast cancer in vivo. VEGF/FGF2-mediated angiogenesis increased in the chronic stress group compared to the control group. PPARγ agonist pioglitazone (PioG) injection offset the pro-tumorigenic effect of chronic stress. Moreover, specific β₂-adrenergic receptor (β₂R) antagonist ICI11-8551 inhibited the effect of chronic stress. In vitro, norepinephrine (NE) treatment had a similar tendency to chronic stress. The effect of NE was mediated by the β₂R/adenylate cyclase signaling pathway and suppressed by PioG. PPARγ suppressed VEGF/FGF2 through reactive oxygen species inhibition. Bioinformatics data confirmed that therewas a lowPPARγ expression in breast invasive carcinoma. Lower PPARγ was associated with a significantly worse survival.

Conclusion

β₂R activation induced by chronic stress and related hormones promotes growth and VEGF/FGF2-mediated angiogenesis of breast cancer by down-regulating PPARγ. Our findings hint that β receptor and PPARγ as two target molecules and the novel role for their agonists or antagonists as clinical medicine in breast cancer therapy

The Effect of Cognitive-Emotional Intervention on Growth and Posttraumatic Stress in Mothers of Children With Cancer: A Randomized Clinical Trial

BACKGROUND

To diminish the negative impact and improve the positive outcomes on the parents of children with cancer, it is crucial to attend to their problems. This is especially significant in the case of mothers as the main caregivers. The present study aimed at evaluating the efficiency of cognitive-emotional intervention on growth and posttraumatic stress in mothers of children with cancer hospitalized in the chemotherapy ward.

PROCEDURE

This randomized clinical trial was conducted on 100 mothers of children with cancer who presented to the chemotherapy ward of a hospital located in southeastern Iran in 2018. The eligible mothers were chosen and randomly assigned to intervention and control groups. Mothers in the intervention group as a whole received 5 sessions of cognitive-emotional intervention. The sessions were held twice a week, each lasting 60 to 90 minutes. Sixteen weeks after the intervention, posttest data were collected through the Posttraumatic Stress Disorder Checklist and Posttraumatic Growth Inventory. The data were then analyzed using SPSS 21 utilizing statistical tests including independent and paired t tests, χ, and covariance analysis.

RESULTS

The results show that the mean value of posttraumatic stress in mothers of children with cancer after cognitive-emotional training in the intervention group (25.92±5.29) was significantly lower than that in the control group (44.94±11.92; P=0.0001). Moreover, in the posttest, the mean value of posttraumatic growth in the intervention group (92.06±5.50) was significantly more than that in the control group (62.98±15.08; P=0.0001).

CONCLUSIONS

Alleviating posttraumatic stress, the cognitive-emotional intervention proposed in this research had a significant and positive impact on posttraumatic growth in mothers of children diagnosed with cancer. Therefore, implementing this intervention in the chemotherapy department and throughout the course of the children's treatment is highly recommended for their caregivers, especially mothers of children diagnosed with cancer.

Feelings, thoughts and experiences of women diagnosed with adnexal mass: A qualitative study

Adnexal masses have a risk of malignancy, especially in postmenopausal women, thus affecting the physical, psychological, and social lives of women with such masses. In addition, patients require a long duration of hospitalization during treatment. In earlier studies, researchers have focused on the experiences of newly diagnosed women or the side effects of treatment. However, women's experiences during the hospitalization period have been ignored. In this study we explored the feelings, thoughts, experiences, and nursing care needs of women hospitalized with adnexal mass diagnosis. In this qualitative study, interviews were conducted with 11 women hospitalized for an adnexal mass or ovarian cancer diagnosis. The feelings, thoughts, and experiences of the women were negatively affected. They were more likely to rely on internal motivation and had lesser expectations of professional support. Thus, nurses should provide women with this diagnosis social support and facilitate their adaptation to the hospital. The diagnosis and treatment of adnexal masses is a complex process that requires teamwork. Therefore, navigator nurses can be of great help to women during their illness.

Intolerance of uncertainty, social support, and loneliness in relation to anxiety and depressive symptoms among women diagnosed with ovarian cancer

OBJECTIVE

Intolerance of uncertainty (IU) is a trait variable that captures an individual's lack of tolerance for unknown outcomes and events. Positive correlations between IU and mental health symptoms have been observed in various populations, while social variables (social support and decreased loneliness) seem to serve as protective factors against psychological distress among individuals with cancer. The present study examined the moderation effect of social support and loneliness in the relationship between IU and mental health symptoms among women diagnosed with ovarian cancer.

METHODS

This study was a cross-sectional design involving 131 women diagnosed with ovarian cancer recruited through social media and other online sources. Participants completed questionnaires that assessed their IU (prospective and inhibitory), anxiety symptoms, depressive symptoms, social support, and loneliness. Moderated regression analyses were applied to test the hypothesis that low social support and high loneliness would exacerbate the relationship between IU and symptoms of anxiety and depression.

RESULTS

The hypothesized moderation effects (social support × IU, loneliness × IU) were not supported in the anxiety and depressive symptoms models. Post hoc linear regression analyses indicated that IU and loneliness were predictive of depressive and anxiety symptoms. Loneliness was the strongest predictor in both the anxiety and depressive symptoms models, followed by IU.

CONCLUSIONS

The findings indicate that loneliness and IU-particularly inhibitory IU-are important considerations in understanding mental health symptoms among women diagnosed with ovarian cancer. Addressing both loneliness and IU may be an important avenue in clinical settings.

Longitudinal Relationships between Social Support and Posttraumatic Growth among Adolescent Survivors of the Wenchuan Earthquake

This study aimed to explore the longitudinal relationships between social support and posttraumatic growth (PTG) among adolescent survivors of the Wenchuan earthquake. Follow-up assessments were conducted with 452 participants at 12, 18, and 24 months after the earthquake. The results showed that the level of social support at 12 and 18 months following the earthquake predicted subsequent PTG, but not vice versa. In addition, multi-group analyses of gender showed no gender differences between social support and PTG in the cross-lagged model. Thus, psychological interventions and care for survivors should focus on improving adolescent perceptions of social support when responding to stressful experiences.