Factors Contributing to Posttraumatic Growth and Its Buffering Effect in Adult Children of Cancer Patients Undergoing Treatment

Correlates of post-traumatic growth among persons bereaved from cancer: A systematic review and meta-analysis

BACKGROUND

Recent research identified that cancer bereavement can lead to post-traumatic growth (PTG). Although PTG and its correlates are well explored in cancer patients and survivors, persons bereaved from cancer have received scant attention. Therefore, the present review attempts to identify the correlates of PTG among persons bereaved from cancer.

METHODS

A systematic search in PubMed, Web of Science, APA PsycNet, Science Direct, Scopus, and Wiley was conducted to identify quantitative studies published in English, resulting in 12 eligible reports being included in the final analysis. JBI critical checklists were employed to appraise the risk of bias.

RESULTS

The review identified 17 correlates, which were classified into four categories: demographic factors (age, gender, religious status, level of education), loss-related factors (time since death, quality of death, prolonged grief symptoms), interpersonal factors (relationship to the deceased, social support, attachment style, bereavement behaviours) and intrapersonal factors (resilience, coping, rumination, benevolence, meaningfulness, self-worth). Random effects meta-analyses on six correlates revealed correlation coefficients of age = -0.02 (95% CI: -0.35-0.31), gender = 0.27 (95% CI: 0.08-0.45), time since death = 0.09 (95% CI: -0.02-0.20), quality of death = 0.29 (95% CI: -0.01-0.54), prolonged grief symptoms = 0.22 (95% CI: 0.08-0.35) and relationship to the deceased = 0.13 (95% CI: -0.03-0.29). Fixed effects meta-analysis was performed for social support (r = 0.13, 95% CI: 0.04-0.21). However, PTG was found to be significantly associated with gender, prolonged grief symptoms, and social support.

CONCLUSIONS

Very few studies examined PTG among persons bereaved from cancer, highlighting the need for increased attention, understanding, and conceptualisation of PTG in the population.

Why emotional neglect brings suicidal ideation? The mediating effect of meaning in life and the moderating effect of post-stress growth

BACKGROUND

Emotional neglect during childhood has long-lasting negative effects on individuals, and it is often hidden and unrecognized. Previous research has not fully understood its unique effects on mental health outcomes, especially when considering the co-occurrence with other forms of maltreatment. The meaning-making coping and growth model suggests that individuals achieve positive psychological outcomes by constructively integrating negative experiences into their self-concept, which may be a protective mechanism against the detrimental effects of emotional neglect.

OBJECTIVE

This study aimed to examine the relationship between emotional neglect and suicidal ideation among undergraduates, accounting for the presence of emotional abuse and physical neglect, and to investigate the mediating role of meaning in life and the moderating role of post-stress growth in this relationship.

METHODS

A self-reported survey was conducted with 3132 undergraduate students from a university in South China. The survey assessed emotional neglect, emotional abuse, physical neglect, suicidal ideation, post-stress growth, and meaning in life.

RESULTS

Meaning in life partially mediated the relationship between emotional neglect and suicidal ideation. Post-stress growth moderated the association between emotional neglect and the sense of meaning in life, in particular the moderation effect was stronger when emotional abuse was weaker.

CONCLUSIONS

Meaning in life mediated the relationship between emotional neglect and suicide ideation. Post-stress growth moderated the mediation effect such that it was weakened among individual with a higher level of post-stress growth. This study contributes to the understanding of the psychopathological processes following emotional neglect and the development of positive personal changes thereafter.

