Depression, Anxiety and Post-traumatic Growth Among Bereaved Adults: A Latent Class Analysis

Longitudinal profile of post-traumatic symptoms in HealthCare Workers during COVID-19 pandemic: A latent transition model

INTRODUCTION

Pandemics have the potential to be considered traumatic event, increasing the risk of developing post-traumatic stress symptoms (PTSS) in HealthCare Workers (HCW). However, few longitudinal studies have evaluated the impact of prolonged exposure to the risk imposed by COVID-19. Our aim was to identify subgroups of HCW with profiles of PTSS, how this profile changed during the pandemic and which variables were related to these changes.

METHODS

We evaluated the levels of PTSS and psychological distress in a Brazilian HealthCare Workers' sample (n = 1398) in three waves of assessment: from May to June 2020 (Wave 1), December 2020 to February 2021 (Wave 2) and May to August 2021 (Wave 3), using Latent Profile Analysis (LPA) to identify subgroups with different profiles of symptms, and then, Latent Transition Analysis (LTA) was applied to examine changes in symptom profiles over time, including gender, psychiatric diagnosis history, and pandemic-related fears as covariates.

RESULTS

two profiles were identified: high-PTSS profile (Wave 1-23%; Wave 2-64% and Wave 3-73%) and a low-PTSS (Wave 1-77%; Wave 2-36% and Wave 3-27%). Being female, fear of contamination, and fearing financial problems were strong predictors of changes in the profile. In addition, the participants had a high probability of being in the high-PTSS in the long run.

CONCLUSION

These results suggests that targeted interventions can mitigate the impact of pandemic. Providing financial support, and psychological support can be beneficial for those with psychiatric diagnoses and experiencing bereavement.

Research hotspots and theme trends in post-traumatic growth: A co-word analysis based on keywords

Objectives

To analyze and summarize the research hotspots and advancement of post-traumatic growth (PTG) over the past 15 years based on co-word analysis of keywords, and provide references for PTG-related research and clinical intervention.

Methods

All studies related to PTG were retrieved from PubMed and Web of Science (WOS) from January 2013 to July 2022. A total of 11 Medical Subject Headings (MeSH) and keywords were used to identify qualified studies. Bibliographic Item Co-occurrence Matrix Builder (BICOMB; version 2.0) was used to conduct high-frequency keywords extraction and matrix setup, Graphical Clustering Toolkit (gCLUTO; version 1.0) was employed to perform clustering analysis, and SPSS (version 25.0) was used to carry out strategic diagram analysis.

Results

A total of 2,370 publications were selected, from which 38 high-frequency keywords were extracted. The results revealed six research hotspots on PTG during the period from 2013 to 2022, including research on i) emotional reactions after negative life events, ii) PTG among cancer survivors, iii) rumination and resilience after trauma, iv) PTG among children and adolescents, v) role of social support and coping strategy in PTG, and vi) association between PTG and quality of life.

Conclusions

This co-word analysis effectively reveals an overview of PTG over the past 15 years. The six research categories deduced from this study can reflect that the research content in the field of PTG is abundant, but some research topics have not yet been mature. The findings of this study are of great value to future investigations associated with PTG.

"Psychometric properties of the Arabic version of the post-traumatic growth inventory with university students in Jordan

Post-traumatic Growth plays a key role to cope with traumatic incidents. The scale for Post-Traumatic Growth Inventory (PTGI) has been used by several researchers in different languages. This study aims to evaluate the Arabic-translated version of the PTGI scale by focusing on its validity in different languages and contexts. This study introduces an Arabic version of the PTGI-M normed with 417 undergraduate students at a large university in Jordan. The internal consistency (Cronbach's alpha) and test-retest reliability of the instrument were 0.97 and 0.82, respectively. Bivariate correlation was used to approximate the concurrent validity (CV). Significant correlations were found between the PTGI-M and the beck depression inventory (BDI), perceived stress scale (PSS), Taylor's manifest anxiety (TMAS), satisfaction with life (SWL), and the Rosenberg self-esteem scale (RSES). Confirmatory factor analysis (CFA) to assess the convergent and discriminant validity of the translated scale. Convergent and discriminant validity was established for the Arabic version of the PTGI-M by conducting a confirmatory factor analysis (CFA). In conclusion, this study proposes that future investigations should consider analysing the total PTGI-M subtotal scores to comprehend the complexity of the post-traumatic growth experience.

Severity and Longitudinal Course of Depression, Anxiety and Post-Traumatic Stress in Paediatric and Young Adult Cancer Patients: A Systematic Review and Meta-Analysis

BACKGROUND

A diagnosis of cancer and treatment may constitute a highly traumatic period for paediatric cancer patients (PYACPs). However, no review has comprehensively analysed how the mental health of PYACPs is acutely affected and the longitudinal course.

METHODS

This systematic review followed PRISMA guidelines. Comprehensive searches of databases were conducted to identify studies of depression, anxiety and post-traumatic stress symptoms in PYACPs. Random effects meta-analyses were used for the primary analysis.

RESULTS

From 4898 records, 13 studies were included. Acutely after diagnosis, depressive and anxiety symptoms were significantly elevated in PYACPs. Depressive symptoms only significantly decreased after 12 months (standardised mean difference, SMD = -0.88; 95% CI: -0.92, -0.84). This downward trajectory persisted to 18 months (SMD = -1.862; 95% CI: -1.29, -1.09). Anxiety symptoms similarly only decreased after 12 (SMD = -0.34; 95% CI: -0.42, -0.27) up to 18 months (SMD = -0.49; 95% CI: -0.60, -0.39) after the cancer diagnosis. Post-traumatic stress symptoms showed protracted elevations throughout follow-up. Overall, significant predictors of poorer psychological outcomes included unhealthy family functioning, concomitant depression or anxiety, poor cancer prognosis or experiencing cancer and treatment-related side effects.

CONCLUSIONS

While depression and anxiety may improve over time with a favourable environment, post-traumatic stress may have a protracted course. Timely identification and psycho-oncological intervention are critical.

Post-traumatic growth among childhood cancer survivors: A qualitative meta-synthesis

PURPOSE

To conduct a meta-synthesis of qualitative studies on the post-traumatic growth experiences of childhood cancer survivors.

METHOD

Various databases, including PubMed, Cochrane Library, Web of Science, EMBASE, PsycInfo, ProQuest, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Data, China Science and Technology Journal Database (CSTJ), and China Biology Medicine (CBM) were used to retrieve qualitative studies on childhood cancer survivors who experienced post-traumatic growth.

RESULTS

Eight papers were included in this study, and similar fragments were combined to form eight categories, which were further combined into four synthesized findings: adjustment of cognitive system, enhancement of personal strength, improving relationships with others, resetting of life goals.

CONCLUSIONS

Post-traumatic growth was observed in some childhood cancer survivors. The potential resources and positive forces contributing to this growth are of great significance in the fight against cancer, in tapping into individual and social resources to help survivors grow, and in improving their survival rates and quality of life. It also provides a new perspective for healthcare providers regarding the relevant psychological interventions.

The impact of family function on post-traumatic reactions of Chinese adolescents infected with COVID-19: a latent profile study

Background

Since the end of 2019, Corona Virus Disease 2019, also known as COVID-19, has broken out in various countries. However, the change of China's COVID-19 prevention and control policy and the sharp increase in the number of infected people are making the teenagers have post-traumatic reactions. Negative post-traumatic reactions include: post-traumatic stress disorder (PTSD), depression, anxiety. Positive post-traumatic reaction mainly refers to post-traumatic growth (PTG). The purpose of this study is to explore the post-traumatic reaction, which refers to PTSD, depression, anxiety and the co-occurrence pattern of growth after trauma and to further explore the influence of family function on different categories of Post-traumatic Reactions.

Methods

Latent profile analysis (LPA) was used to explore the co-occurrence of PTSD, depression, anxiety, and PTG. Multiple logistics regression was used to analyze the influence of family function on different categories of post-traumatic response.

Results

There were three categories of post-traumatic reactions in adolescents infected with COVID-19 adolescents infected with COVID-19, namely: growth class, struggling class, and pain class. Multivariate Logistic regression showed that the growth class and struggling class were affected by problem solving and behavior control in family function, while the growth class and pain class were affected by problem solving, roles, behavior control, and general functioning. Multiple logistic regression showed that the growth class and struggling class were affected by problem solving and roles.

Conclusions

The findings of this study provide evidence for the identification of high-risk individuals and the provision of effective interventions in clinical practice, as well as the influence of family functioning on the different categories of PTSD among adolescents infected with COVID-19.