Resilience, optimism and posttraumatic growth in first-time mothers

This study examines the association between posttraumatic growth (PTG) and two psychological attributes, resilience and optimism, in first-time mothers, after controlling for demographic and motherhood-related characteristics. PTG, the self-examination triggered by life-changing events, contains five factors: (1) relating to others, (2) new possibilities, (3) personal strength, (4) spiritual change, and (5) appreciation of life. Outcomes from studies conflict on whether PTG is associated with the two psychological attributes of resilience (the ability to resume one's life after adversity) and optimism (viewing life in a positive light). This study used a cross-sectional design. A convenience sample of first-time mothers whose infants were between 3 months and 1 year (N = 415) completed questionnaires containing several standardized and reliable instruments including those measuring the independent variables of resilience and optimism, and the dependent variable of PTG. A STROBE checklist guided the reporting of this study. Resilience was associated with overall PTG and four of its five factors. Optimism also was associated with overall PTG but only associated with two of its five factors. PTG profiles and squared semipartial correlations indicated that resilience had the stronger association, compared to optimism, with PTG and most of its factors. Our study's findings on the strong link between resilience and PTG suggest the need for research examining the impact of specific psychosocial nursing activities (e.g., providing emotional support; assisting others to identify their own strengths; encouraging the mobilization of one's internal resources; furnishing needed resources and referrals; and supplying health education and information), as these activities may not only promote resilience but also may contribute to PTG.

The adaptation of soldiers to post-service life - the mediating impact of political views on the relationship between violence and adaptation

Introduction

The current research explores the association between political views, combat experiences, and the adaptation of soldiers to post-service life. Violent experiences in military service were explored as contributors to both positive and negative dimensions of adaptation, while political views served as possible mediators.

Methods

Three hundred and twenty Israeli veterans participated in the study.

Results

Political views were correlated with adaptation, especially left-to-right voting and anti-militarism. The results support the mediating role of political beliefs (left-right voting and militarism) in the relationship between combat experience and adaptation to post-service life.

Discussion

We contend that political perceptions affect adaptation through sense-making of the combat experiences and the individual processing of these experiences, and the willingness to continue in reserve service, which allows social support and recognition. In addition, they are linked to a sense of bitterness following the reduction of public participation in military and reserve service.

Pathways to post-traumatic growth in Korean female cancer patients: the mediation effects of coping strategies and resilience

ABSTRACTBackground: Cancer is a life-threatening disease in Korean women. Female cancer patients in Korea have reported poor physical functioning and psychological distress after diagnosis. However, some patients experience post-traumatic growth (PTG), which includes positive feelings and changes.Objective: The main purpose of this study was to examine the relationships between PTG and its associated factors in Korean female cancer patients to understand how female cancer patients achieve PTG while experiencing cancer diagnosis and treatment. This study aimed to improve the quality of life of many Korean female patients with cancer.Methods: This study investigated the structural model of the paths from the disruption of core beliefs (CBD), coping strategies, and resilience to PTG in a sample of female cancer patients. In total, 164 middle-aged women diagnosed with cancer were included in the final sample.Results: First, it was determined that the proposed structural model was substantial and had high fit indices. Second, problem-solving was positively associated by the CBD routes. Third, it was also favorably expected that problem-solving would lead to resilience and resilience would lead to PTG. These findings are important for developing future interventions for Korean female cancer patients and can be considered as an important variable to improve their PTG.

Post-traumatic growth 5 years after cancer: identification of associated actionable factors

BACKGROUND

The number of cancer survivors is growing increasingly worldwide. The long-term negative consequences of the disease are now better known. Cancer may also foster positive outcomes. Some survivors consider life after cancer as the start of a new life and experience positive changes called post-traumatic growth (PTG) measured by a scale developed by Tedeschi and Calhoun.

OBJECTIVE

The purpose of this article was to explore actionable factors affecting PTG, particularly those in relation with health care management and those that reflected health behavior changes.

METHODS

This study included the 1,982 participants in the VICAN cohort who responded to the questionnaire on living conditions 2 and 5 years after diagnosis. Factors associated with a moderate or high PTG (score ≥ 63) were identified using logistic regressions.

RESULTS

Factors positively associated with moderate or high PTG were being satisfied with the time spent by health care team on information (OR:1.35 [1.08;1.70]), increased physical activity (OR:1.42 [1.04;1.95]) and healthier diet (OR:1.85 [1.44;2.36]) since diagnosis, and having benefited from psychological support at diagnosis (OR:1.53 [1.16;2.01]).