Prevalence of and Factors Associated with Negative Psychological Symptoms among Elderly Widows Living Alone in a Chinese Remote Sample: A Cross-Sectional Study

(1) Background: Research indicates that most elderly widows are at a high risk of experiencing negative psychological symptoms. It is common for elderly women in rural and remote areas to live alone without family support to cope with stress due to the mass rural-to-urban migration of China’s youth labor force. Such a situation further worsens their psychological health and well-being. However, the prevalence of and risk factors associated with negative psychological symptoms (loneliness, depression, and anxiety) among remote elderly widows living alone in China are currently unclear; (2) Methods: A cross-sectional study was conducted in Hunan Province, China. The loneliness was assessed through the University of California at Los Angeles Loneliness Scale (ULS-8). The depression and anxiety were assessed with the Short Form Geriatric Depression Scale (GDS-15) and Generalized Anxiety Disorder Scale (GAD-7), respectively. The Chi-square test and correlation analysis were conducted to identify factors associated with negative psychological symptoms. Logistic regression was performed to predict risk and protective factors contributing to loneliness, depression, and anxiety symptoms. The significance level was set as p < 0.05; (3) Results: A total of 271 remote elderly widows living alone were enrolled in the present study. Additionally, 234 valid questionnaires were returned (valid response rate = 86.3%). The prevalence of loneliness, depression and anxiety was 8.1%, 44.0%, and 16.7%, respectively. Acute or chronic medical conditions, marital happiness, being the primary caregiver before widowhood and anticipating the death of the spouse differed significantly in the distribution of negative psychological symptoms. Logistic regression analysis predicted that participants who were satisfied with their marriage had a lower likelihood to experience loneliness, depression, and anxiety (p < 0.05). Being the spouse’s primary caregiver before widowhood was more likely to have symptoms of loneliness (p < 0.01). Those with various acute or chronic medical conditions were more likely to suffer from depression (p < 0.01); (4) Conclusions: Remote elderly widows living alone in China are prone to loneliness, depression, and anxiety symptoms. Being the primary caregiver before widowhood and having many acute or chronic medical conditions are risk factors for loneliness and depression, respectively. Marital happiness is the protective factor against negative psychological symptoms. To accomplish the goal of equitable access to mental health care in China, evidence-based policy and resource development to support psycho-social interventions that prevent and manage negative psychological symptoms for remote elderly widows living alone are urgently needed.

A phenomenological exploration of work-related post-traumatic growth among high-functioning adults maltreated as children

Introduction

Childhood maltreatment is a highly prevalent traumatic experience, and its adverse psychological and behavioral consequences are well-documented. Notwithstanding these adverse outcomes, many individuals who suffered from traumatic experiences report post-traumatic growth, i.e., transformative positive changes resulting from their struggle to cope. Post-traumatic growth has been extensively explored among adult survivors of childhood maltreatment, with findings indicating both the previously recognized domains (personal strength, relating to others, appreciation of life, openness to new possibilities, and spiritual change) as well as abuse-specific domains of growth (e.g., increased ability to protect themselves from abuse). However, little attention has been given to vocational aspects of post-traumatic growth among survivors, despite the central role and importance of work in adulthood. Exploration of post-traumatic growth at work has focused on certain vocational traumatic experiences, such as those which occur in the military, or through secondary trauma. This exploratory qualitative study focuses on the question: What is the lived experience of work-related post-traumatic growth among high-functioning adult survivors of CM?

Method

Twenty in-depth interviews were held with high-functioning working adults who were maltreated as children. Phenomenological analysis was applied to the retrospective data reported in these interviews.

Result

Rich descriptions of work-related positive psychological changes were provided by all participants. Analysis revealed that survivors' post-traumatic growth corresponded with all five previously recognized domains of growth: changes in self, relating to others, openness to new possibilities, finding meaning to the abuse, and appreciation of life. It also revealed that work is perceived as a form of resistance (a subtheme of changes in self), and that finding meaning entails three emerging subthemes: being a survivor and a role model, giving others what was needed and never received, and making a better world.

Discussion

While the vocational lives of survivors of childhood maltreatment have rarely been examined through the lens of post-traumatic growth, our results show this lens to be highly valuable. Work-related post-traumatic growth has relevance not only regarding vocational traumas occurring in adulthood as has been previously studied, but also in the context of childhood traumas. Moreover, our research broadens the understanding of the possible domains of work-related growth.

Validation of an ultra-short version of the posttraumatic growth inventory in Colombian adults exposed to COVID-19

We aimed to evaluate whether an ultra-short version of the Posttraumatic Growth Inventory (PTGI) has adequate psychometric properties, with a Colombian sample (N = 931) vulnerable to SaRS-CoV-2 infection. Results indicated that adequate indicators of goodness-of-fit, convergent validity, internal consistency, and factorial invariance. Therefore, this instrument is recommended for the screening of posttraumatic growth associated with the COVID-19 pandemic that may be present in the Colombian population.

Prolonged grief and posttraumatic growth among middle-aged and older widowed persons: A latent class analysis and testing for the role of social support

Evidence has shown that symptoms of grief co-occur with posttraumatic growth following loss. Using latent class analysis among a Togolese sample of middle-aged/older widowed persons, we identified three classes along their experiences of grief-growth interaction (combined grief/growth, predominantly growth, and low-medium growth classes). The combined grief/growth class members were more likely to have lost their spouses recently and to report greater marital relationship satisfaction with their spouse before their death. The perceived social support from family was predictive of the predominantly growth class membership. The findings provide a nuanced understanding of grief, which is dominated by psychopathology and negative outcomes.

Changes in depressive symptoms among family caregivers of patients with cancer after bereavement and their association with resilience: A prospective cohort study

Objectives

To elucidate changes in depressive symptoms after bereavement and the impact of pre‐loss resilience on such changes and on the extent of complicated grief and posttraumatic growth.

Methods

Prospective cohort surveys were provided to family caregivers of patients with cancer in four palliative care units (PCUs) before and after bereavement. Pre‐loss Connor–Davidson Resilience Scale scores, pre‐ and post‐loss Patient Health Questionnaire‐9 scores, post‐loss Brief Grief Questionnaire scores, and the expanded Posttraumatic Growth Inventory scores were determined.

Results

Out of 186 bereaved family caregivers, 71 (38.2%) responses were analyzed, among which 47% pre‐loss and 15% post‐loss responses suggested to be a high risk for major depressive disorder (MDD). Approximately 90% of family caregivers at a high risk for post‐loss MDD were already at a high risk for pre‐loss MDD. Even after adjustment of the background variables as covariates, the interaction effect between family caregivers' pre‐loss depressive symptoms and resilience on post‐loss depressive symptoms was observed (F = 7.29; p < 0.01). Moreover, pre‐loss resilience was not associated with other bereavement outcome measures.

Conclusions

Among family caregivers of patients with cancer in PCUs, 47% and 15% had high risk for MDD before and after bereavement, respectively. Moreover, pre‐loss resilience mitigated post‐loss depressive symptoms among family caregivers who had high risk for MDD before bereavement. However, considering the study's small sample size, further research is needed.

Profiles of grief, post-traumatic stress, and post-traumatic growth among people bereaved due to COVID-19

BACKGROUND

COVID-19 deaths elevate the prevalence of prolonged grief and post-traumatic stress symptoms among the bereaved, yet few studies have examined potential positive outcomes. Moreover, how COVID-19 bereavement affects individual-level mental health outcomes is under-researched.

OBJECTIVE

This is the first study to use latent profile analysis (LPA) to identify heterogeneous profiles of prolonged grief, post-traumatic stress and post-traumatic growth among people bereaved due to COVID-19 and to identify predictors of latent class membership.

METHODS

Four hundred and twenty-two Chinese participants who were bereaved due to COVID-19 completed an online survey between September and October 2020. The survey included the International (ICD-11) Prolonged Grief Disorder Scale (IPGDS), the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Post-traumatic Growth Inventory (PTGI). LPA was run in Mplus, and the 3-step auxiliary approach was used to test the predicting effects of potential predictors of latent class membership identified with chi-square tests and ANOVAs.

RESULTS

Four latent profiles were identified: resilience (10.7%), growth (20.1%), moderate-combined (42.2%) and high-combined (27.0%). The bereaved who shared a close relationship with the deceased and identified COVID-19 as the fundamental cause of death were more likely to be in the high-combined group. A conflictful bereaved-deceased relationship reduces the chance of being in the growth group. Moreover, the death of a younger person and loss of a partner attributed to maladaptive outcomes.

CONCLUSIONS

Serious attention needs to be paid to the mental health issues of people bereaved due to COVID-19 because nearly 70% of this group would have a moderate-combined or high-combined symptom profile. Special care should be given to those who lost someone younger, lost a partner or shared a close relationship with the deceased. Grief therapies that work on the conflicts between the deceased and the bereaved and unfinished business can be applied to facilitate growth.