CONCLUSION

High PTG is positively associated with health behavior and time spent on information. Our findings suggest that appropriate clinical and educational interventions can help foster growth after the experience of cancer. Even if we do not know what causes what, it is admitted that the interventions leading to an increase of physical activity, for example, are good from all points of view.

The Relationship Between Caregiver Burden and Posttraumatic Growth in Caregivers of Patients With Metastatic Cancer

Objective

In this study, we aimed to examine the effect of post-traumatic growth and depressive symptoms on caregiver burden in caregivers of cancer patients.

Methods

This was a single-center cross-sectional observational descriptive study conducted at a medical oncology clinic. The study included 214 caregivers of cancer patients. Participants were assessed with a sociodemographic information form, the Turkish versions of the Zarit Caregiver Burden Scale (ZCBS), the Posttraumatic Growth Inventory (PTGI), and the Beck Depression Inventory (BDI).

Results

The mean ZCBS, PTGI, and BDI scores were 42.7 ±13.8, 67.8 ±22.3, and 13.5 ±9.8, respectively. There was a negative correlation (r=-0.407, p<0.001) between the ZCBS and the PTGI total scores, a positive correlation (r=0.636, p<0.001) between the ZCBS total and BDI scores, and a negative correlation (r=-0.426, p<0.001) between the PTGI total and BDI scores. Age, gender, income level, and history of psychiatric treatment were not independent predictive factors for the ZCBS total scores. PTGI total score (B=-0.107, 95% CI: -0.178 to -0.037, p=0.003) and BDI score (B=0.776, 95% CI: 0.602-0.950, p<0.001) were independent predictive factors for ZCBS total scores.

Conclusions

Our study revealed a significant negative relationship between caregiver burden and PTGI in caregivers of metastatic cancer patients, and it was found that depression negatively affects burden in caregivers. Posttraumatic growth can be a protective buffer against the burden of care and depression among caregivers.

Community Post-traumatic Growth: Israeli Ultra-Orthodox Coping with Coronavirus

The present study sheds light on the phenomenon whereby groups experience adversity, following which they show signs of growth. We propose the conceptualization of post-traumatic growth as a phenomenon that also exists at the group level, “community post-traumatic growth” (CPTG). The concept of CPTG is explained using a case study on the ultra-Orthodox Jewish community in Israel following the first wave of the coronavirus disease 2019 (COVID-19) pandemic. The study describes shared characteristics of Israeli ultra-Orthodox society and the crisis it experienced during the first wave of the COVID-19 pandemic, both in terms of physiological features such as the relatively high proportion of affected people and in terms of psychological characteristics such as the shut-down of synagogues and yeshivas, and the perceived discrimination they experienced from the general population in Israel. The present study views the sense of discrimination as a traumatic factor at the group level. In total, 256 participants completed online questionnaires examining three hypotheses: (1) sense of discrimination (trauma) will be correlated with level of CPTG; (2) the level of identification with the ultra-Orthodox culture will be positively related to CPTG, while the level of identification with Israeli culture will be negatively correlated with CPTG; (3) the level of life satisfaction of the individual will be predicted by CPTG. The results supported the hypotheses and are discussed at length in the discussion section.

Posttraumatic Growth after the Fukushima Nuclear Disaster: Examination of Free Descriptions among Fukushima Residents Who Lived in the Evacuation Area

We examined the differences in the posttraumatic growth (PTG) free descriptions from clusters of Fukushima residents (evacuation and non-evacuation zones) who experienced the Great East Japan Earthquake, and the relationship between "recovery from radiation anxiety" and the PTG-free description classification in these regions. A mail survey was conducted in August 2016 among Fukushima residents aged 20-79 years for free descriptions of their PTG. Participants were then divided into the "no anxiety," "recovered from anxiety," and "unrecovered from anxiety" groups based on their "recovery from radiation anxiety." Data from 786 responses were analyzed. The PTG-free descriptions were classified into eight categories. Among those who lived in the evacuation zone versus those in the non-evacuation zone, "relating to others" (non-evacuation zone: 11.9% vs. evacuation zone: 18.4%) and "appreciation of life" (non-evacuation zone: 2.7% vs. evacuation zone: 9.8%) were significantly higher, and "increased awareness of disaster prevention" (non-evacuation zone: 20.4% vs. evacuation zone: 8.0%) was significantly lower. In the evacuation zone, "renewed recognition of nuclear issues" was significantly lower than the expected value in the no anxiety group (3.1%) and significantly higher than the expected value in the recovered group (22.9%). Further studies are needed to build support measures and potentially aid in preparing for future disasters.

Coping strategies mediate the association between family functioning and posttraumatic growth in family caregivers of people with dementia

OBJECTIVES

This study aimed to examine the mediating effect of coping strategies on the relationship between family functioning and posttraumatic growth in family caregivers of people with dementia (PwD).

METHODS

A total of 124 family caregivers of PwD from a memory clinic were investigated from July to October 2017. Family functioning, coping strategies, and posttraumatic growth of family caregivers of PwD were measured. Data were processed using descriptive statistics, correlation analysis, regression analysis, and structural equation modelling.

RESULTS

Posttraumatic growth was observed in family caregivers of PwD. The caregiver's gender, relationship with the patient, and difficulty balancing financial income and expenditures in the past month, as well as disease severity of PwD, are significant predictors of posttraumatic growth. There were significantly positive correlations among posttraumatic growth, family functioning and positive coping strategies (P＜0.01). Positive coping strategies exert a complete mediating effect between family functioning and posttraumatic growth (β = 0.49, P < 0.05).

CONCLUSIONS

A model of the posttraumatic growth of family caregivers of PwD can be established, and the relevant mechanisms can be explored. Healthcare providers should pay attention to the family functioning of caregivers and take effective measures to provide them with positive coping strategies to promote their posttraumatic growth.

Does Posttraumatic Growth Buffer the Association Between Death Anxiety and Quality of Life Among People living with HIV/AIDS?

People living with HIV (PLWH) may experience death anxiety (DA), which can be detrimental to quality of life. Posttraumatic growth (PTG), however, is antithetical to DA, with its positive attributes at odds with negative psychosocial outcomes. Previous research has not examined the buffering effect of PTG on the association between DA and quality of life. Therefore, in addition to the direct effects of DA and PTG on health-related quality of life (HRQoL), we investigated the moderating role of PTG on the relationship between DA and HRQoL among people living with HIV/AIDS (PLWH) in Nigeria. Using cross-sectional design and availability sampling method, we selected 201 outpatients (men, n = 63, 31.3%, women, n = 138, 68.7%, mean age = 40.1, SD = 10.5) managed for HIV/AIDS in a Nigerian tertiary healthcare institution. Death Anxiety Inventory-Revised, Posttraumatic Growth Inventory-Short Form, and Patient-Reported Outcome Quality of Life-HIV were used to access DA, PTG and HRQoL, respectively. Results showed that while adjusting for socio-demographic factors (age, gender, time since diagnosis and educational status), DA was associated with physical health, mental health and social relationships domains of HRQoL as well as overall HRQoL. In contrast, PTG did not evidence significant association with HRQoL dimensions and overall HRQoL. The moderation effect of PTG on the association between DA and HRQoL was not supported. Independent of PTG, alleviating DA may be an important target in terms of therapeutic intervention towards improving quality life of PLWH.

Posttraumatic growth during cognitive behavioural therapy for posttraumatic stress disorder: Relationship to symptom change and introduction of significant other assessment

Posttraumatic growth (PTG) may play a role in the treatment of posttraumatic stress disorder (PTSD) as it is supposed to have either beneficial or dysfunctional effects on treatment-related PTS symptom (PTSS) changes. This study examined whether cognitive behavioral therapy (CBT) for PTSD patients can foster PTG assessed by self-reports and reports from significant others. Forty-eight PTSD patients participating in trauma-focused CBT were assessed twice: at the beginning of therapy (T1) and after 3 months of therapy (T2, N = 34). We used the Clinician Administered PTSD Scale and the Posttraumatic Growth Inventory (PTGI), and constructed a significant other version of the PTGI (PTGI-SOA). The PTSS severity declined during the course of treatment, whereas PTG levels remained stable. Both the PTGI and PTGI-SOA were associated with higher PTSS reduction at T2. The results suggest that PTG is associated with greater improvement in PTSS during trauma-focused CBT, even though treatment could not directly enhance PTG. Significant other assessments seem to be a promising approach to improve PTG measurement.

Diagnosis of cancer is not a death sentence: Examining posttraumatic growth and its associated factors in cancer patients

Objectives: Posttraumatic growth (PTG) is the experience of positive psychological growth as a result of struggle with highly challenging life crises. This study was conducted to investigate the degree of PTG and its associated factors, as well as to identify which positive psychological parameters most significantly associated with greater PTG among Malaysian cancer patients. Design, sample, & methods: This cross-sectional survey included 195 patients with different cancer diagnoses. Perceived spousal support, level of hope, level of optimism, and PTG were measured using various validated indexes. Findings: The total mean score for PTG Inventory-Short Form (PTGI-SF) was 39.87 (±9.09). Female gender, Islamic religious belief, and having higher level of hope and greater spousal support were associated with a higher PTGI-SF score, and the most significant predictor was the hope scale. Conclusions: Malaysian cancer patients exhibited a high level of PTG, and hope was the positive psychological factor which was most significantly associated with PTG. Implications for psychosocial providers: Psychosocial interventions that promote positive psychology should be included in the treatment for cancer patients.

The prevalence of moderate-to-high posttraumatic growth: A systematic review and meta-analysis

BACKGROUND

Posttraumatic growth (PTG) is positive psychological changes after encountering challenging events. The main purpose of this meta-analysis was to summarize the prevalence of moderate-to-high PTG in people who experienced traumatic events and to understand what social-demographic and trauma characteristics distinguish those who show a high rate of PTG from those of low level.

METHODS

Six electronic databases were searched. Loney's appraisal criteria were used to evaluate the quality of studies. Freeman-Turkey double arcsine transformation method was used to calculate the combined prevalence. Age, time since event, type of trauma and trauma form were analyzed as subgroup factors. According to the source of the trauma, the type of trauma was divided into three different categories: disease, accident and specific profession. Specific profession refers to firefighters, veterans, intensive care staff, etc. The complex working environment, irregular lifestyle, various unpredictable factors, as well as the frequently adverse stimuli from others contribute to great physical and mental pressure.

RESULTS

Twenty-six articles were deemed as qualified for this systematic review and meta-analysis. The level of PTG across studies ranged from 10% to 77.3%, and heterogeneity tests showed high heterogeneity (I²= 92.3%, 95%CI = 90.1%-94.0%, p < 0.01). Random effect model was chosen to calculate the combined prevalence and the prevalence was 52.58% (95%CI = 48.66%-56.48%). People whose age was younger than 60,had shorter time since trauma,worked in a specific profession and suffered from direct trauma reported high rate of moderate-to-high PTG.

LIMITATIONS

Because the included studies haven't provided adequate PTG-related information, these factors could not be used to performed subgroup analyses. In addition, some studies were excluded due to the different standard may lead to deviation of the combined prevalence.

CONCLUSIONS

Nearly half of the investigated individuals reported moderate-to-high PTG after experiencing a traumatic event. Future research needs to further study the determinants of PTG to provide relevant interventions for the victims of trauma.

Posttraumatic growth and its correlates in primary caregivers of schizophrenic patients

CONTEXT

The concept of posttraumatic growth (PTG) is important to focus on positive outcomes of a challenging process like caregiving.

AIMS

The aim of the present study is to investigate the factors inclusively considered to be related to PTG in primary caregivers of schizophrenic patients.

SETTINGS AND DESIGN

This cross-sectional study was conducted with caregivers of patients with schizophrenia between January 2013 and February 2014 at a mental health hospital.

MATERIALS AND METHODS

The study was carried out on 109 schizophrenic patients followed up at Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, and 109 family members who are the primary caregivers of the patients. All caregivers were evaluated with Posttraumatic Growth Inventory, Multidimensional Scale of Perceived Social Support, Ways of Coping Inventory, and the Basic Personality Traits Inventory and Religious Orientation Scale.

STATISTICAL ANALYSIS

Kruskal-Wallis and Mann-Whitney U-test were used in quantitative analysis of data. Spearman's correlation analysis was used in the determination of correlation between variables. Linear regression analysis was used in the determination of predictors of PTG.

RESULTS

Optimistic and problem-focused coping, perceived social support (total and all three - family, friends, significant others - domains), personality traits such as extraversion, conscientiousness, and openness to experience, and religiousness were found to be related with PTG. Religiousness, perceived social support, and openness to experience were independent predictors of PTG.

CONCLUSIONS

Interventions to caregivers of schizophrenic patients on the domains of social support and coping strategies may contribute to caring process in a positive change.

Evaluating the Factor Structure of the Persian Version of Posttraumatic Growth Inventory in Cancer Patients

PURPOSE

This study aimed to assess the factor structure of the Persian version of posttraumatic growth inventory (P-PTGI).

METHODS

Participants included 272 Iranian people of Azari ethnicity (111 women and 161 men), aged between 21 and 91 years (mean 52.65 years), who were diagnosed with cancer and were referred to the oncology department of the university hospital. The P-PTGI was assessed to determine the construct validity, using various indices of confirmatory factor analysis and standardized lambda coefficient, followed by further assessment of the discriminant and convergent validities by using the structural equation model. LISREL 8.8 for Windows and SPSS were used for data analysis.

RESULTS

The calculated values of comparative fit index, incremental fit index, normed fit index, and non-normed fit index > .90 and the values of standardized root-mean-square residual < .08 indicate an acceptable fit for the original PTGI. Considering that the values of average variance extracted (.52-.74) were greater than the square of correlation coefficients between the five dimensions of P-PTGI, discriminant validity was approved. Convergent validity was confirmed through a high value of standardized lambda coefficient (.52-.92) between the items and their related factors.

CONCLUSIONS

This study revealed that P-PTGI has an acceptable validity and reliability for posttraumatic growth assessment in Iranian cancer patients and its factor structure is similar to that of the original form developed by Tedeschi and Calhoun.

Exploring Facilitators of Post-traumatic Growth in Patients with Spinal Cord Injury: A Qualitative Study

Introduction

There is increasing evidence regarding people’s reactions to life stressors in which people also may show positive experiences following a traumatic event. The aim of the present study was to explain the facilitators of post-traumatic growth based on the experiences of patients with a spinal cord injury.

Methods

This was a qualitative study conducted on 16 Iranian patients with a spinal cord injury using semistructured, in-depth interviews, and content analysis in 2015. These participants, despite their spinal cord injury, were successful in their lives and were considered successful members of society. A purposive sampling method was used until reaching data saturation, and then the collected data were analyzed using a content analysis method.

Results

The study revealed several factors as facilitators of post-traumatic growth in the patients. The extracted facilitators were put into seven categories of main concepts, including existence of support resources, contact with spinal cord injury associations, spiritual beliefs, positive attitude toward injury, access to proper facilities, enhancement of knowledge and awareness, and active presence in society.

Conclusion

Different factors may facilitate post-traumatic growth in patients with a spinal cord injury. Understanding these facilitators may help us in designing educational, support, and consulting programs for patients and their families as well as to the correct the support programs.